Domantas Jasilionis Sustainability of life expectancy improvements in Europe Demographic Research Centre
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?
Recent concerns about longevity progress A) An unexpected decline in life expectancy in 2015
Recent changes in life expectancy in high income countries in international media
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 -0.40-0.37-0.36-0.35-0.29-0.27-0.26-0.25-0.24-0.21-0.21-0.16-0.16-0.12-0.09-0.09-0.09-0.03-0.02-0.02 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. 0.02 0.08 0.10 0.16 0.21 0.23 0.31 0.34-0.6-0.4-0.2 0 0.2 0.4 Data: 0.6 Human Mortality Database, 2018. Eurostat, 2018. Change in female life expectancy at birth, 2014-2015
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?
Recent concerns about longevity progress B) Unfavourable trends in the UK and USA
1990 1992 1994 Recent slow-down or decline in the UK and USA Life expectancy at birth, 1990-2016 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 Life expectancy at birth, years 4 2 0 8 MALES UK Life expectancy at birth, years 84 82 80 78 FEMALES UK USA 6 4 USA 76 74 2 72 0 70 Source: Human Mortality Database, 2018.
1990 1992 1994 1996 1998 2000 2002 Are the UK and USA alone? Life expectancy at birth, 1990-2016 2004 2006 2008 2010 2012 2014 2016 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 Life expectancy at birth, years MALES Life expectancy at birth, years FEMALES 4 2 0 UK Netherlands 84 82 80 Netherlands Germany UK USA 8 Germany 78 6 USA 76 4 74 2 72 0 70 Source: Human Mortality Database, 2018.
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?
Longevity divergences - an integral part of health transition process?
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.
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 Life expectancy trends in selected European countries after 1950: convergence-divergence-???convergence??? Life expectancy at birth 85 80 MALES Germany Sweden Life expectancy at birth 85 FEMALES Sweden Denmark 80 Finland 75 Finland Denmark 75 70 65 Estonia Poland 70 65 Poland Estonia Lithuania Latvia Russia 60 55 Lithuania Latvia Russia 60 55 End of era of infectious diseases Cardiovascular revolution 50 50 Source: Vallin, Jasilionis, Meslé, 2017; Katus, 2000; Human Mortality Database, 2018.
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 Life expectancy at birth in selected developed countries after 1990: remarkable achievements, persisting disparity Life expectancy at birth, years 90 85 80 75 MALES EU before 2004 USA S. Korea Japan Switzerland Australia 81.5 Life expectancy at birth, years 90 85 80 75 EU before 2004 Switzerland FEMALES Spain Australia S. Korea 87.2 USA Japan 77.1 70 70 Russia New EUmembers 65 60 New EU members 66.5 65 60 55 Russia 55 Source: Human Mortality Database, 2018; EUROSTAT, 2018.
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 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 8 6 4 2 0 8 6 4 Sweden Italy Switzerland UK Spain Germany USA 81.5 78.4 76.4 88 86 84 82 80 78 76 74 Italy Switzerland Netherlands Japan UK Germany Danemark Spain 87.2 85.6 82.8 USA 81.4 2 72 0 70 Source: Human Mortality Database, 2018; EUROSTAT, 2018.
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 Convergence in life expectancy in enlarged European Union? Divergence among the new member states. Life expectancy at birth, years 90 85 80 75 70 65 60 EU before 2004 Poland MALES Slovenia Estonia Slovak R. Hungary Czech R. 80.6 69.5 Latvia Lithuania Life expectancy at birth, years 90 85 80 75 70 65 60 EU before 2004 Slovenia FEMALES Hungary Estonia Spain Poland Czech R. 86.3 Latvia 80.0 Slovak R. Lithuania 55 55 Source: Human Mortality Database, 2018; EUROSTAT, 2018.
0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 Where are resources for further longevity advances? Age-specific death rates in 2016. 1 1 0.1 MALES 0.1 FEMALES 0.01 New EU members Russia Australia 0.01 New EU members Japan USA Russia S. Korea 0.001 Japan 0.001 0.0001 Spain Switzerland 0.0001 Italy Switzerland 0.00001 0.00001 Source: Human Mortality Database, 2018; EUROSTAT, 2018.
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 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.
Variations in resources for further longevity advances: The decisive role of mortality changes at old ages 6.0 5.0 Contributions of mortality changes at different ages to the total change in female life expectancy at birth, 2006-2016 4.0 3.0 +2.9 +3.2 80+ 65-79 2.0 1.0 +1.2 +1.4 +1.2 +1.4 +1.0 +1.6 +1.5 +1.0 +2.0 15-64 1-14 0 0.0 Source: Human Mortality Database, 2018; EUROSTAT, 2018.
Health revolution at old ages: is it continuing?
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 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.
