Gavrilov-Longevity in the 21st Century

8/8/2019 Gavrilov-Longevity in the 21st Century

http://slidepdf.com/reader/full/gavrilov-longevity-in-the-21st-century 1/78

How Long Will We Live in t he

21st Cent ury?

Dr. Leonid A. Gavr ilov, Ph.D.

Dr. Natalia S. Gavr ilova, Ph.D.

Center on AgingNORC and the University of Chicago

Chicago, Illinois, USA



Trends in Life Expectancy at 60Females

Source: Human Mortality Database

17

19

21

23

25

27

29

L i f e

e x p e c t a n c

y

a t

6 0

USA

France

Ireland

GB



I n 2006 slow progress in lif e expectancyimprovement in t he Unit ed States

has been not iced

Mesle, F, Vall in , J. Diverging t rends in

female old-age mortalit y: The Unit edStates and t he Netherlands versusFrance and Japan.

. 2006.

NRC Panel on Diverging Mor talit y



New breakt hrough in

understanding and predict ing

human mort al i t y:Delayed effect s of smoking behavior aremuch more important t han previously

thought

Forecasting United Statesmortality using cohortsmoking histories. Wang

H, Preston SH. Proc Natl Acad Sci U S A . 2009 Jan13;106(2):393-8



Proport ion of deaths in di f ferentcauses due t o smoking

UK, 2000

Source: Murphy, Di Cesare. Presentation at the 2010 Annual Meeting of thePopulation Association of America, Dallas, TX.





Average number of years spent as a cigarette smoker before age 40 among men and womenin different birth cohorts.

Wang H , Preston S H PNAS 2009;106:393-398

©2009 by National Academy of Sciences



Probability of surviving from age 50 to 85 using different projection methods: United States,2004–2034.

Wang H , Preston S H PNAS 2009;106:393-398

©2009 by National Academy of Sciences



New Breakt hrough (2)

Most Recent References:

Contribution of Smoking to InternationalDifferences in Life Expectancy. by Samuel H.Preston, Dana A. Glei, and John R. Wilmoth. In:International Differences in Mortality at Older

Ages: Dimensions and Sources . US NationalResearch Council, The National Academies Press,2010.

http://www.nap.edu/catalog.php?record_id=12945 A new method for estimating smoking-attributable

mortality in high-income countries. Preston SH,Glei DA, Wilmoth JR. Int J Epidemiol . 2010

Apr;39(2):430-8.

http://www.nap.edu/catalog.php?record_id=12945

http://www.nap.edu/catalog.php?record_id=12945



The Fut ure (men)

The smoking epidemic among men has recededin nearly all industrialized countries.

In view of the lag between smoking behavior and

smoking-attributable mortality, it is reasonable toexpect that men in nearly all the study countrieswill benefit from reductions in the smoking-attributable fraction of deaths, thereby boosting

life expectancy.

Preston, Glei, Wilmoth. International Differences in Mortality at Older

Ages: Dimensions and Sources. NAS, 2010.



The Fut ure (w omen)

Among women, however, a later uptake of smoking has produced an upsurge in smoking-attributable deaths. In most countries in thisstudy, the prevalence of smoking among womenhas begun to decline, albeit much later than formen. But the effects of earlier increases havebeen playing a more powerful role in women's

mortality profiles and are likely to continue doingso for some time to come.

Preston, Glei, Wilmoth. International Differences in Mortality at Older Ages:

Dimensions and Sources. NAS, 2010.



New t rend: gender dif ferent ial inlife expectancy is narrow ing

Source: Glei, Horiuchi (2007), Population Studies, 61: 141 - 159



Gender dif ferent ial in LE at age 65

Source: Thorslund et al. Presentation at the REVES meeting in Havana

(2010).





Cancer Death Rates* Among Men, US,1930-2004

*Age-adjusted to the 2000 US standard population.

Source: US Mortality Data 1960-2004, US Mortality Volumes 1930-1959,National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.

