News
15.02.2023: New publication
Biases in Assertions of Self-Rated Health: Exploring the Role of the Respondent, Country of Residence, and Interviewer
Lazarevič, Patrick
Comparative Population Studies. 2023 Feb 15; doi: 10.12765/CPoS-2023-04
Abstract: Comparative analyses frequently examine respondents’ self-rated health (SRH), assuming that it is a valid and comparable measure of generic health. However, given SRH’s vagueness, this assumption is questionable due to (1) manifold non-health influences, such as personal characteristics including optimism, interviewer effects on the rating, and cultural contexts, as well as (2) potential gender, age- or country-specific expectations for one’s health or frames of reference. Conceptually, two major components of SRH can be distinguished: latent health and reporting behavior. While latent health exclusively refers to objective health status, reporting behavior collectively refers to non-health characteristics (NH) affecting SRH. The present paper is primarily concerned with the latter and aims to identify whether and how NH bias SRH, including possible differences by gender, age, and country of residence. The presented analyses are based on data from 16,183 participants in five countries drawn from the fifth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE). Latent health is controlled via a wide array of health indicators and the residuals are examined with a model covering NH from three different sources: the interviewer, the respondent, and the country of residence. To identify subgroup-specific response behaviors, all analyses are carried out separately by gender, three age groups (50-64, 65-79, and 80+ years), and country of residence. The analyses uncovered influences of – among others–the interviewer’s SRH, the respondent’s life satisfaction, and the country of residence on SRH, while other factors differed by subgroup. The amount of explained variance due to such reporting behavior (with a mean of seven percent) can be deemed meaningful, considering that controlling for latent health already explains around half of SRH’s variance. The greatest source of non-health influences was respondent characteristics, with the interviewer and country having smaller effects. These results illustrate the importance of taking NH into account when using SRH measures. Future research on complementing SRH with factual questions in survey design is advisable.
14.02.2023: New publication
Alcohol-related mortality in four European countries: A multiple-cause-of-death study
Fihel, Agnieszka; Trias-Llimós, Sergi; Muszyńska-Spielauer, Magdalena M.; Majerová, Markéta
Drug and Alcohol Review. 2023 Feb 14; doi: 10.1111/dar.13624
Abstract: The impact of conditions that partly or indirectly contribute to drinking-related mortality is usually underestimated. We investigate all alcohol-related multiple (underlying and contributory) causes of death and compare mortality distributions in countries with different levels and patterns of drinking. Analysis of population-level mortality data for persons aged 20 and over in Austria, Czechia, Poland and Spain. Age-standardised death rates and standardised ratios of multiple to underlying cause were calculated for alcohol-related causes of death. Multiple-cause mortality ranged from 20 to 58 deaths per 100,000 for men and from 5 to 16 per 100,000 for women. Liver diseases were the most common underlying and multiple causes, but mental and behavioural disorders were the second or third, depending on country and sex, most prevalent multiple mentions. Two distinct age patterns of alcohol-related mortality were observed: in Czechia and Poland an inverted-U distribution with a peak at the age of 60–64, in Austria and Spain a distribution increasing with age and then levelling off for older age groups. The importance of alcohol-related conditions that indirectly impact mortality can be re-assessed with the use of contributory mentions. The multiple-cause-of-death approach provides convergent results for countries characterised by similar patterns of alcohol consumption. Multiple-cause mortality was almost double the level of mortality with alcohol as the underlying cause, except in Poland. Mental and behavioural disorders were mostly certified as contributory to other, non-alcohol-related underlying causes of death.
03.02.2023: New publication
A global assessment of the impact of violence on lifetime uncertainty
Aburto, José Manuel; di Lego, Vanessa; Riffe, Tim; Kashyap, Ridhi; van Raalte, Alyson; Torrisi, Orsola
Science Advances. 2023 Feb. 03; 9: eadd9038
Abstract: Uncertainty around age at death, or lifetime uncertainty, is a key public health indicator and a marker of inequality in survival in a population1. How does the extent of violence in a country affect inequalities in survival and lifetime uncertainty? Here we address this question by quantifying the impact of violence on dispersion in the ages at death, the metric most commonly used to measure lifetime uncertainty. Using mortality data by sex for 162 countries from the Global Burden of Disease Study2 and the Internal Peace Index3 between 2008-2017, we find that the most violent countries are also those with the highest lifetime uncertainty. In the Middle East, conflict-related deaths at young ages are the largest contributor to lifetime uncertainty. In Latin America, a similar pattern is attributable to homicides and interpersonal violence. Although the effects are larger in magnitude for men, the consequences remain considerable for adolescent girls and women in their early reproductive years. Our study points to a double burden of violence on longevity: not only does violence shorten individual lives, it also makes the length of life less predictable in a population.
10.12.2022: New publication
Cross-sectional estimates of population health from the survey of health and retirement in Europe (SHARE) are biased due to health-related sample attrition
Muszyńska-Spielauer, Magdalena; Spielauer, Martin
SSM—Population Health. 2022 Nov 17; 20: 101290
Abstract: Cross-sectional data from the Survey of Health, Ageing and Retirement in Europe (SHARE) are a common source of information in comparative studies of population health in Europe. In the largest part, these data are based on longitudinal samples, which are subject to health-specific attrition. This implies that estimates of population health based on cross-sectional SHARE datasets are biased as the data are selected on the outcome variable of interest. We examine whether cross-sectional datasets are selected based on health status. We compare estimates of the prevalence of full health, healthy life years at age 50 (HLY), and rankings of 18 European countries by HLY based on the observed, cross-sectional SHARE wave 7 datasets and full samples. The full samples consist of SHARE observed and attrited respondents, whose health trajectories are imputed by microsimulation. Health status is operationalized across the global index of limitations in activities of daily living (GALI). HLY stands for life expectancy free of activity limitations. Cross-sectional datasets are selected based on health status, as health limitations increase the odds of attrition from the panel in older age groups and reduce them in younger ones. In older age groups, the prevalence of full health is higher in the observed cross-sectional data than in the full sample in most countries. In most countries, HLY is overestimated based on the cross-sectional data, and in some countries, the opposite effect is observed. While, due to the small sample sizes of national surveys, the confidence intervals are large, the direction of the effect is persistent across countries. We also observe shifts in the ranking of countries according to HLYs of the observed data versus the HLYs of the full sample. We conclude that estimates on population health based on cross-sectional datasets from longitudinal, attrited SHARE samples are over-optimistic.
30.11.2022: New publication
Trends in Activity Limitations From an International Perspective: Differential Changes Between Age Groups Across 30 Countries
Beller, Johannes; Luy, Marc; Giarelli, Guido; Regidor, Enrique; Lostao, Lourdes; Tetzlaff, Juliane; Geyer, Siegfried
Journal of Aging and Health. 2022 Nov 25; doi: 10.1177/08982643221141123
Abstract: Objectives: Examine trends in limitations among young (15–39), middle-aged (40–64) and older age-groups (>=65) and their socioeconomic differences. Methods: Population-based European Social Survey data (N = 396,853) were used, covering 30 mostly European countries and spanning the time-period 2002–2018. Limitations were measured using a global activity limitations indicator. Results: Age-differential trends in limitations were found. Activity limitations generally decreased in older adults, whereas trends varied among younger and middle-aged participants, with decreasing limitations in some countries but increasing limitations in others. These age-differential trends were replicated across limitation severity and socioeconomic groups; however, stronger limitation increases occurred regarding less-severe limitations. Discussion: Functional health has improved in older adults. Contrarily, the increasing limitations in younger and middle-aged individuals seem concerning, which were mostly observed in Western and Northern European countries. Given its public health importance, future studies should investigate the reasons for this declining functional health in the young and middle-aged.
16.09.2022: New publication
Estimating Trends in Working Life Expectancy based on Health Insurance Data from Germany – Challenges and Advantages
Tetzlaff, Juliane; Luy, Marc; Epping, Jelena; Geyer, Siegfried; Beller, Johannes; Stahmeyer, Jona Theodor; Sperlich, Stefanie; Tetzlaff, Fabian
SSM—Population Health. 2022 Aug 22; 19: 101215
Abstract: Against the backdrop of population aging and growing strain on pension systems, monitoring the development of Working Life Expectancy (WLE) is vital to assess whether the policies taken are effective. This is the first study investigating time trends and educational inequalities in WLE based on German health insurance data. The analyses are based on the data of the AOK Lower Saxony (N = 3,347,912) covering three time periods (2006-08, 2011-13, and 2016-18). WLE is defined as years spent in the labor force (i.e. in employment and unemployment) and was calculated for each age between 18 and 69 years for the three periods to depict changes over time using multistate life table analysis. Educational inequalities in 2011-13 are reported for two educational levels (8–11 years and 12–13 years of schooling). WLE increased in both sexes with increases being stronger among women. This holds irrespective of whether WLE at age 18 (35.8–38.3 years in men, 27.5–34.0 years in women) or the older working-age (e.g. at age 50 10.2–11.7 years in men, 7.8–10.5 years in men) is considered. Among women at all ages and men from their mid-20s onwards, WLE was higher among higher-educated individuals. Inequalities were most pronounced among women (e.g. Δ3.1 years in women, Δ1.3 years in men at age 50). The study supports previous research indicating that measures to extend working life are effective, but that noticeable inequalities in WLE exist. Health insurance data represent a valuable source for such research that has so far remained untapped. The data provide a suitable basis to investigate trends and inequalities in WLE. Future research should build on the strengths of the data by broadening the research towards a more comprehensive analysis of the development of WLE from a health perspective.
22.08.2022: New publication
Rating Health and Rating Change: How Canadians Rate Their Health and Its Changes
Lazarevič, Patrick; Quesnel-Vallée, Amélie
Journal of Aging and Health. 2022 Aug 22; doi: 10.1177/08982643221119654
Abstract: Objectives: We investigated the contribution of five health domains to self-rated health (SRH) cross-sectionally and longitudinally and whether these contributions differ by gender or age. Methods: Employing dominance analyses, we quantified the contributions of functioning, diseases, pain, mental health, and behavior to both SRH at a point in time and for changes in SRH using data from the Canadian National Population Health Survey (NPHS, 1994–2011). Results: Cross-sectionally and longitudinally, functioning was the most important health domain, followed by diseases and pain. There were no meaningful differences in the ranking by gender while functioning, diseases, and pain were more relevant in older cohorts. Discussion: Functioning, diseases, and pain systematically were the most important health domains in both cross-sectional and longitudinal analyses. While these results held for women and men, they were more salient for older adults. This points to a gender-invariant but age-graded process, confirming previous research with European data.
08.08.2022: New publication
Well-being adjusted health expectancy: a new summary measure of population health
Muszyńska-Spielauer, Magdalena; Luy, Marc
European Journal of Population. 2022 Aug 08; 38: 1009-1031
Abstract: We propose a new summary measure of population health (SMPH), the well-being-adjusted health expectancy (WAHE). WAHE belongs to a subgroup of health-adjusted life expectancy indicators and gives the number of life years equivalent to full health. WAHE combines health and mortality information into a single indicator with weights that quantify the reduction in well-being associated with decreased health. WAHE's advantage over other SMPHs lies in its ability to differentiate between the consequences of health limitations at various levels of severity and its transparent, simple valuation function. Following the guidelines of a Committee on Summary Measures of Population Health, we discuss WAHE's validity, universality, feasibility sensitivity and ensure its reproducibility. We evaluate WAHE's performance compared to life expectancy, the most commonly used indicators of health expectancy (HE) and disability-adjusted life expectancy (DALE) in an empirical application for 29 European countries. Data on health and well-being are taken from the 2018 EU-SILC, and the life tables are from Eurostat. DALE is taken from the database of the Global Burden of Disease Programme. WAHE's sensitivity to univariate and multivariate state specifications is studied using the three Minimum European Health Module health dimensions: chronic morbidity, limitations in activities of daily living, and self-rated health. The empirical tests of the indicators’ correspondence reveal that WAHE has the strongest correlation with the other SMPHs. Moreover, WAHE estimates are in agreement with all other SMPHs. Additionally, WAHE and all other SMPHs form a group of reliable indicators for studying population health in European countries. Finally, WAHE estimates are robust, regardless of whether health is defined across one or multiple simultaneous dimensions of health. We conclude that WAHE is a useful and reliable indicator of population health and performs at least as well as other commonly used SMPHs.
