International Differences in Mortality at Older Ages Dimensions and Sources (2010) / Chapter Skim
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3 Are International Differences in Health Similar to International Differences in Life Expectancy?--Eileen M. Crimmins, Krista Garcia, and Jung Ki Kim
3 Are International Differences in Health Similar to International Differences in Life Expectancy?--Eileen M. Crimmins, Krista Garcia, and Jung Ki Kim
Pages 68-102
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From page 68... ...
Crimmins, Krista Garcia, and Jung Ki Kim The question addressed in this chapter is whether people in countries with relatively low life expectancy after age 50 have worse health than those in countries with longer life expectancy. We begin with a short discussion of the theoretical relationships between mortality and population health and the potential complexity of the link between measures of health and mortality.
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From page 69... ...
Diagnostic definitions can differ across countries and change over time. For instance, the blood pressure cutoff value indicating hypertension has gotten lower over time, so that diagnosis occurs at an earlier stage of severity in more recent years.
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Heart disease tends to be a major cause of both mortality and disability. In this analysis, we examine self-reported indicators of functioning, disability, and disease presence and cancer incidence from registries.
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and to life expectancy at ages 50 and 65 in 2004 from the Human Mortality Database. After examining country differences in the prevalence of health conditions and risk factors, we use the microdata in a pooled equation for surveys designed to be comparable to examine country differences among individuals in health outcomes with controls for age, diseases, and health behaviors.
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In the older age range, ADL difficulties are fairly similar among Denmark, France, Italy, Spain, and the United States. Again, ADL functioning problems are greater among the English.
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. ." For the Nihon University Japanese Longitudinal Study on Aging (NUJLSOA)
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Differences in Disease Prevalence We examine cross-national differences in self-reports of three diseases from national surveys: heart disease, stroke, and diabetes (see Table 3-2)
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(a) Heart Disease United States 28.4 1.00 22.1 1.00 36.4 1.00 28.0 1.00 Denmark 9.9 0.35 7.8 0.35 15.9 0.44 13.0 0.46 France 18.5 0.65 10.8 0.49 28.8 0.79 16.3 0.58 Italy 12.4 0.44 10.1 0.46 18.7 0.51 14.3 0.51 Netherlands 13.6 0.48 8.8 0.40 21.7 0.60 12.9 0.46 Spain 11.3 0.40 11 0.50 15.1 0.41 15.5 0.55 England 23.0 0.81 19.0 0.86 32.2 0.88 26.4 0.94 Japan NA NA NA NA 14.4 0.40 12.2 0.44 Canada 13.8 0.49 10.7 0.48 21.8 0.60 18.1 0.65 (b)
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value is higher among the 50+ population than among the 65+ population, indicating larger differences at younger ages. National heart disease prevalence is not closely related to national life expectancy (see Figure 3-2[a]
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r = – 0.666 r = – 0.483 (c) Diabetes Men Women LE LE Fig3-2b24 .eps 20 Japan Canada Spain 22 France Australia Italy 18 Japan Spain Australia Canada France 20 Italy USA England USA Netherlands England 16 Denmark Netherlands 18 Denmark 14 16 7 9 11 13 15 17 19 21 23 7 9 11 13 15 17 19 Percentage SR Diabetes Percentage SR Diabetes Regression coef ficient = 0.137 (p = .
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From page 78... ...
. Neither heart disease nor stroke is significantly 4We also examined diabetes prevalence for the age-standardized population ages 20-79 from OECD reports, which are based on a combination of measured biological markers and selfreports -- and therefore are not truly comparable across countries.
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2 Spain France England Australia 0. 2 England Australia Canada 0.1 Italy Netherlands 0.1 Spain Denmark Netherlands Denmark USA Italy USA Canada 0 0 0 5 10 15 20 25 0 5 10 15 20 Percentage SR Diabetes Percentage SR Diabetes Regression coefficient = – 0.011 (p = .179 )
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. We examine differences in incidence of all cancers except nonmelanoma skin cancer but also for four specific cancers: prostate cancer for men, breast cancer for women, lung cancer, and colorectal cancer.
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n lia SA Fr k ce he l y s n . n lia Au d a .K Au d a .K ar nd ai pa ar nd ai pa et I t a et Ita ra an ra an U U U Sp a m U Sp a m rla Ja rla Ja st an st an en en C C D D N N Incidence Mortalit y Fig3-4h.eps Fig3-4g.eps FIGURE 3-4 Age-standardized cancer incidence and mortality rates, 2002.
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. We examine national differences in the prevalence of three indicators of physiological dysregulation that are risk factors for mortality, cardiovascular disease, and diabetes: high cholesterol, high blood pressure, and obesity.
