Longevity, life expectancy and healthy
life expectancy
Professor Sarah Harper
University of Oxford
IARU
Unviersity of Tokyo
2016年 12月 20日
Worlds 1st Super- centenarion
Geert Adriaans Boomgaard
Oxford Institute of Population Ageing
Worlds 1st Super- centenarion
FOUGHT WITH NAPOLEAN….
Geert Adriaans Boomgaard
21 September 1788 Groningen,
Netherlands
3 February 1899
110 years 135 days
Record male life until 1966
Oxford Institute of Population Ageing
§ 
Jeanne Calment of France, who died in 1997 aged 122 years,
164 days, had the longest human lifespan documented.
§ 
The oldest verified man ever recorded is Jiroemon Kimura of
Japan, who died in 2013 aged 116 years and 54 days
Oxford Institute of Population Ageing
§ 
Will increases in both life expectancy and in life extension or
longevity continue?
§ 
§ 
Will life expectancy increase in line with life extension?
§ 
§ 
will we all enjoy the benefits of longevity or will it be for a few?
Will increases in life expectancy be accompanied by increases
in life extension or are we seeing a compression of longevity
after 100?
§ 
§ 
will there be an increase in average years lived by humans and also
maximum years attained by a human being?
will the predicted increases in centenarians over the coming century
be accompanied by increases in super-centenarians?
Will advances in life expectancy be matched by advances in
healthy life expectancy?
Oxford Institute of Population Ageing
Life expectancy, selected OECD countries, men and women, birth
Birth
88
Japanwomen
Remainingyearsoflife
86
Francewomen
84
UKwomen
82
USAwomen
Japanmen
80
Francemen
78
UKmen
76
USAmen
74
72
2000
2001
2002
Source:OECD
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Life expectancy, selected OECD countries, men and women, age 65
Age65
Remainingyearsoflife
25
24
Japanwomen
23
Francewomen
UKwomen
22
USAwomen
21
Japanmen
20
Francemen
19
UKmen
18
USAmen
17
16
15
2000
2001
2002
Source:OECD
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Life expectancy, selected OECD countries, men and women, age 80
Age80
12
Japanwomen
11
Francewomen
Remainingyearsoflife
UKwomen
10
USAwomen
Japanmen
9
Francemen
8
UKmen
USAmen
7
6
2000
2001
Source:OECD
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Proportion of persons surviving to
successive ages
1.0
0.9
1991
1971
1951
1931
Proportion surviving
0.8
0.7
2011
1911
1891
1871
0.6
1851
0.5
0.4
0.3
0.2
0.1
0.0
0
10
20
30
40
50
Age
60
70
Oxford Institute of Population Ageing
80
90
100
110
Source: ONS / Oxford Institute of Population Ageing
UK Male Mortality 1911-2005
10,000
9,000
!"#$%&'"()
*$(+,-./'-0)
1."%$-()
1,-%23./'-0)
8,000
Deaths per million adults
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0
1911
1921
1931
1941
1951
1961
1971
1981
1991
Source: ONS / Oxford Institute of Population Ageing
Oxford Institute of Population Ageing
Prevalence of obesity (BMI > 30), age 50+
40
35
30
25
20
15
10
5
0
Source: US Centers for Disease Control
Oxford Institute of Population Ageing
Effect of Obesity on Female Life
Expectancy
Mehta/Chang: 22% of female
at age
5041% of female gap
PSC:
1.8
gap
PSC
1.6
Mehta/Chang
1.4
1.2
1
0.8
0.6
0.4
0.2
0
US
France
Italy Netherlands Spain Denmark Canada England
Source: Prospective Studies Collaboration (PSC);
Mehta and Chang (2010)
from Preston and Stokes “Is the High Level of Obesity in the
United States Related to Its Low Life Expectancy?” 2010
Oxford Institute of Population Ageing
Picture: Colourbox
Oxford Institute of Population Ageing
Public Health
Age 55
Reduced LE
Increased DY
Obesity
1.4
5.9
Smoking
4
3.8
Alcohol
3
3.1
(Klijs et al., 2011a).
Oxford Institute of Population Ageing
Will increases in both life expectancy and in life extension or
longevity continue?
will there be an increase in average years lived by humans and also
maximum years attained by a human being?
Will life expectancy increase in line with life extension?
will we all enjoy the benefits of longevity or will it be for a few?
The Inequality question
Will increases in life expectancy be accompanied by increases in
life extension or are we seeing a compression of longevity after
100?
!!
Will advances in life expectancy be matched by advances
in healthy life expectancy?
