July 30, 2014

More Chronic Conditions = Fewer Years on Earth

Researchers from Johns Hopkins Bloomberg School of Public Health recently published this piece of news: the more chronic diseases you have, the shorter your life expectancy.

According to senior study author Gerard Anderson, a professor in the Department of Health Policy and Management at Johns Hopkins: "When you’re getting sicker and sicker, the body’s ability to handle illness deteriorates and that compounds. Once you have multiple conditions, your life expectancy becomes much shorter.”

By itself, that news isn’t all that surprising; people with a combination of illnesses are more likely to die before their healthy neighbors.

But here’s where the news gets more troubling. Compared to people in other developed countries, Americans already have a so-so life expectancy (#35 on the list, according to the World Health Organization's 2013 rankings, shown below). Now, those Hopkins researchers report that the life expectancy for Americans – which has been rising by about .1 years each year – is not maintaining that steady growth. Unlike citizens in other developed nations, Americans now have a decelerating life expectancy.

The Danger of Multiple Chronic Diseases
Why? Americans are developing more and more health problems. In fact, the Hopkins study reports that a whopping 80 percent of all Americans over 67 have multiple chronic illnesses. 

While we can boast about hospital quality here, the American healthcare system – by far the most expensive per capita in the world – doesn’t meaningfully serve the same high percentage of residents that we see in other developed countries. 

At the end of the day, it boils down to this: Americans don't choose wisely when it comes to the Holy Grail of wellness: diet and exercise.

The likely culprit in America is our obesity epidemic. Three of most common chronic diseases in America -- heart disease, high blood pressure, and diabetes – are all conditions that find accommodating hosts in obese people.

Over a Million Surveyed
The Hopkins / Bloomberg team studied health records of about 1.4 million Medicare recipients around the country. In that large sample, researchers tracked 21 different chronic conditions. For every chronic disease, study participants LOST 1.8 years of life expectancy. 

With four in five seniors having at least two chronic illnesses – and many dealing with a lot more than two – it’s no wonder these circumstances would slow the historically-regular growth of American life expectancy.

It makes sense. And because seniors in other developed countries do not have the same high rate of multiple chronic illnesses -- or the same out-of-control spread of diabetes – life expectancies there have not shown the same leveling-out that researchers have seen in America.

Here’s an example the study team used to illustrate the impact on life expectancy of chronic diseases. A 75-year-old woman can expect to live:
  • 17.3 more years, if she has NO chronic medical conditions.
  • 12 more years, if she has five chronic conditions.
  • 5 more years, if she has ten chronic diseases.
Not Only How Many Conditions, But Which Ones?
It’s not just the number of chronic conditions that matter; it’s the type of condition. For example, a 67-year-old newly diagnosed with a heart condition can expect to live another 21.2 years. But a 67-year-old just diagnosed with Alzheimer’s is likely to live only 12 more years.

Lead study author Eva DuGoff said: “There are interaction effects among the diseases that result in decreases in life expectancy. Any condition on its own has a particular effect. When you have heart disease plus cancer, that has a particular affect, and then those start to accumulate.”

Dugoff noted an irony the study data revealed: “In some ways we’re a victim of our own success. As we’re living longer and our health system has gotten better, no longer are people dying of heart disease at age 50 so now they’re dying of heart disease later when they have other things like cancer as well.”

Then Dugoff sounded the alarm, noting that the emerging obesity epidemic in America -- with its burden of ever-increasing chronic diseases -- is trumping improved healthcare opportunities. “We need to reorient our healthcare system to care for chronic conditions. If we don’t reorientate ourselves in that way, the impact of chronic conditions on life expectancy could be extremely negative.”