0

20

40

60

80

100

1 9 3 0

1 9 3 5

1 9 4 0

1 9 4 5

1 9 5 0

1 9 5 5

1 9 6 0

1 9 6 5

1 9 7 0

1 9 7 5

1 9 8 0

1 9 8 5

1 9 9 0

1 9 9 5

2 0 0 0

Lung & bronchus

Colon & rectum

Stomach

Rate Per 100,000

Prostate

Pancreas

LiverLeukemia



Cancer Death Rates* Among Women, US,1930-2004

*Age-adjusted to the 2000 US standard population.Source: US Mortality Data 1960-2004, US Mortality Volumes 1930-1959,National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.

0

20

40

60

80

100

1 9 3 0

1 9 3 5

1 9 4 0

1 9 4 5

1 9 5 0

1 9 5 5

1 9 6 0

1 9 6 5

1 9 7 0

1 9 7 5

1 9 8 0

1 9 8 5

1 9 9 0

1 9 9 5

2 0 0 0

Lung & bronchus

Colon & rectum

Uterus

Stomach

Breast

Ovary

Pancreas

Rate Per 100,000





Cancer Incidence Rates* by Sex, US, 1975-2004

*Age-adjusted to the 2000 US standard population and adjusted for delays in reporting.Source: Surveillance, Epidemiology, and End Results Program, Delay-adjusted Incidence database:SEER Incidence Delay-adjusted Rates, 9 Registries, 1975-2004, National Cancer Institute, 2007.

0

100

200

300

400

500

600

700

1975 1978 1981 1984 1987 1990 1993 1996 1999 2002

Both Sexes

Men

Women

Rate Per 100,000







0

50

100

150

200

250

1965 1970 1975 1980 1985 1990 1995 2000 2005

A S R

( w o r l d ) p e r 1 0 0 , 0

0 0 USA (SEER)

England

Norway

Finland

Slovakia

The Netherlands

Japan (Osaka)

Breast cancer incidence rates (age 35-74) in selecteddeveloped countries





US advant age in cancerscreening and t reatment

Compared t o European count r ies, t he

US performs part icularly w ell int erms of cancer screening and cancersurvival. (Ho, Preston, 2010)



Change in the US Death Rates* by Cause,1950 & 2005

* Age-adjusted to 2000 US standard population.

Sources: 1950 Mortality Data - CDC/NCHS, NVSS, Mortality Revised.2005 Mortality Data: US Mortality Data 2005, NCHS, Centers for Disease Control and Prevention, 2008.

HeartDiseases

CerebrovascularDiseases

Influenza &Pneumonia

Cancer

1950

2005

Rate Per 100,000





Effect of Pharmaceut ical I nnovat ion onMortalit y, by Age

Source: Schnittker J, Karandinos G (2010). Social Science & Medicine.



Ranking of US age-specif ic death ratesamong a comparison set of 18 of OECD

count ries in 2005

OECD – Organization for Economic Cooperation and Development.

From Ho and Preston (2010)



US li fe expectancy at age 75has much bet t er ranking

among developed count r iescompared t o LE at age 50

“ Unusually vigorous deployment oflif e-saving t echnologies by t he UShealt h care syst em at very old age is

cont ribut ing to the age-pat t ern of USmortalit y rankings” (Ho, Preston, 2010

annual meeting of the Population Association of America, Dallas, TX)



Changes in female LE at age 65 in t he Unit ed

States betw een 1984 and 2000, by cause

In the U.S. gains in lifeexpectancy due to mortalityreduction from heart diseaseswere offset by mortalityincrease from mental

disorders, cancer, infectiousand respiratory diseases.

At the same time, France andJapan enjoyed total gain in LEof more than 2.5 years with

mortality reduction from almostall causes.

Mesle, Vallin, 2006. Populationand Development Review, 32:123-145.



Mortalit y at older ages may besensit ive t o many factors

Accessibi lit y and qualit y of medicalcare

Life st yle and proper nut ri t ion Social netw ork ing, et c.

