1. Improvements in Life Expectancy: Past, Present and Future
John R. Iacovino, M.D., F.A.C.P.
Medical Director / Senior Consultant
Consistency • Accuracy • Professionalism

2. Overview Mortality Improvements By Period The Aging Process
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

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

4. Future life expectancy can be calculated for any starting age
Life expectancy for both sexes, US,
Year
At birth
At age 65
At age 75
1900
47.3 13
1950
68.2 (45%)
13.9
10.9
2000
77.0 (13%)
18.0 (29%)
11.4
The cohort improvement in life expectancy since birth reflects different changes in our over-all health.
US Vital Statistics 2004 4

5. Life expectancy at birth 1900 to 200079 74
Source: U.S. Vital Statistics, 2004

6. Mortality Improvements .
Time period
% annual improvement
% of improvement by age
Reason
1900 to 1940 1
80% in those under age 45
Better nutrition and public health measures
1940 to 1960 2
Even across ages
Declining infectious diseases, vaccines and antibiotics
1960 to present
1 to 1.5
65% in those over age 45
Reduction in CV events and decline in preemie deaths
2000 forward ??
? Greatest at oldest ages
↑ LE: Health Care
Genetics
↓ LE: Allocation of Resources
Obesity Epidemic
Cutler and Meara, Sept 2001, Changes in the Age Distribution of Mortality Over the 20th Century

7. 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

8. 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.

9. 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

10. 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.

11. 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

12. Phase 3: 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

13. Phase 3:
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

14. 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)

15. 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):

16. Phase 4: 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):

17. 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.

18. Phase 5: 2000 forward Continuing and future challenges
Smoking
Obesity
Inactivity

19. Trends in Cigarette Smoking Prevalence
Trends in Cigarette Smoking Prevalence* (%) by Gender, Adults 18 and Older, US,
*Redesign of survey in 1997 may affect trends.
Source: National Health Interview Survey, , National Center for Health Statitics, Centers for Disease Control and Prevention, 2004.

20. Phase 5: 2000 forward Recent health loses - Obesity rises
15% of Americans were obese in , but up to 31% in
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

21. Opportunities for improvement: Trends in Overweight
Opportunities for improvement: Trends in Overweight* Prevalence (%), Children and Adolescents, by Age Group, US,
People who become overweight in childhood and adolescence are more likely to be overweight or obese as adults. With at least half of the overweight children becoming overweight adults, future adult populations are at increased risk for developing cancer and other serious chronic diseases. The prevalence of overweight children and adolescents has increased since the 1970s, with the most dramatic increases occurring in the late 1980s and 1990s. In fact, over the past three decades the proportion of overweight children has doubled among 2-5 year olds and tripled among 6-19 year olds.
*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, , , , , National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, 2004. 21

22. 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

23. 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

24. 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.

25. Who lives the longest? Best socio-economic class and education
Best genes
Best medical care and risk factor reduction

26. Years of Life Remaining at Age 6519 15
Source: U.S. Vital Statistics, 2004

27. Years of Life Remaining at Age 85
6.5
5.8
Source: U.S. Vital Statistics, 2004

28. Aging Process Causes Free radicals Mutations DNA repair failure
Antioxidants
Mutations
DNA repair failure
Waste product accumulation
Telomere shortening

29. 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

31. 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

32. 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

33. 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

34. 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)

35. Source: Centers for Disease Control and Prevention, National Center for Health Statistics (US)
US Population Decennial Life Table

36. Change colors
Source: Centers for Disease Control and Prevention, National Center for Health Statistics (US)
US Population Decennial Life Table

37. Fasano Associates 6th Annual Life Settlement Conference
26 October 2009
Washington, DC
     
Michael Fasano
Fasano Associates
th Street, NW – Suite 250
Washington, DC 20005
(fax)