Dynamics of life expectancy and life span equality Aburto, José Manuel; Villavicencio, Francisco; Basellini, Ugofilippo ...
Proceedings of the National Academy of Sciences - PNAS,
03/2020, Volume:
117, Issue:
10
Journal Article
Peer reviewed
Open access
As people live longer, ages at death are becoming more similar. This dual advance over the last two centuries, a central aim of public health policies, is a major achievement of modern civilization. ...Some recent exceptions to the joint rise of life expectancy and life span equality, however, make it difficult to determine the underlying causes of this relationship. Here, we develop a unifying framework to study life expectancy and life span equality over time, relying on concepts about the pace and shape of aging. We study the dynamic relationship between life expectancy and life span equality with reliable data from the Human Mortality Database for 49 countries and regions with emphasis on the long time series from Sweden. Our results demonstrate that both changes in life expectancy and life span equality are weighted totals of rates of progress in reducing mortality. This finding holds for three different measures of the variability of life spans. The weights evolve over time and indicate the ages at which reductions in mortality increase life expectancy and life span equality: the more progress at the youngest ages, the tighter the relationship. The link between life expectancy and life span equality is especially strong when life expectancy is less than 70 y. In recent decades, life expectancy and life span equality have occasionally moved in opposite directions due to larger improvements in mortality at older ages or a slowdown in declines in midlife mortality. Saving lives at ages below life expectancy is the key to increasing both life expectancy and life span equality.
Dry and irritated mucous membranes of the eyes and airways are common symptoms reported in office-like environments. Earlier studies suggested that indoor pollutants were responsible. We have ...re-evaluated, by review of the literature, how low relative humidity (RH) may influence the immediately perceived indoor air quality (IAQ), including odour, and cause irritation symptoms (i.e. longer-term perceived IAQ). “Relative humidity” were searched in major databases, and combined with: air quality, cabin air, dry eyes, formaldehyde, inflammation, mucous membranes, offices, ozone, pungency, sensory irritation, particles, precorneal tear film, sick building syndrome, stuffy air, and VOCs.
The impact of RH on the immediately and longer-term perceived IAQ by VOCs, ozone, and particles is complex, because both the thermodynamic condition and the emission characteristics of building materials are influenced. Epidemiological, clinical, and human exposure studies indicate that low RH plays a role in the increase of reporting eye irritation symptoms and alteration of the precorneal tear film. These effects may be exacerbated during visual display unit work.
The recommendation that IAQ should be “dry and cool” may be useful for evaluation of the immediately perceived IAQ in material emission testing, but should be considered cautiously about the development of irritation symptoms in eyes and upper airways during a workday. Studies indicate that RH about 40% is better for the eyes and upper airways than levels below 30%. The optimal RH may differ for the eyes and the airways regarding desiccation of the mucous membranes.
Previous studies have shown through theoretical analyses that the ratio of the partial pressure of oxygen in arterial blood (PaO2) to the inspired oxygen fraction (FiO2) varies with the FiO2 level. ...The aim of the present study was to evaluate the relevance of this variation both theoretically and experimentally using mathematical model simulations, comparing these ratio simulations with PaO2/FiO2 ratios measured in a range of different patients.
The study was designed as a retrospective study using data from 36 mechanically ventilated patients and 57 spontaneously breathing patients studied on one or more occasions. Patients were classified into four disease groups (normal, mild hypoxemia, acute lung injury and acute respiratory distress syndrome) according to their PaO2/FiO2 ratio. On each occasion the patients were studied using four to eight different FiO2 values, achieving arterial oxygen saturations in the range 85-100%. At each FiO2 level, measurements were taken of ventilation, of arterial acid-base and of oxygenation status. Two mathematical models were fitted to the data: a one-parameter 'effective shunt' model, and a two-parameter shunt and ventilation/perfusion model. These models and patient data were used to investigate the variation in the PaO2/FiO2 ratio with FiO2, and to quantify how many patients changed disease classification due to variation in the PaO2/FiO2 ratio. An F test was used to assess the statistical difference between the two models' fit to the data. A confusion matrix was used to quantify the number of patients changing disease classification.
The two-parameter model gave a statistically better fit to patient data (P < 0.005). When using this model to simulate variation in the PaO2/FiO2 ratio, disease classification changed in 30% of the patients when changing the FiO2 level.