Many r isk factors of m iddle age do

not w ork at older ages This may create divergent t rends in

different count ries and uncert aint y in

longevit y forecast s



Month of Birth

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

l i f e

e x p e c t a n c y a t a g e 8 0 , y e a r s

7.6

7.7

7.8

7.9

1885 Birth Cohort1891 Birth Cohort

Life Expectancy and Month of BirthData source :Social Security

Death Master File

Published in:

Gavrilova, N.S.,Gavrilov, L.A. Search

for Predictors ofExceptional HumanLongevity. In: “Living to 100 and Beyond ”Monograph. TheSociety of Actuaries,Schaumburg, Illinois,USA, 2005, pp. 1-49.



U.S. t rends in selected healt houtcomes (age 50+ )

Source: Goldman et al., National Tax Journal, 2010. Data from the National

Health Interview Survey

smoking

hypertension

obesity

diabetes



Obesity

Receives now t he most at t ent ion of

polit icians and mass media



Trends in Overweight* Prevalence (%), Adults 18 and Older, US,1992-2006

1992 1995

1998

Less than 50% 50 to 55% More than 55% State did not par ti cipate in survey

*Body mass index of 25.0 kg/m2or greater. Source: Behavioral Risk Factor Surveillance System, CD-ROM (1984-1995,

1998) and Public Use Data Tape (2004, 2006), National Center for Chronic Disease Prevention and Health Promotion,Centers for Disease Control and Prevention, 1997, 2000, 2005, 2007.

2006





Trends in Obesity* Prevalence (%), By Gender, AdultsAged 20 to 74, US, 1960-2006†

*Obesity is defined as a body mass index of 30 kg/m2 or greater. † Age adjusted to the 2000 US standard population. Source:National Health Examination Survey 1960-1962, National Health and Nutrition Examination Survey, 1971-1974, 1976-1980,

1988-1994, 1999-2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, 2004. 2003-2004, 2005-2006: National Health and Nutrition Examination Survey Public Use Data Files, 2003-2004, 2005-2006, NationalCenter for Health Statistics, Centers for Disease Control and Prevention, 2006, 2007.

13

11

1615

12

1715

13

17

23

21

26

31

28

343332

353534

36

0

5

10

15

20

25

30

35

40

45

Both sexes Men Women

P r e v a

l e n c e ( % )

NHES I (1960-62) NHANES I (1971-74) NHANES II (1976-80) NHANES III (1988-94)

NHANES 1999-2002 NHANES 2003-2004 NHANES 2005-2006



Trends in Overweight* Prevalence (%), Children andAdolescents, by Age Group, US, 1971-2004

*Overweight is defined as at or above the 95th percentile for body mass index by age and sex based onreference data.Source: National Health and Nutrition Examination Survey, 1971-1974, 1976-1980, 1988-1994, 1999-2002,National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, 2004. 2003-2004: OgdenCL, et al. Prevalence of Overweight and Obesity in the United States, 1999-2004. JAMA 2006; 295 (13): 1549-55.

54

65

7

5

7

11 1110

16 16

14

19

17

0

5

10

15

20

2 to 5 years 6 to 11 years 12 to 19 years

P r e v a l e n c e ( % )

NHANES I (1971-74) NHANES II (1976-80) NHANES III (1988-94)

NHANES 1999-2002 NHANES 2003-2004



Obesit y does not give muchchance t o survive t o 100

A study of body height andbody build of centenarians

when they were youngadults (aged 30) using

WWI civil draft registration

cards.Gavrilova N.S., Gavrilov L.A. Can exceptionallongevity be predicted? Contingencies [Journal of theAmerican Academy of Actuaries], 2008, July/August

issue, pp. 82-88.



Result s of mult ivar iate study

Medium height vs shortand tall height

1.35 0.260

Slender and mediumbuild vs st out build

2.63* 0.025

Farming 2.20* 0.016

Marr ied vs unmarr ied 0.68 0.268

Nat ive born vs foreign b. 1.13 0.682



Estimated 2-yearprobability of dying(confidence intervals)for obese and nonobese

men and women aged70 and older: AHEAD1993–1998 (a blacksquare representsobese individuals, anda white box representsnonobese individuals).

