Trends in socioeconomic inequalities in life expectancy and lifespan variation in Chile.

Background: Socioeconomic disparities in life expectancy are well-documented in various contexts, including Chile. However, there is a lack of research examining trends in life expectancy inequalities and lifespan variation over time. Addressing these gaps can provide crucial insights into the dynamics of health inequalities. Methods: This study utilizes data from census records, population surveys, and death certificates to compare the life expectancy and the lifespan variation at age 26 of individuals according to their rank in the distribution of years of education within their own birth cohort. The analysis spans three periods (1991, 2002, and 2017) and focuses on two educational groups: individuals in the first (lowest) quintile and tenth (highest) decile of educational attainment. Changes in life expectancy are disaggregated by major causes of death to elucidate their contributions to overall trends. Results: Consistent with existing literature, our findings confirm that individuals with lower education levels experience lower life expectancy and higher lifespan variation compared to their more educated counterparts. Notably, by 2017, life expectancy for individuals in the lowest quintile of education has caught up with that of the top decile in 1991, albeit with contrasting trends between genders. Among women, the gap has reduced, while it has increased for males. Moreover, lifespan variation decreased (increased) over time for individuals in the tenth decile (first quintile). The leading causes of death that explain the increase in life expectancy in women and men in the tenth decile as well as women in the first quintile are cardiovascular, cancer, respiratory and digestive diseases. In the case of males in the first quintile, few gains have been made in life expectancy resulting from cancer and a negative contribution is associated with digestive conditions. Conclusions: This study underscores persistent socioeconomic disparities in life expectancy in Chile, emphasizing the importance of ongoing monitoring of health inequalities across different demographic segments. The gender-specific and educational gradient trends highlight areas for targeted interventions aimed at reducing health disparities and improving overall population health outcomes. Further research is warranted to delve into specific causes of death driving life expectancy differentials and to inform evidence-based policy interventions.

[Direct and indirect impact of COVID-19 on life expectancy at birth in Chile in 2020]. / Impacto directo e indirecto del COVID-19 en la esperanza de vida al nacer de Chile en el año 2020.

This article shows the direct and indirect impacts of COVID-19 on life expectancy in Chile in 2020, based on mortality statistics published in March 2023. To this end, a counterfactual mortality was estimated for 2020 without COVID-19; based on the pattern of mortality by cause of death from 1997 to 2019, mortality charts were created to calculate life expectancy from 2015 to 2020 and an estimation for 2020, and the difference between expected and observed life expectancy in 2020 was then separated by age group and cause of death. Life expectancy in 2020 interrupted the upward trend from 2015 to 2019, showing a decline of 1.32 years in men and 0.75 years in women compared to 2019. Compared to the estimated 2020, life expectancy was 1.51 years lower in men and 0.92 years lower in women, but the direct impact of COVID-19 on the decrease in life expectancy was greater (1.89 for men and 1.5 for women) in the 60-84 age group in men and the 60-89 age group in women. The direct negative impact of COVID-19 on life expectancy was partially mitigated by significant positive indirect impacts on two groups of causes of death: diseases of the respiratory system and infectious and parasitic diseases. This study shows the need to differentiate direct and indirect impacts of COVID-19, due to the implications for public health when the intensity of COVID-19 decreases and mobility restrictions are suspended.

El artículo muestra el impacto directo e indirecto del COVID-19 en la esperanza de vida de Chile durante el año 2020, utilizando las estadísticas de defunciones definitivas publicadas en marzo del año 2023. Para ello, se estimó una mortalidad contrafactual para año 2020 sin el COVID-19, siguiendo el patrón de mortalidad según causas de muerte desde 1997 a 2019, se elaboraron tablas de mortalidad para calcular la esperanza de vida para los años 2015 a 2020 y para el año 2020 estimado, y luego se descompuso la diferencia entre la esperanza de vida esperada y observada del año 2020 según grupos de edad y causas de muerte. La esperanza de vida del año 2020 quiebra la tendencia a su aumento entre 2015 y 2019, mostrando un retroceso, en hombres y en mujeres, con respecto al año 2019, de 1,32 y 0,75 años respectivamente. Con respecto al año 2020 estimado, la esperanza de vida del 2020 observado es 1,51 años menor en hombres y 0,92 en mujeres, pero el impacto directo del COVID-19 en pérdida de esperanza de vida fue mayor, 1,89 para los hombres y 1,5 para las mujeres, concentrándose en las edades entre los 60 y 84 años en hombres y entre 60 y 89 años en mujeres. El impacto directo negativo del COVID-19 a la esperanza de vida en parte fue contrarrestado por impactos indirectos positivos significativos en dos grupos de causas de muerte, las enfermedades del sistema respiratorio y las enfermedades infecciosas y parasitarias. El estudio muestra la necesidad de distinguir los impactos directos e indirectos del COVID-19, por la incidencia que pueden tener en la salud pública cuando el COVID-19 baje su intensidad y se eliminen las restricciones de movilidad.

