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The aging of the world population is now an unquestionable fact. The World Health Organization (WHO) points out in its World Report on Aging and Health published in 2015 two main causes: the increase in life expectancy and the decrease in fertility rates. The United Nations (UN) announced that Spain will become the oldest country in the world in 2050, with 44% of citizens over 60 years of age and the median age of 55.2 years. Whether this event is interpreted optimistically or as a demographic problem will depend on the quality of the years of life gained.

El envejecimiento de la población mundial es ya un hecho incuestionable. La Organización Mundial de la Salud (OMS) señala en su Informe mundial sobre el envejecimiento y la salud publicado en 2015 dos causas principales: el aumento en la esperanza de vida y el descenso de las tasas de fecundidad. La Organización de Naciones Unidas (ONU) anunció que España llegará a ser el país más envejecido del mundo en 2050, siendo el 44% de la ciudadanía mayor de 60 años y la mediana de edad de 55,2 años. Si este acontecimiento es interpretado con optimismo o como un problema demográfico dependerá de la calidad de los años de vida ganados.

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Life expectancy is one of the primary population health indicators and in turn increases in life expectancy indicate improvements in population health and human welfare. Therefore, one of the ultimate goals of the countries is to increase the life expectancy. This article studies the effect of education and income inequalities, ICT indicators, CO2 emissions, and real GDP per capita on life expectancy in the new EU members for the period of 2010-2022 by employing fixed effects regression. The coefficients of panel regression uncover that education and income inequalities and CO2 emissions negatively impact life expectancy, but ICT indicators of internet usage and mobile cellular subscriptions and real GDP per capita positively affects the life expectancy. The findings of the panel regression analysis indicate that public policies to decrease the inequalities in education and income will make a contribution to life expectancy.

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We estimate the efficiency of health spending in 145 middle and high-income and the potential gains from improving efficiency for a range of health system outputs using Robust Data Envelopment Analysis for 2010-2014 and 2015-2019 and examine associations with health system characteristics. Focusing on Latin American and Caribbean countries, we find large variability in efficiency and overall substantial potential gains in the later period, despite improvements over time. Our results suggest that, for example, improving spending efficiency could increase life expectancy at birth by 3.5 years (4.6%), or slightly more than the 3.4-year improvement in average life expectancy in the region between 2000 and 2015. Similarly, improved efficiency could reduce neonatal mortality by 6.7 per 1,000 live births (62%), increase service coverage by 6 percentage points (8.7%), and reduce the rich-poor gap in birth attendance by 10 percentage points (12.6%). We find that governance quality is positively associated with efficiency. Overall, the findings indicate an urgent need to improve efficiency in the region and substantial scope for realizing the potential gains of such improvements.

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OBJECTIVES: To analyze the fertility rate trends in the GCC countries and their association with socioeconomic factors so that policymakers may use the study findings for future healthcare plans. METHODS: Total population, crude death rate, life expectancy, literacy rate, human development index (HDI), female employment, unemployment rate, urbanisation, gross domestic product (GDP) per capita and inflation were chosen as possible predictors of TFR trends. The data were collected for the Global Burden of Disease 2021 study and other official databases such as the World Bank, the United Nations Development Program and Our World in Data for the 6 Gulf Cooperation Council (GCC) countries. Mean with standard deviation and percentage change was calculated to assess trends of TFR and all other variables from 1980-2021. RESULTS: The fertility rate declined in all 6 countries in 2021 compared to 1980. The highest decline was found in the United Arab Emirates (75.5%), while the lowest was in Kuwait (60.9%). From 1980-2021, total population, life expectancy, HDI, literacy rate, GDP, urbanisation, and female labor force increased in all GCC countries. The total population, life expectancy, urbanisation, female labor force, GDP and HDI were negatively and significantly correlated with TFR (p<0.01). The literacy rate showed a negative and significant correlation with TFR in Bahrain, Kuwait, Saudi Arabia, and Qatar. CONCLUSION: The TFR is declining in GCC countries. The plausible causes include the inclination towards postponement of marriages and excessive costs of living. These trends and associations need to be evaluated by policymakers so that they identify priority areas for interventions, allocate resources and formulate developmental plans accordingly to ensure strategic progress of the region.

