Poster Session on Health, mortality and longevity (3)

The death rates of regional subpopulations, accounting for unobserved heterogeneity in their distribution of deaths were analyzed. There was found that force of mortality alter the frailty distributions of regional subpopulations. At the end of the health crisis in Ukraine regional subpopulations of East and South are less heterogeneous in their distribution of deaths in comparison with the population from North and West. Changes in the frailty distribution resulted in lower standardized life expectancy of about half a year for the population of North. The subpopulations of East and South manifest the lowest standardized life expectancy. The absence of any effect among West subpopulation supports the assumption that the power of health crisis influence on the frailty distribution in regional subpopulations depends of population epigenetical background.

Background: Though, education has positive impact on health but education alone will not help in recognizing, reporting health problems and utilization of health care. Similarly, in case of maternal health, women need proper health knowledge to recognize health problems and opting for health care; otherwise misconception may lead to adverse health outcomes. The study assesses the level of health knowledge of women and its systematic association with the reporting of maternal health problems and health care utilization by Indian women.
Methods: Indian Human Development Survey (IHDS-2005) data is used. Simple bivariate and multivariate analyses: binary logistic regression, multinomial regression, principal component analysis and significance test are used.
Results: Though socio-economic factors ar important predictors of reporting of maternal health problems and utilization of maternal health care, the study found a huge variation in reporting of maternal health problems and health care utilization within same socio-economic groups by level of health knowledge. Increasing level of health knowledge is positively associated with reporting of greater pregnancy and post-natal complications and greater level of ante-natal, institutional delivery and post-natal care seeking by women.

“Preventable” hospitalizations have been proposed as indicators of health plan performance. Preventable hospitalizations present a broader view and refer to those admissions 'resulting from diseases preventable through population-based health promotion strategies, eg. alcohol-related conditions' and those 'avoidable through injury prevention (eg. road traffic accidents). Ambulatory Care-Sensitive Conditions Hospitalizations (ACSCs) analyses may also be used to identify or evaluate interventions that are likely to be effective in fulfilling health needs. The objective of this study is to know the composition and the tendency among the elderly and the ACSC and to correlate this to the coverage and access to primary care services in Rio de Janeiro, Brazil, between 2000 and 2010. We observed the tendency of reduced ACSC mainly of the chronic lung diseases during this period. We found a high correlation between the interventions in elderly primary care and the decrease of ACSC, what indicates effectiveness of the health program. The elderly men have more risk to ACSC than women. The results show that the study of ACSC is relevant for monitoring the performance of the health system with regard to improving the quality of life for elderly people.

Japan’s extraordinary low level of old-age mortality is well documented compared to other countries. Less well understood is how the health of the Japanese older population fares relative to other countries, and whether differences persist in consistent ways across major domains of morbidity – chronic diseases, functioning and disability. To the extent that Japan’s low mortality is brought about by the postponement of disease and its sequelae, we would expect to see cross-national differences in the timing of morbidity across all major domains. Here, we compare Japanese mortality and morbidity to the mortality and morbidity experiences of older populations in Taiwan and the US. We draw on demographic models of healthy life expectancy to summarize how major domains of morbidity combine with all-cause mortality to produce cross-national differences in the years of life with and without major types of morbidity. We use a simulation approach to evaluate how morbidity/mortality timing shapes the cross-national differences in healthy life expectancy. By using Japan as a standard, this study will provide unique insights into the possible morbidity avenues by which a population’s health can be significantly improved.

Andrea Werdecker, Ulrich Mueller
Regional Differences in Diabetes Mellitus Type 2 (T2DM) Morbidity and Mortality in North America and Europe:
Reality or Measurement Artefact?
Short Abstract Prepared for Presentation at IUSSP 2013
Cancer, Metabolic Syndrome, Dementias are the dominant health problems in aging societies, T2DM advancing all three. The considerable regional differences in T2DM prevalence may be questioned, and so are estimations of undiagnosed T2DM. OECD multiplied observed prevalence for the UK by 1,5 and doubled for other European countries. In the US, lowest diabetes prevalence is found in Midwest, Northeast, highest in Southern, Appalachian states, with variation 150% as compared to the lowest, applying for men and women, younger and older (60+) alike. In European Union, prevalence variation is even higher at 180-200% highest in Portugal, Germany vs. UK, Sweden. However, when correlated with regional obesity rates or ischemic heart disease and stroke mortality, this variation seems plausible, being good news since it justifies regional prevention strategies. Estimating undiagnosed T2DM by elevated Fastening Plasma Glucose and HbA1c alone, however, leads to much lower total prevalence than still assumed in authoritative sources.