Este artigo apresenta os impactos direto e indireto da COVID-19 na expectativa de vida no Chile em 2020 a partir de estatísticas de mortalidade publicadas em março de 2023. Para tanto, foi estimada uma mortalidade contrafactual para 2020 sem a COVID-19; a partir do padrão de mortalidade por causa de morte de 1997 a 2019, foram criadas tabelas de mortalidade para calcular a expectativa de vida para o período de 2015 a 2020 e para o ano estimado de 2020 e, em seguida, a diferença entre a expectativa de vida esperada e observada em 2020 foi separada por faixa etária e causa de morte. A expectativa de vida em 2020 interrompe a tendência de aumento entre 2015 e 2019, mostrando um declínio com relação a 2019 de 1,32 ano nos homens e 0,75 ano nas mulheres. Com relação ao ano estimado de 2020, a expectativa de vida observada é 1,51 ano menor nos homens e 0,92 nas mulheres, mas o impacto direto da COVID-19 na diminuição da expectativa de vida foi maior (1,89 para homens e 1,5 para mulheres), concentrando-se nas idades entre 60 e 84 anos nos homens e entre 60 e 89 anos nas mulheres. O impacto direto negativo da COVID-19 na expectativa de vida foi parcialmente atenuado por impactos indiretos positivos significativos em dois grupos de causas de morte: doenças do sistema respiratório e doenças infecciosas e parasitárias. Este estudo mostra a necessidade de diferenciar impactos diretos e indiretos da COVID-19, devido às implicações para a saúde pública quando a intensidade da COVID-19 diminuir e as restrições de mobilidade forem suspensas.

Research Note: COVID-19 Is Not an Independent Cause of Death.

The COVID-19 pandemic has had overwhelming global impacts with deleterious social, economic, and health consequences. To assess the COVID-19 death toll, researchers have estimated declines in 2020 life expectancy at birth (e0). When data are available only for COVID-19 deaths, but not for deaths from other causes, the risks of dying from COVID-19 are typically assumed to be independent of those from other causes. In this research note, we explore the soundness of this assumption using data from the United States and Brazil, the countries with the largest number of reported COVID-19 deaths. We use three methods: one estimates the difference between 2019 and 2020 life tables and therefore does not require the assumption of independence, and the other two assume independence to simulate scenarios in which COVID-19 mortality is added to 2019 death rates or is eliminated from 2020 rates. Our results reveal that COVID-19 is not independent of other causes of death. The assumption of independence can lead to either an overestimate (Brazil) or an underestimate (United States) of the decline in e0, depending on how the number of other reported causes of death changed in 2020.

Anos potenciais de vida perdidos por aids no sexo feminino, no Sul do Brasil: estudo descritivo, 2007-2017 / Años potenciales de vida perdidos por sida en el sexo femenino, del Sur de Brasil: un estudio descriptivo, 2007-2017 / Years of potential life lost due to AIDS in female, in Southern Brazil: a descriptive study, 2007-2017

Objetivo: descrever os anos potenciais de vida perdidos (APVPs) por aids na população do sexo feminino e analisar sua associação com raça/cor da pele e indicadores de vulnerabilidade social em Porto Alegre/RS, Brasil. Métodos: estudo descritivo, considerando-se os óbitos do sexo feminino por aids em 2007-2017; os dados foram obtidos no banco do Sistema de Informações sobre Mortalidade; foram calculados valores brutos e taxas de APVPs por 1 mil óbitos, considerando-se os distritos sanitários e a raça/cor da pele. Resultados: entre 1.539 óbitos, foram estimados cerca de 51 mil anos potenciais de vida, representando 86,5 anos perdidos/1 mil pessoas do sexo feminino; identificou-se maior proporção de óbitos naquelas de raça/cor da pele branca (53,4%); porém, maior taxa de APVPs ocorreu para as de raça/cor da pele preta/parda residentes em regiões de maior vulnerabilidade. Conclusão: os resultados sugerem o impacto de desigualdades raciais na diminuição dos anos potenciais de vida, em função do óbito por aids.