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OBJECTIVE: To assess the trend in mortality rates and years of potential life lost (YPLL) due to suicide among adolescents in Northeast Brazil. METHODS: This is an ecological time series study, with secondary data from 2011 to 2020 from the Mortality Information System for adolescents aged 10 to 19 years in the Northeast region of Brazil. Groups of causes from the 10th Revision of the International Classification of Diseases were included: X60-X84 (intentionally self-inflicted injuries), Y10-Y19 (poisoning of undetermined intent), and Y87 (sequelae of intentional self-harm). Mortality coefficients and frequency distribution by sociodemographic variables, place of occurrence, and method of suicide were estimates. YPLL were estimated by gender and age. Joinpoint regression analysis was used, and the annual percentage change (APC) was determined with 95% confidence intervals. RESULTS: A total of 2,410 deaths were recorded, with a predominance of adolescents aged between 15 and 19, males, of mixed-race, low schooling, and home was the main place of occurrence. The trend in the death rate was increasing in the Northeast (APC: 3.6%; p = 0.001), in girls aged 10 to 14 (APC: 8.7%; p = 0.003), in boys aged 15 to 19 (APC: 4.6%; p = 0.002) and in Bahia (APC: 8.1%; p = 0.012). Hanging/strangulation was the main method adopted by both sexes. The YPLL due to suicide were 11,110 in 2011 and 14,960 in 2020. CONCLUSION: The precociousness of suicide committed by girls and the increase in mortality among older adolescents are noteworthy, and specific preventive measures need to be adopted for these groups in order to reduce this preventable cause of death.

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The socioeconomic and technological developments of the past decades have enabled unique progress associated to increased life expectancy and better health for a large part of the world's population; however, multimorbidity, frailty and disability are also on the rise. Geroscience as the new biology of aging is based on the evidence that the main risk factor for noncommunicable chronic diseases (NCD) is the aging process; however, its technology is mostly used for the scientific study of longevity and its interaction with aging medicine and geriatrics is still limited. In this perspective, the need for a tighter exchange between geroscience and geriatrics for longer health span and intrinsic capacity is discussed in the context of existing evidence and knowledge gaps.

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CONTEXT: The economy has been long recognised as an important determinant of population health and a healthy population is considered important for economic prosperity. AIM: To systematically review the evidence for a causal bidirectional relationship between aggregate economic activity (AEA) at national level for High Income Countries, and 1) population health (using mortality and life expectancy rates as indicators) and 2) inequalities in population health. METHODS: We undertook a systematic review of quantitative studies considering the relationship between AEA (GDP, GNI, GNP or recession) and population health (mortality or life expectancy) and inequalities for High Income Countries. We searched eight databases and grey literature. Study quality was assessed using an adapted version of the Effective Public Health Practice Project's Quality Assessment tool. We used Gordis' adaptation of the Bradford-Hill framework to assess causality. The studies were synthesised using Cochrane recommended alternative methods to meta-analysis and reported following the Synthesis without Meta-analysis (SWiM) guidelines. We assessed the certainty of the evidence base in line with GRADE principles. FINDINGS: Of 21,099 records screened, 51 articles were included in our analysis. There was no evidence for a consistent causal relationship (either beneficial or harmful) of changes in AEA leading to changes in population health (as indicated by mortality or life expectancy). There was evidence suggesting that better population health is causally related to greater AEA, but with low certainty. There was insufficient evidence to consider the causal impact of AEA on health inequalities or vice versa. CONCLUSIONS: Changes in AEA in High Income Countries did not have a consistently beneficial or harmful causal relationship with health, suggesting that impacts observed may be contextually contingent. We tentatively suggest that improving population health might be important for economic prosperity. Whether or not AEA and health inequalities are causally linked is yet to be established.