The PaO2/FiO2 ratio depends on both the FiO2 level and the arterial oxygen saturation level. As a minimum, the FiO2 level at which the PaO2/FiO2 ratio is measured should be defined when quantifying the effects of therapeutic interventions or when specifying diagnostic criteria for acute lung injury and acute respiratory distress syndrome. Alternatively, oxygenation problems could be described using parameters describing shunt and ventilation/perfusion mismatch.
Management of mechanical ventilation in intensive care patients is complicated by conflicting clinical goals. Decision support systems (DSS) may support clinicians in finding the correct balance. The ...objective of this study was to evaluate a computerized model-based DSS for its advice on inspired oxygen fraction, tidal volume and respiratory frequency. The DSS was retrospectively evaluated in 16 intensive care patient cases, with physiological models fitted to the retrospective data and then used to simulate patient response to changes in therapy. Sensitivity of the DSS’s advice to variations in cardiac output (CO) was evaluated. Compared to the baseline ventilator settings set as part of routine clinical care, the system suggested lower tidal volumes and inspired oxygen fraction, but higher frequency, with all suggestions and the model simulated outcome comparing well with the respiratory goals of the Acute Respiratory Distress Syndrome Network from 2000. Changes in advice with CO variation of about 20% were negligible except in cases of high oxygen consumption. Results suggest that the DSS provides clinically relevant and rational advice on therapy in agreement with current ‘best practice’, and that the advice is robust to variation in CO.
This study analyzes the complexity of female longevity improvements. As socioeconomic status is found to influence health and mortality, we partition all individuals, at each age in every year, into ...five socioeconomic groups based on an affluence measure that combine an individual's income and wealth. We identify the particular socioeconomic groups that have been driving the standstill for Danish females at older ages. Within each socioeconomic group, we further analyze the cause of death patterns. The decline in life expectancy for Danish females is present for four out of five subgroups, however, with particular large decreases for the low‐middle and middle‐affluence groups. Cancers, smoking‐related lung and bronchus causes, and other diseases particularly contribute to the stagnation. For four of the five socioeconomic groups only small cardiovascular improvement are experienced during the period of stagnating life expectancy compared to an equally long and subsequent period.
Abstract
Background
Cross-national comparison studies on gender differences have mainly focussed on life expectancy, while less research has examined differences in health across countries. We aimed ...to investigate gender differences in cognitive function and grip strength over age and time across European regions.
Methods
We performed a cross-sectional study including 51 292 men and 62 007 women aged 50 + participating in the Survey of Health, Ageing and Retirement in Europe between 2004–05 and 2015. Linear regression models were used to examine associations.
Results
In general, women had better cognitive function than men, whereas men had higher grip strength measures. Sex differences were consistent over time, but decreased with age. Compared with men, women had higher cognitive scores at ages 50–59, corresponding to 0.17 SD (95% CI 0.14, 0.20) but slightly lower scores at ages 80–89 (0.08 SD, 95% CI 0.14, 0.00). For grip strength, the sex difference decreased from 18.8 kg (95% CI 18.5, 19.1) at ages 50–59 to 8.5 kg (95% CI 7.1, 9.9) at age 90 + . Northern Europeans had higher cognitive scores (19.6%) and grip strength measures (13.8%) than Southern Europeans. Gender differences in grip strength were similar across regions, whereas for cognitive function they varied considerably, with Southern Europe having a male advantage from ages 60–89.
Conclusion
Our results illustrate that gender differences in health depend on the selected health dimension and the age group studied, and emphasize the importance of considering regional differences in research on cognitive gender differences.
Mortality forecasting has received increasing interest during recent decades due to the negative financial effects of continuous longevity improvements on public and private institutions’ ...liabilities. However, little attention has been paid to forecasting mortality from a cohort perspective. In this article, we introduce a novel methodology to forecast adult cohort mortality from age-at-death distributions. We propose a relational model that associates a time-invariant standard to a series of fully and partially observed distributions. Relation is achieved via a transformation of the age-axis. We show that cohort forecasts can improve our understanding of mortality developments by capturing distinct cohort effects, which might be overlooked by a conventional age–period perspective. Moreover, mortality experiences of partially observed cohorts are routinely completed. We illustrate our methodology on adult female mortality for cohorts born between 1835 and 1970 in two high-longevity countries using data from the Human Mortality Database.