05.04.2022: New publication
The impact of COVID-19 vaccines on the Case Fatality Rate: The importance of monitoring breakthrough infections
Di Lego, Vanesssa; Sánchez-Romero, Romero; Prskawetz, Alexia
International Journal of Infectious Diseases. 2022 April 5; 119: 178-183
Abstract: Objectives: This study aimed to test the behavior of the case fatality rate (CFR) in a mixed population of vaccinated and unvaccinated individuals by illustrating the role of both the effectiveness of vaccines in preventing deaths and the detection of infections among both the vaccinated (breakthrough infections) and unvaccinated individuals. Methods: We simulated three hypothetical CFR scenarios that resulted from a different combination of vaccine effectiveness in preventing deaths and the efforts in detecting infections among both the vaccinated and unvaccinated individuals. Results: In the presence of vaccines, the CFR depends not only on the effectiveness of vaccines in preventing deaths but also on the detection of breakthrough infections. As a result, a decline in the CFR may not imply that vaccines are effective in reducing deaths. Likewise, a constant CFR can still mean that vaccines are effective in reducing deaths. Conclusions: Unless vaccinated people are also tested for COVID-19 infection, the CFR loses its meaning in tracking the pandemic. This shows that unless efforts are directed at detecting breakthrough infections, it is hard to disentangle the effect of vaccines in reducing deaths from the probability of detecting infections on the CFR.
11.02.2022: New Publication
The gender gap in life expectancy in urban and rural China, 2013-2018
Wu, Jinjing; KC, Samir; Luy, Marc
Frontiers in Public Health. 2022 Feb 11; 10: 749238
Abstract: Gender differences in mortality are embedded within mortality transitions. Rural residents generally lag behind their urban counterparts in the transitions. The study objective is to identify major causes of death that drive gender differences in mortality in urban and rural China. We use age-, gender-, urban-rural- and cause-specific mortality data (2013–2018) derived from the national mortality surveillance system that covered about 24% of the Chinese population. We apply Arriaga's method to decompose age- and cause-specific contributions to the gender gap in life expectancy at birth. Analyses are stratified by urban-rural residence. We find that women had a higher life expectancy at birth than men in both urban and rural areas. Cancers, cardiovascular disease, external causes, and respiratory disease accounted for more than 90% of the gender gap in both areas during 2013–2018. In urban areas, the gender gap decreased from 5.17 years in 2013–2015 to 4.98 years in 2016–2018. In rural areas, the gender gap stayed rather constant (2013–2015: 5.68 years; 2016–2018: 5.65 years). Traffic accidents, among external causes, contributed the most to decreasing the gender gap (urban: −0.07 years; rural: −0.10 years), especially in the 0–44 age group. However, the decrease in the gender gap was counteracted by an increase in the gender gap attributable to ischemic heart disease (urban: +0.05 years; rural: +0.08 years) and lung cancer (urban: +0.02 years; rural: +0.05 years) in older age groups. The gender gap attributable either to cerebrovascular disease or to chronic lower respiratory disease decreased in urban areas but increased in rural areas. We conclude that the urban-rural variations in the cause-specific contributions to the gender gap in China suggest the necessity of implementing urban-rural-specific interventions to improve population health and health equity.
20.12.2021: New Publication
Decrease in life expectancy in Germany in 2020: men from eastern Germany most affected
Luy, Marc; Sauerberg, Markus; Muszynska-Spielauer, Magdalena; di Lego, Vanessa
Comparative Population Studies. 2021 Dec 20; 46: 555-574
Abstract: The COVID-19 pandemic caused an increase in mortality in 2020 with a resultant decrease in life expectancy in most countries around the world. In Germany, the reduction in life expectancy at birth between 2019 and 2020 was comparatively small, at -0.20 years. The decrease was stronger among men than among women (-0.24 vs. -0.13 years) and in eastern rather than in western Germany (-0.36 vs. -0.16 years). Men in eastern Germany experienced the biggest decline in life expectancy at birth (-0.41 years). For western German men, the decline was less pronounced (-0.19 years). Among women, the decline in life expectancy at birth was also greater in eastern (-0.25 years) than in western Germany (-0.10 years). As a result of these developments, the differences in life expectancy between the two parts of Germany, and between women and men, increased compared with the previous year. Life expectancy at age 65 decreased more strongly than life expectancy at birth for both sexes and in all regions. This reflects the fact that it was mainly older age groups that were affected by the increase in mortality in 2020. This paper provides further insights into mortality changes in 2020, based on age decomposition and an analysis of lifespan inequality. We conclude that the population in eastern Germany was hit harder by the COVID-19 pandemic in 2020 than the population in the western Germany.
02.11.2021: New Publication
The male-female health-mortality paradox: research report of the ERC project HEMOX
Luy, Marc (ed.)
VID Research Reports. 2021 Nov 2; Volume 40
This book includes a collections of articles about health and longevity of Catholic order members that were produced for the ERC project HEMOX ("The male-female health-mortality paradox"). It includes the following chapters:
09.06.2021: New Publication
Gender disparities in health at older ages and their consequences for well being in Latin America and the Caribbean
Nepomuceno, Marília R.; di Lego, Vanessa; Turra, Cássio M.
Vienna Yearbook of Population Research. 2021 Jun 05; 10.1553/populationyearbook2021.res2.1
Abstract: Women live longer but can expect to spend more years in poorer health compared to men. In the context of population aging and declining gender ratios at older ages, there are increasing concerns about how this disadvantage in female health will affect well-being and sustainability, particularly in developing regions that are rapidly aging. Our study compares differences in health expectancies at older ages for men and women in order to assess gender disparities in health. We use data from the Survey on Health, Well-Being, and Aging in Latin America and the Caribbean to decompose the gender gap into total and age-specific mortality and disability effects in seven cities in the region. Our results show that at older ages, higher disability rates among women reduced the gender gap in healthy life expectancy by offsetting women’s mortality advantage. In addition, we find that women’s mortality advantage decreased almost systematically with age, which reduced the contribution of the mortality effect to the gender gap at older ages. Although the gender gap in health followed a similar pattern across the region, its decomposition into mortality and disability effects reveals that there was substantial variation among cities. Thus, across the region, the implications of the gender gap in health for well-being vary, and the policies aimed at reducing this gap should also differ.
30.05.2021: New Publication
Das Mortalitätsgeschehen während der COVID-19-Pandemie in Deutschland und anderen europäischen Ländern
Sauerberg, Markus
Post-Pandemic Populations: Die soziodemografischen Folgen der COVID-19-Pandemie in Deutschland. 2021 May 16, pp. 14-19
This paper gives a short overview about excess mortality due to COVID-19 in Germany and other European countries.
01.05.2021: PhD to Markus Sauerberg
Markus Sauerberg successfully defended his PhD thesis at Vienna University of Economics and Business. CONGRATULATIONS from the whole DELAG team!!!
30.03.2021: New Publication
Testing and measuring the life expectancy of Roma and Travellers
Luy, Marc
Roma and Travellers in six countries. Technical Report. 2021 Mar 30; 10.2811/106484, pp. 114-139
Abstract: Several studies suggest that the population of Roma and Travellers is severely disadvantaged in health and mortality. According to the most widely cited and generally accepted data from the Council of Europe, life expectancy (LE) of this subgroup is between 10 and 15 years lower than that of the general population. However, all existing reports about levels and trends of Roma and Travellers' LE are substantially limited in the comprehensiveness and quality of the available data. As a consequence, it is not clear whether the disadvantage in the number of life years is actually that high. The aim of the present work is therefore to provide additional estimates derived by a different approach and for subpopulations of Roma and Travellers for which no such estimates exist so far. For this purpose, the European Union Agency for Fundamental Human Rights (FRA) included particular questions to the 2019 Roma and Travellers Survey (RTS 2019) which allow the application of a specific indirect approach to estimate LE on the basis of proportions of still living mothers and fathers, the so-called "Orphanhood Method" (OM). The data turned out to be a reliable basis for applying the OM. The results confirm previous estimates regarding the extent of differences in LE between Roma and Travellers and the total national populations. In line with previous reports, the estimated extent of Roma and Travellers' disadvantage varies between countries. For 2016, the estimated differences in LE at birth to the total national populations lies between 7.1 years for female Gypsies and Travellers in the United Kingdom and 14.2 years for male Roma and Caravan Dwellers in Belgium.
28.01.2021: New Publication
An indirect method to monitor the fraction of people ever infected with COVID-19
Sánchez-Romero, Miguel; di Lego, Vanessa; Prskawetz, Alexia; Queiroz, Bernardo L.
PLOS ONE. 28 Jan 2021; 16: 1
Abstract: The number of COVID-19 infections is key for accurately monitoring the pandemics. However, due to differential testing policies, asymptomatic individuals and limited large-scale testing availability, it is challenging to detect all cases. Seroprevalence studies aim to address this gap by retrospectively assessing the number of infections, but they can be expensive and time-intensive, limiting their use to specific population subgroups. In this paper, we propose a complementary approach that combines estimated (1) infection fatality rates (IFR) using a Bayesian melding SEIR model with (2) reported case-fatality rates (CFR) in order to indirectly estimate the fraction of people ever infected (from the total population) and detected (from the ever infected). We apply the technique to the U.S. due to their remarkable regional diversity and because they count with almost a quarter of all global confirmed cases and deaths. We obtain that the IFR varies from 1.25% (0.39–2.16%, 90% CI) in Florida, the most aged population, to 0.69% in Utah (0.21–1.30%, 90% CI), the youngest population. By September 8, 2020, we estimate that at least five states have already a fraction of people ever infected between 10% and 20% (New Jersey, New York, Massachussets, Connecticut, and District of Columbia). The state with the highest estimated fraction of people ever infected is New Jersey with 17.3% (10.0, 55.8, 90% CI). Moreover, our results indicate that with a probability of 90 percent the fraction of detected people among the ever infected since the beginning of the epidemic has been less than 50% in 15 out of the 20 states analyzed in this paper. Our approach can be a valuable tool that complements seroprevalence studies and indicates how efficient have testing policies been since the beginning of the outbreak.
12.11.2020: New Publication
The Role of Education for Assessing Population Health: An Analysis of Healthy Life Expectancy by Educational Attainment for 16 European Countries
Sauerberg, Markus
Vienna Institute of Demography Working Papers. 2020 Nov 12; VID-WP 05/2020
Abstract: Healthy life expectancy (HLE) is a prominent summary indicator for evaluating and comparing the levels of population health status across Europe. Variations in HLE, however, do not necessarily reflect underlying differences in health and mortality levels among countries and are particularly sensitive when broken down by population subgroups. For instance, despite European countries showing large HLE inequalities by educational level, these countries are also highly heterogenous regarding their educational population composition, which most likely affects their HLE levels. We demonstrate how this compositional effect shapes HLE levels by providing HLE estimates of educational attainment and gender for 16 European countries using the Sullivan method. We use prevalence data about activities of daily living (ADLs) limitations from the European Union Statistics on Income and Living Conditions (EU-SILC) and mortality data from the Eurostat database. We then quantify the magnitude of educational inequalities based on the composite inequality index (CII). Finally, we express total HLE as the sum of education-specific HLEs, weighted by the educational population structure. As expected, we find large educational inequalities in HLE, with men’s CII ranging from about 8.5 years in Portugal to approximately 3 years in Romania. For women, educational inequalities are slightly smaller. The decomposition reveals the population structure’s strong effects on HLE, which can elicit misleading conclusions about people’s health status and potentially turn HLE into an improper measure of educational differences as opposed to a measure of health gaps. For example, low-, medium-, and highly educated individuals in Portugal show more healthy life years than their counterparts in Poland. Still, Poland’s total HLE value slightly exceeds that of Portugal, indicating favorable health and mortality conditions in Poland. However, Poland’s greater relative number of highly educated individuals in its population is responsible for producing this higher total HLE value. We conclude that education is not only paramount for assessing health inequalities across European countries, but also the population composition by educational attainment, because it drives the differences in HLE levels.
