Centenarians: who are they? A description of the total Swedish centenarian population in terms of living arrangements, health, and care utilization.

BACKGROUND: The global centenarian population has doubled each decade and is expected to continue growing. However, information regarding how they live, their health status, and care needs is limited. AIMS: This study aims to describe the total Swedish centenarian population in terms of health status, living arrangements, and socio-demographic characteristics. METHODS: This nationwide register-based study included all Swedish people reaching age 100 between 2013 and 2018. We analyzed their socio-demographic characteristics, living arrangements, number of prescribed drugs, and health status. Moreover, their care transitions from age 100 and two years forward were described. RESULTS: Of 5,882 centenarians (80.7% women), only 15.0% lived at home without formal care and 24.5% cohabited on their 100th birthday. Men (22.7%) were more likely than women (13.2%) to live at home without care. Approximately half of the centenarians lived in care homes, with fewer men (41.0%) than women (54.0%). Around 66.6% had a child living within the 50 km range. Most (76.5%) had an income below the median for Swedish older adults. Almost none were free from drugs, and polypharmacy was common (65.3%). Over half had at least one morbidity. Two years later, only 4.3% lived at home without care, and 63.9% died. CONCLUSION: Sweden's centenarian population is highly dependent on home care and care homes. Among the ones still living at home, the vast majority live alone and have low incomes. Strategies to manage health and social care demands of this growing population group in the coming decade are important.

Frailty Among Breast Cancer Survivors: Evidence From Swedish Population Data.

Incidence and survival of breast cancer, the most common cancer among women, have been increasing, leaving survivors at risk of aging-related health conditions. In this matched cohort study, we examined frailty risk with the Hospital Frailty Risk Score among breast cancer survivors (n = 34,900) and age-matched comparison subjects (n = 290,063). Women born in 1935-1975, registered in the Swedish Total Population Register (1991-2015), were eligible for inclusion. Survivors had a first breast cancer diagnosis in 1991-2005 and survived ≥5 years after initial diagnosis. Death date was determined by linkage to the National Cause of Death Registry (through 2015). Cancer survivorship was weakly associated with frailty (subdistribution hazard ratio (SHR) = 1.04, 95% confidence interval (CI): 1.00, 1.07). In age-stratified models, those diagnosed at younger ages (<50 years) had higher risk of frailty (SHR = 1.12, 95% CI: 1.00, 1.24) than those diagnosed at ages 50-65 (SHR = 1.03, 95% CI: 0.98, 1.07) or >65 (SHR = 1.09, 95% CI: 1.02, 1.17) years. Additionally, there was increased risk of frailty for diagnoses in 2000 or later (SHR = 1.15, 95% CI: 1.09, 1.21) compared with before 2000 (SHR = 0.97, 95% CI: 0.93, 1.17). This supports work from smaller samples showing that breast cancer survivors have increased frailty risk, particularly when diagnosed at younger ages.

Cardiovascular Mortality Gap Between the United States and Other High Life Expectancy Countries in 2000-2016.

OBJECTIVES: Reductions in U.S. cardiovascular disease (CVD) mortality have stagnated. While other high life expectancy countries (HLCs) have also recently experienced a stall, the stagnation in CVD mortality in the United States appeared earlier and has been more pronounced. The reasons for the stall are unknown. We analyze cross-national variations in mortality trends to quantify the U.S. exceptionality and provide insight into its underlying causes. METHODS: Data are from the World Health Organization (2000-2016). We quantified differences in levels and trends of CVD mortality between the United States and 17 other HLCs. We decomposed differences to identify the individual contributions of major CVD subclassifications (ischemic heart disease [IHD], stroke, other heart diseases). To identify potential behavioral explanations, we compared trends in CVD mortality with trends in other causes of death related to obesity, smoking, alcohol, and drugs. RESULTS: Our study has four central findings: (a) U.S. CVD mortality is consistently higher than the average of other HLCs; (b) the U.S.-HLC gap declined until around 2008 and increased thereafter; (c) the shift from convergence to divergence was mainly driven by slowing IHD and stroke mortality reductions and increasing mortality from other CVD causes; (d) among the potential risk factors, only obesity- and alcohol-related mortality showed age-specific temporal changes that are similar to those observed for cardiovascular mortality. DISCUSSION: The exceptional changes in U.S. CVD mortality are driven by a distinct pattern of slowing reductions in IHD and stroke mortality and deteriorating mortality from other CVD causes. Obesity and alcohol abuse appear to be interrelated factors.