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and NHNS (2004) for Japan; and from the WHO Global InfoBase for the Netherlands, Spain, and Canada.
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Women Men LE LE 31.5 38 31.0 Australia 37 Japan Japan 30.5 36 Canada 30.0 35 Spain Australia 29.5 Spain England 34 Canada 29.0 USA Netherlands 33 28.5 Netherlands USA England 32 28.0 27.5 31 10 20 30 40 50 20 25 30 35 40 45 50 55 Percentage with High Cholesterol Percentage with High Cholesterol Regression coef ficient = – 0.0 02 (p = .960 ) Regression coefficient = – 0.028 (p = .699 )
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. Based on an analysis of people ages 35-64 and using data from the late 1990s and early 2000s, measured blood pressure was shown to be lower in the United States and Canada and higher in European countries including Italy, England, and Spain.
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% U.S. Self-Reported Hypertension Ages 50+ Ages 65+ United States 53.6 1.00 55.1 1.00 57.2 1.00 62.7 1.00 Denmark 30.4 0.57 28.1 0.51 41.8 0.73 32.6 0.52 France 25.5 0.48 31.7 0.58 31.4 0.55 39.3 0.63 Italy 35.8 0.67 38.1 0.69 43.8 0.77 46.4 0.74 Netherlands 22.8 0.43 27.8 0.50 27.4 0.48 32.7 0.52 Spain 27.0 0.50 37.6 0.68 34.3 0.60 49.5 0.79 England 36.0 0.67 38.7 0.70 41.7 0.73 47.0 0.75 Japan NA NA NA NA 30.5 0.53 34.3 0.55 Canada 29.5 0.55 35.2 0.64 37.3 0.65 47.1 0.75 Australia 24.4 0.46 29.2 0.53 36.7 0.64 41.8 0.67 Measured High Blood Pressure (≥140/90mmHg)
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Overall, the Netherlands appears to be the country with the lowest use of antihypertensives. All of this makes it somewhat hard to determine the relative risk across countries due to elevated blood pressure.
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or any hyper tensive medication Men Women LE Fig3-6a.eps LE 19.5 23 Japan Canada 19.0 Spain 22 18.5 21 Spain 18.0 Canada Japan 20 17.5 USA Netherlands 17.0 19 USA England 16.5 18 England 16.0 Netherlands 17 15.5 15.0 16 55 60 65 70 75 80 40 50 60 70 80 Percentage with High Blood Pressure Percentage with High Blood Pressure or Using Medication or Using Medication Regression coef ficient = – 0.174 (p = .120 ) Regression coefficient = – 0.026 (p = .690 )
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. There is very little change when health behaviors are controlled, although being obese and having been a smoker are linked to more heart disease.
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are not obese. Having been a smoker increases the relative likelihood of heart disease by more than 30 percent.
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Overweight is linked to odds ratios indicating a doubling of the relative likelihood of having diabetes, whereas being obese multiplies the odds ratios by 3.54 times for men and 5.2 times for women. The effects of country of interview on functioning and ADLs disability with and without controls for the health behaviors and for the presence of the three diseases (heart disease, diabetes, and stroke)
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TABLE 3-8 Odds Ratios from Logistic Regressions of Country, Age, and Health Behaviors on Self-Reported Prevalence of Heart Disease, Stroke, and Diabetes Heart Disease Stroke Diabetes Men Women Men Women Men Women M1 M2 M1 M2 M1 M2 M1 M2 M1 M2 M1 M2 Age 1.06*
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1.49* Heart disease 2.13*
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This includes functioning and ADL disability levels, prevalence of heart disease, diabetes, and obesity, and incidence of some cancers. Many other countries rank poorly in some health indicators but do not rank poorly in others, so it is hard to determine a clear ranking for other countries.
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For the countries for which we have individual data, we examined the occurrence of comorbidity of heart disease, stroke, and diabetes. We found dramatically higher levels of comorbidity in the United States than in other countries, indicating a larger portion of the population with multiple serious health risks in the United States (see Table 3-10)
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. Because our analysis relied on self-reports of diagnosed heart disease, not limited to myocardial infarction, it is possible that national differences in the prevalence of heart disease are affected by reporting and diagnostic differences.
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As we mentioned earlier, increasing survival among people with diseases and functioning problems can lead to a higher prevalence of health problems in the population. Finally, our cross-sectional data are limited in making any connection between earlier risk factors, lifelong health behaviors, and lifetime circumstances that could affect later health.
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. Chronic Diseases and Associated Risk Factors in Australia, 00.
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American Journal of Public Health, , 1554-1556. Chronic Condition Data Warehouse.
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Nihon University Japanese Longitudinal Study of Aging.
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From page 101... ...
. The paradox of high risk of stroke in population with low risk of coronary heart disease.
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