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Leading causes of years lived with disability by country, age group, and sex, Region of the Americas, 2019 Male
Source publication
Objective. To describe the life expectancy, healthy life expectancy, disease burden, and leading causes of mortality and disability in adults aged 65 years and older in the Region of the Americas from 1990 to 2019.
Methods. We used estimates from the Global Burden of Disease Study 2019 to examine the level and trends of life expectancy, healthy l...
Contexts in source publication
Context 1
... 2019, diabetes mellitus, and age-related and other hearing loss ranked first and second as causes of disability in most countries in both sexes and all age groups 65 years and older. Lower back pain, and blindness and vision loss were also common in most countries and in most age groups ( Figure 6, Figure S12 in the appendix). ...
Context 2
... 2019, diabetes mellitus, and age-related and other hearing loss ranked first and second as causes of disability in most countries in both sexes and all age groups 65 years and older. Lower back pain, and blindness and vision loss were also common in most countries and in most age groups ( Figure 6, Figure S12 in the appendix). ...
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Citations
... Over the years, dual chamber pacing has become a standard approach for the treatment of permanent or paroxysmal third-or high-degree atrioventricular block (AVB) [4,5]. Life expectancy of heart disease patients has also increased signifi cantly with improved primary and secondary prevention [6,7]. This led to an in-crease in the number of PPM implantations and allowed us to analyze its long-term eff ects. ...
Introduction
Data on the development of left ventricular dysfunction after permanent pacemaker implantation are available. Myocardial collagen deposition is a well-known mechanism that occurs in left ventricular remodelling. This gave us reason to dynamically monitor the levels of the main molecules involved in collagen synthesis, PIPC (carboxy-terminal propeptide of type I procollagen) and PIIINP (amino-terminal propeptide of type III procollagen).
Materials and Methods
PIPC and PIIINP levels were studied using enzyme-linked immunoassays in plasma from 45 patients (25 men, 20 women, 72.1 ± 9 years) and 46 controls (24 men, 22 women, 71.9 ± 8.7 years) without known cardiovascular diseases (except arterial hypertension, conduction disorder, indication for the procedure) at baseline (immediately before PPM implantation for patients), at 12 and 24 weeks.
Results
There was no difference in baseline levels of PICP and PIIINP between patients and controls (p > 0.05, Table abstract). At week 12, PICP levels increased significantly in patients compared to baseline in controls (p < 0.05, Table abstract). At week 24, values continued to increase and were again significantly higher than baseline in the controls (p < 0.001, Table abstract). At the 12-week follow-up visit, PIIINP values in patients were significantly higher than those at baseline in controls (p < 0.001, Table abstract). At week 24, the values of the patients were still higher than those of the controls, but the difference was not significant (p > 0.05, Table abstract).
Conclusion
This study showed early activation of collagen synthesis < 6 months after PPM (permanent pacemaker) implantation. Due to the selection of patients without concomitant cardiovascular pathology, we have reason to assume that it is a result of the procedure itself and a serious prerequisite for increased collagen deposition in the myocardium.
... Las ECV son la principal causa de mortalidad prematura, por lo que producen una reducción de la esperanza de vida de la población en toda la Región. Además, son también una causa importante de discapacidad y disparidad socioeconómica [5]. La presión arterial sistólica (PAS) elevada es el principal factor de riesgo modificable para las ECV. ...
Propósito de la revisión. HEARTS en las Américas es la adaptación regional de la iniciativa mundial HEARTS, de la Organización Mundial de la Salud, para la prevención y el control de las enfermedades cardiovascula-res (ECV). Su objetivo general es impulsar el cambio de la práctica clínica y de la gestión en los entornos de atención primaria, por parte de los servicios de salud, a fin de mejorar el control de la hipertensión y reducir el riesgo de ECV. En esta revisión se describe la iniciativa HEARTS en las Américas. En primer lugar, se resume la situación epidemiológica regional en cuanto a la mortalidad por ECV y las tendencias en el control de la hipertensión a nivel poblacional; a continuación, se explica la razón de ser de los principales componentes de la intervención: el sistema de manejo orientado a la atención primaria y la vía clínica de HEARTS. Por último, se examinan los factores clave para acelerar la expansión de HEARTS: los medicamentos, la atención basada en el trabajo en equipo y un sistema de monitoreo y evaluación.