Oxford Institute of Population Ageing
Will advances in life expectancy be matched
by advances in healthy life expectancy?
Relationship of life expectancy healthy life expectancy:
Compression of morbidity: HLE increasing faster than LE
expectancy - extra years of life are healthy ones
Expansion of morbidity: HLE not pacing LE - extra years of life
are unhealthy ones. Modern drivers of longevity (science and
technology) enabling those with frailty to live longer.
Dynamic equilibrium: DLE increasing but severity of ill health is
reducing.
Pushing back onset of frailty but maintaining that state for
longer.
Oxford Institute of Population Ageing
Data – problematic
Lack of harmonisation of health measures reduces
comparisons
§ 
The Global Burden of Disease programme - estimate
healthy life expectancy for 187 countries worldwide Disability Adjusted Life Years (DALY) (Chris Murry)
§ 
EU healthy life years (HLY), a DFLE
§ 
Global Activity Limitation Indicator (GALI) “Participation
restriction”: World Health Organization International
Classification of Functioning, Disability and Health.
(Van Oyen et al., 2006; Berger et al., 2015)
Oxford Institute of Population Ageing
Changes (years) in life expectancy (LE) and health expectancies (HE) at birth, age 65 and age
85 based on different measures of ill health, Japan, Switzerland, UK and USA, men and women
Measure of ill health
LE
Change (years) over time period
Age 65
Age 85
HE
LE
HE
LE
HE
1995–2004
Activity limitation
2.3
1.2
1.7
0.8
1995–2004
2005–2009
1995–2004
ADL limitation
Care needs
Less than good health
2.3
2.0
1.7
0.8
1.7
1.3
0.2
−0.7
0.4
1.0
0.1
−0.3
2008–2012
Activity limitation
0.8
0.4
1.4
−0.1
0.8
2008–2012
Less than good health
0.4
0.5
−0.1
0.7
Birth
Period
Men
Japan
Switzerland
UK 2001–2010
2.9
Disability
2.7
3.6
2.1
1.7
0.7
0.4
Less than good health
2.7
3.5
2.1
1.2
0.7
0.3
USA 2000–2006
Activity limitation
1.0
0.7
1.0
1.0
0.3
0.3
Japan 1995–2004
Activity limitation
1.7
0.8
2.3
0.8
1995–2004
2005–2009
ADL limitation
Care needs
1.7
1.7
2.3
0.8
1.2
0.5
0.6
0.4
1995–2004
Less than good health
2.4
−0.7
1.4
−0.4
0.1
1.4
−0.2
−0.2
0.1
0.6
−0.2
−0.6
2001–2010
Women
Switzerland 2008–2012
2008–2012
UK 2001–2010
2001–2010
USA 2000–2006
Activity limitation
0.3
3.0
Less than good health
Disability
2.0
1.9
1.7
0.8
0.6
0.1
Less than good health
2.0
3.7
1.7
1.3
0.6
0.6
Activity limitation
0.9
0.5
0.7
0.8
0.3
0.3
Source: Hashimoto et al., 2010 (Japan); European Health and Life Expectancy Information System (Switzerland); Office for National Statistics (UK); Molla
and Madans, 2010 (USA).
Changes (years) in life expectancy (LE) and health expectancies (HE) at birth, age 65 and age
85 based on different measures of ill health, Japan, Switzerland, UK and USA, men and women
Measure of ill health
LE
Change (years) over time period
Age 65
Age 85
HE
LE
HE
LE
HE
1995–2004
Activity limitation
2.3
1.2
1.7
0.8
1995–2004
2005–2009
1995–2004
ADL limitation
Care needs
Less than good health
2.3
2.0
1.7
0.8
1.7
1.3
0.2
−0.7
Birth
Period
Men
Japan
0.4
1.0
Source: Hashimoto et al., 2010 (Japan); European Health and Life Expectancy Information System (Switzerland); Office for National Statistics (UK); Molla
and Madans, 2010 (USA).
0.1
−0.3
Changes (years) in life expectancy (LE) and health expectancies (HE) at birth, age 65 and age
85 based on different measures of ill health, Japan, Switzerland, UK and USA, men and women
Birth
Measure of
ill health
LE
HE
LE
HE
1995–
2004
Activity
limitation
2.3
1.2
1.7
0.8
1995–
2004
ADL
limitation
2.3
2.0
1.7
1.3
2005–
2009
Care needs
0.8
1995–
2004
Less than
good health
1.7
Period
Men
Japan
Change (years) over time period
Age 65
Age 85
LE
HE
0.2
0.4
0.1
−0.7
1.0
−0.3
Source: Hashimoto et al., 2010 (Japan); European Health and Life Expectancy Information System (Switzerland); Office for National Statistics (UK); Molla
and Madans, 2010 (USA).