The concern for a further global rise of asbestos-related diseases is growing. A recent WHO study on global mesothelioma deaths reported between 1994 and 2008, shows an increase in mortality worldwide (Delgermaa, Takahashi et al. 2011). Because Belgian data have not been reported as a consequence of the regionalization process, Belgium was not included in this study.
With companies as Eternit, Belgium has been a top producer and a top consumer of asbestos worldwide. Nonetheless, asbestos-related mortality remained largely unexplored for Belgium.
Our aim is to improve the understanding of the impact of asbestos in an international perspective by providing a descriptive analysis of mesothelioma mortality in Belgium (1969-2008).
Compared to the results of the WHO study, Belgium ranks fourth in the world in age adjusted mortality rates, just behind the UK, Australia and Italy. The high male/female ratio points to occupational related hazards, a fact confirmed by our geographical analysis. Mesothelioma mortality is higher in areas with a history of industrial asbestos use. Finally, our results also suggest a further increase in asbestos-related mortality in Belgium.

Married live longer and their advantage tends to increase with time. Whether marital benefits result from selection or protection is still lively discussed. But while the marital advantage increases, the share of the married in the population decreases. We explored the dynamics of marital status mortality differentials in the Czech Republic since 1961. Unlinked death counts and census marital structures were used. The differentials were measured by life expectancy at age 30; its differences and changes were decomposed by the step-wise replacement algorithm. Mortality differences by marital status have considerably increased between 1961 and 1991 due to the worsening survival of the unmarried adults. Since 1991 the differentials rose only slightly and shifted to older age groups. Never-married lag the most, with 9.58 years shorter life expectancy compared to married men (7.70 years for women) in 2010. The decline of marriage and further increase of divorciality resulted in a loss of 0.89 years of the overall male life expectancy. Individuals lacking spousal support were particularly vulnerable before the transition. In spite of their mortality recovery after 1991, they are still far behind the married ones. A plausible explanation is that the marital benefits are now available to more positively selected population.

A fundamental question in human aging research is what makes us survive to and at older ages. The separation and reunification of Germany provides us with a unique opportunity to assess external determinants of human survival to oldest ages on a population scale. In this context, we seek to estimate the impact of mortality selection among older East Germans before reunification as a reason for the quick catch up of life expectancy to the West after reunification. We use a gamma gompertz model to account for mortality convergence due to frailty variations caused by changing external conditions. We assume that the unfavourable conditions before reunification lead to a survival of more robust individuals than in the West and to quicker convergence of mortality among these age groups.

During the last century, India experienced drastic improvement in life expectancy. Did the extra years gained to the life expectancy have really improved the quality of life? Such question becomes prominent when one considers the changes in morbidity. So far, no study has been available by combining mortality and morbidity changes to a single index by representing health status in India. This paper is an exploration of quality of life by using Disability Free Life Expectancy (DFLE) rates in India. It followed methodology forwarded by Sullivan (1971). It used three levels of disability rates -perceived morbidity, restricted activity and also confined to bed by using the data from SRS and NSSO. It found that DFLE is declined in higher rates in advanced states indicating a considerable decline in the quality of life with the advancement in life expectancy, especially to the older ages. Females and urbanites have considerable decline in quality of life than that of males and rural people. The study also found that prominent role of chronic/degenerative diseases in losses in DFLE. All the three levels of disability for DFLE found similar pattern. It concludes that mere increase in longevity does not mean better life. It is high time for India to have effective interventions to improve the quality of life along with life expectancy.

Existing research has examined the mortality risk for older people living in different types of long-term care accommodation; however the impact of the duration of older people’s stay in different living arrangements and housing types on their mortality risk is relatively under-researched. Using data from the British Household Panel Survey this research estimates transitions to death by different demographic characteristics, socio-economic position, health status, living arrangements and transitions in housing type. In doing so, the analysis presents the relative risk of mortality for different groups depending on their socio-demographic characteristics in the years immediately before death. The paper shows that an individual’s transition to residential housing within 12 months of the final wave before dying is the strongest predictor of subsequent mortality. In contrast to this group, older people who have lived in residential care for at least 12 months show lower risk of mortality. The results contribute to our understanding of mortality risk during different housing transitions, and have policy implications for the design of long-term care accommodation in the UK.