Abstract
IMPORTANCE Health-adjusted life expectancy, a measure of healthy longevity, lags longevity gains, resulting in a healthspan-lifespan gap. OBJECTIVE To quantify the healthspan-lifespan gap across the globe, investigate for sex disparities, and analyze morbidity and mortality associations. DESIGN, SETTING, AND PARTICIPANTS This retrospective cross-sectional study used the World Health Organization (WHO) Global Health Observatory as the global data source and acquired national-level data covering all continents. The 183 WHO member states were investigated. Statistical analysis was conducted from January to May 2024. EXPOSURES Data represent 2 decades of longitudinal follow-up. MAIN OUTCOMES AND MEASURES Changes in life expectancy and health-adjusted life expectancy, as well as the healthspan-lifespan gap were quantified for all participating member states. Gap assessment was stratified by sex. Correlations of the gap with morbidity and mortality were examined. RESULTS The healthspan-lifespan gap has widened globally over the last 2 decades among 183 WHO member states, extending to 9.6 years. A sex difference was observed with women presenting a mean (SD) healthspan-lifespan gap of 2.4 (0.5) years wider than men (P < .001). Healthspan-lifespan gaps were positively associated with the burden of noncommunicable diseases and total morbidity, and negatively with mortality. The US presented the largest healthspan-lifespan gap, amounting to 12.4 years, underpinned by a rise in noncommunicable diseases. CONCLUSIONS AND RELEVANCE This study identifies growing healthspan-lifespan gaps around the globe, threatening healthy longevity across worldwide populations. Women globally exhibited a larger healthspan-lifespan gap than men.
Generated Summary
This study, a retrospective cross-sectional analysis, utilized data from the World Health Organization (WHO) Global Health Observatory, investigating healthspan-lifespan gaps among 183 WHO member states. The research aimed to quantify these gaps, explore sex disparities, and analyze the associated morbidity and mortality. The study involved the collection and analysis of national-level data across all continents, focusing on changes in life expectancy and health-adjusted life expectancy over two decades (2000-2019). The methodology included statistical analyses to determine the healthspan-lifespan gap for each member state, stratified by sex, and examined its correlation with morbidity and mortality rates. The healthspan-lifespan gap was calculated by subtracting health-adjusted life expectancy from life expectancy. Kernel density estimates were used to visualize the distribution of health-adjusted life expectancy and life expectancy. Associations between life expectancy and the healthspan-lifespan gap were visualized using Bland-Altman plots. Statistical significance was defined as a 2-tailed P-value less than 0.05.
Key Findings & Statistics
- The global healthspan-lifespan gap has widened over the past two decades among 183 WHO member states, extending to 9.6 years.
- The mean (SD) rate of lifespan increase was 0.29 (0.20) years per calendar year, which was not matched by the mean healthspan increase of 0.24 (0.18) years per calendar year (P < .001).
- The greatest increases in lifespan were observed in Rwanda, Malawi, Burundi, Ethiopia, and Zambia, with increases of 1.1, 1.0, 1.0, 0.9, and 0.9 years per calendar year, respectively.
- The greatest increases in healthspan were documented in Rwanda, Malawi, Burundi, Uganda, and Ethiopia, with mean increases of 1.0, 0.9, 0.9, 0.8, and 0.8 years per calendar year, respectively.
- The mean health-adjusted life expectancy was 63.3 years, contrasting with a 72.5-year mean life expectancy (P < .001).
- The mean healthspan-lifespan gap across WHO member states was 9.2 years.
- The largest healthspan-lifespan gaps were observed in the US (12.4 years), Australia (12.1 years), New Zealand (11.8 years), United Kingdom of Great Britain and Northern Ireland (11.3 years), and Norway (11.2 years).
- A sex difference was observed, with women presenting a mean (SD) healthspan-lifespan gap of 2.4 (0.5) years wider than men (P < .001).