Resultados recientes. Hasta el momento, 33 países y territorios de América Latina y el Caribe se han com-prometido a integrar este programa en toda su red de atención primaria de salud para el 2025. El aumento de la cobertura y del control de la hipertensión en los entornos de atención primaria de salud (en comparación con el modelo tradicional) es prometedor y confirma que las intervenciones que se promueven como parte de HEARTS son factibles y resultan aceptables para las comunidades, los pacientes, los prestadores de ser-vicios de salud, los responsables de la toma de decisiones y los financiadores. En esta revisión se destacan algunos casos de implementación satisfactoria.
Conclusiones. Ampliar el uso de un tratamiento eficaz de la hipertensión y optimizar el control del riesgo de ECV es una forma pragmática de acelerar la reducción de la mortalidad por ECV y, al mismo tiempo, de fortalecer los sistemas de atención primaria de salud para responder con calidad y de manera eficaz y equi-tativa al desafío que entrañan las enfermedades no transmisibles, no solo en los países de ingresos bajos o medianos, sino en todas las comunidades a nivel mundial.
Palabras clave Hipertensión; enfermedades cardiovasculares; atención primaria de salud; salud pública; Américas
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... Hence, evaluating whether healthcare systems address healthcare needs and responses to the aging population is imperative [15]. Despite its importance, cross-national studies on life expectancy and HALE in older adults and their correlation with healthcare performance are limited [3,16] Most studies focused on individual national populations [17][18][19][20][21]. Furthermore, the varying definition of healthcare system performance and related indicators among different countries poses challenges in comparing these metrics within a single study [22]. ...
... We examined changes in life expectancy and HALE by describing life expectancy and HALE for those aged 70-74 years in the 33 countries in 1990 and 2019. We also calculated unhealthy years of life (life expectancy-HALE), and the proportion of unhealthy years of life on total life expectancy [(life expectancy-HALE)/ life expectancy] [18] for those aged 70-74 in 1990 and 2019. A linear regression analysis was conducted to investigate associations between life expectancy, HALE, unhealthy years of life, and HAQ in 1990 and 2019. ...
Objectives
This study aimed to examine changes in life expectancy (LE), health-adjusted life expectancy (HALE), unhealthy years of life, and disease burden of older people in industrialised countries and associations with health systems.
Methods
We used estimates of LE and HALE, unhealthy years of life, years of life loss (YLL), years lived with disability (YLD) for individuals aged 70 years and over in 33 industrialised countries from 1990 to 2019 from the Global Burden of Disease Study 2019. A linear regression analysis was conducted to examine the association of health outcomes with the Healthcare Access and Quality (HAQ) index.
Results
LE and HALE increased with improved HAQ index from 1990 to 2019. However, the number of unhealthy years of life increased. An increased HAQ index was associated with decreases in YLL. However, changes in YLD were relatively small and were not correlated with HAQ index.
Conclusions
The healthcare system needs to more address the increased morbidity burden among older people. It should be designed to handle to healthcare needs of the ageing population.
... Considering the global population aging, the projection of HLE has been gaining attention, with studies consistently demonstrating its strong link to quality of life and overall health status [5]. A higher HLE among aged adults enables them to better manage diseases and health concerns while maintaining their independence [6]. ...
Background
Healthy life expectancy (HLE) projections are required for optimising social and health service management in the future. Existing studies on the topic were usually conducted by selecting a single model for analysis. We thus aimed to use an ensembled model to project the future HLE for 202 countries/region.
Methods
We obtained data on age-sex-specific HLE and the sociodemographic index (SDI) level of 202 countries from 1990 to 2019 from the Global Burden of Disease (GBD) database and used a probabilistic Bayesian model comprised of 21 forecasting models to predict their HLE in 2030.
Results
In general, HLE is projected to increase in all 202 countries, with the least probability of 82.4% for women and 81.0% for men. Most of the countries with the lowest projected HLE would be located in Africa. Women in Singapore have the highest projected HLE in 2030, with a 94.5% probability of higher than 75.2 years, which is the highest HLE in 2019 across countries. Maldives, Kuwait, and China are projected to have a probability of 49.3%, 41.2% and 31.6% to be the new entries of the top ten countries with the highest HLE for females compared with 2019. Men in Singapore are projected to have the highest HLE at birth in 2030, with a 93.4% probability of higher than 75.2 years. Peru and Maldives have a probability of 48.7% and 35.3% being new top ten countries in male’s HLE. The female advantage in HLE will shrink by 2030 in 117 countries, especially in most of the high SDI and European countries.
