Domantas Jasilionis Sustainability of life expectancy improvements in Europe. Demographic Research Centre

Transcription

1 Domantas Jasilionis Sustainability of life expectancy improvements in Europe Demographic Research Centre

2 INTRODUCTION AND OUTLINE Recent concerns about longevity progress Longevity divergences - and integral part of health transition process? Health revolution at old ages: is it continuing? Equitable and inequitable pathways to national longevity advances?

3 Recent concerns about longevity progress A) An unexpected decline in life expectancy in 2015

4 Recent changes in life expectancy in high income countries in international media

5 Striking simultaneous drop in life expectancy at birth in 2015 Greece Hungary Belgium Germany France UK Czech R. Italy Lithuania Slovak. R. Switzerland Netherlands Slovenia USA Poland Australia Portugal Austria Ireland Sweden Denmark Spain Latvia S. Korea Japan Russia Estonia Finland Features of the 2015 crisis : Mostly affected older people Direct (influenza/respiratory) and indirect effects (other diseases) USA: drug-related/external causes. Recovery in 2016 in most cases Data: 0.6 Human Mortality Database, Eurostat, Change in female life expectancy at birth,

6 A warning sign for the future? First time in decades, affecting so many countries Magnitude of effect on life expectancy at birth Re-emergence of drug and vaccine resistant infections? more similar threats in the future? Modern health care systems in the most advanced high income countries were unprepared? more profound problems?

7 Recent concerns about longevity progress B) Unfavourable trends in the UK and USA

8 Recent slow-down or decline in the UK and USA Life expectancy at birth, Life expectancy at birth, years MALES UK Life expectancy at birth, years FEMALES UK USA 6 4 USA Source: Human Mortality Database, 2018.

9 Are the UK and USA alone? Life expectancy at birth, Life expectancy at birth, years MALES Life expectancy at birth, years FEMALES UK Netherlands Netherlands Germany UK USA 8 Germany 78 6 USA Source: Human Mortality Database, 2018.

10 UK and USA: different patterns and reasons USA: role of deaths of despair [drugs, alcohol, violence] at adult ages + systematic deterioration across variety of conditions and risk factors (Case & Deaton 2015; Woolf et al. 2018). UK: stalling improvements at old ages, specific factors related to general socio-economic circumstances affecting the poorest elderly? (Hiam et al. 2018) Important questions: More countries affected, signs of new divergence? Signs of prolonged deviations?

11 Longevity divergences - an integral part of health transition process?

12 Health transition as a set of divergence-convergence cycles health transition beyond a simple epidemiological change relating longevity advances and medical causes of death. each major health progress first induces a phase of longevity divergence between and within countries. vanguards benefit first, laggards catching-up: new major progress new leaders? Recent evidence: cardiovascular revolution of the 1970s long-standing East-West health divide. ongoing fight against ageing-related diseases. Source: Vallin & Meslé 2004; Meslé & Vallin 2006.

13 Life expectancy trends in selected European countries after 1950: convergence-divergence-???convergence??? Life expectancy at birth MALES Germany Sweden Life expectancy at birth 85 FEMALES Sweden Denmark 80 Finland 75 Finland Denmark Estonia Poland Poland Estonia Lithuania Latvia Russia Lithuania Latvia Russia End of era of infectious diseases Cardiovascular revolution Source: Vallin, Jasilionis, Meslé, 2017; Katus, 2000; Human Mortality Database, 2018.

14 Life expectancy at birth in selected developed countries after 1990: remarkable achievements, persisting disparity Life expectancy at birth, years MALES EU before 2004 USA S. Korea Japan Switzerland Australia 81.5 Life expectancy at birth, years EU before 2004 Switzerland FEMALES Spain Australia S. Korea 87.2 USA Japan Russia New EUmembers New EU members Russia 55 Source: Human Mortality Database, 2018; EUROSTAT, 2018.

15 Life expectancy at birth in selected high income countries: variation at very high life expectancy levels Life expectancy at birth, years 0 MALES Life expectancy at birth, years 90 FEMALES Sweden Italy Switzerland UK Spain Germany USA Italy Switzerland Netherlands Japan UK Germany Danemark Spain USA Source: Human Mortality Database, 2018; EUROSTAT, 2018.

