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Longevity in the 21 st Century

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  1. Longevity in the 21st Century Richard Willets

  2. Longevity in the 21st Century Background 20th Century Trends International Experience Medical Advances The Threat From Infectious Diseases Projecting the Future Implications

  3. Longevity in the 21st Century Background 20th Century Trends International Experience Medical Advances The Threat From Infectious Diseases Projecting the Future Implications

  4. Background The UK Actuarial Profession established a Working Party in 2003 to produce a review paper on longevity trends Richard Willets (chairman) Adrian Gallop Tony Leandro Joseph Lu Angus Macdonald Keith Miller Stephen Richards Neil Robjohns John Ryan Howard Waters

  5. Background The paper “Longevity in the 21st Century” was presented to the Faculty of Actuaries on 15 March 2004 and the Institute of Actuaries on 26 April 2004 A separate paper “The cohort effect: insights and explanations” (Richard Willets) was presented at the same meetings

  6. Background A Working Party of the Continuous Mortality Investigation Bureau (C.M.I.B.) is considering the issue of future mortality projection New projections are planned for 2005 to be used with new “00” series tables This group published Working Paper 3 – “Projecting future mortality – a discussion paper” in March 2004 A recent seminar at Staple Inn backed the call for “measures of uncertainty” in projections

  7. Longevity in the 21st Century Background 20th Century Trends International Experience Medical Advances The Threat From Infectious Diseases Projecting the Future Implications

  8. 20th Century Trends Reduction in the mortality rate for males aged 65-74 in the England & Wales population since 1901 20% fall between 1901 & 1969 (68 years) Source: own calculations using O.N.S. data

  9. 20th Century Trends Reduction in the mortality rate for males aged 65-74 in the England & Wales population since 1901 20% fall between 1901 & 1969 (68 years) 20% fall between 1969 & 1986 (17 years) Source: own calculations using O.N.S. data

  10. 20th Century Trends Reduction in the mortality rate for males aged 65-74 in the England & Wales population since 1901 20% fall between 1901 & 1969 (68 years) 20% fall between 1969 & 1986 (17 years) 20% fall between 1986 & 1996 (10 years) Source: own calculations using O.N.S. data

  11. 20th Century Trends Reduction in the mortality rate for males aged 65-74 in the England & Wales population since 1901 20% fall between 1901 & 1969 (68 years) 20% fall between 1969 & 1986 (17 years) 20% fall between 1986 & 1996 (10 years) 20% fall between 1996 & 2002 (6 years) Source: own calculations using O.N.S. data

  12. 20th Century Trends At the beginning of the 21st Century we are observing accelerating rates of improvement at older ages Average annual rates of mortality improvement for males in the population of England & Wales Source: own calculations using O.N.S. data – trend lines fitted using log linear regression Note: “mortality improvement” is taken to mean the % reduction in mortality rate

  13. 20th Century Trends At the beginning of the 21st Century we are observing accelerating rates of improvement at older ages Average annual rates of mortality improvement for females in the population of England & Wales Source: own calculations using O.N.S. data – trend lines fitted using log linear regression Note: “mortality improvement” is taken to mean the % reduction in mortality rate

  14. 20th Century Trends Heart disease mortality is falling sharply Heart disease deaths per 1,000,000 – males aged 60-69 in England & Wales “Premature death from heart disease in England could be almost unheard of within a decade” Source: own calculations using O.N.S. data

  15. 20th Century Trends Mortality rates are falling in other causes Deaths per 1,000,000 – males aged 60-69 in Eng & Wales Cancer Stroke Source: own calculations using O.N.S. data

  16. 20th Century Trends Future projections should be grounded in as good an understanding of the past as possible The paper focuses on “five key forces” currently shaping the pattern of mortality change

  17. 20th Century Trends The paper focuses on “five key forces” currently shaping the pattern of mortality change:- The UK “cohort effect” The “ageing of mortality improvement” Past patterns of cigarette smoking Increased uncertainty at younger ages Widening social-economic class differentials

  18. The UK “cohort effect” Rate of mortality improvement by age group and decade – females in England & Wales Source: own calculations using O.N.S. figures

  19. The UK “cohort effect” Rate of mortality improvement by age group and decade – females in England & Wales the “cohort effect” Source: own calculations using O.N.S. figures

  20. The UK “cohort effect” Rate of mortality improvement by age group and decade – males in England & Wales the “cohort effect” Source: own calculations using O.N.S. figures

  21. The UK “cohort effect” Mortality projections Faster improvements have been observed for the UK generation born 1925-1945 – centred on 1931 This feature has been explicitly allowed for in G.A.D. mortality projections since the 1990s In 2002 the C.M.I.B. published a paper which described a similar effect in insurance and pensioner data – centred on 1926 The C.M.I.B. published three “interim” projections which allowed for this feature (known as the “short”, “medium” and “long” cohort projections)

  22. The UK “cohort effect” Impact of year of birth in a model of mortality change for males in the population of England & Wales Source: own calculations using O.N.S. figures

  23. The UK “cohort effect” Impact of year of birth in a model of lung cancer mortality change for males in the population of E&W Source: own calculations using O.N.S. figures

  24. The UK “cohort effect” Female cumulative constant tar cigarette consumption (CCTCC) by age and central year of birth, UK Rate of lung cancer mortality for females in England & Wales by year of birth Age group Sources: O.N.S. & Lee et al (1993)

  25. The UK “cohort effect” Impact of year of birth in a model of heart disease mortality change for males in the population of E&W Source: own calculations using O.N.S. figures

  26. The UK “cohort effect” Impact of year of birth in a model of mortality change for males in the population of E&W Source: own calculations using O.N.S. figures

