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The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age–sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6–6·6), from 65·3 years (65·0–65·6) in 1990 to 71·5 years (71·0–71·9) in 2013, HALE at birth rose by 5·4 years (4·9–5·8), from 56·9 years (54·5–59·1) to 62·3 years (59·7–64·8), total DALYs fell by 3·6% (0·3–7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6–29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non–communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition—in which increasing sociodemographic status brings structured change in disease burden—is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions. Bill & Melinda Gates Foundation.

(1) Background: Because of the rapid expansion of the aging population in China, their health status transition and future medical expenditure have received increasing attention. This paper analyzes the health transition of the elderly and how their health transition impacts medical expenditures. At the same time, feasible policy suggestions are provided to respond to the rising medical expenditure and the demand for social care. (2) Methods: The data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015 and analyzed using the Markov model and the Two-Part model (TPM) to forecast the size of the elderly population and their medical expenditures for the period 2020–2060. (3) Results: The study indicates that: (1) for the elderly with a mild disability, the probability of their health improvement is high; in contrast, for the elderly with a moderate or severe disability, their health deterioration is almost certain; (2) the frequency of the diagnosis and treatments of the elderly is closely related to their health status and medical expenditure; alternatively, as the health status deteriorates, the intensity of the elderly individuals’ acceptance of their diagnosis and treatment increases, and so does the medical expense; (3) the population of the elderly with mild and moderate disability demonstrates an inverted “U”-shape, which reaches a peak around 2048, whereas the elderly with severe disability show linear growth, being the target group for health care; (4) with the population increase of the elderly who have severe disability, the medical expenditure increases significantly and poses a huge threat to medical service supply. Conclusions: It is necessary to provide classified and targeted health care according to the health status of the elderly. In addition, improving the level of medical insurance, establishing a mechanism for sharing medical expenditure, and adjusting the basic demographic structure are all important policy choices.

We use data from two representative US household surveys, the Medical Expenditure Panel Survey (MEPS) and the Health and Retirement Study (RAND-HRS) to estimate transition probability matrices between health states over the lifecycle from age 20–95. We compare nonparametric counting methods and parametric methods where we control for individual characteristics as well as time and cohort effects. We align two year transition probabilities from HRS with one-year transition probabilities in MEPS using a stochastic root method assuming a Markov structure. We find that the nonparametric counting method and the regression specifications based on ordered logit models produce similar results over the lifecycle. However, the counting method overestimates the probabilities of transitioning into bad health states. In addition, we find that young women have worse health prospects than their male counterparts but once individuals get older, being female is associated with transitioning into better health states with higher probabilities than men. We do not find significant differences of the conditional health transition probabilities between African Americans and the rest of the population. We also find that the lifecycle patterns are stable over time. Finally, we discuss issues with controlling for time effects, sample attrition, the Markov assumption, and other modeling issues that can arise with categorical outcome variables.

Background Most previous research on migrant health in Europe has taken a cross-sectional perspective, without a specific focus on the older population. Having knowledge about inequalities in health transitions over the life course between migrants and non-migrants, including at older ages, is crucial for the tailoring of policies to the demands of an ageing and culturally diverse society. We analyse differences in health transitions between migrants and non-migrants, specifically focusing on the older population in Europe. Methods We used longitudinal data on migrants and non-migrants aged 50 and older in 10 southern and western European countries from the Survey of Health, Ageing and Retirement in Europe (2004–2015). We applied multinomial logistic regression models of experiencing health deterioration among individuals in good health at baseline, and of experiencing health improvement among individuals in poor health at baseline, separately by sex, in which migrant status (non-migrant, western migrant, non-western migrant) was the main explanatory variable. We considered three dimensions of health, namely self-rated health, depression and diabetes. Results At older ages, migrants in Europe were at higher risk than non-migrants of experiencing a deterioration in health relative to remaining in a given state of self-rated health. Western migrants had a higher risk than non-migrants of becoming depressed, while non-western migrants had a higher risk of acquiring diabetes. Among females only, migrants also tended to be at lower risk than non-migrants of experiencing an improvement in both overall and mental health. Differences in the health transition patterns of older migrants and non-migrants remained robust to the inclusion of several covariates, including education, job status and health-related behaviours. Conclusions Our findings indicate that, in addition to having a health disadvantage at baseline, older migrants in Europe were more likely than older non-migrants to have experienced a deterioration in health over the study period. These results raise concerns about whether migrants in Europe are as likely as non-migrants to age in good health. We recommend that policies aiming to promote healthy ageing specifically address the health needs of the migrant population, thereby distinguishing migrants from different backgrounds.

The purpose of this research was to evaluate the quality of life of elderly people in a Long-Stay Care Facility for the Elderly (ILPI) in the city of Teresina. This is a descriptive and exploratory study with a quantitative methodology. Data collection was carried out between March and April 2019, through the application of the Pentacle of Well-being questionnaire for the elderly at a Long-stay Care Facility in the city of Teresina-PI. Data analysis was performed using the Tabwin 4.1.4 program. Twenty elderly people were interviewed and as to the profile found, 45% (n = 9) were between 80 and 89 years old and 50% (n = 10) were female and male. Regarding the questionnaire, the components nutrition, preventive behavior, social relationship and stress control showed satisfactory results, except for the component ‘physical activity’, in which 65% (n = 13) of the elderly rarely perform any physical activity. The lifestyle of the elderly is considered satisfactory, however, the Physical Activity component showed an unsatisfactory result.