The rate by which mortality increase with age is the same for those who experienced chronic disease as for the general population.

BACKGROUND: Mortality doubles approximately every 6-7 years during adulthood. This exponential increase in death risk with chronological age is the population-level manifestation of ageing, and often referred to as the rate-of-ageing. OBJECTIVE: We explore whether the onset of severe chronic disease alters the rate-of-ageing. METHODS: Using Swedish register data covering the entire population of the birth cohorts 1927-30, we analyse whether being diagnosed with myocardial infarction, diabetes or cancer results in a deviation of the rate-of-ageing from those of the total population. We also quantify the long-term mortality effects of these diseases, using ages with equivalent mortality levels for those with disease and the total population. RESULTS: None of the diseases revealed a sustained effect on the rate-of-ageing. After an initial switch upwards in the level of mortality, the rate-of-ageing returned to the same pace as for the total population. The time it takes for the rate to return depends on the disease. The long-term effects of diabetes and myocardial infarction amount to mortality levels that are equivalent to those aged 5-7 years older in the total population. For cancer, the level of mortality returns to that of the total population. CONCLUSION: Our results suggest an underlying process of ageing that causes mortality to increase at a set pace, with every year older we become. This process is not affected by disease history. The persistence of the rate-of-ageing motivates a critical discussion of what role disease prevention can play in altering the progression of ageing.

The rise in the number of long-term survivors from different diseases can slow the increase in life expectancy of the total population.

BACKGROUND: Recent improvements in life expectancy in many countries stem from reduced mortality from cardiovascular disease and cancer above the age of 60. This is the combined result of decreased incidence and improved survival among those with disease. The latter has led to a higher proportion in the population of people with a past history of disease. This is a group with higher mortality than the general population. How growing shares of persons with past history of disease and improved survival with disease have affected changes in life expectancy of the total population is the objective of this paper. METHODS: Using register data for the total Swedish population, we stratified the population based on whether individuals have been diagnosed with myocardial infarction, stroke, hip fracture, colon cancer, or breast cancer. Using a novel decomposition approach, we decomposed the changes in life expectancy at age 60 between 1994 and 2016 into contributions from improved survival with disease and from changes in proportion of people with past history of disease. RESULTS: Improvements in survival from disease resulted in gains of life expectancy for the total population. However, while the contributions to life expectancy improvements from myocardial infarction, stroke and breast cancer were substantial, the contributions from the other diseases were minor. These gains were counteracted, to various degrees, by the increasing proportion of people with raised mortality due to a past history of disease. For instance, the impact on life expectancy by improved survival from breast cancer was almost halved by the increasing share of females with a past history of breast cancer. CONCLUSION: Rising numbers of survivors of different diseases can slow the increase in life expectancy. This dynamic may represent the costs associated with successful treatment of diseases, and thus, a potential "failure of success." This dynamic should be considered when assessing mortality and life expectancy trends. As populations are aging and disease survival continues to improve, this issue is likely to become even more important in the future.

The effects of increasing longevity and changing incidence on lifetime risk differentials: A decomposition approach.

Increasing longevity can distort time trends in summary measures of health and mortality, such as the lifetime risk of getting diseased. If not observing a cohort, this lifetime risk is calculated with cross-sectional data on age-specific incidence and survival. In those instances, incidence and survival may work in opposite directions resulting in lifetime risk estimates where, reductions in incidence might be offset by a simultaneous longevity increase. The proposed method decomposes the difference between two lifetime risks into contributions of changing incidence and changing survival. The approach can be extended to measure the contributions of changes in disease related mortality and even case fatality. We illustrate the method with hypothetical examples as well as remaining lifetime risk at age 60 of experiencing a myocardial infarction, colorectal cancer and hip fractures for Swedish males. The empirical examples show that the influence of increasing longevity on the development of lifetime risk depends on the respective age profile of occurrence. In the cases of myocardial infarction and hip fracture, longevity increases of the general population counterbalanced or even exceeded the substantial gains in disease incidence, while for colorectal cancer, the lifetime risk was almost unaffected by the longevity improvement. This was because colorectal cancer has an on average earlier onset than myocardial infarction and hip fracture.