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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

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
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
life expectancy at birth 1900 to 2000
Life expectancy at birth 1900 to 2000

79

74

Source: U.S. Vital Statistics, 2004

mortality improvements
Mortality Improvements.

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

phase 1 1900 to 1940 life expectancy increased 16 years
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

phase 1 1900 to 1940 explanations for declining death rate
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.

phase 1 1900 to 1940 classic public health improvements for whole society
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

phase 1 1900 to 1940 on the downside heart disease and cancer increased
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.

phase 2 1940 to 1960 life expectancy increased 6 4 years
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

phase 3 1960 to 1990
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

phase 3 1960 1990
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

major reasons for cv decline which has the greatest impact
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)

phase 4 1981 to 2000
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

phase 4 1981 to 200016
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

phase 5 2000 forward life expectancy is increasing but
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.

slide19

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.

phase 5 2000 forward recent health loses obesity rises
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

slide21
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.

phase 5 2000 forward diabetes increasing
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

value of preventive life style
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

decline in elderly mortality is accelerating
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.
who lives the longest
Who lives the longest?

Best socio-economic class and education

Best genes

Best medical care and risk factor reduction

years of life remaining at age 65
Years of Life Remaining at Age 65

19

15

Source: U.S. Vital Statistics, 2004

years of life remaining at age 85
Years of Life Remaining at Age 85

6.5

5.8

Source: U.S. Vital Statistics, 2004

aging process causes
Aging Process Causes
  • Free radicals
    • Antioxidants
  • Mutations
  • DNA repair failure
  • Waste product accumulation
  • Telomere shortening
telomeres
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

slide30

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

the future are telomeres the best life expectancy calculator
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

hayflict limit
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
telomeres33
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

effect of disease elimination on life expectancy
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)

slide35

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

US Population Decennial Life Table 1989-1991

slide36

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

US Population Decennial Life Table 1989-1991

slide37

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)

[email protected]

www.fasanoassociates.com

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