01.09.2020: New DELAG team member
The Research Group "Health and Longevity" of the Vienna Institute of Demography welcomes our new team member Magdalena M. Muszynska-Spielauer (see DELAG Team). Magdalena is a demographer with an economic background. She holds a Ph.D. from the Warsaw School of Economics, studied and worked at the Max Planck Institute for Demographic Research and Duke University. She will work primary on the LETHE project (see Projects).
31.08.2020: New Publication
The cross-sectional average length of healthy life (HCAL): a measure that summarizes the history of cohort health and mortality
Sauerberg, Markus; Guillot, Michel; Luy, Marc
Population Health Metrics. 31 Aug 2020; 18: 21
Abstract: Healthy life years have superseded life expectancy (LE) as the most important indicator for population health. The most common approach to separate the total number of life years into those spent in good and poor health is the Sullivan method which incorporates the health dimension to the classic period life table, thus transforming the LE indicator into the health expectancy (HE) indicator. However, life years derived from a period life table and health prevalence derived from survey data are based on different conceptual frameworks. Method: We modify the Sullivan method by combining the health prevalence data with the conceptually better fitting cross-sectional average length of life (CAL). We refer to this alternative HE indicator as the “cross-sectional average length of healthy life” (HCAL). We compare results from this alternative indicator with the conventional Sullivan approach for nine European countries. The analyses are based on EU-SILC data in three empirical applications, including the absolute and relative level of healthy life years, changes between 2008 and 2014, and the extent of the gender gap. Results: HCAL and conventional HE differ in each of these empirical applications. In general, HCAL provides larger gains in healthy life years in recent years, but at the same time greater declines in the proportion of healthy life years. Regarding the gender gap, HCAL provides a more favourable picture for women compared to conventional HE. Nonetheless, the extent of these differences between the indicators is only of minor extent. Conclusions: Albeit the differences between HE and HCAL are small, we found some empirical examples in which the two indicators led to different conclusions. It is important to note, however, that the measurement of health and the data quality are much more important for the healthy life years indicator than the choice of the variant of the Sullivan method. Nonetheless, we suggest to use HCAL in addition to HE whenever possible because it widens the spectrum of empirical analyses and serves for verification of results based on the highly sensitive HE indicator.
26.05.2020: New Publication
Understanding the cross-sectional association between life expectancy and healthy life years: the CroHaM hypothesis
Luy, Marc
Vienna Institute of Demography Working Papers. 2020 Mar 26; VID-WP 03/2020
Abstract: A central question of interdisciplinary health research is whether the life years gained through increasing life expectancy are primarily spent in good or poor health. Two opposing models have been proposed: "expansion of morbidity" and "compression of morbidity". Existing research based on longitudinal data and time series has supported both approaches, depending on the particular dimension of health under consideration. In this paper we hypothesize that the longitudinal health dimension-specific expansion and compression effects exist equivalently in the cross-sectional association between health and mortality (CroHaM), affecting differences in the number of healthy life years between populations and subpopulations with different levels of life expectancy. The CroHaM hypothesis roots in the observation that most health differentials within and between populations are caused primarily by social factors and it builds on Link and Phelan's "theory of fundamental social causes". We present empirical support for the hypothesis by analyzing the relationship between life expectancy and healthy life years on the basis of different health dimensions for a sample of female and male Catholic order members and their counterparts in the general populations of Germany and Austria. Finally, we outline that the CroHaM hypothesis may also contribute to a better understanding of differences in life years spent in good or poor health and make suggestions for further testing of the CroHaM hypothesis.
21.03.2020: New Publication
Gender differences in healthy and unhealthy life expectancy
Di Lego, Vanessa; Di Giulio, Paola; Luy, Marc
International Handbook of Health Expectancies. 2020 Mar 19; 10.1007/978-3-030-37668-0_11
Abstract: There is consistent evidence that women live longer than men at all ages, but spend a higher proportion of their total life expectancy in poorer health, a phenomenon described as the "male-female health-survival paradox" or the "gender paradox in health and mortality". However, it is difficult to explain the process because morbidity by sex differs considerably across domains of health, age groups, social contexts and severity level. In addition, women and men report differently their health in surveys, making it cumbersome to understand whether what drives the paradox is a higher female morbidity or male mortality, a different reporting behaviour, or all of those aspects together. The aim of this chapter is to demonstrate the magnitude of those differences in Europe using different health domain indicators (activity limitation, chronic morbidity and self-perceived health) from the EHEMU Information System and the reporting behaviour by sex from the SHARE survey vignettes.
22.02.2020: New Publication
The gender health gap in Europe's ageing societies: universal findings across countries and age groups?
Schmitz, Alina; Lazarevič, Patrick
European Journal of Ageing. 2020 Feb 17; 10.1007/s10433-020-00559-6
Abstract: We provide a systematic country and age group comparison of the gender gap in several generic health indicators and more specific morbidity outcomes. Using data from the Survey of Health, Ageing and Retirement (SHARE), we examined the gender gap in the prevalence of poor self-rated health, chronic health conditions, activity limitations, multimorbidity, pain, heart attacks, diabetes, and depression in three age groups (50-64, 65-79, and 80+) based on linear probability models with and without adjustment for covariates. While women were typically disadvantaged regarding poor self-rated health, chronic health conditions, activity limitations, multimorbidity, pain, and depression, men had a higher prevalence of heart attacks and diabetes. However, the gender gap's magnitude and sometimes even its direction varied considerably with some age trends apparent. Regarding some health indicators, the gender gap tended to be higher in Southern and Eastern Europe than in Western and Northern Europe. All in all, the presence of a gender health gap cannot be regarded as a universal finding as the gap tended to widen, narrow or even reverse with age depending on the indicator and country.
04.12.2019: New Publication
Bedeutung des Gesundheitsindikators bei der Analyse der Gesundheitsfolgen informeller Pflege. Anderer Indikator, anderes Ergebnis?
[Importance of health indicators in the analysis of health effects on informal caregivers. Different indicator, different result?]
Kaschowitz, Judith; Lazarevič, Patrick
Zeitschrift für Gerontologie und Geriatrie. 2019 Dec 04; 53: 10–16;
Abstract: Background: Analysis of the health of informal caregivers is gaining in importance. Research has shown negative effects of caregiving on mental health but the results regarding physical health were ambiguous. It remains unclear whether this can be traced back to the use of different health indicators. Objective: Do the results on the relationship between informal caregiving and health vary depending on the care setting (domestic or external) and the outcome measure? Material and methods: The relationship between informal caregiving inside and outside the domestic setting and the health of the caregiver was modelled using data from the Survey of Health, Ageing and Retirement in Europe (SHARE, waves 1, 2, 4–6). The direction and strength of the relationship between informal caregiving and eight indicators of physical and mental health were compared both cross-sectionally and longitudinally. Results: For most health indicators and in the cross-sectional as well as longitudinal models, negative health effects could be observed. While caregivers in the domestic setting reported worse health than non-caregivers, the opposite was true for caregivers outside the household. The longitudinal model revealed that both negative and positive health changes during informal caregiving were evident depending on the health indicator used. Conclusion: The results confirmed health differences between caregivers inside and caregivers outside the domestic setting. For caregivers outside the household different health outcomes of caregiving were found depending on the chosen health indicator. This underlines that the chosen health indicator as well as the care population under study substantially affect the results of the analysis and the subsequent conclusions.
01.12.2019: New Publication
Stalling of mortality in the United Kingdom and Europe: an analytical review of the evidence
Murphy, Michael; Luy, Marc; Torrisi, Orsola
Social Policy Working Paper 11-19, LSE Department of Social Policy. 2019 Nov 07
Abstract: Improvement in UK mortality rates has declined substantially in this decade and the overall value is now close to zero, a finding which has become politically controversial. A similar but less severe change has been observed in some neighbouring European countries, and the US has exhibited a longer term deterioration in mortality improvement. We review the literature and associated commentary on this phenomenon. These UK trends are observed across sex and age groups, but appear to be more marked in more deprived areas. We assess the hypotheses that have been put forward to explain these trends within a framework that distinguishes between short-term fluctuations and longer-term underlying trends; in particular, the role of seasonal influenza, changes in cardio-vascular disease mortality, Government austerity measures and tempo effects. We conclude that that there is no clear evidence for any specific explanation or combination of causes and that additional studies, especially those including cross-national comparisons are needed.
17.10.2019: New Publication
The male-female health-mortality paradox
Di Lego, Vanessa; Lazarevič, Patrick; Luy, Marc
Encyclopedia of Gerontology and Population Aging. 2019 Oct 17; 10.1007/978-3-319-69892-2_798-2
Abstract: The differences in life expectancy between women and men remained more or less constant until the first half of the twentieth century, with a female advantage of around 2–3 years, and started to increase thereafter. This increase of the gap coincided with a rise among men in cardiovascular diseases, cancer, and accidents and a fall in maternal mortality and in causes of death related to pregnancy among women. Since the beginning of the 1980s, the gap between women and men in overall life expectancy has been slowly narrowing in the developed world. In light of this universal observable male excess mortality, it is surprising that studies on gender differences in morbidity report that women are in worse health than men and that women spend a higher proportion of their total life expectancy in poor health and with limitations. Researchers have most commonly addressed this paradox by focusing either on male excess mortality or on female excess morbidity. Another complementary approach has been to attribute at least a part of the paradox to methodological artifacts that arise due to the survey framework and the behavior dynamics between respondents and interviewers. This encyclopedia entry summarizes all these issues and provides corresponding empirical evidence.
23.09.2019: New Publication
Was misst Self-Rated Health? Die Basis subjektiver Gesundheit und Unterschiede nach Geschlecht, Alter und Kohorte in Europa und Kanada
Lazarevič, Patrick
Springer VS. 2019 Nov 27; 10.1007/978-3-658-28026-0
Abstract: Die Definition und Messung von Gesundheit ist der analytische Dreh- und Angelpunkt vieler empirischer Studien. Aus pragmatischen Gründen ist es jedoch oft nicht möglich, umfassende Gesundheitsdaten zu erheben, weshalb häufig eine subjektive Bewertung der Befragten ("Self-Rated Health") verwendet wird. Doch inwieweit wird dabei aufgrund unterschiedlicher Erwartungen, Maßstäbe oder Erfahrungen derselbe Gesundheitsstatus unterschiedlich bewertet? Diese und andere Fragen stehen im Fokus dieser Arbeit. Dabei stellt sich z. B. heraus, dass es große Altersunterschiede darin gibt, welche Gesundheitsaspekte in welchem Ausmaß in die Bewertung eingehen.
08.08.2019: New Publication
Life expectancy: frequently used, but hardly understood
Luy, Marc; Di Giulio, Paola; Di Lego, Vanessa; Lazarevič, Patrick; Sauerberg, Markus
Gerontology. 2019 Aug 08; 10.1159/000500955
Abstract: Period life expectancy is one of the most used summary indicators for the overall health of a population. Its levels and trends direct health policies, and researchers try to identify the determining risk factors to assess and forecast future developments. The use of period life expectancy is often based on the assumption that it directly reflects the mortality conditions of a certain year. Accordingly, the explanation for changes in life expectancy are typically sought in factors that have an immediate impact on current mortality conditions. It is frequently overlooked, however, that this indicator can also be affected by at least three kinds of effects, in particular in the situation of short-term fluctuations: cohort effects, heterogeneity effects, and tempo effects. We demonstrate their possible impact with the example of the almost Europe-wide decrease in life expectancy in 2015, which caused a series of reports about an upsurge of a health crisis, and we show that the consideration of these effects can lead to different conclusions. Therefore, we want to raise an awareness concerning the sensitivity of life expectancy to sudden changes and the menaces a misled interpretation of this indicator can cause.