Conclusions
HLE will likely continue to increase in most countries and regions worldwide in the future. More attention needs to be paid to combatting obesity, chronic diseases, and specific infectious diseases, especially in African and some Pacific Island countries. Although gender gaps may not be fully bridged, HLE could partially mitigate and even eliminate them through economic development and improvements in health care.
... With 2 million deaths annually, CVD remains the deadliest disease in all countries of the Americas [4•]. CVD is the main cause of premature mortality, reducing the population's life expectancy regionwide, and is a major cause of disability and socioeconomic disparity [5]. High systolic blood pressure (SBP) is the main modifiable risk factor for CVD. ...
Purpose of Review
HEARTS in the Americas is the regional adaptation of Global Hearts, the World Health Organization initiative for cardiovascular disease (CVD) prevention and control. Its overarching goal is to drive health services to change managerial and clinical practice in primary care settings to improve hypertension control and CVD risk management. This review describes the HEARTS in the Americas initiative. First, the regional epidemiological situation of CVD mortality and population hypertension control trends are summarized; then the rationale for its main intervention components: the primary care-oriented management system and the HEARTS Clinical Pathway are described. Finally, the key factors for accelerating the expansion of HEARTS are examined: medicines, team-based care, and a system for monitoring and evaluation.
Recent Findings
Thus far, 33 countries in Latin America and the Caribbean have committed to integrating this program across their primary healthcare network by 2025. The increase in hypertension coverage and control in primary health care settings compared with the traditional model is promising and confirms that the interventions under the HEARTS umbrella are feasible and acceptable to communities, patients, providers, decision-makers, and funders. This review highlights some cases of successful implementation.
Summary
Scaling up effective treatment for hypertension and optimization of CVD risk management is a pragmatic way to accelerate the reduction of CVD mortality while strengthening primary healthcare systems to respond effectively, with quality, and equitably, to the challenge of non-communicable diseases, not only in low-middle income countries but in all communities globally.
... The rapid increase in life expectancy is outpacing the increase in healthy life expectancy, implying that people are living their extended years with multiple morbidities and complications, physical and cognitive impairment, and frailty [1]. Such complex conditions often lead to challenges with self-care (that is the ability to establish behaviours to promote and maintain one's health and well-being) for older adults along the health and illness trajectory. ...
Background
The ageing population requires seamless, integrated health and social care services in the community to promote the health of older adults. However, inadequate financial resources, a lack of clear operational guidelines, and various organisational work cultures may affect the implementation quality and sustainability of these services. As a unique approach, this study seeks to examine the preliminary effects of a health-social partnership programme on the health self-management of community-dwelling older adults in Hong Kong. Additionally, the study seeks to ascertain key insights into the mechanisms and processes required to implement and sustain a self-care management programme in broader practice in community settings.
Methods
This study will use a hybrid effectiveness-implementation design. During the 3-month programme, subjects in the intervention group will receive four Zoom video conference sessions and four telephone calls conducted by a health-social service team that will include a nurse case manager, community workers, general practitioners, a Chinese medicine practitioner, and social workers. Subjects in the control group will receive a monthly social telephone call from a trained research assistant to rule out the possible social effect of the intervention. The reach, effectiveness, adoption, implementation, and maintenance framework (i.e. RE-AIM framework) will be used to evaluate the implementation and effectiveness outcomes. Of the five dimensions included in the RE-AIM framework, only effectiveness and maintenance outcomes will be collected from both the intervention and control groups. The outcomes of the other three dimensions—reach, adoption, and implementation—will only be collected from subjects in the intervention group. Data will be collected pre-intervention, immediately post-intervention, and 3 months after the intervention is completed to evaluate the maintenance effect of the programme.
Discussion
This programme will aim to enhance health-promoting self-care management behaviours in older adults dwelling in the community. This will be the first study in Hong Kong to use the hybrid effectiveness-implementation design and involve key stakeholders in the evaluation and implementation of a health self-management programme using a health-social service partnership approach. The programme, which will be rooted in the community, may be used as a model, if proven successful, for similar types of services.