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Congenital birth defects (CBD) play a significant role in causing child mortality globally. The incidence and mortality of CBD vary widely across countries, and the underlying causes for this divergence remain incompletely comprehended. We conducted an analysis to investigate the relationship between the incidence and mortality of CBD in 189 countries and their Human Development Index (HDI). In this study, CBD data from 189 countries was used from the Global Burden of Diseases Study (GBD) 2019, and HDI data was collected for the same countries. Later, the relationship between CBD and HDI was analyzed, and the impact of gross national income (GNI) per capita, expected years of schooling, mean years of schooling and life expectancy at birth was quantified using principal component regression. The age-standardized incidence rate (ASIR) varied between 66.57 to 202.24 per 100,000, with a 95% uncertainty interval (UI) of 57.20-77.51 and 165.87-241.48 respectively. The age-standardized mortality rate (ASMR) also showed a rang from 1.38 to 26.53 (14.03-39.90) per 100,000, with the 95%UI of 0.91-2.09 and 14.03-39.90 respectively. Both the incidence and mortality rates of CBD decreased with the increased HDI (incidence: r = -0.38, p < 0.001, mortality: r = -0.77, p < 0.001). Our investigation revealed significant variations in the incidence and mortality of CBD among countries with different development levels. In conclusion, the global incidence and mortality of CBD vary significantly among countries, possibly due to differences in the accessibility of health services.

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BACKGROUND: Knowledge about impact of age and comorbidities on outcome in patients with leadless pacemakers (LPM) is limited. OBJECTIVES: To analyse outcome in LPM patients according to age and comorbidities. METHODS: This Swiss, multi-centre, retrospective analysis includes all patients with LPM implanted between 2015 and 2022. Charlson-Comorbidity-Index (CCI) was determined and patients were divided into a low- (CCI ≤ 5) and high-comorbidity (CCI > 5) group. Peri-procedural complications, in-hospital death, and all-cause mortalities were assessed. Finally, all-cause mortality according to three groups (CCI ≤ 3, 4-5, >5) was compared to age and sex-adjusted mortality in the general Swiss population. RESULTS: 863 patients (median age 81 years, 65% male, 42% with CCI > 5) were included. Peri-procedural/long-term complication rates did not differ between the low- vs. high-comorbidity groups (2.6% vs. 1.7%, p = 0.48 and 1.2% vs. 2.8%, p = 0.12, respectively). In-hospital (3.6% vs. 0.6%, p = 0.002) and all-cause mortality (HR 2.9, 95%CI 2.2-3.8, p < 0.001) were significantly higher in the high-comorbidity group resulting in a three-year mortality of 58% (95%CI 51-65%) vs. 22% (95%CI 17-27%) in the low-comorbidity group. In patients with a CCI ≤ 3, all-cause mortality was comparable to the age- and sex-adjusted mortality of the general Swiss population. CONCLUSIONS: In elderly patients with high comorbidity, LPM implantation was not associated with increased peri-procedural/long-term complications. All-cause mortality in LPM patients with a CCI ≤ 3 was comparable to age- and sex-adjusted mortality in the general Swiss population. Despite a relatively high three-year mortality due to competing risk factors, LPM implantation is safe, even in elderly patients with high comorbidity. CONDENSED ABSTRACT: In this Swiss, multi-centre, retrospective cohort analysis, 863 patients implanted with a leadless pacemaker were included and divided into a high-comorbidity (with a CCI > 5) and low-comorbidity (with a CCI ≤ 5) group. There was no between group difference in terms of implantation outcomes and peri-operative or long-term complications. Furthermore, all-cause mortality during follow-up in patients with a CCI ≤ 3 was comparable to age- and sex-adjusted mortality in the general Swiss population. These data indicate that LPM implantation is a safe procedure, even in elderly patients with high comorbidity.

