Life expectancy in UK falls and is expected to fall further

[studiot]

BBC report which states the above and looks at possible reasons.

https://www.bbc.co.uk/news/health-50631220

Dows anyone have comparable figures for other places?

[iNow]

It's been falling in the US, too

https://www.theatlantic.com/health/archive/2018/11/us-life-expectancy-keeps-falling/576664/

[studiot]

35 minutes ago, iNow said:

It's been falling in the US, too

https://www.theatlantic.com/health/archive/2018/11/us-life-expectancy-keeps-falling/576664/

Thanks.

The website of that rag is much less busy and therefore makes it actually readable, unlike our rags that I usually give up on.

[CharonY]

There are, though different countries collect different health information which sometimes makes direct comparison a bit iffy. I would also like to note that seemingly the article is using slightly different measures in a somewhat jumbled way. Also, it should be noted that there is a limit what we can theoretical achieve in life-span so at some point it is expected to just fluctuate rather than increase.

That being said, looking at comparative data, the UK, falls behind other OECD countries, but the UK is consistently at the bottom. Taking 2015 (where there is harmonized OECD data allowing direct comparison) the female life expectancy was for example 81.47 in the US, 82.72 UK, 82.98 Germany, 84.01 Canada with Japan having the highest (87.02) and the average being 84.17. the male values are (same order): 76.5, 79.05, 78.13, 79,93, 80.78, average: 79.48.

In the US, there have been analyses showing that especially African Americans had an extreme low life expectancy, though in recent years that gap has become narrower. Unfortunately it is only partially due to lower mortality, another part is an increasing white mortality. However, most OECD countries experienced life expectancy decline around that time (though e.g. Canada and Australia did not experience that). 

However, there are different patterns. In the US, the decline was driven by increased mortality in folks younger than 65, whereas in most other countries it was driven by mortality increase in the older part of the population. In the latter group, cardiovascular and respiratory diseases (including flu) explained most of the pattern. In the US, drug-related deaths played a major role (especially for men), as well as influenza-related deaths (there were a number of serious outbreaks).

 

[iNow]

1 hour ago, studiot said:

Dows anyone have comparable figures for other places?

The WHO keeps this info: https://www.who.int/gho/mortality_burden_disease/life_tables/en/

[mistermack]

More sedentary lifestyles, for childhood onwards. More drug use. More low-skilled immigration, adding to the numbers of smokers and poor diets. More take aways and high-fat foods. 

I would have thought that vaping would have a positive effect though. I know lifetime smokers who no longer smoke cigarettes, having given up with the help of vaping. Vitamin supplements don't seem to have made a big difference. I take one a day, just as an attempt to counter my lousy diet. 

[CharonY]

8 minutes ago, mistermack said:

More sedentary lifestyles, for childhood onwards. More drug use. More low-skilled immigration, adding to the numbers of smokers and poor diets. More take aways and high-fat foods. 

Many of the additional deaths in the UK were in the older population, i.e. those that were likely to have smoked for a long while. Among younger folks, drug use and related incidents appear to be a major factor. With regard to diet, some studies suggest that recent immigrants eat healthier, though once they get accustomed to their host country diet (For Canada and UK there is data) the nutritional quality of the diet declines. Specifically for the UK it should also be mentioned that on average immigrants to the UK are, on average, healthier than their British counterparts (data is based on various Labour Force Surveys and subsequent analyses based on that data) . This is a phenomenon that some have termed the "migrant health advantage". For the most part it is because mostly healthy folks immigrate (which of course is not true for asylum seekers, which usually suffer from low health). 

Once getting older, this advantage diminishes, depending on the group of immigrant and the level of heavy labour. For example, above 65 most immigrants from EU and SE asia reprt less issues than their British counterparts, whereas East European and Pakistani immigrants had more issues. However, when taking skill level into account, all age groups of immigrants reported less health issues than their UK born counter-part. In fact, the levels of health issues in low skilled immigrants is about that of high-skilled UK born folks, except for the highest age bracket where it is similar to medium-low skilled UK-born workers.

There is also data regarding smoking, showing that in men only immigrants from India and Sub-Saharan Africa are smoking less than UK-born folks (the highest rate is found in East European immigrants), whereas in women only the East European group smoked more than UK-born women.

[mistermack]

14 minutes ago, CharonY said:

Specifically for the UK it should also be mentioned that on average immigrants to the UK are, on average, healthier than their British counterparts

Depends what you mean by healthier. They are probably fitter, but their life expectancy in their country of origin would have been a lot less than their British counterparts. I can believe that they might well be fitter, given a less sedentary childhood and later life. Whether that will translate into a longer life in this country, who knows? It probably will, if they keep off the cigarettes and drugs but it will take years to be sure. 