30.05.2019: REVES Poster Award for Patrick Lazarevič
Congratulations! Patrick Lazarevič received the REVES Poster Award for his poster "A New Short Generic Measure of Health: Is the Minimum European Health Module an Option?"
10.05.2019: PhD to Patrick Lazarevič
Patrick Lazarevic successfully defended his PhD thesis at TU Dortmund today. CONGRATULATIONS from the whole DELAG team!!!
08.03.2019: New Publication
The impact of increasing education levels on rising life expectancy: a decomposition analysis for Italy, Denmark, and the USA
Luy, Marc; Zannella, Marina; Wegner-Siegmundt, Christian; Minagawa, Yuka; Lutz, Wolfgang; Caselli, Graziella
Genus. 2019 Mar 07; 75: 11; 10.1186/s41118-019-0055-0
Abstract: Significant reductions in mortality are reflected in strong increases in life expectancy particularly in industrialized countries. Previous analyses relate these improvements primarily to medical innovations and advances in health-related behaviors. Mostly ignored, however, is the question to what extent the gains in life expectancy are related to structural changes in the populations due to increasing education levels. We decompose changes of the total populations’ life expectancy at age 30 in Italy, Denmark, and the United States, over the 20-year period between 1990 and 2010 into the effects of education-specific mortality changes ("M effect") and changes in the populations' educational structure ("P effect"). We use the "replacement decomposition technique" to further subdivide the M effect into the contributions by the individual education groups. While most of the increases in life expectancy are due to the effect of changing mortality, a large proportion of improvements in longevity can indeed be attributed to the changing structure of the population by level of education in all three countries. The estimated contribution of the P effect ranges from around 15 percent for men in the United States to approximately 40 percent for women in Denmark. This study demonstrates strong associations between education and overall population health, suggesting that education policies can also be seen as indirect health policies.
04.02.2019: New Publication
Socioeconomic disparity in adult mortality in India: estimations using the orphanhood method
Saikia, Nandita; Bora, Jayanta Kumar; Luy, Marc
Genus. 2019 Feb 04; 75: 7; 10.1186/s41118-019-0054-1
Abstract: Due to a lack of data, no study has yet documented differences in adult life expectancy in India by education, caste, and religion. Our objective was therefore to examine disparities in socioeconomic status (SES) in the adult mortality rate (40q30) and life expectancy at age 15 (e15) in India. We estimated adult mortality by SES with the orphanhood method to analyze information related to the survival of respondents’ parents. We used data from the India Human Development Survey 2011–2012. SES was measured by education, caste, religion, and income of the either deceased adults or their offspring. A consistency analysis between orphanhood estimates and official statistics confirmed the robustness of the estimates. Mortality is higher among adults who are illiterate, belong to deprived castes or tribes, have children with a low level of education, and have a low level of household income. The adult mortality rate varies marginally by religion in India. Life expectancy at 15 (e15) is about 3.50 and 5.7 years shorter for illiterate men and women, respectively, compared with literate men and women. The parameter e15 also varies significantly by educational attainment of offspring. On average, parents of children educated to higher secondary level (and above) gain an extra 3.8–4.6 years of adult life compared to parents of illiterate children. Disparity in e15 by caste and religion is smaller than disparity by education or income. These findings reveal that the adult mortality burden falls disproportionately on illiterate adults and adults with less educated offspring. Thus, educational disparity in adult mortality appears to be prominent in Indian context. In the absence of adult mortality statistics by SES in India, we recommend that large-scale surveys should continue collecting data to allow indirect techniques to be applied to estimate mortality and life expectancy in the country
05.12.2018: New Publication
Immediate versus delayed detection of Takotsubo syndrome after epileptic seizures
Stöllberger, Claudia; Sauerberg, Markus; Finsterer, Josef
Journal of the Neurological Sciences. 2019 Feb 15; 397: 42-47
Abstract: Takotsubo syndrome (TTS) is often preceded by emotional or physical stress. Epileptic seizures are described in >100 cases. It is unknown whether patients with immediate and delayed detection of seizure-induced TTS differ. We screened the literature and compared clinical and electrocardiographic (ECG) findings. In 48 cases with seizure-associated TTS, the time between seizure and TTS-detection was reported. Troponin levels were elevated in 37/40. ECG abnormalities were negative T-waves (40%), ST-elevations (33%) and ventricular fibrillation/flutter (10%). Immediate detection was reported in 23 patients, in the remaining 25 patients, TTS was detected 5–288 h postictally. Patients did not differ in gender, age or symptoms. Negative T-waves were more frequent in patients with delayed detection (64 vs. 13%, p = .0009), whereas ECG-abnormalities suggesting acute myocardial infarction tended to be more prevalent in patients with immediate detection. Due to lack of typical symptoms, seizure-induced TTS can be overlooked. Postictally, an ECG should be recorded and troponin levels measured. New T-wave inversions might indicate seizure-induced TTS.
29.11.2018: New Publication
Soziale Unterschiede in der Lebenserwartung [Social differences in life expectancy]
Lampert, Thomas; Hoebel, Jens; Kroll, Lars Eric; Luy, Marc
Public Health Forum. 2018 Nov 28; 26(4): 325-327
Abstract: Social differences in mortality can be understood as an extreme form of social and health inequalities. The studies available for Germany prove that the average life expectancy at birth in the socially disadvantaged population groups is about 5–10 years lower than in the socially better-placed population groups. Furthermore, if only the life-time spent in good health is taken into account, the social differences are even greater. Similar social differences in life expectancy are reported for other European countries and also for the USA.
Zusammenfassung: Soziale Unterschiede in der Mortalität können als extreme Ausprägungsform sozialer und gesundheitlicher Ungleichheiten verstanden werden. Die für Deutschland vorliegenden Studien sprechen dafür, dass die mittlere Lebenserwartung bei Geburt in den sozial benachteiligten Bevölkerungsgruppen etwa 5–10 Jahre niedriger liegt als in den sozial besser gestellten Bevölkerungsgruppen. Wird nur die bei guter Gesundheit verbrachte Lebenszeit berücksichtigt, fallen die sozialen Unterschiede sogar noch größer aus. Für andere europäische Länder und auch die USA werden ähnlich ausgeprägte soziale Unterschiede in der Lebenserwartung berichtet.
31.05.2018: REVES Poster Award for Patrick Lazarevič
Congratulations! Patrick Lazarevič received the third prize of the REVES Poster Award for his poster "Self-rated health as a generic health measurement? Identifying the health information used and the role of gender, age, and country"
27.04.2018: PAA Poster Award for Markus Sauerberg and Marc Luy
Markus Sauerberg and Marc Luy received the PAA Poster Award for their poster "Decreasing Life Expectancy in the United States Between 2014 and 2015: Severe Health Crisis or Just Tempo Effects?"
01.04.2018: New DELAG team member
The Research Group "Health and Longevity" of the Vienna Institute of Demography welcomes our new team member Patrick Lazarevič (see DELAG Team). Patrick is sociologist and he started his Ph.D. project on methodological difficulties in the examination of age(ing) at the TU Dortmund University. He will continue this work inside the LETHE project (see Projects).
10.03.2018: Award for Vanessa Di Lego
Vanessa Di Lego et al.'s article "Mortality selection among adults in Brazil: The survival advantage of Air Force officers" was chosen by editors of the journal Demographic Research as one of the very best papers in Volume 37 of Demographic Research. Congratulations!!! [Link to Article]
01.02.2018: New DELAG team member
The Research Group "Health and Longevity" of the Vienna Institute of Demography welcomes our new team member Vanessa Di Lego (see DELAG Team). Vanessa completed her Ph.D. in demography at the Center for Development and Regional Planning (Cedeplar) in Brazil. Vanessa will work primarily inside the LETHE project (see Projects).
20.10.2017: New publication
Acute coronary syndrome in immigrants and non-immigrants. Results of an Austrian prospective pilot study
Gündüz, Duygu; Lejak, Anita; Wiedemann, Angela; Avanzi, Marion; Winkler, Walther-Benedikt; Ucar-Altenberger, Hadice; Stöllberger, Caludia; Weidinger, Franz
Wiener klinische Wochenschrift. 2017 Oct 20; 129(23-24): 900-905.
Abstract: There are indications that immigrant patients with acute coronary syndrome (ACS) differ in demographic characteristics and clinical presentation from non-immigrant patients. The aim of this prospective pilot study was to gather clinical and sociodemographic data from patients with ACS and to compare immigrants with non-immigrants. Included were consecutive patients who underwent acute coronary angiography in one cardiological department for ACS from September 2011 to September 2013. Information was gathered about age, sex, results of the coronary angiography, classical risk factors, socioeconomic characteristics as well as ethnicity. Patients who had their place of birth outside Austria were specified as immigrants. A total of 100 patients (29% female) with a mean age of 60 years (range 34–91 years) were included. Of the patients 35 (35%) were immigrants, 12 came from Serbia, 4 from Bosnia, 3 from South America, 2 from Germany, 2 from Turkey, 2 from the Czech Republic, 2 from Croatia, 2 from Macedonia, and 1 each from Bangladesh, Poland, Romania, Libya, Bulgaria and Pakistan. Immigrants tended to be younger on average (56 vs. 62 years, p = 0.04) and had a two or multivessel disease more often than the non-immigrants but this difference was not significant (51% vs. 38%, p = 0.29). There were no differences between non-immigrants and immigrants concerning the classical risk factors for ACS (hypercholesterinemia 60% vs. 69%, nicotine abuse 51% vs. 60%, hypertension 69% vs. 79%) except diabetes mellitus (15% vs. 37%, p = 0.02). Sociodemographic data showed differences in education and socioeconomic status (SES). Non-immigrants had jobs with high skill level more often than immigrants (30% vs. 4%, p = 0.02), although there was no difference between immigrants and non-immigrants in the level of high education (9% each); however, immigrants more often had low education (31% vs. 11%, p = 0.01) and a monthly income below 1000 € than non-immigrants (41% vs. 14%, p = 0.03). These results reveal that immigrants with ACS suffered more often from coronary two or multivessel disease and diabetes mellitus and were slightly younger than non-immigrants, although they did not differ regarding classical risk factors. Results suggest that the lower SES of immigrants compared with non-immigrants might contribute to the severity of coronary heart disease.
01.09.2017: Start of the ERC project LETHE / Beginn des ERC-Projekts LETHE
Today started our new research ERC project LETHE for the duration of 5 years (until August 2022). It’s main aim will be to better understand the measurement and estimation sensitivity of the "Health Expectancy" indicator (see Projects).
