Tag: "life expectancy"

Life Expectancy Drops First Time Since 1993

cdcThe Centers for Disease Control and Prevention (CDC), a federal agency, has reported the remarkable news that U.S. life expectancy has dropped for the first time since 1993. According to Mortality in the United States, 2015 (NCHS Data Brief No.  267, December 2016):

  • Life expectancy for the U.S. population in 2015 was 78.8 years, a decrease of 0.1 year from 2014.
  • The age-adjusted death rate increased 1.2% from 724.6 deaths per 100,000 standard population in 2014 to 733.1 in 2015.
  • The 10 leading causes of death in 2015 remained the same as in 2014. Age-adjusted death rates increased for eight leading causes and decreased for one.

The one death rate which improved was for cancer. So, we are “winning” that war, at least relatively speaking.

The entire decrease was for life expectancy at birth. Life expectancy at age 65 was unchanged from the previous year. In other words, children and working-age people are bearing the burden of this decline.

5 Myths about Cancer Care

PIC2In this month’s Health Affairs, leading health economists Dana P. Goldman and Tomas Philipson challenge five myths about cancer care. To the right we have an infographic that explains them very clearly.

The most economically interesting one is the fourth. This appears to challenge the notion that we should be skeptical about paying high prices for therapies that might buy only a short time of good life. (In health-economics, we use terms like Quality-Adjusted Life Year [QALY] and Disability-Adjusted Life Expectancy [DALE].)

The classic approach to these calculations was illustrated by Professor Christopher Conover in a recent article:

…[M]ost of the gains were concentrated in the 35-64 age group, which narrows the plausible range of what the average gain in life expectancy might be. Someone who is 60-64 is 7.3 times as likely to die in a given year as someone age 35-39. The reason this matters is that there are reasonably well-accepted rules of thumb about the value of what’s called a quality-adjusted life year (QALY).

Liberals in a Funk Because Inequality Doesn’t Seem to Matter

Five college students.Lane Kenworthy, a sociologist at the University of Arizona…finds no meaningful impact of inequality on growth one way or the other. “Income inequality isn’t the only thing that differed between these two periods,” he said.

Similarly, Mr. Kenworthy found no significant relationship between increasing inequality and life expectancy, infant mortality or college graduation rates, among others. Even when some patterns do mesh — teenage pregnancy rates fell a little more slowly in countries where the share of income going to the top 1 percent grew fastest — the relationship is weak. If you take the United States and Britain off the list, the relationship disappears.

Source: Eduardo Porter, The New York Times.

Health Inequality (Hint: It Doesn’t Have Very Much to Do With Medical Care)

Depending on where you live in Cook County, your prospects for reaching a ripe old age vary dramatically — from about 65 years in the poorest sections of Austin on Chicago’s West Side to 85 or so in parts of neighboring Belmont Cragin. Living a longer, healthier life goes with owning your home, having a college education and earning a high income…

1012898_221432048033850_1007320439_nHow long and how well you live have more to do with your ZIP code than with your DNA code — or your medical care. If you live in a neighborhood where the median household income is less than $25,000 a year, your life expectancy is about 14 years shorter than that of someone in a neighborhood where the median annual household income is more than $53,000…

We are co-chairs of the Robert Wood Johnson Foundation Commission to Build a Healthier America, which releases its report [today]…The commission’s recommendations for improving our nation’s health have little to do with the health care system. They highlight three priorities: expanding access to high-quality early childhood development services; revitalizing low-income neighborhoods; and broadening the mission of doctors, nurses and other health care providers to go beyond medical treatment and help address nonmedical factors affecting health.

Alice Rivlin and Mark McClellan in the Chicago Tribune.

The Last of Life, For Which the First Was Made?

This is from a NBER Working Paper by David Cutler, Kaushik Ghosh, and Mary Beth Landrum:

Hutils-5587035ealth status in the year or two just prior to death has been relatively constant over time; in contrast, health measured three or more years before death has improved measurably…We show that disability-free life expectancy is increasing over time, while disabled life expectancy is falling. For a typical person aged 65, life expectancy increased by 0.7 years between 1992 and 2005. Disability-free life expectancy increased by 1.6 years; disabled life expectancy fell by 0.9 years. The reduction in disabled life expectancy and increase in disability-free life expectancy is true for both genders and for non-whites as well as whites. Hence, morbidity is being compressed into the period just before death.