16 Convergence in life expectancy in enlarged European Union? Divergence among the new member states. Life expectancy at birth, years EU before 2004 Poland MALES Slovenia Estonia Slovak R. Hungary Czech R Latvia Lithuania Life expectancy at birth, years EU before 2004 Slovenia FEMALES Hungary Estonia Spain Poland Czech R Latvia 80.0 Slovak R. Lithuania Source: Human Mortality Database, 2018; EUROSTAT, 2018.

17 Where are resources for further longevity advances? Age-specific death rates in MALES 0.1 FEMALES 0.01 New EU members Russia Australia 0.01 New EU members Japan USA Russia S. Korea Japan Spain Switzerland Italy Switzerland Source: Human Mortality Database, 2018; EUROSTAT, 2018.

18 Variations in resources for further longevity advances: Changes in male survival from age 15 to 65 years. 100% 90% 80% 70% 60% 50% Italy Sweden Germany Switzerland Czechia France Hungary Poland Estonia UK Spain 91% Lithuania 60% Russia Survivorship until 65 years approaches 90% in majority of high income countries. limited effect on LEB in future. 40% Source: Human Mortality Database, 2018.

19 Variations in resources for further longevity advances: The decisive role of mortality changes at old ages Contributions of mortality changes at different ages to the total change in female life expectancy at birth, Source: Human Mortality Database, 2018; EUROSTAT, 2018.

20 Health revolution at old ages: is it continuing?

21 Recent trends in female survival between ages 65 and 80 90% 85% 80% 75% Switzerland Netherlands France Italy 86% Japan Spain Sweden 70% 65% USA Germany UK 73% 60% Denmark Czech R. 55% 50% 45% 40% Source: Human Mortality Database, 2018; EUROSTAT, 2018.

22 Surviving beyond 80: are there further improvements? 65% 60% 55% 50% Switzerland Spain Japan USA Italy Sweden 61% France 52% Female survival between ages 80 and 90, : continuing progress at varying pace 45% 40% 35% 30% UK 45% Germany Denmark 38% Netherlands Czech R. 25% 20% Source: Human Mortality Database, 2018.

23 and even beyond 90? 14% 12% 10% 8% Japan UK Spain Switzerland France Survival probability between ages 90 and 100, Less systematic and more variable across countries. 6% 4% Sweden Germany 2% 0% Source: Human Mortality Database, 2018.

24 The decisive role of health advances at increasingly old ages Main resource for further increase in human longevity. Best-performing vanguard countries show remarkable pace of longevity improvements. Steady improvements beyond the age 80, signs of important progress after the age 90. Important questions: Health revolution at old age = another cycle of divergence? Another leap forward is difficult: fighting disability, old-age mental diseases, poor risk profiles (obesity ),

25 Equitable and inequitable pathways to national longevity advances? A) Lifespan disparity

26 Life table as inequality arena: distribution of incomes male life table ages at death, Germany Switzerland Sweden USA Life span disparity: More equal distribution is a pathway to more sustainable progress? OR Life expectancy may still improve keeping high inequality in age at death? AGE Source: Human Mortality Database, 2018.

27 Lifespan disparity and pathways towards higher life expectancy Lifespan disparity E-dagger, years Germany USA MALES, Switzerland Smaller unsustainable progress with high disparity Moderate progress in both disparity and LEB Sweden Life expectancy at birth, years Source: Human Mortality Database, 2018.

28 Equitable and inequitable pathways to national longevity advances? B) Social disparities and compositional change

29 National-level record (best practice) male LE at age 65, male LE for high education group in Finland, Sweden, Norway, and Switzerland, and members of Royal Academy of Sciences (UK) Life expectancy at age 65 (years) Sweden Australia Japan Norway Switzerland Finland (High ed.) Sweden (High ed.) Norway (High ed.) Switzerland(High ed.) Countries-records Royal Society (UK) pre-1975 Males Highly educated vanguards: Life expectancy levels close or above best practice national life expectancies. Systematic further increases despite initially very high levels of life expectancies No signs of stagnation or substantial deceleration. 17 E_record Linear (Finland (High ed.)) Switzerland Linear (Countries-records) Linear (E_record) Spain France European records Source: Jasilionis & Shkolnikov, Data sources: Human Mortality Database 2015; unpublished data by Statistics Finland, Statistics Norway, and Statistics Sweden; Martikainen et 2013; Schumacher and Vilpert 2004; OECD/Murtin et al. 2017; Andreev et al, 2011.