01.08.2017: New DELAG team member
The Research Group "Health and Longevity" of the Vienna Institute of Demography welcomes our new PhD student Markus Sauerberg (see DELAG Team). Markus studied demography at the University of Rostock and completed successfully the program of the European Doctoral School of Demography. His main tasks will be inside the LETHE project (see Projects)
Biases in Assertions of Self-Rated Health: Exploring the Role of the Respondent, Country of Residence, and Interviewer
Lazarevič, Patrick
Comparative Population Studies. 2023 Feb 15; doi: 10.12765/CPoS-2023-04
Abstract: Comparative analyses frequently examine respondents’ self-rated health (SRH), assuming that it is a valid and comparable measure of generic health. However, given SRH’s vagueness, this assumption is questionable due to (1) manifold non-health influences, such as personal characteristics including optimism, interviewer effects on the rating, and cultural contexts, as well as (2) potential gender, age- or country-specific expectations for one’s health or frames of reference. Conceptually, two major components of SRH can be distinguished: latent health and reporting behavior. While latent health exclusively refers to objective health status, reporting behavior collectively refers to non-health characteristics (NH) affecting SRH. The present paper is primarily concerned with the latter and aims to identify whether and how NH bias SRH, including possible differences by gender, age, and country of residence. The presented analyses are based on data from 16,183 participants in five countries drawn from the fifth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE). Latent health is controlled via a wide array of health indicators and the residuals are examined with a model covering NH from three different sources: the interviewer, the respondent, and the country of residence. To identify subgroup-specific response behaviors, all analyses are carried out separately by gender, three age groups (50-64, 65-79, and 80+ years), and country of residence. The analyses uncovered influences of – among others–the interviewer’s SRH, the respondent’s life satisfaction, and the country of residence on SRH, while other factors differed by subgroup. The amount of explained variance due to such reporting behavior (with a mean of seven percent) can be deemed meaningful, considering that controlling for latent health already explains around half of SRH’s variance. The greatest source of non-health influences was respondent characteristics, with the interviewer and country having smaller effects. These results illustrate the importance of taking NH into account when using SRH measures. Future research on complementing SRH with factual questions in survey design is advisable.
14.02.2023: New publication
Alcohol-related mortality in four European countries: A multiple-cause-of-death study
Fihel, Agnieszka; Trias-Llimós, Sergi; Muszyńska-Spielauer, Magdalena M.; Majerová, Markéta
Drug and Alcohol Review. 2023 Feb 14; doi: 10.1111/dar.13624
Abstract: The impact of conditions that partly or indirectly contribute to drinking-related mortality is usually underestimated. We investigate all alcohol-related multiple (underlying and contributory) causes of death and compare mortality distributions in countries with different levels and patterns of drinking. Analysis of population-level mortality data for persons aged 20 and over in Austria, Czechia, Poland and Spain. Age-standardised death rates and standardised ratios of multiple to underlying cause were calculated for alcohol-related causes of death. Multiple-cause mortality ranged from 20 to 58 deaths per 100,000 for men and from 5 to 16 per 100,000 for women. Liver diseases were the most common underlying and multiple causes, but mental and behavioural disorders were the second or third, depending on country and sex, most prevalent multiple mentions. Two distinct age patterns of alcohol-related mortality were observed: in Czechia and Poland an inverted-U distribution with a peak at the age of 60–64, in Austria and Spain a distribution increasing with age and then levelling off for older age groups. The importance of alcohol-related conditions that indirectly impact mortality can be re-assessed with the use of contributory mentions. The multiple-cause-of-death approach provides convergent results for countries characterised by similar patterns of alcohol consumption. Multiple-cause mortality was almost double the level of mortality with alcohol as the underlying cause, except in Poland. Mental and behavioural disorders were mostly certified as contributory to other, non-alcohol-related underlying causes of death.
03.02.2023: New publication
A global assessment of the impact of violence on lifetime uncertainty
Aburto, José Manuel; di Lego, Vanessa; Riffe, Tim; Kashyap, Ridhi; van Raalte, Alyson; Torrisi, Orsola
Science Advances. 2023 Feb. 03; 9: eadd9038
Abstract: Uncertainty around age at death, or lifetime uncertainty, is a key public health indicator and a marker of inequality in survival in a population1. How does the extent of violence in a country affect inequalities in survival and lifetime uncertainty? Here we address this question by quantifying the impact of violence on dispersion in the ages at death, the metric most commonly used to measure lifetime uncertainty. Using mortality data by sex for 162 countries from the Global Burden of Disease Study2 and the Internal Peace Index3 between 2008-2017, we find that the most violent countries are also those with the highest lifetime uncertainty. In the Middle East, conflict-related deaths at young ages are the largest contributor to lifetime uncertainty. In Latin America, a similar pattern is attributable to homicides and interpersonal violence. Although the effects are larger in magnitude for men, the consequences remain considerable for adolescent girls and women in their early reproductive years. Our study points to a double burden of violence on longevity: not only does violence shorten individual lives, it also makes the length of life less predictable in a population.
10.12.2022: New publication
Cross-sectional estimates of population health from the survey of health and retirement in Europe (SHARE) are biased due to health-related sample attrition
Muszyńska-Spielauer, Magdalena; Spielauer, Martin
SSM—Population Health. 2022 Nov 17; 20: 101290
Abstract: Cross-sectional data from the Survey of Health, Ageing and Retirement in Europe (SHARE) are a common source of information in comparative studies of population health in Europe. In the largest part, these data are based on longitudinal samples, which are subject to health-specific attrition. This implies that estimates of population health based on cross-sectional SHARE datasets are biased as the data are selected on the outcome variable of interest. We examine whether cross-sectional datasets are selected based on health status. We compare estimates of the prevalence of full health, healthy life years at age 50 (HLY), and rankings of 18 European countries by HLY based on the observed, cross-sectional SHARE wave 7 datasets and full samples. The full samples consist of SHARE observed and attrited respondents, whose health trajectories are imputed by microsimulation. Health status is operationalized across the global index of limitations in activities of daily living (GALI). HLY stands for life expectancy free of activity limitations. Cross-sectional datasets are selected based on health status, as health limitations increase the odds of attrition from the panel in older age groups and reduce them in younger ones. In older age groups, the prevalence of full health is higher in the observed cross-sectional data than in the full sample in most countries. In most countries, HLY is overestimated based on the cross-sectional data, and in some countries, the opposite effect is observed. While, due to the small sample sizes of national surveys, the confidence intervals are large, the direction of the effect is persistent across countries. We also observe shifts in the ranking of countries according to HLYs of the observed data versus the HLYs of the full sample. We conclude that estimates on population health based on cross-sectional datasets from longitudinal, attrited SHARE samples are over-optimistic.
30.11.2022: New publication
Trends in Activity Limitations From an International Perspective: Differential Changes Between Age Groups Across 30 Countries
Beller, Johannes; Luy, Marc; Giarelli, Guido; Regidor, Enrique; Lostao, Lourdes; Tetzlaff, Juliane; Geyer, Siegfried
Journal of Aging and Health. 2022 Nov 25; doi: 10.1177/08982643221141123
Abstract: Objectives: Examine trends in limitations among young (15–39), middle-aged (40–64) and older age-groups (>=65) and their socioeconomic differences. Methods: Population-based European Social Survey data (N = 396,853) were used, covering 30 mostly European countries and spanning the time-period 2002–2018. Limitations were measured using a global activity limitations indicator. Results: Age-differential trends in limitations were found. Activity limitations generally decreased in older adults, whereas trends varied among younger and middle-aged participants, with decreasing limitations in some countries but increasing limitations in others. These age-differential trends were replicated across limitation severity and socioeconomic groups; however, stronger limitation increases occurred regarding less-severe limitations. Discussion: Functional health has improved in older adults. Contrarily, the increasing limitations in younger and middle-aged individuals seem concerning, which were mostly observed in Western and Northern European countries. Given its public health importance, future studies should investigate the reasons for this declining functional health in the young and middle-aged.
16.09.2022: New publication
Estimating Trends in Working Life Expectancy based on Health Insurance Data from Germany – Challenges and Advantages
Tetzlaff, Juliane; Luy, Marc; Epping, Jelena; Geyer, Siegfried; Beller, Johannes; Stahmeyer, Jona Theodor; Sperlich, Stefanie; Tetzlaff, Fabian
SSM—Population Health. 2022 Aug 22; 19: 101215
Abstract: Against the backdrop of population aging and growing strain on pension systems, monitoring the development of Working Life Expectancy (WLE) is vital to assess whether the policies taken are effective. This is the first study investigating time trends and educational inequalities in WLE based on German health insurance data. The analyses are based on the data of the AOK Lower Saxony (N = 3,347,912) covering three time periods (2006-08, 2011-13, and 2016-18). WLE is defined as years spent in the labor force (i.e. in employment and unemployment) and was calculated for each age between 18 and 69 years for the three periods to depict changes over time using multistate life table analysis. Educational inequalities in 2011-13 are reported for two educational levels (8–11 years and 12–13 years of schooling). WLE increased in both sexes with increases being stronger among women. This holds irrespective of whether WLE at age 18 (35.8–38.3 years in men, 27.5–34.0 years in women) or the older working-age (e.g. at age 50 10.2–11.7 years in men, 7.8–10.5 years in men) is considered. Among women at all ages and men from their mid-20s onwards, WLE was higher among higher-educated individuals. Inequalities were most pronounced among women (e.g. Δ3.1 years in women, Δ1.3 years in men at age 50). The study supports previous research indicating that measures to extend working life are effective, but that noticeable inequalities in WLE exist. Health insurance data represent a valuable source for such research that has so far remained untapped. The data provide a suitable basis to investigate trends and inequalities in WLE. Future research should build on the strengths of the data by broadening the research towards a more comprehensive analysis of the development of WLE from a health perspective.
22.08.2022: New publication
Rating Health and Rating Change: How Canadians Rate Their Health and Its Changes
Lazarevič, Patrick; Quesnel-Vallée, Amélie
Journal of Aging and Health. 2022 Aug 22; doi: 10.1177/08982643221119654
Abstract: Objectives: We investigated the contribution of five health domains to self-rated health (SRH) cross-sectionally and longitudinally and whether these contributions differ by gender or age. Methods: Employing dominance analyses, we quantified the contributions of functioning, diseases, pain, mental health, and behavior to both SRH at a point in time and for changes in SRH using data from the Canadian National Population Health Survey (NPHS, 1994–2011). Results: Cross-sectionally and longitudinally, functioning was the most important health domain, followed by diseases and pain. There were no meaningful differences in the ranking by gender while functioning, diseases, and pain were more relevant in older cohorts. Discussion: Functioning, diseases, and pain systematically were the most important health domains in both cross-sectional and longitudinal analyses. While these results held for women and men, they were more salient for older adults. This points to a gender-invariant but age-graded process, confirming previous research with European data.
08.08.2022: New publication
Well-being adjusted health expectancy: a new summary measure of population health
Muszyńska-Spielauer, Magdalena; Luy, Marc
European Journal of Population. 2022 Aug 08; 38: 1009-1031
Abstract: We propose a new summary measure of population health (SMPH), the well-being-adjusted health expectancy (WAHE). WAHE belongs to a subgroup of health-adjusted life expectancy indicators and gives the number of life years equivalent to full health. WAHE combines health and mortality information into a single indicator with weights that quantify the reduction in well-being associated with decreased health. WAHE's advantage over other SMPHs lies in its ability to differentiate between the consequences of health limitations at various levels of severity and its transparent, simple valuation function. Following the guidelines of a Committee on Summary Measures of Population Health, we discuss WAHE's validity, universality, feasibility sensitivity and ensure its reproducibility. We evaluate WAHE's performance compared to life expectancy, the most commonly used indicators of health expectancy (HE) and disability-adjusted life expectancy (DALE) in an empirical application for 29 European countries. Data on health and well-being are taken from the 2018 EU-SILC, and the life tables are from Eurostat. DALE is taken from the database of the Global Burden of Disease Programme. WAHE's sensitivity to univariate and multivariate state specifications is studied using the three Minimum European Health Module health dimensions: chronic morbidity, limitations in activities of daily living, and self-rated health. The empirical tests of the indicators’ correspondence reveal that WAHE has the strongest correlation with the other SMPHs. Moreover, WAHE estimates are in agreement with all other SMPHs. Additionally, WAHE and all other SMPHs form a group of reliable indicators for studying population health in European countries. Finally, WAHE estimates are robust, regardless of whether health is defined across one or multiple simultaneous dimensions of health. We conclude that WAHE is a useful and reliable indicator of population health and performs at least as well as other commonly used SMPHs.