High correlation between life expectancy and healthy
life expectancy for men in EU25+ countries
20
France
Iceland
18
16
Life
Expectancy
at 65
14
CC=0.64
12
10
0
2
4
6
8
10
12
Healthy life expectancy at 65
Oxford Institute of Population Ageing
14
16
18
Eurostat 2009 data
Change (years) in life expectancy (LE) and healthy life years (HLY) at birth, age 65 and age
85 between 2005 and 2010, men and women, selected EU countries.
Birth
Age 65
Age 85
LE
HLY
LE
HLY
LE
HLY
Italy
1.4
-
1.0
-1.8
0.5
0.2
France
1.5
−0.5
1.2
0.5
0.9
0.4
Poland
1.4
-2.7
0.8
-1.7
0.5
0.1
Denmark
1.2
-6.1
0.9
-1.4
0.3
-0.2
Hungary
2.0
4.1
0.8
0.3
0.7
0.02
EU27
1.6
0.7
1.1
0.1
0.7
1.5
Italy
1.1
-
1.0
-3.1
0.9
0.5
France
1.5
−1.2
1.4
0.1
1.4
1.7
Poland
1.4
-4.6
1.0
-2.7
0.9
-0.1
Denmark
0.9
-7
0.6
-1.2
0.2
-0.3
Hungary
1.4
4.3
1.0
0.9
0.6
-0.1
EU27
1.4
0.1
1.0
0
0.8
-
Men
Women
Source: European Health and Life Expectancy Information System
Life expectancy (LE) and healthy life years (HLY), selected EU countries and regions, men at
Age 65
Age 65
20
EU (27) LE
Denmark LE
Remaining years of life
15
France LE
Italy LE
Hungary LE
Poland LE
10
EU (27) HLY
Denmark HLY
France HLY
5
Italy HLY
Hungary HLY
Poland HLY
0
2004
2005
2006
2007
2008
2009
Source: European Health and Life Expectancy Information System
2010
2011
2012
2013
Life expectancy (LE) and healthy life years (HLY), selected EU countries and regions, men at
Age 85
Age 85
8.0
Remaining years of life
7.0
EU (27) LE
Denmark LE
6.0
France LE
Italy LE
5.0
Hungary LE
Poland LE
4.0
EU (27) HLY
3.0
Denmark HLY
France HLY
2.0
Italy HLY
Hungary HLY
1.0
Poland HLY
0.0
2004
2005
2006
2007
2008
2009
Source: European Health and Life Expectancy Information System
2010
2011
2012
2013
Three scenarios for changing relationship between life expectancy at 65 and
disability-free life expectancy between 2006 and 2026 in the UK. Percentages
refer to proportion of remaining life expectancy that is disability-free. It
decreases in all scenarios.
Life years without disability
2006
Ageing
only
16.7
2026
90%
1.8
86%
90%
19.5
5
86%
3.1
16.7
2026
0
1.8
18.5
2006
90%
3
16.7
2026
Improving
health
1.8
18.8
2006
Poorer
health
Life years with disability
10
2.9
15
Oxford Institute of Population Ageing
20
87%
25
Source: C Jagger, R
Matthews. 2008 findings
from ESRC IMAP 2030 project
Change in dementia prevalence over time.
Wu et al, 2015 Dementia in Western Europe: epidemiological evidence and implications for
policy making, The Lancet
Oxford Institute of Population Ageing
!!
Will increases in both life expectancy and in life extension or
longevity continue?
!!
!!
will there be an increase in average years lived by humans and also
maximum years attained by a human being?
Will life expectancy increase in line with life extension?
!!
will we all enjoy the benefits of longevity or will it be for a few?
The Inequality question
!!
Will increases in life expectancy be accompanied by increases
in life extension or are we seeing a compression of longevity
after 100?
!!
Will advances in life expectancy be matched by advances in
healthy life expectancy?
Oxford Institute of Population Ageing
The inequality question …..
It was originally thought that social class differentials in mortality
were to be understood mainly in terms of poverty measures:
inadequate nutrition, overcrowded living conditions, poor
sanitation and personal hygiene, and hazardous working
conditions.
Now evident that despite the considerable improvements in the
standard of living of the lower socio-economic groups, there is still
a large gap in LE and larger (increasing) in HLE
Social gradient in mortality risk: lower income groups within a
society have a higher mortality rate, despite being well above the
poverty line.