30 Latvia Hungary Poland Finland USA Denmark Austria Italy Norway England & Wales France Sweden Hungary Latvia Poland Denmark USA England & Wales Finland Austria Norway Sweden Italy France TOTAL AND EDUCATION-SPECIFIC LIFE EXPECTANCY AT AGE 25 IN SELECTED OECD COUNTRIES, DIFF=13.9 yrs MALES DIFF=5.9 yrs High TOTAL Low DIFF=8.3 yrs FEMALES DIFF=2.7 yrs High All Low 61.0 Source: Murtin, Mackenbach, Jasilionis, d Ercole, 2017.

31 Increase in life expectancy gap by education for Swedish and Finnish men, Higher Secondary Lower than sec. DIFF: 3.2 yrs SWEDEN DIFF: 4.6 yrs DIFF: 5.4 yrs DIFF: 4.9 yrs FINLAND DIFF: 6.5 yrs DIFF: 7.0 yrs Source: Jasilionis, Martikainen, Shkolnikov, 2017.unpublished data by Statistics Finland, Statistics Sweden.

32 COMPOSITIONAL CHANGE AND NATIONAL LONGEVITY e(30), years 59 Changes in national female life expectancy at age 30, Sweden, years Deaths and population by ethnicity from census PROPORTION OF POPULATION (%) Source: Jasilionis, Martikainen, Shkolnikov, 2017.unpublished data by Statistics Sweden.

33 COMPOSITIONAL CHANGE AND NATIONAL LONGEVITY Changes in national and group-specific female life expectancy at age 30, Sweden, e(30), years % / +6yrs Higher Secondary +31% / +4 yrs Deaths and population by ethnicity from census Lower than secondary PROPORTION OF POPULATION (%) - 59% / +3.4 yrs Education-specific ( ) Education-specific ( ) Source: Jasilionis, Martikainen, Shkolnikov, 2017.unpublished data by Statistics Sweden.

34 Educational growth as a factor of national longevity rise: Sweden & Finland: VS Contributions of A) reductions in group-specific mortality and B) improvements in education structure to the total gain in NATIONAL female life expectancy at age TOTAL GAIN: YRS SWEDEN TOTAL GAIN: YRS TOTAL GAIN: YRS Increase in % with Secondary ed., decrease in Lower ed. Increase in % with Higher ed. Mortality improvement (Higher education) FINLAND TOTAL GAIN: YRS Mortality improvement (Secondary AND Lower than sec. groups) Source: Jasilionis, Martikainen, Shkolnikov, 2017.unpublished data by Statistics Finland, Statistics Sweden.

35 Importance of inequality and compositional change Equitable mortality reductions (lifespan disparity) for more sustainable longevity improvements. Remarkable progress in vanguard sub-populations, despite becoming increasingly massive (high education). Education remains important for national longevity even in the most advanced nations. Questions: education is just one compositional dimension with limited resources for further growth. opposite effects of decline in % of married or increase in obesity or other unfavorable biomedical factors.

36 Concluding remarks Life expectancy is a key characteristic of human development, reflecting current mortality conditions. Each sign predicting longevity reversals should be taken seriously; persisting inequalities is a threat for sustainable progress. Optimism from past experiences in overcoming health challenges, leading to the phase of convergence. Varying trajectories and patterns challenges for forecasting [period conditions].

37 ACKNOWLEDGEMENTS Vladimir Shkolnikov (MPIDR), Pekka Martikainen (Helsinki University), Dmitri Jdanov (MPIDR) Statistics Finland, Statistics Sweden, Statistics Lithuania for continuous data support for research on socio-economic longevity disparities. This study has been supported by the Max Planck Society within the framework of the project On the edge of societies: New vulnerable populations, emerging challenges for social policies and future demands for social innovation. The experience of the Baltic Sea States ( ). 37