Trial registration
Clinicaltrials.gov, NCT04442867. Submitted 19 June 2020
... Life Expectancy (LE) and Health-adjusted life expectancy (HALE) are indicators that reflect the population's health conditions; they are closely related to the socioeconomic level and both the quality of and access to health services that people have [1][2][3][4][5][6][7]. These indicators are often used to identify gaps and inequities within and between countries. ...
... These indicators are often used to identify gaps and inequities within and between countries. In order to calculate them, information is collected through censuses, vital statistics, or surveys, such as mortality, morbidity, and disability data, among others [1][2][3][4][5][6][7]. ...
... LE refers to the average number of years that a person at birth or at a certain age is expected to live, assuming that mortality rates remain constant at a given place and time [1][2][3][4]. This indicator represents the number of years that a person of a given age is expected to live [1][2][3][4]. ...
Introduction
Life expectancy (LE) and Health-adjusted life expectancy (HALE) are summary indicators that reflect a population’s general life conditions and measure inequities in health outcomes. The objective of this study was to identify the differences in LE and HALE by sex, age group, and state in Mexico from 1990 to 2019. Also, to evaluate whether the changes in HALE are related to sociodemographic indicators and indicators of access to and quality of health services.
Methods
A secondary analysis was performed based on the Global Burden of Disease, Injuries, and Risk Factors Study (GBD). Data were obtained for LE (by sex and state) and HALE (by sex, age group, and state) for the years 1990, 2010, and 2019. The correlations between HALE with the Socio-Demographic Index (SDI) and with the Healthcare Access and Quality (HAQ) Index were estimated for 1990 and 2019 (by total population and sex).
Results
LE and HALE had an absolute increase of 6.7% and 6.4% from 1990 to 2019, mainly among women, although they spent more years in poor health (11.8 years) than men. The patterns of LE and HALE were heterogeneous and divergent by state. In 2019, the difference in HALE (for both sex) between the states with the highest (Hidalgo) and the lowest (Chiapas) value was 4.6 years.
Conclusions
Progress in LE and HALE has slowed in recent years; HALE has even had setbacks in some states. Gaps between men and women, as well as between states, are persistent. Public and population policymaking should seek to lengthen LE and focus on ensuring that such years are spent in good health and with good quality of life.
... Chronic diseases are a long-term and progressive condition that is not transmitted from one person to another, but imposes a significant burden on the individual, society, and family. 1 These diseases are silently and gradually spreading worldwide and affect the global population. 2 Improvements in the quality of healthcare along with an increase in life expectancy in recent years have led to an increase in the burden of chronic diseases. 3 Statistics indicate that one in every three adults is affected by one or more chronic diseases. Additionally, it has been observed that nearly three-quarters of the elderly population in developed countries are affected by chronic diseases, and this number is expected to significantly increase. ...
... 4 Due to the increase in hope for life and urbanization, chronic diseases are expanding day by day and are recognized as the main causes of morbidity and mortality worldwide. 3 According to the Burden of Disease Study in the United States in 2018, more than 45% of disability-adjusted life years in the country are caused by chronic diseases. 5 Based on available statistics, 5.83% of deaths and 1.78% of all diseases in Iran in 2019 were related to non-communicable chronic diseases. ...
Objectives
This study was conducted with the aim of determining the validity and reliability of the Persian version of “General Medication Adherence Scale (GMAS)” in chronic patients in Iran.
Methodology
The study was conducted among patients with chronic diseases in five hospitals of Iran. In this study, after cultural validation, using the steps of Content, Response Reaction, and Internal structure evaluations, the research sample was increased to 150 individuals for exploratory factor analysis (EFA) and 313 chronic patients for confirmatory factor analysis (CFA) to confirm the construct validity. Cronbach's alpha coefficient was used to assess internal consistency, and test-retest method was used to evaluate the reliability of the tool.
Findings
The results of EFA and CFA confirmed the tool with three factors and 11 items. The R ² index in the above model was estimated at 0.99, indicating that 99% of the variation in medication adherence scores in research units was explained by GMAS with 11 items. The main indices of the model in factor analysis were all above 0.9, indicating a good fit for the model.
Discussion
Overall, the study results showed that the Persian version of GMAS has acceptable and practical characteristics for evaluating medication adherence, and it can be used as a valid tool in various related fields.