Oxford Institute of Population Ageing
Inequalities and Life Course
‘
§ 
Foetal origins hypothesis’, which links impaired foetal growth
with increased risk of cardiovascular mortality.
§ 
There is also a clear relationship between marital status and
mortality risk: married people tend to have better health and to
live longer than never-married people, who in turn do somewhat
better than the divorced or widowed.
§ 
Most recently social class, unemployment and education were
found to be strongly related to variation in LE and DFLE at birth
but were less influential in explaining variations at age 85.
Oxford Institute of Population Ageing
Inequality in Mortality
Club Vita
UK data set: 2 million
Occupational Pension Records
Oxford Institute of Population Ageing
Rate ratios for age-standardised mortality rates for different
socioeconomic and retirement categories
(deaths per 100,000 pop)
Regional distribution of factors associated with high mortality in men
and womena (percentages)
Comparison of life expectancy top and bottom salary quintiles for
different regions
Comparison of life expectancy top and bottom Carstairs quintiles for
different regions
DevianceAnalysis
Differential longevity
Comparison of UK life expectancies from age 65
Men
Low
12.0
Low income
Ill health retiree
Unhealthy lifestyle
High
23.0
Difference
11.0 years
High income
Normal health retiree
Healthy lifestyle
Source: Oxford Institute of Population Ageing
Oxford Institute of Population Ageing
Proportion of 65 year old men expected
to survive to each older age
% probability of
reaching age x
100
Unhealthy lifestyle, ill health retiree, poor
Healthy lifestyle, normal health retiree, rich
‘Average’ individual
75
50
25
0
65
75
Age
85
Oxford Institute of Population Ageing
95
Source: Oxford Institute of Population Ageing
Impact of different factors on longevity
12
Manual employee, poor, unhealthy lifestyle, ill health retiree
if he did a non-manual job
0.7
if he retired in normal health
1.8
4
if he also had a high income
4.6
if he also had a healthy lifestyle
0
5
10
15
20
Remaining Expectancy from age 65
25
Will increases in both life expectancy and in life extension or
longevity continue?
will there be an increase in average years lived by humans and also
maximum years attained by a human being?
Will life expectancy increase in line with life extension?
will we all enjoy the benefits of longevity or will it be for a few?
The Inequality question
!!
Will increases in life expectancy be accompanied by
increases in life extension or are we seeing a compression
of longevity after 100?
Will advances in life expectancy be matched by advances in healthy
life expectancy?
Oxford Institute of Population Ageing
Determinants of the shape of mortality and
morbidity in 21st Century
§ 
§ 
§ 
§ 
Healthy Living
Disease Prevention and Cure
Regenerative medicine
Age-Retardation.
Key Question
How much life expectancy can we expect to gain without the
intensive application of scientific medicine?
Estimate the impact on life expectancy of delaying the onset of
what we know to be age-related diseases rather than eliminating
them altogether.
Oxford Institute of Population Ageing
Centenarians
Will increases in life expectancy
be accompanied by increases in
life extension or are we seeing a
compression of longevity after
100?
Oxford Institute of Population Ageing
Centenarians
Oxford Institute of Population Ageing
Centenarians
Projected number of centenarians in the USA
6m
5m
4m
3m
2m
1m
>1m
2010 2020 2030 2040 2050 2060 2070 2080
Source: Oxford Institute of Population Ageing Statistics
Oxford Institute of Population Ageing
Oxford Institute of Population Ageing
Source: Christiansen et al Lancet 2009
Determinants of the shape of mortality and
morbidity in 21st Century
§ 
§ 
§ 
§ 
Healthy Living
Disease Prevention and Cure
Regenerative medicine
Age-Retardation.
Key Question
How much life expectancy can we expect to gain with the
intensive application of scientific medicine?
Oxford Institute of Population Ageing
Bio-Technology
Oxford Institute of Population Ageing
Reprogramming
Skin Cell
Stem Cells
Human
Therapeutic cell type
Picture: Time (left) Paul J Fairchild, Dunn School of Pathology (right)
Oxford Institute of Population Ageing
Oxford Institute of Population Ageing
The Challenge……
Thechallengeinallregionsishowtosustainand
enhancewell-beingacrossanindividual’slife,while
atthesamePmereducingtheinequaliPeswithin
eachgeneraPon,andensuringanequitable
reallocaPonofresourcesbetweenthegeneraPons.
Oxford Institute of Population Ageing
www.ageing.ox.ac.uk
Oxford Institute of Population Ageing
Picture: Nasir Hamid/Oxford University
Oxford Institute of Population Ageing