Objetivo: describir los años potenciales de vida perdidos (APVP) por SIDA en la población femenina y analizar la asociación con raza/color e indicadores de vulnerabilidad social en Porto Alegre/RS, Brasil. Métodos: estudio descriptivo considerando muertes por SIDA en el sexo femenino entre 2007 y 2017; los datos se obtuvieron de la base de datos del sistema de información de mortalidad; los valores brutos y las tasas de APVP por cada 1 mil muertes se calcularon considerando los distritos de salud y la raza/color de piel. Resultados: entre 1.539 muertes, se perdieron 51.000 años potenciales de vida, lo que representa 86,5 años perdidos por cada 1 mil personas del sexo femenino; se identificó una mayor proporción de muertes para la raza blanca/color de piel (53,4%), pero una mayor tasa de APVP entre las negras que viven en regiones de mayor vulnerabilidad. Conclusión: los resultados sugieren el impacto de las desigualdades raciales en la reducción de los años potenciales de vida, por muerte por SIDA.

Objective: to describe the years of potential life lost (YPLL) due to AIDS among the female population and analyze its association with race/skin color and social vulnerability indicators in Porto Alegre, capital city of the state of Rio Grande do Sul, Brazil. Methods: this was a descriptive study that took into consideration AIDS deaths in female between 2007 and 2017; data were obtained from the Mortality Information System; crude values and YPLL rates per 1,000 deaths were calculated, taking into consideration health districts and race/skin color. Results: of the 1,539 deaths, approximately 51,000 years of potential life were estimated, representing 86.5 years lost/1,000 female; it could be seen a higher proportion of deaths among female of White race/ skin color (53.4%); however, a higher rate of YPLL was found among female of Black and mixed race/skin color living in regions of greater vulnerability. Conclusion: the results suggest the impact of racial inequalities on the decrease in years of potential life due to AIDS deaths.

Well beyond the 60s? The impact of a pandemic on the growth of the older population / Muito além dos 60? Impacto de uma pandemia na dinâmica de crescimento da população idosa

Contrary to expectations that the first decades of the 21st century would experience an increase in lived time, the 2020s cast doubts on the future of old age. The Brazilian population is expected to increase until 2030, when it will reach its maximum, with a total of approximately 215 million inhabitants. A trend of population decline was already in progress and had already been documented, but the pandemic accelerated this process. This study describes a set of projections for the older Brazilian population. The projections were elaborated using the main components method, whose advantages are the possibility of separately projecting the behavior of the three demographic variables (fertility, mortality, and migrations) and obtaining results disaggregated by sex and age groups. Birth data for 2018, 2019, and 2020 suggest a 3.51 and 5.28% decrease in total births between 2018 and 2019 and 2019 and 2020, respectively. Preliminary data for 2021, which indicate the continuation of this trend between 2020­2021, show a 2.32% reduction in the number of births. The hypotheses raised for the mortality patterns, if proven to be accurate, suggest a life expectancy of 72.8 years for men and 76.2 years for women at the final period of the projection, resulting in gains of 4.6 and 2.0 years, respectively. Despite these gains, the levels obtained in 2019, pre-pandemic, would be reached by the male population only between 2035 and 2040.

Contrariando expectativas de que as primeiras décadas do século XXI seriam um tempo de expansão do tempo vivido, os anos 2020 apontam dúvidas com relação ao futuro da velhice. A população brasileira deverá crescer até 2030, quando se projeta que atingirá o seu máximo, com um total de aproximadamente 215 milhões de habitantes. Uma tendência de redução populacional já era documentada e estava em curso, mas a pandemia acelerou o seu movimento. Este artigo apresenta um conjunto de projeções para a população brasileira e idosa. Para a sua elaboração, utilizamos o método das componentes, cujas vantagens são: (a) projetar, isoladamente, o comportamento de cada uma das três variáveis demográficas ­ fecundidade, mortalidade e migrações ­ e (b) obter resultados desagregados por sexo e grupos de idade. Os dados de nascimentos para 2018, 2019 e 2020 apontam para uma diminuição deste total de 3,51% entre 2018 e 2019 e de 5,28% entre 2019 e 2020. Os dados preliminares de 2021, que apontam para uma continuação dessa tendência entre 2020 e 2021 demonstram redução de 2,32% no número de nascimentos. As hipóteses feitas para os padrões de mortalidade, se verificadas, apontam para uma expectativa de vida de 72,8 e 76,2 anos no final do período da projeção, o que resultaria em ganhos de 4,6 e 2,0 anos, para homens e mulheres, respectivamente. Apesar desses ganhos, os níveis obtidos em 2019, pré-pandemia, seriam alcançados pelos homens entre 2035 e 2040.