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 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, 1990-2016: continuing progress at varying pace 45% 40% 35% 30% UK 45% Germany Denmark 38% Netherlands Czech R. 25% 20% Source: Human Mortality Database, 2018.
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 and even beyond 90? 14% 12% 10% 8% Japan UK Spain Switzerland France Survival probability between ages 90 and 100, 1990-2016. Less systematic and more variable across countries. 6% 4% Sweden Germany 2% 0% Source: Human Mortality Database, 2018.
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 ),
Equitable and inequitable pathways to national longevity advances? A) Lifespan disparity
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100 105 110+ Life table as inequality arena: distribution of incomes male life table ages at death, 2015-16 5000 4500 4000 3500 3000 2500 2000 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? 1500 1000 500 0 AGE Source: Human Mortality Database, 2018.
Lifespan disparity and pathways towards higher life expectancy Lifespan disparity E-dagger, years 13.0 12.5 12.0 11.5 11.0 Germany USA MALES, 1990-94 2015-2016 Switzerland Smaller unsustainable progress with high disparity Moderate progress in both disparity and LEB 10.5 10.0 Sweden 9.5 9.0 70 75 80 85 Life expectancy at birth, years Source: Human Mortality Database, 2018.
Equitable and inequitable pathways to national longevity advances? B) Social disparities and compositional change
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) 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 24 23 22 21 20 19 18 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 16 15 14 13 Linear (Countries-records) Linear (E_record) Spain France European records Source: Jasilionis & Shkolnikov, 2016. 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.
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, 2011 65 60 55 50 45 40 35 30 52.5 46.0 41.0 DIFF=13.9 yrs MALES DIFF=5.9 yrs 58.6 55.6 52.7 High TOTAL Low 70 65 60 55 50 45 40 35 30 57.0 54.3 51.2 DIFF=8.3 yrs FEMALES DIFF=2.7 yrs 62.0 59.3 High All Low 61.0 Source: Murtin, Mackenbach, Jasilionis, d Ercole, 2017.
Increase in life expectancy gap by education for Swedish and Finnish men, 1971-75 - 2011-15 60 55 50 45 40 Higher Secondary Lower than sec. DIFF: 3.2 yrs 46.7 45.2 43.5 1971-75 SWEDEN DIFF: 4.6 yrs 49.9 47.8 45.4 1991-95 DIFF: 5.4 yrs 54.2 51.5 48.8 2011-15 60 55 50 45 40 DIFF: 4.9 yrs 43.6 41.9 38.7 FINLAND DIFF: 6.5 yrs 48.5 45.1 42.0 1991-95 DIFF: 7.0 yrs 52.7 48.8 45.7 2011-15 35 35 1971-75 30 30 Source: Jasilionis, Martikainen, Shkolnikov, 2017.unpublished data by Statistics Finland, Statistics Sweden.
COMPOSITIONAL CHANGE AND NATIONAL LONGEVITY e(30), years 59 Changes in national female life expectancy at age 30, Sweden, 1971-75 2011-15. 57 55 53 51 49 47 +5.5 years 2011-15 Deaths and population by ethnicity from census 1971-75 45 0 20 40 60 80 100 PROPORTION OF POPULATION (%) Source: Jasilionis, Martikainen, Shkolnikov, 2017.unpublished data by Statistics Sweden.
COMPOSITIONAL CHANGE AND NATIONAL LONGEVITY Changes in national and group-specific female life expectancy at age 30, Sweden, 1971-75 2011-15. e(30), years 59 +28% / +6yrs 57 55 53 51 49 47 45 Higher Secondary +31% / +4 yrs Deaths and population by ethnicity from census Lower than secondary 0 20 40 60 80 100 PROPORTION OF POPULATION (%) - 59% / +3.4 yrs Education-specific (2011-15) Education-specific (1971-75) Source: Jasilionis, Martikainen, Shkolnikov, 2017.unpublished data by Statistics Sweden.
Educational growth as a factor of national longevity rise: Sweden & Finland: 1971-75 1991-95 VS 1991-95-2011-15 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 30. 5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 TOTAL GAIN: + 2.8 YRS SWEDEN TOTAL GAIN: + 2.8 YRS 1971-75 - 1991-95 1991-95 - 2011-2015 5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 TOTAL GAIN: + 3.6 YRS Increase in % with Secondary ed., decrease in Lower ed. Increase in % with Higher ed. Mortality improvement (Higher education) FINLAND TOTAL GAIN: + 3.8 YRS 1971-75 - 1991-95 1991-95 - 2011-2015 Mortality improvement (Secondary AND Lower than sec. groups) Source: Jasilionis, Martikainen, Shkolnikov, 2017.unpublished data by Statistics Finland, Statistics Sweden.
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.
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].
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 (2016-2021). 37