There is an effect that happens across generations, where second and third generations benefit from the health of their parents and grandparents. It shows up in the across the board increase in height of people in wealthy countries over the last couple of hundred years. Maybe something similar might happen with life expectancy. 

[CharonY]

45 minutes ago, mistermack said:

They are probably fitter, but their life expectancy in their country of origin would have been a lot less than their British counterparts.

That however does not really matter, life expectancy is based on where you current live, as it determines which health-related conditions you face. From there we can take a look at the UK, though I am not sure whether there are detailed immigration-related records.

However, there is Scottish data (Gruer et al.  Epidemiol Community Health 2016;70:1251-1254.) illustrates that. They found that life expectancy for White Scottish and mixed men is shorter to Indian, Pakistani or Chinese folks. Non-Scottish white British folks were a fair bit higher than Scottish, but still lower than the above mentioned. For women, White Scottish and White British were again lower than the above mentioned groups. Now, obviously it is not clear when folks with Indian, Pakistani or Chinese ethnicity actually immigrated. But in aggregate it provides evidence that immigration is unlikely to skew life expectancy data (the impact of Scottish folks on UK data would be much higher, whereas immigrant data would have either no or a slight positive effect, considering population size). Considering that the proportion of first generation immigrants at any time is fairly low, that is unlikely to affect LE as a whole.

That being said, socio-economic status are associated with health status, and assuming an overrepresentation of immigrants in low-skilled jobs could lower their life expectancy (though again, in the case of Scotland, other factors have a much stronger effect, though internal migration is something that should also be checked). However, it does not automatically mean that immigration is (or can be) a driver of lower life expectation. The reason being that even if all immigrants suddenly vanish, there will still be low skilled labour jobs and socioeconomic disparities (in fact, there is evidence that with a contracting economy, such as by removing part of the population, these issues would be amplified). In other words, lower health outcomes would then be shifted toward the native population and thereby not increase overall life expectancy. 

I think it is fair to say that ad hoc determination of such complicated measures are not trivial (or likely to be accurate) and as such it is almost impossible to extrapolate without thorough statistical analyses (and even then models may miss out important parameters).

 

[studiot]

1 hour ago, mistermack said:

More sedentary lifestyles, for childhood onwards. More drug use. More low-skilled immigration, adding to the numbers of smokers and poor diets. More take aways and high-fat foods. 

I would have thought that vaping would have a positive effect though. I know lifetime smokers who no longer smoke cigarettes, having given up with the help of vaping. Vitamin supplements don't seem to have made a big difference. I take one a day, just as an attempt to counter my lousy diet. 

 

Surely the number of smokers / as a number or % of polulation has been declining for some decades now?

[mistermack]

I'm sure it has, and that's bound to be a factor.

I don't have any figures on people giving up with the help of vaping, but my sister and her husband have both given up due to it. Her husband switched to vaping, and he vapes far less than he used to smoke. With nobody else smoking in the house, my sister stopped altogether, without vaping at all. 

Not a scientific study, but it worked great for them. 

[studiot]

47 minutes ago, mistermack said:

I'm sure it has, and that's bound to be a factor.

 

Which is why I find the drop in life expectancy suprising.

[CharonY]

12 minutes ago, studiot said:

Which is why I find the drop in life expectancy suprising.

The increase of respiratory illnesses  2014-17 in UK (and much of Europe) was at least partially driven by an influenza strain (H3N2) which predominantly was fatal for elderly. It has been speculated that due to the increase in the proportion of elderly in the population, age related deaths will increase and thereby diminish life expectancy estimates. Also, as mentioned, the decrease in age-associated diseases have slowed or stopped, adding to that trend.

This is is somewhat analogous to how high infant mortality can diminish life expectancy measures. Lung cancer has been decreasing since 2001 for men, but for women there was first an increase until 2011 and then small decline until 2016.

[mistermack]

23 minutes ago, CharonY said:

The increase of respiratory illnesses  2014-17 in UK (and much of Europe) was at least partially driven by an influenza strain (H3N2) which predominantly was fatal for elderly.

Doesn't say much for the effectiveness of the flu jab. I've never had it, my mother was a nurse dealing mainly with the elderly, and she never had it and didn't recommend it. She reckoned that the reaction to it could be almost as bad as the flu itself. 

I have a friend who's over seventy, and he had it regularly, but the last time, he was ill for a week and had after affects for a lot longer, and he swears he'll never have it again. It's all anecdotal, I have no idea what the figures show. 

[MigL]

Reduced infant mortality and curing ( or at least allowing one to keep living with ) some illnesses/diseases allowed people to live longer.
Unfortunately immune systems of the elderly are greatly reduced, allowing other illnesses/disease that previously weren't a major issue, to become dominant, and start reducing ( or at least stopping the rise of ) life expectancy.
Even nature tends to equilibrium.

