Long-term trends
Practical
Mortality & morbidity compression

From age
1900
1920
1940
1960
1980
2000
2007
Gain, Years 1900–2007
0
49.2
65.4
63.6
69.9
73.9
76.9
77.9
28.7
65
11.9
12.5
12.8
14.4
16.5
17.9
18.6
6.7
75
7.1
7.5
7.6
8.7
10.5
11.3
11.7
4.6
85
4.0
4.2
4.3
4.6
6.0
6.3
n/a
2.3
100
1.6
1.5
2.1
1.9
2.7
2.6
n/a
1.0
US life expectancy 1900–2007 from various ages. Average number of years of life remaining.
1. Please describe the changes in LE at different ages
2. Can you see any pattern?


[USEMAP]
Disability progression—ages 58–79 years: Runners' Club and Community Controls. Progression of
disability in Runner's Club and Community Control groups over 21 years from an average age of 58 is
compared in the figure both with yearly disability values and statistically derived regression
lines. The regression lines are derived from linear mixed models and adjusted for age, gender, BMI,
smoking, and initial disability. Comparison of postponement of disability is represented by the
absolute difference between the two groups in the time required to develop a given level of
disability. The example shown is to reach Health Assessment Questionnaire (HAQ) Disability Index
Scores of 0.10, 0.15, and 0.20. All differences are highly statistically different (P < 0.001).
Lines continue to diverge with age. The postponement is 8.6 years between groups in reaching the
.010 mark, 12.6 years to reach the 0.15 mark, and projected at 16.6 years for the HAQ level of
0.20. Consistent moderately active exercise postpones onset of disability for many years.




Background: Whether rises in life expectancy are increases in good-quality years is of profound
importance worldwide, with population ageing. We investigate how various health expectancies have
changed in England between 1991 and 2011, with identical study design and methods in each decade.
Methods: Baseline data from the Cognitive Function and Ageing Studies in populations aged 65 years
or older in three geographically defined centres in England (Cambridgeshire, Newcastle, and
Nottingham) provided prevalence estimates for three health measures: self-perceived health (defined
as excellent-good, fair, or poor); cognitive impairment (defined as moderate-severe, mild, or none,
as assessed by Mini-Mental State Examination score); and disability in activities of daily living
(defined as none, mild, or moderate-severe). Health expectancies for the three regions combined
were calculated by the Sullivan method, which applies the age-specific and sex-specific prevalence
of the health measure to a standard life table for the same period.
Findings: Between 1991 and 2011, gains in life expectancy at age 65 years (4·5 years for men and
3·6 years for women) were accompanied by equivalent gains in years free of any cognitive impairment
(4·2 years [95% CI 4·2-4·3] for men and 4·4 years [4·3-4·5] for women) and decreased years with
mild or moderate-severe cognitive impairment. Gains were also identified in years in excellent or
good self-perceived health (3·8 years [95% CI 3·5-4·1] for men and 3·1 years [2·7-3·4] for women).
Gains in disability-free years were much smaller than those in excellent-good self-perceived health
or those free from cognitive impairment, especially for women (0·5 years [0·2-0·9] compared with
2·6 years [2·3-2·9] for men), mostly because of increased mild disability.
Interpretation: During the past two decades in England, we report an absolute compression (ie,
reduction) of cognitive impairment, a relative compression of self-perceived health (ie, proportion
of life spent healthy is increasing), and dynamic equilibrium of disability (ie, less severe
disability is increasing but more severe disability is not). Reasons for these patterns are unknown
but might include increasing obesity during previous decades. Our findings have wide-ranging
implications for health services and for extension of working life.