Mortalidad prematura según causas seleccionadas en el Policlínico 5 de septiembre / Premature Mortality due to Selected Causes in 5 de Septiembre Municipality

Introducción: El conocimiento de las tendencias de mortalidad prematura en una población puede contribuir a realizar acciones que disminuyan los años de vida potencial perdidos por distintas causas. Objetivo: determinar la tendencia de mortalidad prematura por enfermedad de arterias, arteriolas y vasos, enfermedad cerebrovascular, infarto agudo del miocardio, diabetes mellitus, enfermedad pulmonar obstructiva crónica y cáncer de mama, próstata, bucal, colon y cérvix en el policlínico 5 de septiembre de Consolación del Sur. Métodos: Se realizó un estudio descriptivo retrospectivo del total de fallecidos prematuramente n = 313 por las causas seleccionadas, para ello se analizaron, a través de estadística descriptiva, los datos del Registro de Mortalidad de la Dirección Provincial de Salud Pública de Pinar del Río. Resultados: Existió correspondencia entre el incremento de la edad y el aumento de los fallecidos, los más afectados fueron el grupo etario 60-69 años, el sexo masculino y el color blanco de piel. Solo las enfermedades de arterias, arteriolas y vasos, la EPOC y la diabetes mellitus mostraron tendencia al ascenso. El mayor riesgo de morir prematuramente correspondió a los Grupos Básicos de Trabajo 2 y 4, y las causas de mayor tasa fueron la enfermedad cerebrovascular, infarto agudo de miocardio y EPOC. La población estudiada perdió 9,86 años de vida como promedio y el cáncer de cérvix fue la enfermedad que más aportó años de vida potencial perdidos. Conclusiones: Se apreció tendencia a la disminución de mortalidad prematura general por las enfermedades estudiadas(AU)

Introduction: Knowledge about tendencies of premature mortality in a population can contribute to carrying out actions that reduce the number of years of potential life lost due to different causes. Objective: To determine the tendency of premature mortality due to disease of the arteries, arterioles and vessels, cerebrovascular disease, acute myocardial infarction, diabetes mellitus, chronic obstructive pulmonary disease (COPD), as well as breast, prostate, oral, colon and cervical cancer in 5 de Septiembre Polyclinic of Consolación del Sur Municipality. Methods: A retrospective and descriptive study was carried out with the total number of prematurely deceased (n=313) for the selected causes. For this purpose, the data from the Mortality Registry of the Provincial Directorate of Public Health of Pinar del Río were analyzed through descriptive statistics. Results: There was a correspondence between increase in age and increase in deaths; the most affected were those in age group 60-69 years, as well as the male sex and white skin color. Only diseases of the arteries, arterioles and vessels, COPD and diabetes mellitus showed an upward tendency. The highest risk for dying prematurely corresponded to the basic work groups 2 and 4, while the causes with the highest rate were cerebrovascular disease, acute myocardial infarction and COPD. The study population lost 9.86 years of life on average and cervical cancer was the disease that accounted for the highest amount of lost years of potential life. Conclusions: There was a tendency towards a decrease in general premature mortality due to the diseases studied(AU)

Lifetime risk of developing diabetes and years of life lost among those with diabetes in Brazil.

BACKGROUND: Given the paucity of studies for low- or middle-income countries, we aim to provide the first ever estimations of lifetime risk of diabetes, years of life spent and lost among those with diabetes for Brazilians. Estimates of Brazil´s diabetes burden consist essentially of reports of diabetes prevalence from national surveys and mortality data. However, these additional metrics are at times more meaningful ways to characterize this burden. METHODS: We joined data on incidence of physician-diagnosed diabetes from the Brazilian risk factor surveillance system, all-cause mortality from national statistics, and diabetes mortality rate ratios from ELSA-Brasil, an ongoing cohort study. To calculate lifetime risk of developing diabetes, we applied an illness-death state model. To calculate years of life lost for those with diabetes and years lived with the disease, we additionally calculated the mortality rates for those with diabetes. RESULTS: A 35-year-old white adult had a 23.4% (95% CI = 22.5%-25.5%) lifetime risk of developing diabetes by age 80 while a same-aged black/brown adult had a 30.8% risk (95% confidence interval (CI) = 29.6%-33.2%). Men diagnosed with diabetes at age 35 would live 32.9 (95% CI = 32.4-33.2) years with diabetes and lose 5.5 (95% CI = 5.1-6.1) years of life. Similarly-aged women would live 38.8 (95% CI = 38.3-38.9) years with diabetes and lose 2.1 (95% CI = 1.9-2.6) years of life. CONCLUSIONS: Assuming maintenance of current rates, one-quarter of young Brazilians will develop diabetes over their lifetimes, with this number reaching almost one-third among young, black/brown women. Those developing diabetes will suffer a decrease in life expectancy and will generate a considerable cost in terms of medical care.

