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. 2016 Jul 12:14:23.
doi: 10.1186/s12963-016-0092-2. eCollection 2016.

Future healthy life expectancy among older adults in the US: a forecast based on cohort smoking and obesity history

Bochen Cao  1
Affiliations

Future healthy life expectancy among older adults in the US: a forecast based on cohort smoking and obesity history

Bochen Cao. Popul Health Metr. .

Abstract

Background: In the past three decades, the elderly population in the United States experienced increase in life expectancy (LE) and disability-free life expectancy (LE(ND)), but decrease in life expectancy with disability (LE(D)). Smoking and obesity are two major risk factors that had negative impacts on these trends. While smoking prevalence continues to decline in recent decades, obesity prevalence has been growing and is currently at a high level. This study aims to forecast the healthy life expectancy for older adults aged 55 to 85 in the US from 2011 to 2040, in relation to their smoking and obesity history.

Methods: First, population-level mortality data from the Human Mortality Database (HMD) and individual-level disability data from the US National Health Interview Survey (NHIS) were used to estimate the transition rates between different health states from 1982 to 2010, using a multi-state life table (MSLT) model. Second, the estimated transition rates were fitted and projected up to 2040, using a modified Lee-Carter model that incorporates cohort smoking and obesity history from NHIS.

Results: Mortality and morbidity for both sexes will continue to decline in the next decades. Relative to 2010, men are expected to have 3.2 years gain in LE(ND) and 0.8 years loss in LE(D). For women, there will be 1.8 years gain in LE(ND) and 0.8 years loss in LE(D). By 2040, men and women are expected to spend respectively 80 % and 75 % of their remaining life expectancy between 55 and 85 disability-free.

Conclusions: Smoking and obesity have independent negative impacts on both the survival and disability of the US older population in the coming decades, and are responsible for the present and future gender disparity in mortality and morbidity. Overall, the US older population is expected to enjoy sustained health improvements and compression of disability, largely due to decline in smoking.

Keywords: Forecast; Healthy life expectancy; Lee-Carter model; Morbidity; Mortality; Multi-state life table; Obesity; Smoking.

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Figures

Fig. 1
Fig. 1
Smoking and obesity trends by birth cohorts
Fig. 2
Fig. 2
Ratios of observed transition rates over time (1982–2010) to observed rates in 1982
Fig. 3
Fig. 3
a Estimates and projections for k(t) from both the conventional and modified Lee-Carter model. b Estimates for a(x) from both the conventional and modified Lee-Carter model. c Estimates for b(x) from both the conventional and modified Lee-Carter model
Fig. 4
Fig. 4
Ratios of projected transition rates in 2040 to transition rates observed in 2010
Fig. 5
Fig. 5
Ratios of transition rates over time for the forecasting period (2010–2040) to observed rates in 2010
Fig. 6
Fig. 6
Observed and forecasted healthy life expectancy (LE and LEND) using different models
See this image and copyright information in PMC

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