The fact that individuals are living longer and thus spending more time in retirement challenges the sustainability of pension systems. This has forced policy makers to rethink the design of pension ...plans to mitigate the burden of increased longevity. Countries such as the Netherlands, Estonia, Denmark and Finland have implemented reforms that link retirement age to changes in life expectancy. However, the demographic and financial implications of such linkages are not well understood. This study analyses the Danish case, using high-quality data from population registers during the period 1985-2016. We identify trends in demographic and actuarial measures after retirement by sex and socio-economic group. We also introduce a new decomposition method to disentangle the demographic sources of socio-economic disparities in pension costs per year of expected benefits. We reach two main results. First, linking retirement age to life expectancy increases uncertainty about length of life after retirement, with the financial cost becoming more sensitive to changes in mortality. Second, socio-economic disparities in lifespans persist regardless of the age at which individuals retire. Males from lower socio-economic groups are at a greater disadvantage, because they spend fewer years in retirement, pay higher pension costs per year of expected benefits and are exposed to higher longevity risk than the rest of the population. This disadvantageous setting is magnified when retirement age is linked to life expectancy.
Particulate matter is linked to adverse health effects, however, little is known about health effects of particles emitted from typical indoor sources. We examined acute health effects of short‐term ...exposure to emissions from cooking and candles among asthmatics. In a randomized controlled double‐blinded crossover study, 36 young non‐smoking asthmatics attended three exposure sessions lasting 5 h: (a) air mixed with emissions from cooking (fine particle mass concentration): (PM2.5: 96.1 μg/m3), (b) air mixed with emissions from candles (PM2.5: 89.8 μg/m3), and c) clean filtered air (PM2.5: 5.8 μg/m3). Health effects (spirometry, fractional exhaled Nitric Oxide FeNO, nasal volume and self‐reported symptoms) were evaluated before exposure start, then 5 and 24 h after. During exposures volatile organic compounds (VOCs), particle size distributions, number concentrations and optical properties were measured. Generally, no statistically significant changes were observed in spirometry, FeNO, or nasal volume comparing cooking and candle exposures to clean air. In males, nasal volume and FeNO decreased after exposure to cooking and candles, respectively. Participants reported additional and more pronounced symptoms during exposure to cooking and candles compared to clean air. The results indicate that emissions from cooking and candles exert mild inflammation in asthmatic males and decrease comfort among asthmatic males and females.
Background
Indirect calorimetry (IC) is considered the accurate way of measuring energy expenditure (EE). IC devices often apply the Haldane transformation, introducing errors at inspiratory oxygen ...fraction (FiO2) >60%. The aim was to assess measurement reliability and agreement between an unevaluated IC (device 2) (Beacon Caresystem, Mermaid Care A/S, Noerresundby, Denmark) not using Haldane transformation and an IC that does (device 1) (Ecovx, GE, Helsinki, Finland) at varying FiO2.
Methods
Twenty healthy male subjects participated, with 16 completing the study (33 ± 9 years, 83.3 ± 16 kg, 1.83 ± 0.08 m). Subjects were mechanically ventilated in pressure support (3cmH2O; positive end‐expiratory pressure: 3cmH2O) at FiO2 of 21%, 50%, 85%, and 21% for 15 minutes at each FiO2. Mean EE, oxygen consumption (VO2), and CO2 production (VCO2) were compared within and between devices across FiO2 levels.
Results
Device 2 showed within‐device EE significant differences at 21% vs 50% FiO2 and device 1 for VCO2 at 50% vs. 85% FiO2. For all variables, both devices showed reliable measurements at 21% and 50% FiO2, but at 85%, FiO2 bias and limits of agreement increased. Between devices, there were significant differences for EE at both 21% and 85% FiO2 for VO2 and for VCO2 at 85% FiO2.
Conclusion
Both systems measured EE, VO2, and VCO2 at 21%–85% FiO2 reliably but with bias at 85% FiO2. The devices were in agreement at 21% and 50% FiO2, but further studies need to confirm accuracy at high FiO2.
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