Reynolds S L et al. The Gerontologist 2005;45:438-444

The Gerontological Society of America

Controversy of obesity:Obesity may be beneficial at older ages at least for men



Smoking Kil ls, Obesit y Disables:A Mult istate Approach of t he US Health and Reti rement Survey

Adult s aged 55+

Source: Reuser, Bonneux , Wil lekens. Obesity , 2009.

Men Women





I s Calor ic Rest r ict ion an Answ er t o theObesit y Epidemic at Older Ages?

“Dietary restriction in rodents has not been shown to beeffective when started in older rodents. Weight loss inhumans over 60 years of age is associated with

increased mortality, hip fracture and increasedinstitutionalization. Calorie restriction in older personsshould be considered experimental and potentiallydangerous. Exercise at present appears to be apreferable t reat ment for older persons.”

Professor John E. Morley is an authorityin geriatric medicine

John E. Morley et al., Current Opinion inClinical Nutrition and Metabolic Care

(2010):



Trends in Prevalence (%) of No Leisure-Time Physical Activity,by Educational Attainment, Adults 18 and Older, US, 1992-2006

Note: Data from participating states and the District of Columbia were aggregated to represent the UnitedStates. Educational attainment is for adults 25 and older.Source: Behavioral Risk Factor Surveillance System CD-ROM (1984-1995, 1996, 1998) and Public Use Data Tape(2000, 2002, 2004, 2005, 2006), National Center for Chronic Disease Prevention and Health Promotion, Centers

for Disease Control and Prevention, 1997, 1999, 2000, 2001, 2003, 2005, 2006, 2007.

0

5

10

15

20

2530

35

40

45

50

55

60

1 9 9 2

1 9 9 4

1 9 9 6

1 9 9 8

2 0 0 0

2 0 0 2

2 0 0 3

2 0 0 4

2 0 0 5

2 0 0 6

Year

P r e v a l e n c e ( % )

Adults with less than a high school education

All adults

Slow improvement in physical activity among U.S. adults



Changes in Diet

Both good and bad t rends On one hand, improvement in food

safety and qualit y. Bet t er aw areness

t hat f ru it s and veggies are usefu l forhealth

On t he other hand, more salt andsugar in f ood and beverages. Higherconsum pt ion of carbs increases r iskof diabetes



Note: Data from participating states and the District of Columbia were aggregated to represent the UnitedStates.Source: Behavioral Risk Factor Surveillance System CD-ROM (1984-1995, 1996, 1998) and Public Use Data Tape

(2000, 2003, 2005), National Center for Chronic Disease Prevention and Health Promotion, Centers for DiseaseControl and Prevention, 1997, 1999, 2000, 2001, 2004, 2006.

24.2 24.4 24.1 24.4 23.6 24.3

0

5

10

15

20

25

30

35

1994 1996 1998 2000 2003 2005

Year

P r e v a l e n

c e ( % )

Trends in Consumption of Five or More RecommendedVegetable and Fruit Servings for Cancer Prevention,

Adults 18 and Older, US, 1994-2005

Soda/cola Sweetened fruit drinks



3541

81

143

13 14

36 38

26

57

40

99

20

3540 39

119

99

128

69

614 11

25

10 93

91 1 1 1

0

20

40

60

80

100

120

140

1965 1977 1988 2002

p e r c a p i t

a c a l o r i e s p e r d a y

Soda/cola Sweetened fruit drinksAlcohol 100% Fruit juiceWhole-fat milk Low-fat milkCoffee Tea

. Per Capita Calories Consumed from Different Beverages by U.S.Adults (age 19 and older), 1965-2002.

Source: Nationwide Food Consumption Surveys (1965, 1977-78) and NHANES

(1988-94, 1999-02); Duffey & Popkin, Obesity (Silver Spring) 2007



Age-Adjusted Trends in Macronutrients and Total Calories Consumed by U.S.Adults (20-74 years), 1971-2004.