[CharonY]

5 hours ago, mistermack said:

. She reckoned that the reaction to it could be almost as bad as the flu itself. 

That is worrying, as it is clearly not the case. An actual influenza infection feels really bad, whereas side effects of the vaccine are generally no worse than a passing fever (and only in 1-2% of the population). The CDC estimates influenza-related death between 2010-2014 (which is a bit broader than direct deaths due to flu) ranging from 12k (2011-2012 season) to 56k (2012-13). In Europe, as mentioned, the decline in life expectancy in several European countries in the last few years were related to rather bad flu seasons.

A challenge with flu vaccination is that the outbreaks change every year and if the prediction is off, folks may get vaccinated against the wrong strain which only offers limited protection. In addition, there are certain strains for which the efficacy of vaccines is somewhat low. However, even imperfect protection has an important impact on human health. As mentioned the vaccine was less effective for the 2014-15 influenzaA H3N2 outbreak. But even with the diminished vaccine, the CDC estimates that ca. 67k hospitalizations were prevented by the vaccine, as well as ca. 1.9 million illnesses. Obviously those numbers are higher for seasons where the vaccines were more effective. 

As such, recommending not to vaccinate, especially for elderly folks does seem somewhat irresponsible.

[zapatos]

5 hours ago, mistermack said:

...my mother was a nurse dealing mainly with the elderly, and she never had it and didn't recommend it. She reckoned that the reaction to it could be almost as bad as the flu itself. 

That is almost unbelievable. I wouldn't want a health care professional taking care of me who felt that way. I'd be concerned for the care I'd receive.

My wife, son and daughter-in-law are all in health care and the flu shot is a work place requirement for them.

[iNow]

It’s amazing how in this the Information Age how terribly misinformed and misguided so many people remain on clearly positive treatments like flu vaccine. 

[CharonY]

1 hour ago, iNow said:

It’s amazing how in this the Information Age how terribly misinformed and misguided so many people remain on clearly positive treatments like flu vaccine. 

I feel that because of the technology misinformation spreads more easily.

[studiot]

6 hours ago, zapatos said:

That is almost unbelievable. I wouldn't want a health care professional taking care of me who felt that way. I'd be concerned for the care I'd receive.

My wife, son and daughter-in-law are all in health care and the flu shot is a work place requirement for them.

I don't know how the 'vaccine' is distributed in the Americas, but in the UK there are two different versions, which can change from year to year as CharonY says.

6 hours ago, CharonY said:

A challenge with flu vaccination is that the outbreaks change every year and if the prediction is off, folks may get vaccinated against the wrong strain which only offers limited protection

Both versions of the vaccines are cocktails containing (hopefully) immunisation against several different strains of flu.

The version given to the general patient population at larger contains fewer strains than the version given to hospital staff.

 

12 hours ago, mistermack said:

Doesn't say much for the effectiveness of the flu jab. I've never had it, my mother was a nurse dealing mainly with the elderly, and she never had it and didn't recommend it. She reckoned that the reaction to it could be almost as bad as the flu itself. 

So your mother would have had a different version from her patients, had she chosen to accept it.

Personally my reaction to the innoculation is so slight that it is difficult to say whether I have any reaction or not.
Certainly I can't see how the balance of risks and benefits don't weigh very very heavily in favour of the vaccination.

[mistermack]

I did say in my post that I was only quoting anecdotes and have no personal experience or knowledge of the figures. My mother was working with the elderly many years ago now, she's been dead more than ten years, and was retired for some time before that. 

However, the friend I mentioned who had the reaction was last year. He always had a flu jab, was happy with it, never had a reaction before, and told me that I should be having it. But his reaction last year was so bad he now swears never again. He wasn't hospitalised, but he was absolutely knocked for six for at least a full week, and was not fully recovered for several weeks after that. Like I said, it's only an anecdote, one person's experience. I know other people who have it every year, and never have any problem. As he did, up to last year. 

I'm nearly seventy, I often think I'm gambling, not having it. It's a gamble both ways. In my case, I virtually never get a cold, and probably haven't had the flu for at least forty years. I don't remember ever having it. I keep a diary, and I went six years once without a cold, the last three were six, three and two year intervals. I know a cold isn't flu, but I seem to resist viruses fairly well. (so far ) 

If I believed in tempting fate, I wouldn't be writing this. 😕

[CharonY]

5 hours ago, studiot said:

I don't know how the 'vaccine' is distributed in the Americas, but in the UK there are two different versions, which can change from year to year as CharonY says.

There are different versions for different ages each year (e.g. live attenuated, produced with eggs,  produced in cells , adjuvanted for the elderly), but the formulation within each cocktail is updated for each season. To make things more complicated there are also trivalent and quadrivalent versions, protecting against three and four strains, respectively. I think the NHS offers mostly quadrivalent vaccines at this point. 

