The rise in the number of long-term survivors from different diseases can slow the increase in life expectancy of the total population

Abstract

Background Recent improvements in life expectancy in many countries stem from reduced mortality from cardiovascular disease and cancer above the age of 60. This is the combined result of decreased incidence and improved survival among those with disease. The latter has led to a higher proportion in the population of people with a past history of disease. This is a group with higher mortality than the general population. How growing shares of persons with past history of disease and improved survival with disease have affected changes in life expectancy of the total population is the objective of this paper. Methods Using register data for the total Swedish population, we stratified the population based on whether individuals have been diagnosed with myocardial infarction, stroke, hip fracture, colon cancer, or breast cancer. Using a novel decomposition approach, we decomposed the changes in life expectancy at age 60 between 1994 and 2016 into contributions from improved survival with disease and from changes in proportion of people with past history of disease. Results Improvements in survival from disease resulted in gains of life expectancy for the total population. However, while the contributions to life expectancy improvements from myocardial infarction, stroke and breast cancer were substantial, the contributions from the other diseases were minor. These gains were counteracted, to various degrees, by the increasing proportion of people with raised mortality due to a past history of disease. For instance, the impact on life expectancy by improved survival from breast cancer was almost halved by the increasing share of females with a past history of breast cancer. Conclusion Rising numbers of survivors of different diseases can slow the increase in life expectancy. This dynamic may represent the costs associated with successful treatment of diseases, and thus, a potential “failure of success.” This dynamic should be considered when assessing mortality and life expectancy trends. As populations are aging and disease survival continues to improve, this issue is likely to become even more important in the future.

Why we should monitor disparities in old-age mortality with the modal age at death

“…Third, improved survival from chronic conditions such as cardiovascular disease has led to a growing proportion of individuals who have experienced an illness at some point in their lifetime [ 35 ]. The rising number of survivors has been shown to slow the increase in life expectancy [ 36 ]. Survivors to major chronic diseases are more likely to die earlier than individuals who have never experienced an illness.…”

Why we should monitor disparities in old-age mortality with the modal age at death

“…Third, improved survival from chronic conditions such as cardiovascular disease has led to a growing proportion of individuals who have experienced an illness at some point in their lifetime [28]. The rising number of survivors has been shown to slow the increase in life expectancy [29]. Survivors to major chronic diseases are more likely to die earlier than individuals who have never experienced an illness.…”

Kan friskere aldring og økt familieomsorg veie opp for lavere tilgang på offentlige helse- og omsorgstjenester?

“…Enkelte studier viser at levealderen har økt raskere i noen undergrupper med helseproblemer enn i befolkningen ellers (13,14), dels fordi mange nettopp behandles for sykdommer, og overlever (15). Levetidsøkningen kan derfor reflektere noe annet enn at det er de friske og sterke som overlever, eller at sykdommer inntreffer senere i dag enn tidligere.…”