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OBJECTIVE: To compare life expectancy levels and within-country geographic variation in life expectancy across six high-income Anglophone countries between 1990 and 2018. DESIGN: Demographic analysis using aggregated mortality data. SETTING: Six high-income Anglophone countries (USA, UK, Canada, Australia, Ireland and New Zealand), by sex, including an analysis of subnational geographic inequality in mortality within each country. POPULATION: Data come from the Human Mortality Database, the WHO Mortality Database and the vital statistics agencies of six high-income Anglophone countries. MAIN OUTCOME MEASURES: Life expectancy at birth and age 65; age and cause of death contributions to life expectancy differences between countries; index of dissimilarity for within-country geographic variation in mortality. RESULTS: Among six high-income Anglophone countries, Australia is the clear best performer in life expectancy at birth, leading its peer countries by 1.26-3.95 years for women and by 0.97-4.88 years for men in 2018. While Australians experience lower mortality across the age range, most of their life expectancy advantage accrues between ages 45 and 84. Australia performs particularly well in terms of mortality from external causes (including drug- and alcohol-related deaths), screenable/treatable cancers, cardiovascular disease and influenza/pneumonia and other respiratory diseases compared with other countries. Considering life expectancy differences across geographic regions within each country, Australia tends to experience the lowest levels of inequality, while Ireland, New Zealand and the USA tend to experience the highest levels. CONCLUSIONS: Australia has achieved the highest life expectancy among Anglophone countries and tends to rank well in international comparisons of life expectancy overall. It serves as a potential model for lower-performing countries to follow to reduce premature mortality and inequalities in life expectancy.

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Economic welfare is essential in the modern economy since it directly reflects the standard of living, distribution of resources, and general social satisfaction, which influences individual and social well-being. This study aims to explore the relationship between national income accounting different attributes and the economic welfare in Pakistan. However, this study used data from 1950 to 2022, and data was downloaded from the World Bank data portal. Regression analysis is used to investigate the relationship between them and is very effective in measuring the relationship between endogenous and exogenous variables. Moreover, generalized methods of movement (GMM) are used as the robustness of the regression. Our results show that foreign direct investment outflow, Gross domestic product growth rate, GDP per capita, higher Interest, market capitalization, and population growth have a significant negative on the unemployment rate, indicating the rise in these factors leads to a decrease in the employment rate in Pakistan. Trade and savings have a significant positive impact on the unemployment rate, indicating the rise in these factors leads to an increase in the unemployment rate for various reasons. Moreover, all the factors of national income accounting have a significant positive relationship with life expectancy, indicating that an increase in these factors leads to an increase in economic welfare and life expectancy due to better health facilities, many resources, and correct economic policies. However, foreign direct investment, inflation rate, lending interest rate, and population growth have significant positive effects on age dependency, indicating these factors increase the age dependency. Moreover, GDP growth and GDP per capita negatively impact age dependency. Similarly, all the national income accounting factors have a significant negative relationship with legal rights that leads to decreased legal rights. Moreover, due to better health facilities and health planning, there is a negative significant relationship between national income accounting attributes and motility rate among children. Our study advocated the implications for the policymakers and the government to make policies for the welfare and increase the social factors.

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Objectives: To determine whether life expectancy (LE) changes between 2000 and 2019 were associated with race, rural status, local economic prosperity, and changes in local economic prosperity, at the county level. Methods: Between 12/1/22 and 2/28/23, we conducted a retrospective analysis of 2000 and 2019 data from 3,123 United States counties. For Total, White, and Black populations, we compared LE changes for counties across the rural-urban continuum, the local economic prosperity continuum, and for counties in which local economic prosperity dramatically improved or declined. Results: In both years, overall, across the rural-urban continuum, and for all studied populations, LE decreased with each progression from the most to least prosperous quintile (all p < 0.001); improving county prosperity between 2000-2019 was associated with greater LE gains (p < 0.001 for all). Conclusion: At the county level, race, rurality, and local economic distress were all associated with LE; improvements in local economic conditions were associated with accelerated LE. Policymakers should appreciate the health externalities of investing in areas experiencing poor economic prosperity if their goal is to improve population health.