HT: Timothy Taylor.

Hits and Misses

The Value of Greater Life Expectancy

Smerete_anti_aging_techniquesGoldman and his colleagues estimate that delayed aging could increase life expectancy by an additional 2.2 years and generate more than $5 trillion in social value. When aging is delayed, say the authors, all fatal and disabling disease risks are also lowered. Although delayed aging would also greatly increase entitlement outlays, the researchers demonstrate that these costs can be managed through modest policy changes, such as indexing the eligibility ages for Social Security and Medicare.

Dana Goldman, David Cutler, etc., in Health Affairs.

More Evidence that Medical Care Improves Life?

A great deal of medical care is wasteful, we are told, because doctors do too much, patients want too much, and death comes anyway.

Yet, even if medical spending does not prolong life it may nevertheless do a lot to reduce the years that people spend disabled. Many people would consider money spent reducing disability money well spent.

Evidence for Significant Compression of Morbidity in the Elderly is a new NBER Working Paper by David M. Cutler, Kaushik Ghosh, and Mary Beth Landrum. Its authors report that although Americans over 65 have more diseases than they used to, disability “has been compressed into the period just before death.” Their results show that although life expectancy increased .7 years (from 17.5 to 18.2) between 1992 and 2005, disability free life expectancy increased 1.6 years (from 8.8 to 10.4).

Throughout the sample period, they find that the prevalence of major disease in the elderly was relatively constant. About 80 percent of the elderly had at least one major condition in the year before death. Many suffered from more than one. Heart disease afflicted about 38 percent of the elderly 12 months before death. Cancer, Alzheimer’s disease, pulmonary disease, heart attacks, and stroke each afflicted about 25 percent. Hip fracture rates afflicted about 9 percent, and Parkinson’s rates about 4 percent.

The increase in disability free life expectancy occurred despite the fact that the prevalence of chronic disabling conditions like Alzheimer’s and pulmonary disease increased. Though medicine may be able to alleviate the suffering of those with these conditions, the increase in disability free life expectancy may have resulted from progress in preventing heart disease, strokes, and hip fracture. The proportion of the elderly population affected by those acute conditions fell from about 40 percent of the population in 1991 to 30 percent in 2009.

The authors are agnostic about whether medical care has caused the improvement, noting that other unnamed “social and environmental factors” might be also be responsible for at least part of the trend.

Taking the Fun Out of Life

A recent Bloomberg article ranked the U.S. health care system 46 out of 48 in efficiency based in part on life expectancy statistics. But Matthew Yglesias at Slate explains that life expectancy is a poor measure of a health care system’s performance:

If we raised the taxes on alcohol and gasoline and then spent all the revenue on a pointless bridge in Alaska, American life expectancy would go up. Not because our health care system would become more efficient, but because fewer people would die in car wrecks and murders. And as it happens, raising those taxes would be a good idea. Fewer people would die in car wrecks and murders!

Is Equality the Right Public Policy Goal?

A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation examines research on health disparities in the United States:

Researchers Erika Cheng and David Kindig found that life expectancy varies from county to county by as much as ten years or more…

In [another] study, the country was divided into race-county units, and the researchers found that the life expectancy of one subgroup of black males, which the authors identified as high-risk urban black males, was more than 20 years shorter than Asian females’ life expectancy.

The brief then asks:

What are the policy implications? The brief discusses what policies can be put in place to ameliorate preventable disparities…

But this runs counter to the normal approach that has dominated health policy research for some time, which is also the economic approach: That is to ask how many additional years of life are produced by spending a dollar on various policy alternatives. The economist’s answer is: we should spend money on various programs until the extra years of life gained per dollar spent are the same across all policy options. When that happens, we are maximizing the years of life gained for a given budget. Alternatively we are minimizing the cost of the extra life expectancy we produce.

If we maximize years of life saved per dollar of expenditure, we may not get more equality. We may get more inequality. I think I can say with some confidence that we definitely would not get absolute equality.