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      Life expectancy, healthy life expectancy, and burden of disease in older people in the Americas, 1990–2019: a population-based study Translated title: Esperanza de vida, esperanza de vida saludable y carga de enfermedad en personas mayores en la Región de las Américas desde 1990 hasta el 2019: estudio poblacional Translated title: Expectativa de vida, expectativa de vida saudável e carga de doença nas pessoas idosas nas Américas, 1990-2019: um estudo populacional


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          To describe the life expectancy, healthy life expectancy, disease burden, and leading causes of mortality and disability in adults aged 65 years and older in the Region of the Americas from 1990 to 2019.


          We used estimates from the Global Burden of Disease Study 2019 to examine the level and trends of life expectancy, healthy life expectancy, years of life lost, years lived with disability, and disability-adjusted life years (DALYs).


          Across the Region, life expectancy at 65 years increased from 17.1 years (95% uncertainty intervals (UI): 17.0–17.1) in 1990 to 19.2 years (95% UI: 18.9–19.4) in 2019 while healthy life expectancy increased from 12.2 years (95% UI: 10.9–12.4) to 13.6 years (95% UI: 12.2–14.9). All-cause DALY rates decreased in each older persons’ age group; however, absolute proportional DALYs increased from 22% to 32%. Ischemic heart disease, stroke, and chronic obstructive pulmonary disease were the leading causes of premature mortality. Diabetes mellitus, age-related and other hearing loss, and lower back pain were the leading causes of disability.


          The increase in life expectancy and decrease of DALYs indicate the positive effect of improvements in social conditions and health policies. However, the smaller increase in healthy life expectancy suggests that, despite living longer, people spend a substantial amount of time in their old age with disability and illness. Preventable and controllable diseases account for most of the disease burden in older adults in the Americas. Society-wide and life-course approaches, and adequate health services are needed to respond to the health needs of older people in the Region.



          Describir la esperanza de vida, la esperanza de vida saludable, la carga de enfermedad y las principales causas de mortalidad y discapacidad en personas adultas de 65 años o más en la Región de las Américas desde 1990 hasta el 2019.


          Se emplearon estimaciones del estudio sobre la carga mundial de enfermedad del 2019 para examinar las tendencias y el nivel de la esperanza de vida, la esperanza de vida saludable, los años de vida perdidos, los años vividos con discapacidad y los años de vida ajustados en función de la discapacidad (AVAD).


          En toda la Región, la esperanza de vida a los 65 años aumentó de 17,1 años (intervalos de incertidumbre [IU] del 95 %: 17,0–17,1) en 1990 a 19,2 años (IU del 95 %: 18,9–19,4) en el 2019, mientras que la esperanza de vida saludable se incrementó de 12,2 años (IU del 95 %: 10,9-12,4) a 13,6 años (IU del 95 %: 12,2–14,9). Las tasas de AVAD debida a cualquier causa disminuyeron en cada grupo etario de mayor edad; sin embargo, los AVAD absolutos proporcionales aumentaron de 22 % a 32 %. La cardiopatía isquémica, los accidentes cerebrovasculares y la enfermedad pulmonar obstructiva crónica fueron las principales causas de muerte prematura. La diabetes mellitus, la pérdida de la audición relacionada con la edad y de otro tipo, y la lumbalgia fueron las principales causas de discapacidad.


          El aumento de la esperanza de vida y la disminución de los AVAD indican el efecto positivo de las mejoras de las condiciones sociales y las políticas de salud. Sin embargo, el menor aumento de la esperanza de vida saludable indica que, a pesar de vivir más tiempo, las personas pasan una parte sustancial de su vejez con discapacidades y enfermedades. Las enfermedades controlables y prevenibles representan la mayor parte de la carga de enfermedad de las personas mayores en la Región. Se requieren enfoques a escala de toda la sociedad y el curso de vida, y servicios de salud adecuados para responder a las necesidades de salud de las personas mayores en la Región.



          Descrever a expectativa de vida, a expectativa de vida saudável, a carga de doenças e as principais causas de mortalidade e incapacidade em adultos a partir dos 65 anos de idade na Região das Américas de 1990 a 2019.


          Utilizamos estimativas do Estudo de Carga Global da Doença 2019 para examinar o nível e as tendências da expectativa de vida, expectativa de vida saudável, anos de vida perdidos, anos vividos com incapacidade e anos de vida ajustados por incapacidade (AVAI).