05.04.2022: New publication
The impact of COVID-19 vaccines on the Case Fatality Rate: The importance of monitoring breakthrough infections
Di Lego, Vanesssa; Sánchez-Romero, Romero; Prskawetz, Alexia
International Journal of Infectious Diseases. 2022 April 5; 119: 178-183
Abstract: Objectives: This study aimed to test the behavior of the case fatality rate (CFR) in a mixed population of vaccinated and unvaccinated individuals by illustrating the role of both the effectiveness of vaccines in preventing deaths and the detection of infections among both the vaccinated (breakthrough infections) and unvaccinated individuals. Methods: We simulated three hypothetical CFR scenarios that resulted from a different combination of vaccine effectiveness in preventing deaths and the efforts in detecting infections among both the vaccinated and unvaccinated individuals. Results: In the presence of vaccines, the CFR depends not only on the effectiveness of vaccines in preventing deaths but also on the detection of breakthrough infections. As a result, a decline in the CFR may not imply that vaccines are effective in reducing deaths. Likewise, a constant CFR can still mean that vaccines are effective in reducing deaths. Conclusions: Unless vaccinated people are also tested for COVID-19 infection, the CFR loses its meaning in tracking the pandemic. This shows that unless efforts are directed at detecting breakthrough infections, it is hard to disentangle the effect of vaccines in reducing deaths from the probability of detecting infections on the CFR.
11.02.2022: New Publication
The gender gap in life expectancy in urban and rural China, 2013-2018
Wu, Jinjing; KC, Samir; Luy, Marc
Frontiers in Public Health. 2022 Feb 11; 10: 749238
Abstract: Gender differences in mortality are embedded within mortality transitions. Rural residents generally lag behind their urban counterparts in the transitions. The study objective is to identify major causes of death that drive gender differences in mortality in urban and rural China. We use age-, gender-, urban-rural- and cause-specific mortality data (2013–2018) derived from the national mortality surveillance system that covered about 24% of the Chinese population. We apply Arriaga's method to decompose age- and cause-specific contributions to the gender gap in life expectancy at birth. Analyses are stratified by urban-rural residence. We find that women had a higher life expectancy at birth than men in both urban and rural areas. Cancers, cardiovascular disease, external causes, and respiratory disease accounted for more than 90% of the gender gap in both areas during 2013–2018. In urban areas, the gender gap decreased from 5.17 years in 2013–2015 to 4.98 years in 2016–2018. In rural areas, the gender gap stayed rather constant (2013–2015: 5.68 years; 2016–2018: 5.65 years). Traffic accidents, among external causes, contributed the most to decreasing the gender gap (urban: −0.07 years; rural: −0.10 years), especially in the 0–44 age group. However, the decrease in the gender gap was counteracted by an increase in the gender gap attributable to ischemic heart disease (urban: +0.05 years; rural: +0.08 years) and lung cancer (urban: +0.02 years; rural: +0.05 years) in older age groups. The gender gap attributable either to cerebrovascular disease or to chronic lower respiratory disease decreased in urban areas but increased in rural areas. We conclude that the urban-rural variations in the cause-specific contributions to the gender gap in China suggest the necessity of implementing urban-rural-specific interventions to improve population health and health equity.
20.12.2021: New Publication
Decrease in life expectancy in Germany in 2020: men from eastern Germany most affected
Luy, Marc; Sauerberg, Markus; Muszynska-Spielauer, Magdalena; di Lego, Vanessa
Comparative Population Studies. 2021 Dec 20; 46: 555-574
Abstract: The COVID-19 pandemic caused an increase in mortality in 2020 with a resultant decrease in life expectancy in most countries around the world. In Germany, the reduction in life expectancy at birth between 2019 and 2020 was comparatively small, at -0.20 years. The decrease was stronger among men than among women (-0.24 vs. -0.13 years) and in eastern rather than in western Germany (-0.36 vs. -0.16 years). Men in eastern Germany experienced the biggest decline in life expectancy at birth (-0.41 years). For western German men, the decline was less pronounced (-0.19 years). Among women, the decline in life expectancy at birth was also greater in eastern (-0.25 years) than in western Germany (-0.10 years). As a result of these developments, the differences in life expectancy between the two parts of Germany, and between women and men, increased compared with the previous year. Life expectancy at age 65 decreased more strongly than life expectancy at birth for both sexes and in all regions. This reflects the fact that it was mainly older age groups that were affected by the increase in mortality in 2020. This paper provides further insights into mortality changes in 2020, based on age decomposition and an analysis of lifespan inequality. We conclude that the population in eastern Germany was hit harder by the COVID-19 pandemic in 2020 than the population in the western Germany.
02.11.2021: New Publication
The male-female health-mortality paradox: research report of the ERC project HEMOX
Luy, Marc (ed.)
VID Research Reports. 2021 Nov 2; Volume 40
This book includes a collections of articles about health and longevity of Catholic order members that were produced for the ERC project HEMOX ("The male-female health-mortality paradox"). It includes the following chapters:
- The HEMOX Project: objectives, implementation and outcomes (M. Luy)
- Die Zeit vor dem Ordensleben [The time before religious life] (D. Krivanek & A. Wiedemann)
- Differences between older Catholic order members and their peers in the general population: an exploration of potential psychosocial selection effects (C.E. Bowen)
- The health of Catholic order members: a comparison with the general population (C. Wegner-Siegmundt & M. Luy)
- The cross-sectional association between health and mortality: insights from the Cloister Study (M. Luy)
- The biological component in sex differences in various facets of health (A. Wiedemann)
- A frailty index to explore ageing in the monastic population (P. Di Giulio)
- Overall level and gender differences in depressive symptoms among older Catholic order members and their peers in the general population (C.E. Bowen)
- Direct effect of education on mortality: insights from the Cloister Study (M. Luy, C. Wegner-Siegmundt & P. Di Giulio)
09.06.2021: New Publication
Gender disparities in health at older ages and their consequences for well being in Latin America and the Caribbean
Nepomuceno, Marília R.; di Lego, Vanessa; Turra, Cássio M.
Vienna Yearbook of Population Research. 2021 Jun 05; 10.1553/populationyearbook2021.res2.1
Abstract: Women live longer but can expect to spend more years in poorer health compared to men. In the context of population aging and declining gender ratios at older ages, there are increasing concerns about how this disadvantage in female health will affect well-being and sustainability, particularly in developing regions that are rapidly aging. Our study compares differences in health expectancies at older ages for men and women in order to assess gender disparities in health. We use data from the Survey on Health, Well-Being, and Aging in Latin America and the Caribbean to decompose the gender gap into total and age-specific mortality and disability effects in seven cities in the region. Our results show that at older ages, higher disability rates among women reduced the gender gap in healthy life expectancy by offsetting women’s mortality advantage. In addition, we find that women’s mortality advantage decreased almost systematically with age, which reduced the contribution of the mortality effect to the gender gap at older ages. Although the gender gap in health followed a similar pattern across the region, its decomposition into mortality and disability effects reveals that there was substantial variation among cities. Thus, across the region, the implications of the gender gap in health for well-being vary, and the policies aimed at reducing this gap should also differ.
30.05.2021: New Publication
Das Mortalitätsgeschehen während der COVID-19-Pandemie in Deutschland und anderen europäischen Ländern
Sauerberg, Markus
Post-Pandemic Populations: Die soziodemografischen Folgen der COVID-19-Pandemie in Deutschland. 2021 May 16, pp. 14-19
This paper gives a short overview about excess mortality due to COVID-19 in Germany and other European countries.
01.05.2021: PhD to Markus Sauerberg
Markus Sauerberg successfully defended his PhD thesis at Vienna University of Economics and Business. CONGRATULATIONS from the whole DELAG team!!!
30.03.2021: New Publication
Testing and measuring the life expectancy of Roma and Travellers
Luy, Marc
Roma and Travellers in six countries. Technical Report. 2021 Mar 30; 10.2811/106484, pp. 114-139
Abstract: Several studies suggest that the population of Roma and Travellers is severely disadvantaged in health and mortality. According to the most widely cited and generally accepted data from the Council of Europe, life expectancy (LE) of this subgroup is between 10 and 15 years lower than that of the general population. However, all existing reports about levels and trends of Roma and Travellers' LE are substantially limited in the comprehensiveness and quality of the available data. As a consequence, it is not clear whether the disadvantage in the number of life years is actually that high. The aim of the present work is therefore to provide additional estimates derived by a different approach and for subpopulations of Roma and Travellers for which no such estimates exist so far. For this purpose, the European Union Agency for Fundamental Human Rights (FRA) included particular questions to the 2019 Roma and Travellers Survey (RTS 2019) which allow the application of a specific indirect approach to estimate LE on the basis of proportions of still living mothers and fathers, the so-called "Orphanhood Method" (OM). The data turned out to be a reliable basis for applying the OM. The results confirm previous estimates regarding the extent of differences in LE between Roma and Travellers and the total national populations. In line with previous reports, the estimated extent of Roma and Travellers' disadvantage varies between countries. For 2016, the estimated differences in LE at birth to the total national populations lies between 7.1 years for female Gypsies and Travellers in the United Kingdom and 14.2 years for male Roma and Caravan Dwellers in Belgium.
28.01.2021: New Publication
An indirect method to monitor the fraction of people ever infected with COVID-19
Sánchez-Romero, Miguel; di Lego, Vanessa; Prskawetz, Alexia; Queiroz, Bernardo L.
PLOS ONE. 28 Jan 2021; 16: 1
Abstract: The number of COVID-19 infections is key for accurately monitoring the pandemics. However, due to differential testing policies, asymptomatic individuals and limited large-scale testing availability, it is challenging to detect all cases. Seroprevalence studies aim to address this gap by retrospectively assessing the number of infections, but they can be expensive and time-intensive, limiting their use to specific population subgroups. In this paper, we propose a complementary approach that combines estimated (1) infection fatality rates (IFR) using a Bayesian melding SEIR model with (2) reported case-fatality rates (CFR) in order to indirectly estimate the fraction of people ever infected (from the total population) and detected (from the ever infected). We apply the technique to the U.S. due to their remarkable regional diversity and because they count with almost a quarter of all global confirmed cases and deaths. We obtain that the IFR varies from 1.25% (0.39–2.16%, 90% CI) in Florida, the most aged population, to 0.69% in Utah (0.21–1.30%, 90% CI), the youngest population. By September 8, 2020, we estimate that at least five states have already a fraction of people ever infected between 10% and 20% (New Jersey, New York, Massachussets, Connecticut, and District of Columbia). The state with the highest estimated fraction of people ever infected is New Jersey with 17.3% (10.0, 55.8, 90% CI). Moreover, our results indicate that with a probability of 90 percent the fraction of detected people among the ever infected since the beginning of the epidemic has been less than 50% in 15 out of the 20 states analyzed in this paper. Our approach can be a valuable tool that complements seroprevalence studies and indicates how efficient have testing policies been since the beginning of the outbreak.
