….and living better for longer

Both lifespan and healthspan are much in the medical news at present.

Healthspan

Healthspan – as you know or you haven’t been concentrating – is the length of life spent in good health, free of serious or debilitating illness. Last month the British Medical Journal published an article which reported that “healthy life expectancy in England & Wales remains lower than a decade ago”.

In England, in 2021 to 2023 men could expect to spend 61.5 years of their lives in good health – for women the figure was 61.9 years. Compared with 2017-2018, male healthspan has fallen by 1.7 years and in women by 1.9 years. Life expectancy has also gone down, to 73.1 years for men and 78.9 for women.

The Healthspan-Lifespan Gap

This parameter was examined in an article in the Journal of the American Medical Association (JAMA), also last month. This was a cross-sectional study covering 183 World Health Organisation member states using data covering two decades of longitudinal follow-up. During this period, the length of life had increased but the gap between healthspan and lifespan had increased more. It now stands at 9.6 years which is between 10 and 15% of total lifespan. The gap is wider in women than men and the most pronounced gap was found in the US. The main association was with a growing burden of chronic noncommunicable disease (NCD). NCDs are those degenerative diseases,mostly of later life, which threaten independence and are the chief causes of death – conditions like cancer, heart disease, stroke, diabetes etc.

The Effects of Physical Activity (PA)

Another article from JAMA at the end of last year reported the age-dependent association between physical activity and all cause mortality. The study also examined the age-dependent associations between other modifiable health factors (high educational level, not smoking, not regularly consuming alcohol, healthy body weight, and living without hypertension and diabetes) and mortality.

The study using a pooled analysis of 4 multi-country mega-cohorts including more than 2 million individuals aged 20 to 97 years. After a  follow-up period of 11.5  years, 177 436 deaths occurred. The beneficial association between meeting the physical activity recommendation (eg, 150 minutes per week of moderate-intensity physical activity) and mortality was confirmed.  PA was consistently associated with a lower risk of mortality across all age groups, but the reduction in risk was greater in older vs younger age groups, especially at high levels of PA – but was greater as age increased. For other modifiable health factors, the associations were, remarkably, smaller as age increased.

Why this matters

Life expectancy across the globe has increased over the past 20 years but has stalled and even gone into reverse over the past decade in many Western countries. At the same time the period of dependency in later life continues to to rise – so there are more and more frail elderly in the community. This affects everyone. The frail elderly are the main users of ambulances, hospital emergency departments, hospital corridors, hospital beds and continued bed occupation after treatment, and care in the community, both at home and in care homes. When you look at that list backwards there is a  clear reverse progression. The cost to the individual is high and to society is enormous. And we are all affected. Even though the otherwise fit and well do not often need emergency hospital treatment, when they do they are caught up in this traffic jam between calling for an ambulance and eventual discharge from hospital.

Conclusions

1. Healthspan (and lifespan) are falling in this country.
2. The gap between healthspan and lifespan is large – and is growing across the world
3. Regular physical activity is directly related to increased healthspan and lifespan – and this effect increases with increasing age. For all other risk factors for mortality it is the other way round – the older you are the less the impact of the risk factor. So the older you are, the more important is adequate physical activity and the less the impact of genetics, obesity, blood pressure, preventive medication (statins etc), poverty and all the other contributors to ill-health.