Cuba's cardiovascular risk factors: International comparison of levels and education gradients.

BACKGROUND: Cuba's life expectancy at 79 is third highest in Latin America. Many attribute this to social investments in health and education, but comparative research is sparse, thus we compare Cuba with neighboring Dominican Republic, Costa Rica due to its strong social protections, and the U.S. Given high cardiovascular mortality, we focus on cardiovascular risk factor levels. To assess the role of health care, we distinguish medically amenable biomarkers from behavioral risk factors. To assess the role of Cuba's focus on equity, we compare education gradients in risk factors. METHODS: We analyze Cuban data from the 10/66 Dementia Research Group baseline survey of urban adults ages 65 plus. Comparison samples are drawn from the Dominican Republic 10/66 survey, the Costa Rican CRELES, and U.S. NHANES. We analyze cross-country levels and education gradients of medically amenable (hypertension, diabetes, hypercholesterolemia, access to health care) and behavioral (smoking, obesity) risk factors,-using sex-stratified weighted means comparisons and age-adjusted logistic regression. RESULTS: Neither medically amenable nor behavioral risk factors are uniformly better in Cuba than comparison countries. Obesity is lower in Cuba, but male smoking is higher. Hypertension, diabetes, and hypercholesterolemia levels are high in all countries, though Cuba's are lower than Costa Rica. Hypertension awareness in Cuba is similar to Costa Rica. Cuba has a higher proportion of hypertensives on treatment than Costa Rica, though lower than the U.S. Comparative gradients by education are similarly mixed. For behavioral factors, Cuba shows the strongest gradients (primarily for men) among the countries compared: smoking improves, but obesity worsens with education. Hypertension awareness also improves with education in Cuba, but Cuba shows no significant differences by education in hypertension treatment. CONCLUSION: Smoking is comparatively high in Cuba, but obesity is low, and the resulting biomarkers show comparatively mixed patterns. Cuba's social protections have not eliminated strong educational gradients in behavioral risk factors, but the healthcare system appears to have eliminated disparities such as in hypertension treatment.

Why do some countries do better or worse in life expectancy relative to income? An analysis of Brazil, Ethiopia, and the United States of America.

BACKGROUND: While in general a country's life expectancy increases with national income, some countries "punch above their weight", while some "punch below their weight" - achieving higher or lower life expectancy than would be predicted by their per capita income. Discovering which conditions or policies contribute to this outcome is critical to improving population health globally. METHODS: We conducted a mixed-method study which included: analysis of life expectancy relative to income for all countries; an expert opinion study; and scoping reviews of literature and data to examine factors that may impact on life expectancy relative to income in three countries: Ethiopia, Brazil, and the United States. Punching above or below weight status was calculated using life expectancy at birth and gross domestic product per capita for 2014-2018. The scoping reviews covered the political context and history, social determinants of health, civil society, and political participation in each country. RESULTS: Possible drivers identified for Ethiopia's extra 3 years life expectancy included community-based health strategies, improving access to safe water, female education and gender empowerment, and the rise of civil society organisations. Brazil punched above its weight by 2 years. Possible drivers identified included socio-political and economic improvements, reduced inequality, female education, health care coverage, civil society, and political participation. The United States' neoliberal economics and limited social security, market-based healthcare, limited public health regulation, weak social safety net, significant increases in income inequality and lower levels of political participation may have contributed to the country punching 2.9 years below weight. CONCLUSIONS: The review highlighted potential structural determinants driving differential performance in population health outcomes cross-nationally. These included greater equity, a more inclusive welfare system, high political participation, strong civil society and access to employment, housing, safe water, a clean environment, and education. We recommend research comparing more countries, and also to examine the processes driving within-country inequities.

Projected impact of diabetes on the Costa Rican healthcare system.

