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. 2021 Jul 6:10:e66590.
doi: 10.7554/eLife.66590.

Future life expectancy in Europe taking into account the impact of smoking, obesity, and alcohol

Fanny Janssen  1   2 , Anastasios Bardoutsos  2 , Shady El Gewily  2 , Joop De Beer  1
Affiliations

Future life expectancy in Europe taking into account the impact of smoking, obesity, and alcohol

Fanny Janssen et al. Elife. .

Abstract

Introduction: In Europe, women can expect to live on average 82 years and men 75 years. Forecasting how life expectancy will develop in the future is essential for society. Most forecasts rely on a mechanical extrapolation of past mortality trends, which leads to unreliable outcomes because of temporal fluctuations in the past trends due to lifestyle 'epidemics'. Methods: We project life expectancy for 18 European countries by taking into account the impact of smoking, obesity, and alcohol on mortality, and the mortality experiences of forerunner populations. Results: We project that life expectancy in these 18 countries will increase from, on average, 83.4 years for women and 78.3 years for men in 2014 to 92.8 years for women and 90.5 years for men in 2065. Compared to others (Lee-Carter, Eurostat, United Nations), we project higher future life expectancy values and more realistic differences between countries and sexes. Conclusions: Our results imply longer individual lifespans, and more elderly in society. Funding: Netherlands Organisation for Scientific Research (NWO) (grant no. 452-13-001).

Keywords: Europe; epidemiology; global health; health behaviours; human; humans; life expectancy; mortality; projection.

Plain language summary

On average, in Europe, men can currently expect to live till the age of 75 and women until they are 82. But what will their lifespans be in the next decades? Reliable answers to this question are essential to help governments plan for future health care and social security costs. While medical improvements are likely to further extend lifespans, lifestyle factors can result in temporal distortions of this trend. Yet, most estimates of future life expectancy fail to consider changing lifestyles, as they only use past mortality trends in their calculations. This can make these projections unreliable: for example, increases in smoking rates among Northern and Western European men led to stagnating male life expectancies in the 1950s and 1960s, but these picked up again after smoking declined. The same pattern is showing for women, except it is lagging as they took up smoking later than men. Based simply on the extrapolation of past mortality trends, current projection models fail to consider the past and predicted modifications of life expectancy trends prompted by changing rates of health behaviours – such as increases followed by (anticipated) declines in alcohol consumption and obesity rates, similar to what was observed with smoking. To produce a more reliable forecast, Janssen et al. incorporated trends in smoking, obesity, and alcohol use into life expectancy projections for 18 European countries. The predictions suggest that life expectancy for women in these countries will increase from 83.4 years in 2014 to 92.8 years in 2065. For men, it will also go up, from 78.3 to 90.5 years. In the future, this integrative approach may help to track the effects of health-behaviour related prevention policies on life expectancy, and allow scientists to account for changes caused by the COVID-19 pandemic. In the meantime, these estimates are higher than those obtained using more traditional methods; they suggest that communities should start to adjust to the possibility of longer individual lifespans, and of larger numbers of elderly people in society.

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Conflict of interest statement

FJ, AB, SE, JD No competing interests declared

Figures

Figure 1.
Figure 1.. Past and projected age-standardised lifestyle-attributable mortality fractions (LAMF) (20–84), 1990–2065, by sex, for 18 European countries.
Figure 1—figure supplement 1.
Figure 1—figure supplement 1.. Past and projected (=median) age-standardised lifestyle-attributable mortality fractions (20–84) (smoking, alcohol, obesity, combined), 1990–2065, by country, men.
Figure 1—figure supplement 2.
Figure 1—figure supplement 2.. Past and projected (=median) age-standardised lifestyle-attributable mortality fractions (20–84) (smoking, alcohol, obesity, combined), 1990–2065, by country, women.
Figure 2.
Figure 2.. Comparison of trends in observed life expectancy at birth (e0) ( = all-cause) with trends in e0 when the effects of smoking, obesity and/or alcohol are removed ( = non-smoking, non-obesity, non-alcohol, non-lifestyle combined), 1950–2014*, men.
*Based on the available information. Reproduced from various panels in Supplementary Figure 3a from Janssen et al., 2021, under the terms of a Creative Commons Attribution License (CC-BY 4.0; https://creativecommons.org/licenses/by/4.0/).
Figure 2—figure supplement 1.
Figure 2—figure supplement 1.. Comparison of trends in observed life expectancy at birth (e0) ( = all-cause) with trends in e0 when the effects of smoking, obesity and/or alcohol are removed ( = non-smoking, non-obesity, non-alcohol, non-lifestyle combined), 1950–2014*, women.
*Based on the available information. Reproduced from various panels in Supplementary Figure 3b from Janssen et al., 2021, under the terms of a Creative Commons Attribution License (CC-BY 4.0; https://creativecommons.org/licenses/by/4.0/).
Figure 3.
Figure 3.. Observed and projected life expectancy at birth (including 95% projection intervals) using our projection approach, which takes into account the impact of smoking, obesity, and alcohol on past and future mortality trends, and the mortality experiences of forerunner countries, 18 European countries, by country and sex, 1990–2065.
Figure 3—figure supplement 1.
Figure 3—figure supplement 1.. Comparison between countries of observed and projected life expectancy at birth, for our projection approach and the Lee–Carter extrapolation of all-cause mortality, 18 European countries, by sex, 1990–2065.
Figure 3—figure supplement 2.
Figure 3—figure supplement 2.. Observed and projected life expectancy at birth (e0), by country and sex, 1990–2065, for our projection approach, which takes into account the impact of smoking, obesity, and alcohol and the mortality experiences of forerunner countries, and for the Lee–Carter mortality projection applied to all-cause mortality.
Figure 3—figure supplement 3.
Figure 3—figure supplement 3.. Observed and individually projected life expectancy at birth (e0) for all-cause mortality, non-lifestyle-attributable mortality, and the combined projection of lifestyle- and non-lifestyle-attributable mortality, 18 European countries, by sex, 1990–2065.
Author response image 1.
Author response image 1.. Age-specific mortality pattern in 1990*, 2014*, and for different projections in 2065, by country, ages 0-130, men. * based on the adjusted rates up to 130 (because of zeros in the observed rates).
Author response image 2.
Author response image 2.. Age-specific mortality pattern in 1990*, 2014*, and for different projections in 2065, by country, ages 0-130, women. * based on the adjusted rates up to 130 (because of zeros in the observed rates).
See this image and copyright information in PMC

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