The effect of smoking on the healthy life expectancy of Palestinian men in the West Bank: a cross-sectional study.

BACKGROUND: The high prevalence of smoking (40%) in men living in the West Bank of the occupied Palestinian territory is a major challenge for the Palestinian health authorities. The aim of this study was to estimate life expectancy and the average lifetime with and without chronic disease in men living in the West Bank who had never smoked, were ex-smokers, or were smokers. METHODS: We used a life table for the male population in the West Bank and Danish relative risk estimates for death for smokers and ex-smokers versus never smokers and data from the 2010 Palestinian Family Survey. We estimated expected life time with and without chronic disease, and the contributions from the mortality and morbidity effects to smoking-related differences in average lifetime with and without chronic disease were assessed by decomposition. FINDINGS: The life expectancy of a Palestinian man aged 15 years who would never start smoking was 59·5 years, of which 41·1 years (95% CI 40·3-41·9) were expected to be without chronic disease. Ex-smokers could expect 57·9 years of remaining life time, 37·7 years (35·9-39·4) of which would be without chronic disease. For life-long heavy smokers, the expected lifetime was 52·6 years, of which 38·5 years (37·3-39·7) would be without chronic disease. Of the total loss of 6·9 years of life expectancy in heavy smokers, the mortality effect accounted for 2·5 years without disease and 4·4 years with disease, whereas the morbidity effect was negligible. The morbidity component of the decomposition accounted for 1·7 years with disease for moderate smokers and 2·9 years without disease for ex-smokers. INTERPRETATION: The high prevalence of smoking causes a considerable loss of life-years and life time without chronic disease. We recommend that the Palestinian health authorities enforce an anti-smoking law. FUNDING: None.

The impact of smoking on expected lifetime with and without chronic disease among Palestinian men in the West Bank.

Background: The purpose of the study was to estimate life expectancy and the average lifetime with and without chronic disease among male never smokers, ex-smokers and smokers living in the West Bank of the occupied Palestinian territory. Methods: The study used a life table for the West Bank male population and Danish relative risk estimates for death for smokers and ex-smokers vs. never smokers and utilized data from the Palestinian Family Survey 2010. Expected lifetime with and without chronic disease was estimated and the contributions from the mortality and the morbidity effect to smoking related difference in average lifetime with and without chronic disease were assessed by decomposition. Results: In the West bank 40% of the male population are smokers. Life expectancy of 15-year-old Palestinian men who would never start smoking was 59.5 years, 41.1 of which were expected to be without chronic disease. Ex-smokers could expect 57.9 years of remaining lifetime, 37.7 years of which without disease. For lifelong heavy smokers (> 20 cigarettes per day), the expected lifetime was reduced to 52.6 years, of which 38.5 years were without chronic disease. Of the total loss of 6.9 years of life expectancy among heavy smokers, the mortality effect accounted for 2.5 years without and 4.4 years with disease, whereas the morbidity effect was negligible. Conclusions: The high prevalence of smoking causes a considerable loss of life years and lifetime without chronic disease. We recommend the Palestinian health authorities to enforce the anti-smoking law.

Increasing disability-free life expectancy among older adults in Palestine from 2006 to 2010.

BACKGROUND: The population of Palestine comprises almost 200 000 Palestinians aged 60 or older. The purpose of the study was to estimate disability-free life expectancy for Palestinians living in the West Bank and Gaza Strip and to evaluate changes from 2006 to 2010. METHODS: The study combined mortality data and prevalence of activity limitation derived from the Palestinian Family Health Surveys carried out in 2006 and 2010. Based on questions about the ability to perform five basic daily activities, disability-free life expectancy was estimated. Changes between 2006 and 2010 were decomposed into contributions from changes in mortality and disability. RESULTS: Life expectancy at age 60 increased from 17.1 years in 2006 to 17.3 years in 2010 for men and from 18.7 years to 19.0 years for women. Disability-free life expectancy increased significantly, by 1.3 years for 60-year-old men (from 12.8 years to 14.1 years) and 1.8 years for 60-year-old women (from 12.6 years to 14.4 years). This increase was seen in the Gaza Strip as well as in the West Bank. While the modest contribution of the mortality effect did not differ between gender and regions, the strong contributions from the disability effects varied, being greatest for women in the Gaza Strip. CONCLUSION: The significant increase in disability-free life expectancy for both genders is remarkable and, to our knowledge, not seen in other low-income countries. This change may be due to decreasing incidence of disability and greater recovery from disability as a result of better prevention, care and rehabilitation of chronic diseases.

Socio-economic status and chronic disease in the West Bank and the Gaza Strip: in and outside refugee camps.

OBJECTIVES: The study investigated the association between socio-economic status (SES) and self-reported chronic disease (CD) among the Palestinian population in the Occupied Palestinian Territory, and whether this association was similar in the refugee camps. METHODS: We used data from representative samples in 2006 and 2010 collected by the Palestinian Central Bureau of Statistics. SES was defined by education, wealth and employment status. Associations between SES and CD were analysed and stratified by living in or outside refugee camps. RESULTS: CD prevalence increased among men and decreased among women in all SES categories and the Odds Ratio for CD was higher inside than outside the refugee camps, except for women in 2006. In both 2006 and 2010 the odds ratio of CD was higher among the lowest SES groups. The pattern of the negative association between SES and CD was similar in and outside the refugee camps. CONCLUSIONS: We found that the highest burden of CD is among those with low SES. In spite of a higher CD Odds Ratio in the refugee camps, the pattern of association between SES and CD did not differ in the refugee camps.

Health expectancy in the occupied Palestinian territory: estimates from the Gaza Strip and the West Bank: based on surveys from 2006 to 2010.

OBJECTIVES: The purpose of the study was to estimate health expectancy for the Palestinian population and to evaluate changes that have taken place over the past 5 years. DESIGN: Mortality data and population-based health surveys. SETTING: The Israeli-occupied Palestinian territory of the Gaza Strip and the West Bank. PARTICIPANTS: 17 034 and 38 071 adults aged 20 or over participating the Palestinian Family Health Surveys of 2006 and 2010. Death rates for 2007 and 2010 covered the entire population. OUTCOME MEASURES: Life expectancy and expected lifetime with and without chronic disease were estimated using the Sullivan method on the basis of mortality data and data on the prevalence of chronic disease. RESULTS: Life expectancy at the age of 20 increased from 52.8 years in 2006 to 53.3 years in 2010 for men and from 55.1 years to 55.7 years for women. In 2006, expected lifetime without a chronic disease was 37.7 (95% CI 37.0 to 38.3) years and 32.5 (95% CI 31.9 to 33.2) years for 20-year-old men and women, respectively. By 2010, this had decreased by 1.6 years for men and increased by 1.3 years for women. The health status of men has worsened. In particular, lifetime with hypertension and diabetes has increased. For women, the gain in life expectancy consisted partly of years with and partly of years without the most prevalent diseases. CONCLUSIONS: Health expectancy for men and women diverged, which could to some extent be due to gender-specific exposures related to lifestyle factors and the impact of military occupation.