INTRODUCTION: Costa Rica, similar to many other Latin American countries is undergoing population aging at a fast pace. As a result of the epidemiological transition, the prevalence of diabetes has increased. This condition impacts not only individual lives, but also the healthcare system. The goal of this study is to examine the expected impact of diabetes, in terms of economic costs on the healthcare system and lives lost. We will also project how long it will take for the number of elderly individuals who are diabetic to double in Costa Rica. METHODS: CRELES (Costa Rican Longevity and Healthy Aging Study), a three-wave nationally representative longitudinal study, is the main source of data for this research (n = 2827). The projected impact of diabetes was estimated in three ways: length of time for the number of elderly individuals with diabetes to double; projected economic costs of diabetes-related hospitalizations and outpatient care; and years of life lost to diabetes at age 60. Data analyses and estimations used multiple regression models, longitudinal regression models, and Lee-Carter stochastic population projections. RESULTS: Doubling time of the diabetic elderly population is projected to occur in 13 calendar years. This will cause increases in hospitalization and outpatient consultation costs. The impact of diabetes on life expectancy at age 60 around the year 2035 is estimated to lead to a loss of about 7 months of life. The rapid pace at which the absolute number of elderly people with diabetes will double is projected to result in a negative economic impact on the healthcare system. Lives will also be lost due to diabetes. CONCLUSION: Population aging will inevitably lead to an increasing number of elderly individuals, who are at greater risk for diabetes due to their lifelong exposure to risk factors. Actions to increase the quality of life of diabetic elderly are warranted. Decreasing the burden of diabetes on elderly populations and the Costa Rican healthcare system are necessary to impact the quantity and quality of life of incoming cohorts. Health promotion and prevention strategies that reduce diabetes risk factors are needed to improve the health of elderly populations.

The burden of disease among Brazilian older adults and the challenge for health policies: results of the Global Burden of Disease Study 2017.

BACKGROUND: Brazil is the world's fifth most populous nation, and is currently experimenting a fast demographic aging process in a context of scarce resources and social inequalities. To understand the health profile of older adults in Brazil is fundamental for planning public policies. METHODS: The estimates were derived from data obtained through the collaboration between the Brazilian Ministry of Health and the Institute of Health Metrics and Evaluation of the University of Washington. The Brazilian Institute of Geography and Statistics provided the population estimates. Data on causes of death came from the Mortality Information System. To calculate morbidity, population-based studies on the prevalence of diseases in Brazil were comprehensively searched, in addition to information obtained from national databases such as the Hospital Information System, the Outpatient Information System, and the Injury Information System. We presented the Global Burden of Disease (GBD) 2017 estimates among Brazilian older adults (60+ years old) for life expectancy at birth (LE), healthy life expectancy (HALE), cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), from 2000 to 2017. RESULTS: LE at birth significantly increased from 71.3 years (95% UI to 70.9-71.8) to 75.2 years (95% UI 74.7-75.7). There was a trend of increasing HALE, from 62.2 years (95% UI 59.54-64.5) to 65.5 years (95% UI 62.6-68.0). The proportion of DALYs among older adults increased from 7.3 to 10.3%. Chronic noncommunicable diseases are the leading cause of death among middle aged and older adults, while Alzheimer's disease is a leading cause only among older adults. Mood disorders, musculoskeletal pain, and hearing or vision losses are among the leading causes of disability. CONCLUSIONS: The increase in LE and the decrease of the DALYs rates are probably results of the improvement of social conditions and health policies. However, the smaller increase of HALE than LE means that despite living more, people spend a substantial time of their old age with disability and illness. Preventable or potentially controllable diseases are responsible for most of the burden of disease among Brazilian older adults. Health investments are necessary to obtain longevity with quality of life in Brazil.

Comparative analysis of completeness of death registration, adult mortality and life expectancy at birth in Brazil at the subnational level.

BACKGROUND: Estimates of completeness of death registration are crucial to produce estimates of life tables and population projections and to estimate the burden of disease. They are an important step in assessing the quality of data. In the case of subnational data analysis in Brazil, it is important to consider spatial and temporal variation in the quality of mortality data. There are two main sources of data quality evaluation in Brazil, but there are few comparative studies and how they evolve over time. The aim of the paper is to compare and discuss alternative estimates of completeness of death registration, adult mortality (45q15) and life expectancy estimates produced by the National Statistics Office (IBGE), Institute for Health Metrics and Evaluation (IHME), and estimates presented in Queiroz et al. (2017) and Schmertmann and Gonzaga (2018), for 1980 and 2010. METHODS: We provide a descriptive and comparative analysis of aforementioned estimates from four (4) sources of estimates at subnational level (26 states and one Federal District) in Brazil from two different points in time. RESULTS: We found significant differences in estimates that affect both levels and trends of completeness of adult mortality in Brazil and states. IHME and Queiroz et al. (2017) estimates converge by 2010, but there are large differences when compared to estimates from the National Statistics Office (IBGE). Larger differences are observed for less developed states. We have showed that the quality of mortality data in Brazil has improved steadily overtime, but with large regional variations. However, we have observed that IBGE estimates show the lowest levels of completeness for the Northern of the country compared to other estimates. Choice of methods and approaches might lead to very unexpected results. CONCLUSION: We produced a detailed comparative analysis of estimates of completeness of death registration from different sources and discuss the main results and possible explanations for these differences. We have also showed that new improved methods are still needed to study adult mortality in less developed countries and at a subnational level. More comparative studies are important in order to improve quality of estimates in Brazil.