12.11.2020: New Publication
The Role of Education for Assessing Population Health: An Analysis of Healthy Life Expectancy by Educational Attainment for 16 European Countries
Sauerberg, Markus
Vienna Institute of Demography Working Papers. 2020 Nov 12; VID-WP 05/2020
Abstract: Healthy life expectancy (HLE) is a prominent summary indicator for evaluating and comparing the levels of population health status across Europe. Variations in HLE, however, do not necessarily reflect underlying differences in health and mortality levels among countries and are particularly sensitive when broken down by population subgroups. For instance, despite European countries showing large HLE inequalities by educational level, these countries are also highly heterogenous regarding their educational population composition, which most likely affects their HLE levels. We demonstrate how this compositional effect shapes HLE levels by providing HLE estimates of educational attainment and gender for 16 European countries using the Sullivan method. We use prevalence data about activities of daily living (ADLs) limitations from the European Union Statistics on Income and Living Conditions (EU-SILC) and mortality data from the Eurostat database. We then quantify the magnitude of educational inequalities based on the composite inequality index (CII). Finally, we express total HLE as the sum of education-specific HLEs, weighted by the educational population structure. As expected, we find large educational inequalities in HLE, with men’s CII ranging from about 8.5 years in Portugal to approximately 3 years in Romania. For women, educational inequalities are slightly smaller. The decomposition reveals the population structure’s strong effects on HLE, which can elicit misleading conclusions about people’s health status and potentially turn HLE into an improper measure of educational differences as opposed to a measure of health gaps. For example, low-, medium-, and highly educated individuals in Portugal show more healthy life years than their counterparts in Poland. Still, Poland’s total HLE value slightly exceeds that of Portugal, indicating favorable health and mortality conditions in Poland. However, Poland’s greater relative number of highly educated individuals in its population is responsible for producing this higher total HLE value. We conclude that education is not only paramount for assessing health inequalities across European countries, but also the population composition by educational attainment, because it drives the differences in HLE levels.
01.09.2020: New DELAG team member
The Research Group "Health and Longevity" of the Vienna Institute of Demography welcomes our new team member Magdalena M. Muszynska-Spielauer (see DELAG Team). Magdalena is a demographer with an economic background. She holds a Ph.D. from the Warsaw School of Economics, studied and worked at the Max Planck Institute for Demographic Research and Duke University. She will work primary on the LETHE project (see Projects).
31.08.2020: New Publication
The cross-sectional average length of healthy life (HCAL): a measure that summarizes the history of cohort health and mortality
Sauerberg, Markus; Guillot, Michel; Luy, Marc
Population Health Metrics. 31 Aug 2020; 18: 21
Abstract: Healthy life years have superseded life expectancy (LE) as the most important indicator for population health. The most common approach to separate the total number of life years into those spent in good and poor health is the Sullivan method which incorporates the health dimension to the classic period life table, thus transforming the LE indicator into the health expectancy (HE) indicator. However, life years derived from a period life table and health prevalence derived from survey data are based on different conceptual frameworks. Method: We modify the Sullivan method by combining the health prevalence data with the conceptually better fitting cross-sectional average length of life (CAL). We refer to this alternative HE indicator as the “cross-sectional average length of healthy life” (HCAL). We compare results from this alternative indicator with the conventional Sullivan approach for nine European countries. The analyses are based on EU-SILC data in three empirical applications, including the absolute and relative level of healthy life years, changes between 2008 and 2014, and the extent of the gender gap. Results: HCAL and conventional HE differ in each of these empirical applications. In general, HCAL provides larger gains in healthy life years in recent years, but at the same time greater declines in the proportion of healthy life years. Regarding the gender gap, HCAL provides a more favourable picture for women compared to conventional HE. Nonetheless, the extent of these differences between the indicators is only of minor extent. Conclusions: Albeit the differences between HE and HCAL are small, we found some empirical examples in which the two indicators led to different conclusions. It is important to note, however, that the measurement of health and the data quality are much more important for the healthy life years indicator than the choice of the variant of the Sullivan method. Nonetheless, we suggest to use HCAL in addition to HE whenever possible because it widens the spectrum of empirical analyses and serves for verification of results based on the highly sensitive HE indicator.
26.05.2020: New Publication
Understanding the cross-sectional association between life expectancy and healthy life years: the CroHaM hypothesis
Luy, Marc
Vienna Institute of Demography Working Papers. 2020 Mar 26; VID-WP 03/2020
Abstract: A central question of interdisciplinary health research is whether the life years gained through increasing life expectancy are primarily spent in good or poor health. Two opposing models have been proposed: "expansion of morbidity" and "compression of morbidity". Existing research based on longitudinal data and time series has supported both approaches, depending on the particular dimension of health under consideration. In this paper we hypothesize that the longitudinal health dimension-specific expansion and compression effects exist equivalently in the cross-sectional association between health and mortality (CroHaM), affecting differences in the number of healthy life years between populations and subpopulations with different levels of life expectancy. The CroHaM hypothesis roots in the observation that most health differentials within and between populations are caused primarily by social factors and it builds on Link and Phelan's "theory of fundamental social causes". We present empirical support for the hypothesis by analyzing the relationship between life expectancy and healthy life years on the basis of different health dimensions for a sample of female and male Catholic order members and their counterparts in the general populations of Germany and Austria. Finally, we outline that the CroHaM hypothesis may also contribute to a better understanding of differences in life years spent in good or poor health and make suggestions for further testing of the CroHaM hypothesis.
21.03.2020: New Publication
Gender differences in healthy and unhealthy life expectancy
Di Lego, Vanessa; Di Giulio, Paola; Luy, Marc
International Handbook of Health Expectancies. 2020 Mar 19; 10.1007/978-3-030-37668-0_11
Abstract: There is consistent evidence that women live longer than men at all ages, but spend a higher proportion of their total life expectancy in poorer health, a phenomenon described as the "male-female health-survival paradox" or the "gender paradox in health and mortality". However, it is difficult to explain the process because morbidity by sex differs considerably across domains of health, age groups, social contexts and severity level. In addition, women and men report differently their health in surveys, making it cumbersome to understand whether what drives the paradox is a higher female morbidity or male mortality, a different reporting behaviour, or all of those aspects together. The aim of this chapter is to demonstrate the magnitude of those differences in Europe using different health domain indicators (activity limitation, chronic morbidity and self-perceived health) from the EHEMU Information System and the reporting behaviour by sex from the SHARE survey vignettes.
22.02.2020: New Publication
The gender health gap in Europe's ageing societies: universal findings across countries and age groups?
Schmitz, Alina; Lazarevič, Patrick
European Journal of Ageing. 2020 Feb 17; 10.1007/s10433-020-00559-6
Abstract: We provide a systematic country and age group comparison of the gender gap in several generic health indicators and more specific morbidity outcomes. Using data from the Survey of Health, Ageing and Retirement (SHARE), we examined the gender gap in the prevalence of poor self-rated health, chronic health conditions, activity limitations, multimorbidity, pain, heart attacks, diabetes, and depression in three age groups (50-64, 65-79, and 80+) based on linear probability models with and without adjustment for covariates. While women were typically disadvantaged regarding poor self-rated health, chronic health conditions, activity limitations, multimorbidity, pain, and depression, men had a higher prevalence of heart attacks and diabetes. However, the gender gap's magnitude and sometimes even its direction varied considerably with some age trends apparent. Regarding some health indicators, the gender gap tended to be higher in Southern and Eastern Europe than in Western and Northern Europe. All in all, the presence of a gender health gap cannot be regarded as a universal finding as the gap tended to widen, narrow or even reverse with age depending on the indicator and country.
04.12.2019: New Publication
Bedeutung des Gesundheitsindikators bei der Analyse der Gesundheitsfolgen informeller Pflege. Anderer Indikator, anderes Ergebnis?
[Importance of health indicators in the analysis of health effects on informal caregivers. Different indicator, different result?]
Kaschowitz, Judith; Lazarevič, Patrick
Zeitschrift für Gerontologie und Geriatrie. 2019 Dec 04; 53: 10–16;
Abstract: Background: Analysis of the health of informal caregivers is gaining in importance. Research has shown negative effects of caregiving on mental health but the results regarding physical health were ambiguous. It remains unclear whether this can be traced back to the use of different health indicators. Objective: Do the results on the relationship between informal caregiving and health vary depending on the care setting (domestic or external) and the outcome measure? Material and methods: The relationship between informal caregiving inside and outside the domestic setting and the health of the caregiver was modelled using data from the Survey of Health, Ageing and Retirement in Europe (SHARE, waves 1, 2, 4–6). The direction and strength of the relationship between informal caregiving and eight indicators of physical and mental health were compared both cross-sectionally and longitudinally. Results: For most health indicators and in the cross-sectional as well as longitudinal models, negative health effects could be observed. While caregivers in the domestic setting reported worse health than non-caregivers, the opposite was true for caregivers outside the household. The longitudinal model revealed that both negative and positive health changes during informal caregiving were evident depending on the health indicator used. Conclusion: The results confirmed health differences between caregivers inside and caregivers outside the domestic setting. For caregivers outside the household different health outcomes of caregiving were found depending on the chosen health indicator. This underlines that the chosen health indicator as well as the care population under study substantially affect the results of the analysis and the subsequent conclusions.
01.12.2019: New Publication
Stalling of mortality in the United Kingdom and Europe: an analytical review of the evidence
Murphy, Michael; Luy, Marc; Torrisi, Orsola
Social Policy Working Paper 11-19, LSE Department of Social Policy. 2019 Nov 07
Abstract: Improvement in UK mortality rates has declined substantially in this decade and the overall value is now close to zero, a finding which has become politically controversial. A similar but less severe change has been observed in some neighbouring European countries, and the US has exhibited a longer term deterioration in mortality improvement. We review the literature and associated commentary on this phenomenon. These UK trends are observed across sex and age groups, but appear to be more marked in more deprived areas. We assess the hypotheses that have been put forward to explain these trends within a framework that distinguishes between short-term fluctuations and longer-term underlying trends; in particular, the role of seasonal influenza, changes in cardio-vascular disease mortality, Government austerity measures and tempo effects. We conclude that that there is no clear evidence for any specific explanation or combination of causes and that additional studies, especially those including cross-national comparisons are needed.
17.10.2019: New Publication
The male-female health-mortality paradox
Di Lego, Vanessa; Lazarevič, Patrick; Luy, Marc
Encyclopedia of Gerontology and Population Aging. 2019 Oct 17; 10.1007/978-3-319-69892-2_798-2
Abstract: The differences in life expectancy between women and men remained more or less constant until the first half of the twentieth century, with a female advantage of around 2–3 years, and started to increase thereafter. This increase of the gap coincided with a rise among men in cardiovascular diseases, cancer, and accidents and a fall in maternal mortality and in causes of death related to pregnancy among women. Since the beginning of the 1980s, the gap between women and men in overall life expectancy has been slowly narrowing in the developed world. In light of this universal observable male excess mortality, it is surprising that studies on gender differences in morbidity report that women are in worse health than men and that women spend a higher proportion of their total life expectancy in poor health and with limitations. Researchers have most commonly addressed this paradox by focusing either on male excess mortality or on female excess morbidity. Another complementary approach has been to attribute at least a part of the paradox to methodological artifacts that arise due to the survey framework and the behavior dynamics between respondents and interviewers. This encyclopedia entry summarizes all these issues and provides corresponding empirical evidence.
23.09.2019: New Publication
Was misst Self-Rated Health? Die Basis subjektiver Gesundheit und Unterschiede nach Geschlecht, Alter und Kohorte in Europa und Kanada
Lazarevič, Patrick
Springer VS. 2019 Nov 27; 10.1007/978-3-658-28026-0
Abstract: Die Definition und Messung von Gesundheit ist der analytische Dreh- und Angelpunkt vieler empirischer Studien. Aus pragmatischen Gründen ist es jedoch oft nicht möglich, umfassende Gesundheitsdaten zu erheben, weshalb häufig eine subjektive Bewertung der Befragten ("Self-Rated Health") verwendet wird. Doch inwieweit wird dabei aufgrund unterschiedlicher Erwartungen, Maßstäbe oder Erfahrungen derselbe Gesundheitsstatus unterschiedlich bewertet? Diese und andere Fragen stehen im Fokus dieser Arbeit. Dabei stellt sich z. B. heraus, dass es große Altersunterschiede darin gibt, welche Gesundheitsaspekte in welchem Ausmaß in die Bewertung eingehen.