1 hour ago, mistermack said:

I keep a diary, and I went six years once without a cold, the last three were six, three and two year intervals.

It depends a lot on how much contact you have with infected folks, which is why herd immunity is so important. 

[StringJunky]

2 hours ago, mistermack said:

I did say in my post that I was only quoting anecdotes and have no personal experience or knowledge of the figures. My mother was working with the elderly many years ago now, she's been dead more than ten years, and was retired for some time before that. 

However, the friend I mentioned who had the reaction was last year. He always had a flu jab, was happy with it, never had a reaction before, and told me that I should be having it. But his reaction last year was so bad he now swears never again. He wasn't hospitalised, but he was absolutely knocked for six for at least a full week, and was not fully recovered for several weeks after that. Like I said, it's only an anecdote, one person's experience. I know other people who have it every year, and never have any problem. As he did, up to last year. 

I'm nearly seventy, I often think I'm gambling, not having it. It's a gamble both ways. In my case, I virtually never get a cold, and probably haven't had the flu for at least forty years. I don't remember ever having it. I keep a diary, and I went six years once without a cold, the last three were six, three and two year intervals. I know a cold isn't flu, but I seem to resist viruses fairly well. (so far ) 

If I believed in tempting fate, I wouldn't be writing this. 😕

Immunization is about protecting everybody, not just ourselves. If we are to be responsible citizens we should protect those that cannot be immunized from ourselves, as we may become vectors. The notion of individual freedom of choice in this matter is the antithesis of herd immunity/social responsibility.

Edited December 3, 2019 by StringJunky

[mistermack]

1 hour ago, StringJunky said:

Immunization is about protecting everybody, not just ourselves. If we are to be responsible citizens we should protect those that cannot be immunized from ourselves, as we may become vectors. The notion of individual freedom of choice in this matter is the antithesis of herd immunity/social responsibility.

That's a very simplistic view. It applies most definitely in the case of the MMR vaccine, where you have an effective vaccine and no serious side effects. 

Where you have vaccines that are far less effective, and that have far more serious possible side effects, the argument doesn't stand up. You can have the jab, and still get flu. You can vaccinate everybody, and still get a serious epidemic of a slightly different type. You can get swine flu, chicken flu, duck flu, Spanish flu, Chinese flu. Comparing flu vaccine to MMR or smallpox is like comparing chalk and cheese. There's no prospect of any degree of herd immunity being achieved by vaccinating the elderly, according to wikipedia, because the vaccine isn't effective enough, and the immune system weakens with age. There's some hint of a statistical effect being achieved by vaccinating the young, but not the old :  

 Influenza (flu) is more severe in the elderly than in younger age groups, but influenza vaccines lack effectiveness in this demographic due to a waning of the immune system with age.^[7][26] The prioritization of school-age children for seasonal flu immunization, which is more effective than vaccinating the elderly, however, has shown to create a certain degree of protection for the elderly.^[7][26]

https://en.wikipedia.org/wiki/Herd_immunity   

Having said all that, I might well get a jab next year. I just had a look at the NHS page on vaccination and apparently, there is a 24% reduction in the chance of a stroke, for people over 65 who have the jab in the autumn. That's enough to sway me so I'll pencil in a jab for next year. I'm more scared of strokes than I am of flu. 

https://www.nhs.uk/news/neurology/flu-jab-may-cut-stroke-risk-by-a-quarter/   

[CharonY]

1 minute ago, mistermack said:

Where you have vaccines that are far less effective, and that have far more serious possible side effects, the argument doesn't stand up.

You are missing the point that increased immunization, even if imperfect, still reduced the overall likelihood of spread. And that is the key aspect of herd immunity. In this, and many other aspects comparing seasonal flu vaccines to others make perfect sense. The real main difference is that they do not confer lifelong protection (though others may also wane over time).

What it does mean is that the prospects of actually eradicating the disease via vaccination is most likely not going to work. Also, reduced immunization efficacy in elderly is not specific to the flu vaccine, it is e.g. also the case for MMR (a phenomenon known as immunosenescence) . As mentioned before, there are specific formulations to elicit an immune response in the elderly (e.g. using adjuvants). The reason why despite lower responses the elderly are especially encouraged to vaccinate, is because they are the most likely to suffer serious or fatal consequences from the flu (~90% of all deaths associated with flu) and estimates have shown significant effects in preventing deaths and hospitalizations (and again, side effects are comparatively rare and the anecdote may very well has been an unrelated effect, especially considering that the person in question did not have adverse effects before).

However, what it also means is that vaccination only the elderly is not going to be enough, the broader population needs to vaccinate to protect those elderly where the vaccine is not effective enough (again, protection by means of herd immunity).