- The largest sex disparities in the gap were in Germany (3.6 years), Spain (3.4 years), France (3.3 years), Portugal (3.2 years), and Lebanon (3.2 years).
- The healthspan-lifespan gap was positively associated with morbidity burden, assessed as total years lived with disability per 100,000 persons (β = 4.4 × 10-4; R2 = 0.42; P < .001).
- The healthspan-lifespan gap was negatively associated with mortality burden, estimated as total years of life lost per 100,000 persons (β = −6.6 × 10−5; R2 = 0.56; P < .001).
- Sex disparity in the healthspan-lifespan gap was positively associated with sex disparity in the noncommunicable disease burden (β = 3.2 × 10−4; R2 = 0.22; P < .001).
- The US mean healthspan-lifespan gap increased from 10.9 to 12.4 years over the past 2 decades.
- Women exhibited a 2.6-year higher healthspan-lifespan gap than men in the US, increasing from 12.2 to 13.7 years.
- Life expectancy increased from 79.2 to 80.7 years in women, and from 74.1 to 76.3 years in men in the US.
Other Important Findings
- The healthspan-lifespan gap was found to be positively associated with the burden of noncommunicable diseases and total morbidity, and negatively with mortality.
- The US healthspan-lifespan gap increased by 29% more than the global mean.
- The sex disparity in the healthspan-lifespan gap was particularly notable, with women globally exhibiting a larger gap than men.
- The US, Australia, and New Zealand exhibited healthspan-lifespan gaps exceeding the upper limit of the 95% CI.
- In contrast, Lesotho, Central African Republic, Somalia, and Kiribati exhibited healthspan-lifespan gaps below the lower limit of the 95% CI.
- The healthspan-lifespan gap correlated with the noncommunicable disease burden assessed as years lived with disability per 100,000 persons (β = 4.4 × 10-4; R2 = 0.55; P < .001).
- Mental and substance use disorders, along with musculoskeletal diseases, contributed most to years lived with disability in the US, whereas musculoskeletal, genitourinary, and neurological diseases contributed most to the differential burden in women.
Limitations Noted in the Document
- The healthspan-lifespan gap is based on estimates of life expectancy and health-adjusted life expectancy, which introduces potential inaccuracies.
- The calculation of health-adjusted life expectancy relies on disability weights assigned to various health conditions, which may not fully reflect the perceptions of diverse populations due to potential survey method biases or the overrepresentation of certain groups.
Conclusion
The study’s findings highlight a growing global trend: while people are living longer, the number of years spent in poor health is also increasing, creating a widening healthspan-lifespan gap. This gap poses a significant challenge to healthy longevity worldwide. The research underscores the need for a shift towards proactive, wellness-focused healthcare systems to address this issue. The study found that women globally experience a larger healthspan-lifespan gap than men, indicating the need for targeted interventions that consider these sex-based differences. The US presents the largest healthspan-lifespan gap, influenced by a substantial burden of noncommunicable diseases, particularly mental and substance use disorders. This highlights the importance of addressing these specific health challenges to improve healthy longevity. The inverse relationship between mortality and the healthspan-lifespan gap suggests a disease paradox, where reduced acute mortality may lead to increased chronic disease burden. As stated in the text, “The widening healthspan-lifespan gap is a global trend…and points to the need for an accelerated pivot to proactive wellness-centric care systems.” The study emphasizes the importance of assessing healthy longevity, which can provide a better understanding of the population’s health status. The study’s identification of key drivers of the healthspan-lifespan gap can assist in prioritizing interventions. The research’s identification of the healthspan-lifespan gap’s association with morbidity and sex-based disparities in the burden of noncommunicable diseases provides valuable insights for implementing targeted interventions. The study highlights the importance of country-specific strategies. In conclusion, the healthspan-lifespan gap represents a critical challenge to healthy aging, requiring concerted efforts at both global and local levels to improve public health.