This report is organized in such a way that the key policy options and strategic priorities are based on the country context, including the burden of non-communicable diseases (NCDs) and associated risk factors and the existing capacity of the health system. Chapter one describes the country and regional contexts and the evidence of the demographic and epidemiological transitions in Bangladesh; chapter two outlines the disease burden of major NCDs, including the equity and economic impact and the common risk factors; chapter three provides an assessment of the health system and its capacity to prevent and control major NCDs; chapter four summarizes ongoing NCD interventions and activities in Bangladesh and highlights the remaining gaps and challenges; and chapter five presents key policy options and strategic priorities to prevent and control NCDs.

Background Older recently widowed women are faced with increased health risks and chronic conditions associated not only with bereavement, but also, older age. Loss and grief, adjusting to living alone, decreased income, and managing multiple chronic conditions can impact on older women’s ability to transition following recent spousal bereavement. Providing appropriate, timely, and effective services to foster this life transition is of critical importance, yet few services directed towards these women exist in Australia, and there is little data describing the experiences of women and their support needs at this time. Methods We conducted a longitudinal mixed method study using in-depth semi-structured interviews and questionnaires that were administered three times over a twelve month period to understand the experiences and needs of older women in the period following their husbands’ deaths. Descriptive statistics and Interpretive Phenomenological Analysis were used to analyse quantitative and qualitative data, respectively, prior to data integration. Results Participants were twenty-one community-dwelling recently widowed older women who were an average age of 71 (SD 6.13) years. The majority of participants scored within normal ranges of depression, anxiety, and stress, yet a subset of participants had elevated levels of each of these constructs (37%, 27%, and 19%, respectively) throughout the study period. Positive self-reports of general health predominated, yet 86% of participants were living with one or more chronic condition and taking an average of 4 medications per day. The majority (76%) experienced exacerbations of existing conditions or were diagnosed with a new illness in the early bereavement period, leading to planned and unplanned hospitalisations and other health service use. Qualitative data provided insight into these experiences, the meanings women ascribed to them, and their reasons for enacting certain health risk behaviours. Conclusions The combination of co-morbidities, polypharmacy, and risk behaviors impacted on medication management and appeared associated with health events. The feminization of ageing and an increasing number of older women living alone with multiple chronic conditions represent significant challenges to health services and societal support systems. Older women’s transition to widowhood signals concomitant health transitions and multidimensional support needs.

23% of the total global burden of disease is attributable to disorders in people aged 60 years and older. Although the proportion of the burden arising from older people (≥60 years) is highest in high-income regions, disability-adjusted life years (DALYs) per head are 40% higher in low-income and middle-income regions, accounted for by the increased burden per head of population arising from cardiovascular diseases, and sensory, respiratory, and infectious disorders. The leading contributors to disease burden in older people are cardiovascular diseases (30·3% of the total burden in people aged 60 years and older), malignant neoplasms (15·1%), chronic respiratory diseases (9·5%), musculoskeletal diseases (7·5%), and neurological and mental disorders (6·6%). A substantial and increased proportion of morbidity and mortality due to chronic disease occurs in older people. Primary prevention in adults aged younger than 60 years will improve health in successive cohorts of older people, but much of the potential to reduce disease burden will come from more effective primary, secondary, and tertiary prevention targeting older people. Obstacles include misplaced global health priorities, ageism, the poor preparedness of health systems to deliver age-appropriate care for chronic diseases, and the complexity of integrating care for complex multimorbidities. Although population ageing is driving the worldwide epidemic of chronic diseases, substantial untapped potential exists to modify the relation between chronological age and health. This objective is especially important for the most age-dependent disorders (ie, dementia, stroke, chronic obstructive pulmonary disease, and vision impairment), for which the burden of disease arises more from disability than from mortality, and for which long-term care costs outweigh health expenditure. The societal cost of these disorders is enormous.

Aims: This paper examines trends in age-specific mortality in a rural South African population from 1992 to 2003, a decade spanning major sociopolitical change and emergence of the HIV/AIDS pandemic. Changing mortality patterns are discussed within a health-transition framework. Methods: Data on population size, structure, and deaths, obtained from the Agincourt health and demographic surveillance system, were used to calculate person-years at risk and death rates. life tables were computed by age, sex and calendar year. Mortality rates for the early period 1992-93 and a decade later, 2002-03, were compared. Results: Findings demonstrate significant increases in mortality for both sexes since the mid-1990s, with a rapid decline in life expectancy of 12 years in females and 14 years in males. The increases are most prominent in children (0-4) and young adult (20-49) age groups, in which increases of two- and fivefold respectively have been observed in the past decade. Sex differences in mortality patterns are evident with increases more marked in females in most adult age groups. Conclusions: Empirical data demonstrate a marked \"counter transition\" with mortality increasing in children and young adults, \"epidemiologic polarization\" with vulnerable subgroups experiencing a higher mortality burden, and a \"protracted transition\" with simultaneous emergence of HIV/AIDS together with increasing non-communicable disease in older adults. The health transition in rural South Africa is unlikely to predict patterns elsewhere; hence the need to examine trends in as many contexts as have the data to support such analyses.