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Disparities in life expectancy between Black and White Americans increased substantially during the COVID-19 pandemic. During the same period, the US experienced the largest increase in homicide on record. Yet, little research has examined the contribution of homicide to Black-White disparities in longevity in recent years. Using mortality data and population estimates, we conduct a comprehensive decomposition of the drivers of Black-White inequality in life expectancy and lifespan variability between 2019 and 2021 among men. We find that homicide is one of the principal reasons why lifespans have become shorter for Black men than White men in recent years. In 2020 and 2021, homicide was the leading contributor to inequality in both life expectancy and lifespan variability between Black and White men, accounting for far more of the racial gap in longevity and variability than deaths from COVID-19. Addressing homicides should be at the forefront of any public health discussion aimed at promoting racial health equity.

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OBJECTIVE: To quantify inequalities in lifespan across multiple social determinants of health, how they act in tandem with one another, and to create a scoring system that can accurately identify subgroups of the population at high risk of mortality. DESIGN: Comparison of life tables across 54 subpopulations defined by combinations of four social determinants of health: sex, marital status, education and race, using data from the Multiple Cause of Death dataset and the American Community Survey. SETTING: United States, 2015-2019. MAIN OUTCOME MEASURES: We compared the partial life expectancies (PLEs) between age 30 and 90 years of all subpopulations. We also developed a scoring system to identify subgroups at high risk of mortality. RESULTS: There is an 18.0-year difference between the subpopulations with the lowest and highest PLE. Differences in PLE between subpopulations are not significant in most pairwise comparisons. We visually illustrate how the PLE changes across social determinants of health. There is a complex interaction among social determinants of health, with no single determinant fully explaining the observed variation in lifespan. The proposed scoring system adds clarification to this interaction by yielding a single score that can be used to identify subgroups that might be at high risk of mortality. A similar scoring system by cause of death was also created to identify which subgroups could be considered at high risk of mortality from specific causes. Even if subgroups have similar mortality levels, they are often subject to different cause-specific mortality risks. CONCLUSIONS: Having one characteristic associated with higher mortality is often not sufficient to be considered at high risk of mortality, but the risk increases with the number of such characteristics. Reducing inequalities is vital for societies, and better identifying individuals and subgroups at high risk of mortality is necessary for public health policy.

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OBJECTIVES: Middle-aged and older adults smoking for years are afflicted by smoking-related diseases and functional limitations; however, little is known about the effect of smoking on nonfatal conditions in middle and later life. This study aims to investigate the impact of smoking on both total life expectancy (TLE) and disability-free life expectancy (DFLE) and the variations in such effects by educational level in China. METHODS: Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS), 2011-2018, with a total sample of 16,859 individuals aged 45 years or older involved in the final analysis. The Activities of Daily Living (ADL) scale was used to measure disability, and the population-based multistate life table method was used to estimate the differences in TLE and DFLE by smoking status and educational attainment. RESULTS: At baseline, 28.9% of participants were current smokers, 8.5% were former smokers, and 62.6% never smoked. Approximately 5.6% were identified with ADL disability. Both current smokers and former smokers experienced lower TLE and DFLE than never smokers, and such differences were particularly prominent among men. Intriguingly, former smokers manifested a lower DFLE for both sexes and a lower TLE among women, though a longer TLE among men, compared with current smokers. Similar differences in TLE and DFLE by smoking status were observed for groups with different levels of education. CONCLUSION: Never smokers live longer and healthier than current smokers and persons who quit smoking. Smoking was associated with greater reductions in TLE and DFLE among men. However, educational attainment might not moderate the adverse effect of smoking on both fatal and nonfatal conditions in the context of China. These findings have implications for disability prevention, aged care provision and informing policies of healthy aging for China and elsewhere.

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The paper continues the study of the population ageing in the regions of the Northwestern Federal District. It characterized population ageing based on prospective ageing indicators that take into account remaining life expectancy. The dynamics of life expectancy (LE) at birth was analyzed. A computation and comparative analysis of the old age threshold for the regions that are part of the Northwestern Federal District have been carried out. A comparative analysis of ageing indicators - traditional and prospective (the proportion of the elderly and the share of the population above the old age threshold) was carried out. It has been found that there are no fundamental differences in the dynamics of life expectancy in older ages, as well as in the of old age threshold, between the regions considered. It is shown that for the male population in almost all regions in 2021, the value of the old age threshold is below 60 years, while for the female population the opposite inequality is observed. Thus, in 2021, the share of men over the old age threshold exceeds the proportion of the elderly in almost all regions considered, and for the female population, the share of the elderly is expected to be higher than the values of the prospective indicator.