          Em toda a Região, a expectativa de vida aos 65 anos aumentou de 17,1 anos (intervalos de incerteza (II) de 95%: 17,0-17,1) em 1990 para 19,2 anos (II de 95%: 18,9-19,4) em 2019, enquanto a expectativa de vida saudável aumentou de 12,2 anos (II de 95%: 10,9-12,4) para 13,6 anos (II de 95%: 12,2-14,9). As taxas de AVAI por todas as causas diminuiu em todos os grupos de pessoas idosas; porém, em termos absolutos, os AVAI proporcionais aumentaram de 22% para 32%. A cardiopatia isquêmica, o acidente vascular cerebral e a doença pulmonar obstrutiva crônica foram as principais causas de mortalidade precoce. A diabetes melitus, a perda da audição – em função da idade ou por outros motivos – e a dor lombar foram as principais causas de incapacidade.


          O aumento da expectativa de vida e a diminuição dos AVAI indicam o impacto positivo das melhorias nas condições sociais e nas políticas de saúde. Porém, o menor aumento na expectativa de vida saudável indica que, apesar de viverem mais, as pessoas passam uma quantidade considerável de tempo na velhice com incapacidade e doença. As doenças preveníveis e controláveis representam a maior parte da carga de doença nas pessoas idosas nas Américas. Abordagens que afetem a sociedade como um todo e o curso de vida, e serviços de saúde adequados, são necessários para atender às necessidades de saúde das pessoas idosas na Região.

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          Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

          Summary Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1–4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0–8·4) while the total sum of global YLDs increased from 562 million (421–723) to 853 million (642–1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6–9·2) for males and 6·5% (5·4–7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782–3252] per 100 000 in males vs s1400 [1279–1524] per 100 000 in females), transport injuries (3322 [3082–3583] vs 2336 [2154–2535]), and self-harm and interpersonal violence (3265 [2943–3630] vs 5643 [5057–6302]). Interpretation Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury. Funding Bill & Melinda Gates Foundation.
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            Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

            Summary Background In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding Bill & Melinda Gates Foundation.
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              Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

              Summary Background How long one lives, how many years of life are spent in good and poor health, and how the population’s state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. Methods We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. Findings Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1–7·8), from 65·6 years (65·3–65·8) in 1990 to 73·0 years (72·7–73·3) in 2017. The increase in years of life varied from 5·1 years (5·0–5·3) in high SDI countries to 12·0 years (11·3–12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1–33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8–15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9–6·7), from 57·0 years (54·6–59·1) in 1990 to 63·3 years (60·5–65·7) in 2017. The increase varied from 3·8 years (3·4–4·1) in high SDI countries to 10·5 years (9·8–11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4–1·7) in Saint Vincent and the Grenadines (62·4 years [59·9–64·7] in 1990 to 63·5 years [60·9–65·8] in 2017) to 23·7 years (21·9–25·6) in Eritrea (30·7 years [28·9–32·2] in 1990 to 54·4 years [51·5–57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6–2·3) in Algeria to 11·9 years (10·9–12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4–78·7]) and males (72·6 years [69·8–75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7–50·2] for females and 42·8 years [40·1–45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8–43·5) for communicable diseases and by 49·8% (47·9–51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8–43·0), although age-standardised DALY rates decreased by 18·1% (16·0–20·2). Interpretation With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health. Funding Bill & Melinda Gates Foundation.

                Author and article information

                Rev Panam Salud Publica
                Rev Panam Salud Publica
                Revista Panamericana de Salud Pública
                Organización Panamericana de la Salud
                30 September 2021
                : 45
                [1 ] normalizedPan American Health Organization Washington D.C. United States of America originalPan American Health Organization, Washington D.C., United States of America
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                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 IGO License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited. No modifications or commercial use of this article are permitted. In any reproduction of this article there should not be any suggestion that PAHO or this article endorse any specific organization or products. The use of the PAHO logo is not permitted. This notice should be preserved along with the article’s original URL. Open access logo and text by PLoS, under the Creative Commons Attribution-Share Alike 3.0 Unported license.

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                Original Research

                health of the elderly,mortality,morbidity,americas,salud del anciano,mortalidad,morbilidad,américas,saúde do idoso,mortalidade,morbidade,américa


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