08.08.2019: New Publication
Life expectancy: frequently used, but hardly understood
Luy, Marc; Di Giulio, Paola; Di Lego, Vanessa; Lazarevič, Patrick; Sauerberg, Markus
Gerontology. 2019 Aug 08; 10.1159/000500955
Abstract: Period life expectancy is one of the most used summary indicators for the overall health of a population. Its levels and trends direct health policies, and researchers try to identify the determining risk factors to assess and forecast future developments. The use of period life expectancy is often based on the assumption that it directly reflects the mortality conditions of a certain year. Accordingly, the explanation for changes in life expectancy are typically sought in factors that have an immediate impact on current mortality conditions. It is frequently overlooked, however, that this indicator can also be affected by at least three kinds of effects, in particular in the situation of short-term fluctuations: cohort effects, heterogeneity effects, and tempo effects. We demonstrate their possible impact with the example of the almost Europe-wide decrease in life expectancy in 2015, which caused a series of reports about an upsurge of a health crisis, and we show that the consideration of these effects can lead to different conclusions. Therefore, we want to raise an awareness concerning the sensitivity of life expectancy to sudden changes and the menaces a misled interpretation of this indicator can cause.
30.05.2019: REVES Poster Award for Patrick Lazarevič
Congratulations! Patrick Lazarevič received the REVES Poster Award for his poster "A New Short Generic Measure of Health: Is the Minimum European Health Module an Option?"
10.05.2019: PhD to Patrick Lazarevič
Patrick Lazarevic successfully defended his PhD thesis at TU Dortmund today. CONGRATULATIONS from the whole DELAG team!!!
08.03.2019: New Publication
The impact of increasing education levels on rising life expectancy: a decomposition analysis for Italy, Denmark, and the USA
Luy, Marc; Zannella, Marina; Wegner-Siegmundt, Christian; Minagawa, Yuka; Lutz, Wolfgang; Caselli, Graziella
Genus. 2019 Mar 07; 75: 11; 10.1186/s41118-019-0055-0
Abstract: Significant reductions in mortality are reflected in strong increases in life expectancy particularly in industrialized countries. Previous analyses relate these improvements primarily to medical innovations and advances in health-related behaviors. Mostly ignored, however, is the question to what extent the gains in life expectancy are related to structural changes in the populations due to increasing education levels. We decompose changes of the total populations’ life expectancy at age 30 in Italy, Denmark, and the United States, over the 20-year period between 1990 and 2010 into the effects of education-specific mortality changes ("M effect") and changes in the populations' educational structure ("P effect"). We use the "replacement decomposition technique" to further subdivide the M effect into the contributions by the individual education groups. While most of the increases in life expectancy are due to the effect of changing mortality, a large proportion of improvements in longevity can indeed be attributed to the changing structure of the population by level of education in all three countries. The estimated contribution of the P effect ranges from around 15 percent for men in the United States to approximately 40 percent for women in Denmark. This study demonstrates strong associations between education and overall population health, suggesting that education policies can also be seen as indirect health policies.
04.02.2019: New Publication
Socioeconomic disparity in adult mortality in India: estimations using the orphanhood method
Saikia, Nandita; Bora, Jayanta Kumar; Luy, Marc
Genus. 2019 Feb 04; 75: 7; 10.1186/s41118-019-0054-1
Abstract: Due to a lack of data, no study has yet documented differences in adult life expectancy in India by education, caste, and religion. Our objective was therefore to examine disparities in socioeconomic status (SES) in the adult mortality rate (40q30) and life expectancy at age 15 (e15) in India. We estimated adult mortality by SES with the orphanhood method to analyze information related to the survival of respondents’ parents. We used data from the India Human Development Survey 2011–2012. SES was measured by education, caste, religion, and income of the either deceased adults or their offspring. A consistency analysis between orphanhood estimates and official statistics confirmed the robustness of the estimates. Mortality is higher among adults who are illiterate, belong to deprived castes or tribes, have children with a low level of education, and have a low level of household income. The adult mortality rate varies marginally by religion in India. Life expectancy at 15 (e15) is about 3.50 and 5.7 years shorter for illiterate men and women, respectively, compared with literate men and women. The parameter e15 also varies significantly by educational attainment of offspring. On average, parents of children educated to higher secondary level (and above) gain an extra 3.8–4.6 years of adult life compared to parents of illiterate children. Disparity in e15 by caste and religion is smaller than disparity by education or income. These findings reveal that the adult mortality burden falls disproportionately on illiterate adults and adults with less educated offspring. Thus, educational disparity in adult mortality appears to be prominent in Indian context. In the absence of adult mortality statistics by SES in India, we recommend that large-scale surveys should continue collecting data to allow indirect techniques to be applied to estimate mortality and life expectancy in the country
05.12.2018: New Publication
Immediate versus delayed detection of Takotsubo syndrome after epileptic seizures
Stöllberger, Claudia; Sauerberg, Markus; Finsterer, Josef
Journal of the Neurological Sciences. 2019 Feb 15; 397: 42-47
Abstract: Takotsubo syndrome (TTS) is often preceded by emotional or physical stress. Epileptic seizures are described in >100 cases. It is unknown whether patients with immediate and delayed detection of seizure-induced TTS differ. We screened the literature and compared clinical and electrocardiographic (ECG) findings. In 48 cases with seizure-associated TTS, the time between seizure and TTS-detection was reported. Troponin levels were elevated in 37/40. ECG abnormalities were negative T-waves (40%), ST-elevations (33%) and ventricular fibrillation/flutter (10%). Immediate detection was reported in 23 patients, in the remaining 25 patients, TTS was detected 5–288 h postictally. Patients did not differ in gender, age or symptoms. Negative T-waves were more frequent in patients with delayed detection (64 vs. 13%, p = .0009), whereas ECG-abnormalities suggesting acute myocardial infarction tended to be more prevalent in patients with immediate detection. Due to lack of typical symptoms, seizure-induced TTS can be overlooked. Postictally, an ECG should be recorded and troponin levels measured. New T-wave inversions might indicate seizure-induced TTS.
29.11.2018: New Publication
Soziale Unterschiede in der Lebenserwartung [Social differences in life expectancy]
Lampert, Thomas; Hoebel, Jens; Kroll, Lars Eric; Luy, Marc
Public Health Forum. 2018 Nov 28; 26(4): 325-327
Abstract: Social differences in mortality can be understood as an extreme form of social and health inequalities. The studies available for Germany prove that the average life expectancy at birth in the socially disadvantaged population groups is about 5–10 years lower than in the socially better-placed population groups. Furthermore, if only the life-time spent in good health is taken into account, the social differences are even greater. Similar social differences in life expectancy are reported for other European countries and also for the USA.
Zusammenfassung: Soziale Unterschiede in der Mortalität können als extreme Ausprägungsform sozialer und gesundheitlicher Ungleichheiten verstanden werden. Die für Deutschland vorliegenden Studien sprechen dafür, dass die mittlere Lebenserwartung bei Geburt in den sozial benachteiligten Bevölkerungsgruppen etwa 5–10 Jahre niedriger liegt als in den sozial besser gestellten Bevölkerungsgruppen. Wird nur die bei guter Gesundheit verbrachte Lebenszeit berücksichtigt, fallen die sozialen Unterschiede sogar noch größer aus. Für andere europäische Länder und auch die USA werden ähnlich ausgeprägte soziale Unterschiede in der Lebenserwartung berichtet.
31.05.2018: REVES Poster Award for Patrick Lazarevič
Congratulations! Patrick Lazarevič received the third prize of the REVES Poster Award for his poster "Self-rated health as a generic health measurement? Identifying the health information used and the role of gender, age, and country"
27.04.2018: PAA Poster Award for Markus Sauerberg and Marc Luy
Markus Sauerberg and Marc Luy received the PAA Poster Award for their poster "Decreasing Life Expectancy in the United States Between 2014 and 2015: Severe Health Crisis or Just Tempo Effects?"
01.04.2018: New DELAG team member
The Research Group "Health and Longevity" of the Vienna Institute of Demography welcomes our new team member Patrick Lazarevič (see DELAG Team). Patrick is sociologist and he started his Ph.D. project on methodological difficulties in the examination of age(ing) at the TU Dortmund University. He will continue this work inside the LETHE project (see Projects).
10.03.2018: Award for Vanessa Di Lego
Vanessa Di Lego et al.'s article "Mortality selection among adults in Brazil: The survival advantage of Air Force officers" was chosen by editors of the journal Demographic Research as one of the very best papers in Volume 37 of Demographic Research. Congratulations!!! [Link to Article]
01.02.2018: New DELAG team member
The Research Group "Health and Longevity" of the Vienna Institute of Demography welcomes our new team member Vanessa Di Lego (see DELAG Team). Vanessa completed her Ph.D. in demography at the Center for Development and Regional Planning (Cedeplar) in Brazil. Vanessa will work primarily inside the LETHE project (see Projects).
20.10.2017: New publication
Acute coronary syndrome in immigrants and non-immigrants. Results of an Austrian prospective pilot study
Gündüz, Duygu; Lejak, Anita; Wiedemann, Angela; Avanzi, Marion; Winkler, Walther-Benedikt; Ucar-Altenberger, Hadice; Stöllberger, Caludia; Weidinger, Franz
Wiener klinische Wochenschrift. 2017 Oct 20; 129(23-24): 900-905.
Abstract: There are indications that immigrant patients with acute coronary syndrome (ACS) differ in demographic characteristics and clinical presentation from non-immigrant patients. The aim of this prospective pilot study was to gather clinical and sociodemographic data from patients with ACS and to compare immigrants with non-immigrants. Included were consecutive patients who underwent acute coronary angiography in one cardiological department for ACS from September 2011 to September 2013. Information was gathered about age, sex, results of the coronary angiography, classical risk factors, socioeconomic characteristics as well as ethnicity. Patients who had their place of birth outside Austria were specified as immigrants. A total of 100 patients (29% female) with a mean age of 60 years (range 34–91 years) were included. Of the patients 35 (35%) were immigrants, 12 came from Serbia, 4 from Bosnia, 3 from South America, 2 from Germany, 2 from Turkey, 2 from the Czech Republic, 2 from Croatia, 2 from Macedonia, and 1 each from Bangladesh, Poland, Romania, Libya, Bulgaria and Pakistan. Immigrants tended to be younger on average (56 vs. 62 years, p = 0.04) and had a two or multivessel disease more often than the non-immigrants but this difference was not significant (51% vs. 38%, p = 0.29). There were no differences between non-immigrants and immigrants concerning the classical risk factors for ACS (hypercholesterinemia 60% vs. 69%, nicotine abuse 51% vs. 60%, hypertension 69% vs. 79%) except diabetes mellitus (15% vs. 37%, p = 0.02). Sociodemographic data showed differences in education and socioeconomic status (SES). Non-immigrants had jobs with high skill level more often than immigrants (30% vs. 4%, p = 0.02), although there was no difference between immigrants and non-immigrants in the level of high education (9% each); however, immigrants more often had low education (31% vs. 11%, p = 0.01) and a monthly income below 1000 € than non-immigrants (41% vs. 14%, p = 0.03). These results reveal that immigrants with ACS suffered more often from coronary two or multivessel disease and diabetes mellitus and were slightly younger than non-immigrants, although they did not differ regarding classical risk factors. Results suggest that the lower SES of immigrants compared with non-immigrants might contribute to the severity of coronary heart disease.
01.09.2017: Start of the ERC project LETHE / Beginn des ERC-Projekts LETHE
Today started our new research ERC project LETHE for the duration of 5 years (until August 2022). It’s main aim will be to better understand the measurement and estimation sensitivity of the "Health Expectancy" indicator (see Projects).
01.08.2017: New DELAG team member
The Research Group "Health and Longevity" of the Vienna Institute of Demography welcomes our new PhD student Markus Sauerberg (see DELAG Team). Markus studied demography at the University of Rostock and completed successfully the program of the European Doctoral School of Demography. His main tasks will be inside the LETHE project (see Projects)