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The article presents a comparative analysis of the process of population aging in the context of demographic and professional risks of depopulation among working population in Russia. The values of the main medical and demographic indicators of population aging for Russia and developed countries were given. The results of UN forecasts, probabilistic forecasts of the total number and some characteristics of the age-sex structure for the population of the Russian Federation were analyzed. The state of demographic disadvantage in Russia and in the world was convincingly shown. Particular attention was paid to the consideration of the demographic risks of a reduction in the working-age population and an increase in the burden on the working-age population. The need for further research on the use of geroprotectors and modern gerontotechnologies as means and methods for preventing premature decline in work ability, slowing down the aging process of workers, reducing the mortality rate among working population and increasing professional longevity has been proven.

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BACKGROUND: Oral cancer is one of the most common cancers in China and seriously threaten life and health of Chinese people. We analysed the trends and disparities of oral cancer mortality rates and the disease burden of oral cancer in China from 2006 to 2021 to provide a reference for its prevention and control. METHODS: Annual death data for oral cancer was gleaned from the China Death Surveillance Database. The age-standardized mortality rate (ASMR), annual percentage change (APC), and average APC (AAPC) were used to analyze the trend of mortality. Loss of life expectancy (LLE) and years of life lost (YLL) were adopted to assess disease burden. RESULTS: From 2006 to 2021, the overall ASMR of oral cancer lightly declined (AAPC: - 0.97%; 95% CI: - 1.89%, - 0.04%), and the similar trend was observed among females (AAPC: - 1.22%; 95% CI: - 1.89%, - 0.55%). The ASMR of males was 2.31-3.16 times higher than that of females per year. The median of LLE for overall, males and females caused by oral cancer from 2006 to 2021 were 0.05, 0.06 and 0.03 years, respectively. There was a decrease of standardized YLL rate from 2006 to 2021 for overall (AAPC: - 1.31%, 95% CI: - 2.24% ~ - 0.37%) and for female (AAPC: - 1.63%, 95% CI: - 2.30% ~ - 0.95%). ASMR in urban areas was 1.02-1.28 times higher than that in rural areas from 2006 to2011, but 0.85-0.97 times lower in urban areas than that in rural areas from 2018 to 2021. The disease burden was higher in urban areas than in rural areas in 2006, whereas the reverse was observed in 2021. CONCLUSIONS: There are severe health gaps and disparities in trends between sexes and different areas in China. Males and rural populations need to be focused on targeted interventions for the main influencing factors.

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Life expectancy exists along a social gradient, where those with a high socioeconomic status (SES) live longer. The effect of SES can be explained via behavioral, material, and psychosocial pathways, which can be modified through social and public health policies. The behavioral pathway states that harmful health behaviors, like smoking, are more common among those of lower SES. The material pathway states that SES give access to different health-beneficial resources, like safe housing or healthy food. Finally, the psychosocial pathway states that a low SES causes a lack of autonomy leading to chronic stress. Understanding how SES affects life expectancy has clinical implications and is important to reduce socioeconomic health inequalities at the population level.

L'espérance de vie suit un gradient social, les personnes avec statut socioéconomique (SSE) élevé vivant plus longtemps. L'effet du SSE sur l'espérance de vie peut être expliqué par des mécanismes comportementaux, matériels et psychosociaux, modifiables par des politiques sociales et de santé publique. Ainsi, les comportements délétères pour la santé, comme le tabagisme, sont plus fréquents chez les personnes ayant un SSE relativement bas. D'un point de vue matériel, le SSE détermine l'accès à des ressources comme un logement de bonne qualité ou une alimentation saine. Enfin, d'un point de vue psychosocial, il est associé notamment au stress chronique. Comprendre comment le SSE affecte l'espérance de vie a des implications cliniques et offre des pistes pour réduire les inégalités en matière de santé à l'échelle de la population.

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