Worldwide Trends in Healthy versus Unhealthy Remaining Life Expectancy at 60

Human life expectancy has been trending upwards, slowly, for a very long time. Life expectancy at birth is influenced by a great many factors that have little to do with aging, and so is much less interesting than, say, life expectancy at 60. At present, that number increases by one year with every passing decade. This has been the case in an environment in which essentially nothing was being done to deliberately target underlying mechanisms of aging. The trend is an incidental side-effect of, most likely, (a) better life-long control over the burden of infectious disease, and (b) general improvements in the ability to treat age-related conditions without addressing their deeper causes, the mechanisms of aging.

The outcome of a modest slowing of aging across the life span coupled with better medicines for age-related diseases that fail to target mechanisms of aging is the situation that we find ourselves in, in which all three of (a) time spent in health, (b) time spent in ill health, and (c) overall life span are increasing over time. Near all of the furor over the burden of healthcare spending in overly centralized medical systems derives from the increase in time spent in ill health. It is expensive and difficult to keep someone going when the therapies to hand do not address the actual causes of ill health, meaning the specific forms of cell and tissue damage that cause aging.

All of this will change dramatically with the advent of rejuvenation therapies that deliberately target that underlying cell and tissue damage. The point of the exercise is to both greatly extend time spent in health and make it possible to take people in late-life disease states and fix their issues, restoring them to health. This won't happen overnight, it will be an incremental progression of ever better partial successes that add up over time, but it will happen.

Long-term Trends in Healthy and Unhealthy Life Expectancy Among Adults Aged 60 - A Global Perspective, 1990-2019

Although life expectancy has been a crucial health population metric, distinguishing between "healthy" and "unhealthy" years lived gains heightened significance, particularly in the face of medical advancements that prolong life. Despite extensive research on life expectancy and healthy life expectancy (HALE), a noticeable gap prevails in concurrent investigations of healthy and unhealthy life expectancies in the older demographic.

Using data derived from the Global Burden of Disease Study 2019 (GBD 2019), our research provides an in-depth analysis of global trends in these three metrics from 1990 to 2019 for older adults. For the study, Life Expectancy at age 60 (LE-60), constructed based on age-specific mortality rates from all locations and estimations years across all populations by sex, and the HALE at age 60 (HALE-60) were employed to assess "healthy" years. Proportion of Years in Ill Health at age 60 (PYIH-60), meaning (LE-60 - HALE-60) / LE-60, has been used to calculate the "unhealthy" years proportion in life expectancy.

The study yields several critical observations. First, the disparity between global life expectancy, which has been on a steady rise, and HALE, suggests a prolonged period of morbidity or disability for older adults. This emphasizes the need for health systems to shift focus from extending life to prioritizing quality of the extended years. Unlike unhealthy life expectancy, augmenting the health life expectancy of a population results in higher per capita output levels and improved labor productivity. This also allows for the reduction of social and medical security costs for older adults. Future research assessing the impact of specific.

Attention must also be paid to regional variations. The swift increase in life expectancy in regions like South Asia and East Asia may be attributed to economic growth, enhancements in healthcare infrastructure, and successful public health interventions. Yet, the concurrent enlargement of unhealthy life expectancy in certain regions underlines the urgency for interventions targeted at addressing health challenges unique to specific regions. The significant increase in China's life expectancy warrants special attention. This progress may be attributed to the country's strategic health reforms, economic growth, and public health initiatives. However, the rise in PYIH-60 among older adults in China indicates an area of concern, suggesting potential areas for targeted healthcare interventions and policy implementation.

The correlation between HALE-60 and various sociodemographic and health system indicators illuminates the interaction between social determinants and health outcomes. The observed positive relationship, showing that an increase in sociodemographic index (SDI), universal health coverage (UHC), healthcare access and quality index (HAQ), and healthcare expenditure leads to an improvement in HALE-60, suggests that comprehensive socio-economic development paired with accessible, high-quality healthcare yields measurable benefits for the aging population.

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