Source: National Center for Health Statistics. Health, United States 2008, With Special Focus on Young Adults. NCHS; 2009

36.9

33.436.1

33.8

42.4

48.2

45.4

50.6

20.7

18.4 18.5 15.6

0

10

20

30

40

50

1971-1974 2001-2004 1971-1974 2001-2004

p e r c e n t e n e r g y

0

500

1000

1500

2000

2500

t o t a l k c a l p e r d a y

Fat Carbohydrate Protein Calories



Risk of Flu and Pandemics

Olshansky SJ, Ault, A.B. The Fourt h St age of t heEpidemiologic Transit ion: The Age of DelayedDegenerat ive Diseases. The Milbank Quarterly, Vol. 64,No. 3 (1986), pp. 355-391.

Olshansky SJ, Carnes BA, Rogers RG, Smith L. Emerginginfect ious diseases: t he fif t h st age of t heepidemiological t ransit ion? World Health StatisticsQuarterly 1998;51:207-17.

Barrett R, Kuzawa CW, McDade T, Armelagos GJ.Emerging and re-emerging infect ious diseases: t hethird epidemiologic t ransit ion. Annual Review of Anthropology 1998;27:247-71.1





Grow th of Health Care Costs

May decrease usage of healt h care







Current t rend

Widening socioeconomicinequalit ies in mort alit y

“ I n most [ studied] count ries, mortal i t y fromcardiovascular diseases declined

proport ionally faster in t he uppersocioeconom ic groups.” (Mackenbach et al.,

2003)



Current view “ …mortality improvement rates for UK adults across

all ages have reached more than 2% a year - mainlydriven by a decrease in the number of peoplesmoking and the healthcare industry's effectivenessin reducing premature deaths, particularly from heart

disease. However, …both of these trends have diminishing

returns in improving mortality, as smoking rateshave already dropped to low proportions and the

decline in premature deaths related tocardiovascular disease treatments is slowing down.”

Risk Management Solutions (Global Pensions - 12 Jul2010)



We considered factors

af fect ing gradual changes inlife expectancy af t er age 50

What about t he opport unit y ofradical increase in survival?



Longevit y Revolut ion t hrough

Biotechnology and genet ic

engineering

"... it may soon be

possible to delay both aging and age-related disease in humans." (p. 162)

The Longevity Revolution: The Benefits and Challenges of Living a Long Life . By Robert N. Butler. 553pp. New York, PublicAffairs, 2008



Longevit y Revolut ion ( 2)

"The present level of development of aging

and longevity research justifies an Apollo-type effort to control aging ...” (p. 187)

L it R l t i ( 3)




"Enthusiasts over the future of cell, tissue, and organ replacement imagine successive,

comprehensive reconstitutions of the body.Replacement or regenerative medicine would push death back, presumably indefinitely.“ (p. 401)

L it R l t i ( 4)




" "Indeed, some believe that humans can master their evolution. Among them is

of Cambridge University, who suggests a life expectancy of

five thousand years by 2100 [17].“ (pp. 13-14)



New academic j ournal on

life-extension and rejuvenat ion

Ful ly indexed by

MEDLI NE

Latest I mpact

Factor* is 4.138



Why Longevit y Revolut ion m ay be delayed?

Because it requires serious funding

and commitment :

It is sheer foolishness to imagine that we can extend life ... without substantial governmental participation"

(p. 11)

“… in 2007 only about 15 to 20 percent of approved grants were funded, depending on the institute. I

believe that at least 30 percent of approved grants (if not more) should be funded. ... When funds are tight,review committees act too cautiously and conservatively. Funds should be available to support

risky research.“ (p.106)

Wh L it R l t i b d l d?



Why Longevit y Revolut ion m ay be delayed?(2)

“Today less than 1 percent of the entire federal budget is spent on medical research. Both to improve health and control costs, I propose that 3 percent of the nation's overall health bill ($1.8

trillion projected as 2005) or $54 billion be available to NIH for medical research from federal revenues. I also propose that of Medicare expenditures, 1 percent (or $3 billion) be devoted to the National Institute on Aging. (p.110)

Wh L it R l t i b d l d?



