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Improvements in Life Expectancy: Past, Present and Future

Improvements in Life Expectancy: Past, Present and Future. John R. Iacovino, M.D., F.A.C.P. Medical Director / Senior Consultant . Consistency • Accuracy • Professionalism. Overview. Mortality Improvements By Period 1900 to 1940 1940 to 1960 1960 /1980 to 2000 2000 and forward

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Improvements in Life Expectancy: Past, Present and Future

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  1. Improvements in Life Expectancy: Past, Present and Future John R. Iacovino, M.D., F.A.C.P. Medical Director / Senior Consultant Consistency • Accuracy • Professionalism

  2. Overview • Mortality Improvements By Period • 1900 to 1940 • 1940 to 1960 • 1960 /1980 to 2000 • 2000 and forward • The Aging Process • Effect of Eliminating Cancer and Heart Disease on Life Expectancy

  3. Source: Centers for Disease Control and Prevention, National Center for Health Statistics (US)

  4. Future life expectancy can be calculated for any starting age US Vital Statistics 2004

  5. Life expectancy at birth 1900 to 2000 79 74 Source: U.S. Vital Statistics, 2004

  6. Mortality Improvements. Cutler and Meara, Sept 2001, Changes in the Age Distribution of Mortality Over the 20th Century

  7. Phase 1: 1900 to 1940 Life expectancy increased 16 years Decline in infant deaths contributed 4 ½ years Decline in childhood mortality contributed 4 ½ years Decline in young adult mortality contributed 3 ½ years Other improvements contributed 3 ½ years Cutler and Meara, Sept 2001, Changes in the Age Distribution of Mortality Over the 20th Century

  8. Phase 1: 1900 to 1940 Explanations for declining death rate In 1900, infections accounted for 32% of all deaths. By 1940, infections were only 8% of deaths. Deaths from pneumonia and influenza fell 2.4% annually between 1900 and 1940 Deaths from TB fell 3 to 6% annually—and fell by 50% after anti-TB drugs were introduced. Deaths from vaccine preventable diseases fell 3 to 6% annually.

  9. Phase 1: 1900 to 1940 Classic public health improvements for whole society Sanitation and safe drinking water Refrigeration and safe food Better housing Better quality air

  10. Phase 1: 1900 to 1940 On the downside, heart disease and cancer increased Heart disease rose from 22% in 1900 to 44% of all deaths in 1940. Cancer deaths rose from 5% in 1900 to 11% of all deaths in 1940.

  11. Phase 2: 1940 to 1960 Life expectancy increased 6.4 years Infections as a cause of death declined faster between 1940 and 1960 than in the first 40 years of the century. Much of this decline was due to medical care: new diagnostic tests and medications Cutler and Meara, Sept 2001, Changes in the Age Distribution of Mortality Over the 20th Century

  12. Phase 3: 1960 to 1990 By 1960, infectious disease mortality is already so low that their further decreases do not materially impact life expectancy. Decline in infant mortality adds only 1 ¼ years Decline in deaths in those over age 45 added 3 ½ years. Cutler and Meara, Sept 2001, Changes in the Age Distribution of Mortality Over the 20th Century

  13. Phase 3: 1960-1990 Virtually all of the mortality gain since 1965 is due to decrease in cardiovascular mortality. Since 1965, cardiovascular disease mortality begins to decline at about 2% per year

  14. Major reasons for CV decline—which has the greatest impact? Technology (coronary care units, angiography, coronary interventions, etc.) 1967 First bypass 1977 First angioplasty Pharmaceutical gains (BP and cholesterol meds, post heart attack protocols) Behavioral life style interventions (better diet, more exercise, less smoking)

  15. Phase 4: 1981 to 2000 Cardiovascular mortality fell by 54% Smoking fell by 35% Population total cholesterol fell 4.2% Introduction of statins Population BP fell 7.7% Note the gain despite increasing obesity and inactivity at the same time. An even greater future opportunity. Unal,B, Am J. Pub Health, 2005 Jan;95(1): 103-108

  16. Phase 4: 1981 to 2000 The improvements in cardiovascular risk-factors account for four times more life-years gained than did all of cardiovascular treatments for known disease. Diet Exercise Smoking Unal,B, Am J. Pub Health, 2005 Jan;95(1): 103-108

  17. Phase 5: 2000 forward Life expectancy is increasing, but Americans lag behind the rest of the world. America ranks about 30th in life expectancy U.S. LE 81 years Japan / China 84 years - #1 Swaziland 33 years - last Immigrants to the US live 3 years longer than their American born relatives.