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I found a fascinating article at Slate.com titled Why Are You Not Dead Yet? In it, author Laura Helmuth explains how and why life expectancy doubled over the past century and a half. Here's how her piece begins:

You may well be living your second life already. Have you ever had some health problem that could have killed you if you’d been born in an earlier era? Leave aside for a minute the probabilistic ways you would have died in the past—the smallpox that didn’t kill you because it was eradicated by a massive global vaccine drive, the cholera you never contracted because you drink filtered and chemically treated water. Did some specific medical treatment save your life? It’s a fun conversation starter: Why are you not dead yet? It turns out almost everybody has a story, but we rarely hear them; life-saving treatments have become routine. I asked around, and here is a small sample of what would have killed my friends and acquaintances:
  • Adrian’s lung spontaneously collapsed when he was 18. 
  • Becky had an ectopic pregnancy that caused massive internal bleeding. 
  • Carl had St. Anthony’s Fire, a strep infection of the skin that killed John Stuart Mill.* 
  • Dahlia would have died delivering a child (twice) or later of a ruptured gall bladder. 
  • David had an aortic valve replaced. 
  • Hanna acquired Type 1 diabetes during a pregnancy and would die without insulin. 
  • Julia had a burst appendix at age 14. 
  • Katherine was diagnosed with pernicious anemia in her 20s. She treats it with supplements of vitamin B-12, but in the past she would have withered away. 
  • Laura (that’s me) had scarlet fever when she was 2, which was once a leading cause of death among children but is now easily treatable with antibiotics. 
  • Mitch was bitten by a cat and had to have emergency surgery and a month of antibiotics or he would have died of cat scratch fever.

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The World Health Organization's 2012 List
So much for "American Exceptionalism," as far as this key metric goes. The USA is way down the list at 35, nestled between Costa Rica (34) and Chile (36). 

