Dataset Information

Fruit and vegetable consumption and its contribution to inequalities in life expectancy and disability-free life expectancy in ten European countries.

ABSTRACT: OBJECTIVES:To assess to what extent educational differences in total life expectancy (TLE) and disability-free life expectancy (DFLE) could be reduced by improving fruit and vegetable consumption in ten European countries. METHODS:Data from national census or registries with mortality follow-up, EU-SILC, and ESS were used in two scenarios to calculate the impact: the upward levelling scenario (exposure in low educated equals exposure in high educated) and the elimination scenario (no exposure in both groups). Results are estimated for men and women between ages 35 and 79 years. RESULTS:Varying by country, upward levelling reduced inequalities in DFLE by 0.1-1.1 years (1-10%) in males, and by 0.0-1.3 years (0-18%) in females. Eliminating exposure reduced inequalities in DFLE between 0.6 and 1.7 years for males (6-15%), and between 0.1 years and 1.8 years for females (3-20%). CONCLUSIONS:Upward levelling of fruit and vegetable consumption would have a small, positive effect on both TLE and DFLE, and could potentially reduce inequalities in TLE and DFLE.

SUBMITTER: Baars AE

PROVIDER: S-EPMC6614160 | biostudies-other | 2019 Jul

REPOSITORIES: biostudies-other

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Fruit and vegetable consumption and its contribution to inequalities in life expectancy and disability-free life expectancy in ten European countries.

Baars Adája E AE Rubio-Valverde Jose R JR Hu Yannan Y Bopp Matthias M Brønnum-Hansen Henrik H Kalediene Ramune R Leinsalu Mall M Martikainen Pekka P Regidor Enrique E White Chris C Wojtyniak Bogdan B Mackenbach Johan P JP Nusselder Wilma J WJ

International journal of public health 20190611 6

<h4>Objectives</h4>To assess to what extent educational differences in total life expectancy (TLE) and disability-free life expectancy (DFLE) could be reduced by improving fruit and vegetable consumption in ten European countries.<h4>Methods</h4>Data from national census or registries with mortality follow-up, EU-SILC, and ESS were used in two scenarios to calculate the impact: the upward levelling scenario (exposure in low educated equals exposure in high educated) and the elimination scenario ...[more]

PMID: 31183533

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Project description:BackgroundTo plan for pensions and health and social services, future mortality and life expectancy need to be forecast. Consistent forecasts for all subnational units within a country are very rare. Our aim was to forecast mortality and life expectancy for England and Wales' districts.MethodsWe developed Bayesian spatiotemporal models for forecasting of age-specific mortality and life expectancy at a local, small-area level. The models included components that accounted for mortality in relation to age, birth cohort, time, and space. We used geocoded mortality and population data between 1981 and 2012 from the Office for National Statistics together with the model with the smallest error to forecast age-specific death rates and life expectancy to 2030 for 375 of England and Wales' 376 districts. We measured model performance by withholding recent data and comparing forecasts with this withheld data.FindingsLife expectancy at birth in England and Wales was 79·5 years (95% credible interval 79·5-79·6) for men and 83·3 years (83·3-83·4) for women in 2012. District life expectancies ranged between 75·2 years (74·9-75·6) and 83·4 years (82·1-84·8) for men and between 80·2 years (79·8-80·5) and 87·3 years (86·0-88·8) for women. Between 1981 and 2012, life expectancy increased by 8·2 years for men and 6·0 years for women, closing the female-male gap from 6·0 to 3·8 years. National life expectancy in 2030 is expected to reach 85·7 (84·2-87·4) years for men and 87·6 (86·7-88·9) years for women, further reducing the female advantage to 1·9 years. Life expectancy will reach or surpass 81·4 years for men and reach or surpass 84·5 years for women in every district by 2030. Longevity inequality across districts, measured as the difference between the 1st and 99th percentiles of district life expectancies, has risen since 1981, and is forecast to rise steadily to 8·3 years (6·8-9·7) for men and 8·3 years (7·1-9·4) for women by 2030.InterpretationPresent forecasts underestimate the expected rise in life expectancy, especially for men, and hence the need to provide improved health and social services and pensions for elderly people in England and Wales. Health and social policies are needed to curb widening life expectancy inequalities, help deprived districts catch up in longevity gains, and avoid a so-called grand divergence in health and longevity.FundingUK Medical Research Council and Public Health England.

Project description:BACKGROUND: The health status of individuals is determined by multiple factors operating at both micro and macro levels and the interactive effects of them. Measures of health inequalities should reflect such determinants explicitly through sources of levels and combining mean differences at group levels and the variation of individuals, for the benefits of decision making and intervention planning. Measures derived recently from marginal models such as beta-binomial and frailty survival, address this issue to some extent, but are limited in handling data with complex structures. Beta-binomial models were also limited in relation to measuring inequalities of life expectancy (LE) directly. METHODS: We propose a multilevel survival model analysis that estimates life expectancy based on survival time with censored data. The model explicitly disentangles total health inequalities in terms of variance components of life expectancy compared to the source of variation at the level of individuals in households and parishes and so on, and estimates group differences of inequalities at the same time. Adjusted distributions of life expectancy by gender and by household socioeconomic level are calculated. Relative and absolute health inequality indices are derived based on model estimates. The model based analysis is illustrated on a large Swedish cohort of 22,680 men and 26,474 women aged 6569 in 1970 and followed up for 30 years. Model based inequality measures are compared to the conventional calculations. RESULTS: Much variation of life expectancy is observed at individual and household levels. Contextual effects at Parish and Municipality level are negligible. Women have longer life expectancy than men and lower inequality. There is marked inequality by the level of household socioeconomic status measured by the median life expectancy in each socio-economic group and the variation in life expectancy within each group. CONCLUSION: Multilevel survival models are flexible and efficient tools in studying health inequalities of life expectancy or survival time data with a geographic structure of more than 2 levels. They are complementary to conventional methods and override some limitations of marginal models. Future research on determinants of health inequalities in the LE of the specific cohort on the household and individual factors could reveal some important causes over the marked household level inequalities.

Dataset Information

Fruit and vegetable consumption and its contribution to inequalities in life expectancy and disability-free life expectancy in ten European countries.

Publications

Fruit and vegetable consumption and its contribution to inequalities in life expectancy and disability-free life expectancy in ten European countries.

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