  18. Phase 5: 2000 forwardContinuing and future challenges Smoking Obesity Inactivity

  19. Trends in Cigarette Smoking Prevalence* (%) by Gender, Adults 18 and Older, US, 1965-2002 *Redesign of survey in 1997 may affect trends. Source: National Health Interview Survey, 1965-2002, National Center for Health Statitics, Centers for Disease Control and Prevention, 2004.

  20. Phase 5: 2000 forwardRecent health loses - Obesity rises 15% of Americans were obese in 1976-80, but up to 31% in 1999-2000 Between 1988 and 2002, percent of overweight adults climbed from 56 to 65% and percent of obese adults went from 23 to 30%. Normal – BMI 18.5 – 24.9 Overweight – BMI 25 – 29.9 Obese – BMI 30 and greater

  21. Opportunities for improvement:Trends in Overweight* Prevalence (%), Children and Adolescents, by Age Group, US, 1971-2002 *Overweight is defined as at or above the 95th percentile for body mass index by age and sex based on reference data. Source: National Health and Nutrition Examination Survey, 1971-1974, 1976-1980, 1988-1994, 1999-2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, 2004.

  22. Phase 5: 2000 forward Diabetes increasing In 1997, 5.1% of Americans had diabetes, in 2002, the number was 6.5%. 12 million Americans now have type 2 diabetes Exercise can prevent and/or delay onset of diabetes On average diabetes decreases life expectancy by about one third

  23. Value of Preventive Life Style A 35-year-old who burns 2,000 calories through exercise each week gains, on average, more than six years of life expectancy. Inverse relationship between cardiovascular fitness and coronary heart disease and all-cause mortality in healthy men and women Increase in 1 MET higher level of maximal aerobic capacity resulted in a 14% decrease in the history of coronary heart disease and/or all-cause mortality Fitness is better correlated with mortality improvement than simple physical activity

  24. Decline in elderly mortality is accelerating • Between 1900 and 1940, mortality in the elderly (over age 65) declined to only 0.3% per year. • Between 1960 and 1990, mortality in the elderly declined 1.1% per year.

  25. Who lives the longest? Best socio-economic class and education Best genes Best medical care and risk factor reduction

  26. Years of Life Remaining at Age 65 19 15 Source: U.S. Vital Statistics, 2004

  27. Years of Life Remaining at Age 85 6.5 5.8 Source: U.S. Vital Statistics, 2004

  28. Aging Process Causes • Free radicals • Antioxidants • Mutations • DNA repair failure • Waste product accumulation • Telomere shortening

  29. Telomeres • Long chains of DNA at the ends of chromosomes • Protect the integrity of the chromosome • Shorten at the end of each cell division Exercise Physiology, Brown, Miller and Eason

  30. http://science.nasa.gov/headlines/y2006/images/telomeres/caps.gifhttp://science.nasa.gov/headlines/y2006/images/telomeres/caps.gif

  31. The Future: Are telomeres the best life expectancy calculator? Aging process Probably genetically preprogrammed We lose the ability to repair aging organs Damage increases as we age “Hayflict Limit” on life expectancy Life style and behaviors profoundly affect the genetic profile

  32. Hayflict Limit • Cells divide freely to a predetermined number of divisions • Then cell division enters a senescence phase • Each division produces a telomere shortening • This creates a ticking back of the genetic inner clock for each subsequent cell division-Replicative Senescence • Stress Induced Premature Senescence

  33. Telomeres • The length of the telomere may determine longevity • Progeria • Very short telomeres • Cancer Cells • Produce an enzyme that prevents shortening – cell “immortality” Exercise Physiology, Brown, Miller and Eason

  34. Effect of Disease Elimination on Life Expectancy Correlations: • Positive elimination correlation • Eliminating cancer or heart disease renders death from other causes in the future more probable • Independent elimination correlation • Eliminating cancer or heart disease has no effect on the probability of death from other causes • Negative elimination correlation • Eliminating cancer or heart disease renders death from other causes in future years less probable Source: Centers for Disease Control and Prevention, National Center for Health Statistics (US)

  35. Source: Centers for Disease Control and Prevention, National Center for Health Statistics (US) US Population Decennial Life Table 1989-1991

  36. Source: Centers for Disease Control and Prevention, National Center for Health Statistics (US) US Population Decennial Life Table 1989-1991

  37. Fasano Associates 6th Annual Life Settlement Conference 26 October 2009 Washington, DC Michael Fasano Fasano Associates 1201 15th Street, NW – Suite 250 Washington, DC 20005 202-457-8188 202-457-8198 (fax) mfasano@fasanoassociates.com www.fasanoassociates.com

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