If the results of the Hopkins study kick in and persist over the next decade, we'll have to watch America slide further and further down the rankings (which, for some reason, did not include "female rank" stats).
rank [4]
CountryOverall life
Male life
Female life
1 Monaco87.285.3189-
2 Japan84.682287.3
3 Andorra84.280.8887.6-
4 Singapore8482287-
5 Hong Kong83.882285.6-
6 San Marino83.582285-
7 Iceland83.381.4685.2-
8 Italy83.180.41085.8-
9 Sweden8381.4684.6-
10 Australia8380.5985.5-
11  Switzerland82.880.41085.4-
12 Canada82.580.41084.6-
13 Spain82.579.51585-
14 France82.379.41985.2-
15 Israel82.180.21384-
16 Luxembourg8279.51584.5-
17 Norway81.980.21383.6-
18 New Zealand81.779.41984-
19 Austria81.578.52484.5-
20 Netherlands81.579.51583.5-
21 Ireland81.479.22283.6-
22 Cyprus81.279.12384.3-
23 Finland81782884-
24 Germany8178.52483.5-
25 Greece81782884-
26 South Korea8177.53084.5-
27 Malta8179.41982.6-
28 Belgium8178.52483.5-
29 United Kingdom8179.51582.5-
30 Liechtenstein80.777.82983.6-
31 Taiwan80.6782883.2-
32 Portugal8076.93782.8-
33 Slovenia80773583-
34 Costa Rica79.878.32781.3-
35 United States79.877.43282.2-
36 Chile79.576.53882.5-
37 Denmark79.5773582-
38 Cuba79.477.43281.4-
40 United Arab Emirates79.277.23481.2-
41 Brunei7977.53080.5-
42 Barbados78.576.23980.8-
43 Kuwait78.275.54180.5-
44 Czech Republic78754281-
45 Panama77.874.64481-
46 Poland77.573.55181.5-
47 Croatia77.574.54580.5-
48 Dominica77.5754180-
49 Uruguay77.374.24880.4-
50 Mexico77.274.24980.2-
51 Maldives77.276.23978.2-
52 Bahrain77754179-
53 Belize76.974.44679.4-
54 Slovakia76.873.45380.2-
55 Bahamas76.573.55179.5-
56 Grenada76.5735480-
57 Brazil76.272.66379.8-
58 Estonia76.1719181.2-
59 Ecuador76735479-
60 Argentina76735479-
61 Saint Vincent and the Grenadines76735479-
62 Oman76735479-
63 Bosnia and Herzegovina76745078-
64 China76747277-
65 Lithuania75.970.810281-
66 Antigua and Barbuda75.874.44677.2-
67 Malaysia75.772.27079.2-
68 Saint Lucia75.571.58279.5-
69 Qatar75.5735478-
70 Mauritius75.2719179.4-
71 Saint Kitts and Nevis75.172.27078-
72 Vietnam75735477-
73 Hungary75719179-
74 Venezuela7571.58278.5-
75 Macedonia75735477-
76 Syria75727278-
77 Thailand74.971.48878.4-
78 Trinidad and Tobago74.871.58278.1-
79 Seychelles74.7719178.4-
80 Sri Lanka74.771.48878-
81 Paraguay74.771.68077.8-
82 Peru74.771.68077.8-
83 El Salvador74.670.810278.4-
84 Jordan74.672.46676.8-
85 Colombia74.672.46676.8-
86 Tonga74.5735476-
87 Cape Verde74.570.610478.4-
88 Latvia74.569.511278.5-
89 Nicaragua74.571.58277.5-
90 Libya74.5719178-
91 Georgia74.570.210678.8-
92 Tunisia74.572.56476.5-
93 Montenegro74.571.58277.5-
94 Bulgaria74.5719178-
95 Suriname74.5727277-
96 Turkey74.472.46676.4-
96 Armenia74.470.610478.2-
97 Saudi Arabia74.372.46676.2-
98 Samoa74719177-
99 Lebanon7472.56476.5-
100 Palau747010778-
101 Romania747010778-
102 Honduras74727276-
103 Albania74727276-
104 Serbia74719177-
105 Jamaica74.871.58278.2-
106 Iran73.5727275-
107 Marshall Islands73.56911675-
108 Algeria73.371.87974.8-
109 Egypt73.271.29075.2-
110 Dominican Republic73.2727274.4-
111 Fiji737010776-
112 Philippines737010776-
113 Solomon Islands73719175-
114 Nauru737010776-
115 Morocco73719175-
116 Belarus72.568.511777.5-
117 Indonesia726811876-
118 Sao Tome and Principe726811876-
119 Vanuatu72719174-
120 Azerbaijan71.569.511274.5-
121 Guatemala71.56811875-
122 Ukraine7165.513476.5-
123 Moldova716712475-
124 Russia706414376-
125 Bhutan70.869.211572.4-
126 Guyana70.567.512373.5-
127 Micronesia706811872-
128 Bangladesh7069.511270.5-
129 Kyrgyzstan696513572-
130 Iraq68.56513572-
131 North Korea696613072-
132   Nepal696811870-
133 Mongolia696513573-
134 Bolivia696712471-
135 Uzbekistan68.56613071-
136 Laos6866.512869.5-
137 Myanmar686613070-
138 Kazakhstan686314673-
139 Comoros686513571-
140 Kiribati686513571-
141 Tajikistan686712469-
142 Papua New Guinea67.56513569-
143 Namibia67.266.212968.2-
144 Pakistan676613068-
145 Turkmenistan66.56314670-
146 Cambodia666414368-
147 Ghana666414368-
148 Madagascar666513568-
149 Botswana6664.514267.5-
150 India656414367-
151 Gabon646215066-
152 Yemen646314666-
153 Timor-Leste646314665-
154 Senegal646215066-
155 Haiti636215064-
156 Sudan636115265-
157 Eritrea61.55915464-
158 Cameroon61.55915464-
159 South Africa615915463-
160 Djibouti615915464-
161 Ethiopia60.55915462-
162 Kenya605915461-
163 Rwanda605915461-
164 Afghanistan605915461-
165 Mauritania59.55716761-
166 Liberia595816260-
167 Tanzania595816261-
168 Benin595816260-
169 Gambia5957.516560.5-
170 Malawi5857.516558.5-
171 Republic of the Congo585716759-
172 Togo5755.516958.5-
173 Burkina Faso56.55417357-
174 Côte d'Ivoire56.55517058-
175 Uganda5654.517257.5-
176 Niger565517057-
177 Zambia55.55417356-
178 Guinea555417356-
179 Equatorial Guinea545317655-
180 Zimbabwe545317655-
181 Burundi535217854-
182 Nigeria535217854-
183 Mozambique52.55217853-
184 Angola525118153-
185 Chad5150.518253.5-
186 Mali515018353-
187 Lesotho515018352-
188 Guinea Bissau504818652-
189 Swaziland504918551-
190 Somalia504818652-
191 Democratic Republic of the Congo49.54818651-
192 Central African Republic48.54718750-
193 Sierra Leone47.54718748

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