Why Longevit y Revolut ion m ay be delayed?(3)

“While the numbers I am suggesting may seem extraordinary, I believe the level of scientific progress in the field since the 1950s justifies such a program, which could be dubbed the Apollo

Program for Aging and Longevity Science.“ (p.110)

" An orbital jump in financing of science is required

to advance longevity and health as well as national wealth .“ (p. 118 - 119)

Reference: The Longevity Revolution: The Benefits and Challenges of Living a LongLife. By Robert N. Butler. 553 pp. New York, PublicAffairs, 2008

G l P di t i



General Predict ion

Effective life-extending technologies may appear within our

lifetime

However they will be initially expensive and not readilyavailable

Therefore, 'longevity risk' will be particularly high for persons

who are HEWM: Healthy (at baseline)

Educated

Wealthy

Motivated

It is conceivable that such HEWM people may reach lifeexpectancy of about 120 years in a foreseeable future.



Acknowledgments

This study w as made possiblethanks t o:

generous support from t heNat ional I nst it ut e on Aging, and

st imulat ing w orking environmentat t he Cent er on Aging,NORC/ Universit y of Chicago



For More I nformat ion and UpdatesPlease Visit Our

Scient if ic and Educat ional Websit eon Human Longevit y:

ht tp:/ / longevity-science.org

And Please Post Your Comment s at

our Scient if ic Discussion Blog:

ht t p:/ / longevit y-science.blogspot .com/



How can w e improve t he actuarial

forecast s of mort alit y and longevit y ?

By taking int o account t he mort alit y law ssummarizing prior experience in mort alit y

changes over age and t ime:

Alt hough age-specif ic mort alit y profiles

for separate causes of death are complexmort alit y f rom all causes demonst ratesrather simple behavior



The Gompert z-Makeham Law

A – Makeham term or background mortality

R e αx – age-dependent mortality; x - age

Death rate is a sum of age-independent component

(Makeham term) and age-dependent component

(Gompertz function), which increases exponentially

with age.

risk of death

Gompert z-Makeham Law of Mort alit y in



Gompert z Makeham Law of Mort alit y inI t al ian Women

Based on the officialItalian period life tablefor 1964-1967.

Source: Gavrilov,Gavrilova, “The Biology of Life Span ” 1991



How can t he Gompert z-Makeham law be used?

By studying t he historical

dynamics of t he mortalit ycomponent s in t his law :

Makeham component Gompertz component

Histor ical Changes in Mort ali t y



Histor ical Changes in Mort ali t ySwedish Females

Age

0 20 40 60 80 100

L o g ( H a z a r d R a

t e )

0.0001

0.001

0.01

0.1

1

1925196019801999

Data source : Human Mortality Database



Extension of t he Gompert z-Makeham

Model Through t heFactor Analysis of Mort alit y Trends

Mortality force (age, time) =

= a0(age) + a1(age) x F1( t ime) + a2(age) x F2( t ime)

Factor Analysis of Mort alit y



Factor Analysis of Mort alit ySw edish Females

Year

1900 1920 1940 1960 1980 2000

F a c t o r s c o r e

-2

-1

0

1

2

3

4 Factor 1 ('young ages')Factor 2 ('old ages')

Data source : Human Mortality Database



Implications

Mort alit y t rends before the 1950s

are useless or even misleading forcur rent forecast s because all t he“ ru les of t he game” has beenchanged



Preliminary Conclusions

There was some evidence for ‘ biological’mortalit y l imit s in t he past , but t hese‘limit s’ proved t o be responsive t o t herecent t echnological and medical progress.

Thus, there is no convincing evidence forabsolute ‘biological’ mort alit y l imit s now .

Analogy for il lust rat ion and clarif ication: There w as

a limit t o the speed of airplane flight in t he past ( ‘sound’barrier) , but it w as overcome by furt her technologicalprogress. Sim ilar observations seems to be applicable tocurrent human m ortalit y decline.





Gavrilov, L., Gavrilova, N.

Reliabilit y t heory ofaging and longevit y.In:

Academic Press, 6th

edition (publishedrecently).

Gavrilov-Longevity in the 21st Century

Documents