  27. The UK “cohort effect” Impact of year of birth in a model of mortality change for males in the population of England & Wales Second cohort due to a wider range of factors First cohort largely due to trends in smoking Source: own calculations using O.N.S. figures

  28. The UK “cohort effect” Research in other fields Researchers in a range of disciplines believe that people born in different generations are likely to experience different health characteristics in later life In epidemiology a “life course” approach to understanding disease trends has developed “…a degree of anticipation is possible within lifetimes…through those things which make an imprint on life at one point, and which are carried forward on into later life.” Professor Michael Wadsworth (1991)

  29. The UK “cohort effect” Possible causes of the UK “cohort effect” Patterns of cigarette consumption World War II Birth rates Diet Welfare State

  30. The ageing of mortality improvement The ages experiencing the most rapid change have shifted upwards Source: own calculations using O.N.S. data for males in England & Wales

  31. The ageing of mortality improvement The ages experiencing the most rapid change have shifted upwards Source: own calculations using O.N.S. data for males in England & Wales

  32. Cigarette smoking Trends in cigarette consumption Consumption of cigarettes in the UK has been falling since the 1960s Smoking prevalence rates stabilised in the 1990s The impact on mortality trends is difficult to quantify because of the enduring nature of the damage caused by cigarette smoking Smoking patterns have certainly contributed towards the cohort effect Reduction in cigarette smoking may account for a half to a third of recent improvements at some ages

  33. Uncertainty at younger ages Increased uncertainty at younger ages In the 1980s and 1990s improvements in health-related causes were offset by deteriorations in a range of different causes, notably:- AIDS Drug & alcohol abuse Liver disease Violent deaths Accidental deaths (other than motor vehicle)

  34. Uncertainty at younger ages Mortality rates for men aged 20-39 in England & Wales as a % of rate in 1989 Together these causes now account for 12% of all deaths for this age group Source: own calculations using O.N.S. data for males in England & Wales

  35. Uncertainty at younger ages Average annual rate of mortality improvement, males aged 20-39, England & Wales, 7 year rolling averages Source: own calculations using O.N.S. data for males in England & Wales

  36. Uncertainty at younger ages Average annual rates of mortality improvement for the population of England & Wales – 1977 to 2002 Source: own calculations using O.N.S. figures - improvement rates for all ages between 20 and 89 have been used.

  37. Widening socio-economic class differentials Differential in life expectancy at age 65 between manual and non-manual classes, England & Wales, 1972-99 Source: own calculations using O.N.S. data for males in England & Wales

  38. Widening socio-economic class differentials Average annual rate of mortality improvement for males in the population of England & Wales and in the C.M.I. dataset for males with life assurance policies, 1961-1999 Source: own calculations using C.M.I.B. & O.N.S. data

  39. Longevity in the 21st Century Background 20th Century Trends International Experience Medical Advances The Threat From Infectious Diseases Projecting the Future Implications

  40. International experience U.K. mortality rates by age relative to an “international average” from 23 developed countries Source: own calculations using W.H.O. data

  41. International experience Expectation of life (years) for males at age 65 for selected countries in 2000 Source: own calculations using W.H.O. data

  42. International experience Pace of mortality improvement for Japanese females by age and calendar year – shaded area shows where change is most rapid Age 85 Age 75 Age 65 Age 55 Source: own calculations using data from www.mortality.org 1960 1970 1980 1990

  43. International experience Pace of mortality improvement for Japanese females by age and calendar year – shaded area shows where change is most rapid Age 85 Age 75 Age 65 3.5% p.a. improvements at age 55 Age 55 Source: own calculations using data from www.mortality.org 1960 1970 1980 1990

  44. International experience Pace of mortality improvement for Japanese females by age and calendar year – shaded area shows where change is most rapid Age 85 Age 75 4.5% p.a. improvements at age 65 Age 65 3.5% p.a. improvements at age 55 Age 55 Source: own calculations using data from www.mortality.org 1960 1970 1980 1990

  45. International experience Pace of mortality improvement for Japanese females by age and calendar year – shaded area shows where change is most rapid Age 85 4.25% p.a. improvements at age 75 Age 75 4.5% p.a. improvements at age 65 Age 65 3.5% p.a. improvements at age 55 Age 55 Source: own calculations using data from www.mortality.org 1960 1970 1980 1990

  46. International experience Pace of mortality improvement for Japanese females by age and calendar year – shaded area shows where change is most rapid 4.0% p.a. improvements at age 85 Age 85 4.25% p.a. improvements at age 75 Age 75 4.5% p.a. improvements at age 65 Age 65 3.5% p.a. improvements at age 55 Age 55 Source: own calculations using data from www.mortality.org 1960 1970 1980 1990

  47. International experience Ratio of average annual rate of improvement over last 10 years vs. previous 30 years – average based on 5 countries (USA, England & Wales, France, Germany & Japan) Source: own calculations using data from www.mortality.org

  48. Longevity in the 21st Century Background 20th Century Trends International Experience Medical Advances The Threat From Infectious Diseases Projecting the Future Implications

  49. Medical advances The pace of scientific development The pace of scientific development appears to be accelerating A substantial element of current improvements are being driven by advances in medicine Improvements in heart disease mortality have been partially caused by:- new medication, e.g. beta-blockers & statins new surgical interventions, e.g. CABG & angioplasty Improvements in cancer mortality have been partially caused by:- advances in treatment improvements in detection

  50. Medical advances The pace of scientific development Will the accelerating pace of medical advancement drive accelerating mortality improvements? Two case studies are considered:- A ‘polypill’ to treat cardio-vascular disease Research into the ageing process