Prospective measures of aging for Central and South America.

By conventional measures, it is often remarked that Central and South America is one of the fastest aging geographic regions in the world. In recent years, however, scholars have sought to problematize the orthodox measures and concepts employed in the aging literature. By not taking dynamic changes in life expectancy into account, measures which hold chronological age constant (e.g. defining a boundary to old age at 60 or 65) represent a very narrow view of population aging. Furthermore, such constant measures may misrepresent differences between territories when performing a comparative analysis. Prospective measures based on the number of years until death present an alternative approach which can adapt to dynamic changes in life expectancy and differences over time and space. The objective of this paper, then, is to apply the new 'prospective' measures of aging to the territories of Central and South America. We calculate prospective median age; an alternative old-age threshold based on the age at which remaining life expectancy is 15 years, and calculate prospective old-age dependency ratio for 1950-2100 using estimated and projected life tables from the latest iteration of the UN's World Population Prospects. These new measures present a very different view of aging in Central and South America. While there are significant differences across countries, the pace and scale of aging are considerably slower and diminished when compared to standard, orthodox measures based on fixed chronological ages. Applying these new measures can not only serve to present a more realistic view of aging which maps onto demographic reality but can also serve to reconceptualize and reframe the issue as something which is far more manageable (e.g. through institutional reform) than is often perceived to be.

Sex differentials in avoidable mortality and potential life expectancy gains in São Paulo, SP, Brazil: a cross-sectional study of the period 2014-2016. / Diferenciais por sexo na mortalidade evitável e ganhos potenciais de esperança de vida em São Paulo, SP: um estudo transversal entre 2014 e 2016.

OBJECTIVE: to estimate potential life expectancy gains and differences between males and females, if avoidable deaths from circulatory system diseases, neoplasms and external causes had been eliminated in São Paulo, SP, Brazil, in the period 2014- 2016. METHODS: this was a cross-sectional study using data from the Mortality Information System (SIM), and the Brazilian Institute of Geography and Statistics (IBGE), using multiple decrement tables. RESULTS: of the 81,087 deaths from the diseases studied here, 75.1% were classified as avoidable; elimination of avoidable deaths due to circulatory system diseases was found to generate the greatest potential life expectancy gains, followed by neoplasms among females and external causes among males. CONCLUSION: magnitude of lost life expectancy due to avoidable deaths differs between males and females; sex differentials in avoidable mortality therefore persist, producing a series of challenges.

Narrowing geographic inequality in life expectancy in Brazil: a multilevel analysis between 1991 and 2010.

OBJECTIVES: To analyze the geographic inequalities in life expectancy (LE) and the probability of survival up to 40 and 60 years in Brazil between 1991 and 2010, to partition the variance of these indicators by including municipalities, states, and macroregions in the analysis, and to test the association between municipal socio-economic and health services indicators with life expectancy. STUDY DESIGN: Multilevel analysis. METHODS: Census data from 1991, 2000, and 2010 were used to calculate the outcomes and the socio-economic variables. Municipalities were separated into centiles according to their values in each outcome. Absolute and relative differences were calculated for each year. Multilevel linear regression models were performed, taking into account three levels: regions, states, and municipalities. Municipal socio-economic and health services variables were included in the model with the 2010 data. RESULTS: All 5545 Brazilian counties showed improvement in the three indicators, but the magnitude varied significantly across the country. The highest gains in LE were observed in the North and Northeast regions. The gap in LE between the 1st and 99th percentile decreased from 19.6 years to 12.2 years. The relative difference also fell, from 1.37 to 1.18. Most counties' socio-economic and health services indicators were associated with the outcomes and explained 86.7%, 31.2%, and 32.4% of the variation in LE attributable to regions, states, and counties, respectively. CONCLUSIONS: The average life expectancy increased between 1991 and 2010. Concomitantly, a reduction in geographic disparities was observed. The counties' socio-economic and health services variables explained much of the variation of the outcomes in 2010.