... Además, se siguen registrando importantes disparidades entre los países de la Región de las Américas y dentro de ellos (3). Esta observación es preocupante debido al efecto de la carga de las ECV sobre la esperanza de vida y la esperanza de vida sana, especialmente en las personas de 65 años o más (4). Estos datos sugieren que las estrategias tradicionales de reducción del riesgo para la prevención de las ECV, el alto riesgo poblacional y las estrategias del sistema de salud no están funcionando lo suficientemente bien, y que se necesitan urgentemente nuevos enfoques para reducir la carga de enfermedad relacionada con las ECV en la población general. ...
Objective:
To quantify the association between the prevalence of population hypertension control and ischemic heart disease (IHD) and stroke mortality in 36 countries of the Americas from 1990 to 2019.
Methods:
This ecologic study uses the prevalence of hypertension, awareness, treatment, and control from the NCD-RisC and IHD and stroke mortality from the Global Burden of Disease Study 2019. Regression analysis was used to assess time trends and the association between population hypertension control and mortality.
Results:
Between 1990 and 2019, age-standardized death rates due to IHD and stroke declined annually by 2.2% (95% confidence intervals: -2.4 to -2.1) and 1.8% (-1.9 to -1.6), respectively. The annual reduction rate in IHD and stroke mortality deaccelerated to -1% (-1.2 to -0.8) during 2000-2019. From 1990 to 2019, the prevalence of hypertension controlled to a systolic/diastolic blood pressure ≤140/90 mmHg increased by 3.2% (3.1 to 3.2) annually. Population hypertension control showed an inverse association with IHD and stroke mortality, respectively, regionwide and in all but 3 out of 36 countries. Regionwide, for every 1% increase in population hypertension control, our data predicted a reduction of 2.9% (-2.94 to -2.85) in IHD deaths per 100 000 population, equivalent to an averted 25 639 deaths (2.5 deaths per 100 000 population) and 2.37% (-2.41 to -2.33) in stroke deaths per 100 000 population, equivalent to an averted 9 650 deaths (1 death per 100 000 population).
Conclusion:
There is a strong ecological negative association between IHD and stroke mortality and population hypertension control. Countries with the best performance in hypertension control showed better progress in reducing CVD mortality. Prediction models have implications for hypertension management in most populations in the Region of the Americas and other parts of the world.
... According to the World Health Organization (1) populations around the world are experiencing a healthy life expectancy in a context of rapid global aging. Unfortunately, a higher life expectancy leads to burden of diseases and disability in older people in the Americas (2). Recent studies have addressed frailty, a condition related to a loss of homeostasis and a deregulation of multiple systems as well as physiological reserve against different types of stressors (3). ...
Introduction
The Clinical-Functional Vulnerability Index (IVCF-20) is a validated multidimensional instrument that has been used in Brazil to evaluate functional disability in frail older adults. The main aim of this study was to assess frailty using this novel screening tool. In addition, to investigate whether frailty was associated with cognitive impairment and functional disability in older adults with affective disorders.
Methods
Participants included were over 60 years old, with affective disorders (depressive or anxiety disorders), from two specialized outpatient clinics. The sample was comprised of 46 patients (30% of a total from 153). The following instruments were applied: Clock Drawing Test (CDT), Mini Mental State Examination (MMSE); Verbal Fluency Test (VFT); Pfeffer Questionnaire or Functional Assessment Questionnaire (FAQ); Katz Index; Geriatric Depression Scale (GDS-15); Geriatric Anxiety Inventory (GAI), and IVCF-20 as well as sociodemographic and clinical questionnaires. The association between the variables of interest was estimated using Spearman correlation.
Results
This study found a negative correlation between frailty and cognitive decline (MMSE; rs = −0.58; p < 0.001); (VFT; rs = −0.60; p < 0.001); (CDT; rs = −0.47; p = 0.001) and a positive correlation between frailty and depressive symptoms (GDS-15; rs = 0.34; p = 0.019) as well as disability for IADLs (FAQ; rs = 0.69; p < 0.001). However, there was no statistical difference in the association between frailty and anxiety symptoms (GAI; rs = 0.24; p = 0.103) or disability for BADLs (Katz; rs = −0.02; p = 0.895).
Discussion
Our data support that the associations between frailty, cognitive and functional disability are prevalent issues in Psychogeriatrics. Assessing frailty in a multidimensional context is essential using a rapid assessment frailty tool in clinical practice.