Study of the relationship between vitamin D deficiency, sunlight incidence and skeletal/extra skeletaldiseases

It is estimated that more than 1 billion people worldwide have vitamin D insufficiency or deficiency. Vitamin D participates in bone mineralization, and is therefore important in osteoporosis, osteomalacia and rickets prevention. However, vitamin D deficiency could also be associated with several other pathologies. The present study aimed to investigate the relationships between vitamin D deficiency and vitamin D deficiency-related disorders in patients. In addition, this study aims to verify if countries with low solar incidence have higher extraskeletal disease death rates when compared to countries with high solar incidence. The vitamin D concentrations were obtained from the Heart Hospital database (Natal/Brazil). The relationship between solar incidenceand death rate for vitamin D deficiency-related disorders was verified. Death rate data were extracted from the 'World Life Expectancy' repository and data about solar incidence were obtained from NASA's Surface Meteorology and Solar Energy project. Thesedata were statistically processed with IBM SPSS v23.0 software and R programming language. Our results showed that patients with vitamin D insufficiency/deficiency showed significantly more bone diseases, thyroid diseases, hypercholesterolemy, hypertriglyceridemia, cancers, diabetes, hepatobiliary diseases, and urinary system diseases. Moreover, countries with high solar incidence have low cancer and multiple sclerosis death rates. This work suggests the participation of vitamin D and sunlight incidence inseveral diseases.

Diferenciais por sexo na mortalidade evitável e ganhos potenciais de esperança de vida em São Paulo, SP: um estudo transversal entre 2014 e 2016 / Diferenciales por sexo en la mortalidad evitable e incrementos potenciales en la esperanza de vida en São Paulo, SP, Brasil: un estudio transversal de 2014 a 2016 / Sex differentials in avoidable mortality and potential life expectancy gains in São Paulo, SP, Brazil: a cross-sectional study of the period 2014-2016

Objetivo: estimar o ganho potencial e as diferenças de esperança de vida entre homens e mulheres, caso os óbitos evitáveis por doenças do aparelho circulatório, neoplasias e causas externas fossem eliminados em São Paulo, SP, Brasil, nos anos de 2014 a 2016. Métodos: estudo transversal, com dados do Sistema de Informações sobre Mortalidade (SIM) e do Instituto Brasileiro de Geografia e Estatística (IBGE), utilizando tábuas de múltiplo decremento. Resultados: dos 81.087 óbitos pelas doenças selecionadas, 75,1% foram classificados como evitáveis; verificou-se que a eliminação dos óbitos evitáveis por doenças do aparelho circulatório gerou os maiores ganhos potenciais de esperança de vida, seguidos dos ganhos por neoplasias, para as mulheres, e por causas externas para os homens. Conclusão: os óbitos evitáveis geram uma perda de esperança de vida de magnitudes distintas, segundo homens ou mulheres; logo, persistem diferenciais por sexo na mortalidade evitável, produzindo uma série de desafios.

Objetivo: estimar las diferencias en la ganancia potencial y la esperanza de vida entre hombres y mujeres, en el caso de que las muertes evitables por enfermedades del sistema circulatorio, neoplasias y causas externas hubieran sido eliminadas en São Paulo, SP, Brasil, de 2014 a 2016. Métodos: datos del Sistema de Información de Mortalidad (SIM) y de la fundación Instituto Brasileño de Geografía y Estadística (IBGE), utilizando tablas de disminución múltiple. Resultados: de las 81.087 muertes por las enfermedades estudiadas, 75,1% se clasificaron como prevenibles; se encontró que la eliminación de las muertes evitables debidas a enfermedades del sistema circulatorio generó las mayores ganancias potenciales en la esperanza de vida, seguidas de las neoplasias para las mujeres y de las causas externas para los hombres. Conclusión: las muertes evitables generan una pérdida de esperanza de vida de diferentes magnitudes, entre hombres y mujeres; por lo tanto, persisten las diferencias de género en la mortalidad evitable, lo que genera una serie de desafíos.

Objective: to estimate potential life expectancy gains and differences between males and females, if avoidable deaths from circulatory system diseases, neoplasms and external causes had been eliminated in São Paulo, SP, Brazil, in the period 2014- 2016. Methods: this was a cross-sectional study using data from the Mortality Information System (SIM), and the Brazilian Institute of Geography and Statistics (IBGE), using multiple decrement tables. Results: of the 81,087 deaths from the diseases studied here, 75.1% were classified as avoidable; elimination of avoidable deaths due to circulatory system diseases was found to generate the greatest potential life expectancy gains, followed by neoplasms among females and external causes among males. Conclusion: magnitude of lost life expectancy due to avoidable deaths differs between males and females; sex differentials in avoidable mortality therefore persist, producing a series of challenges.