Subnational estimates of life expectancy at birth in India: evidence from NFHS and SRS data.

BACKGROUND: Mortality estimates at the subnational level are of urgent need in India for the formulation of policies and programmes at the district level. This is the first-ever study which used survey data for the estimation of life expectancy at birth ([Formula: see text]) for the 640 districts from NFHS-4 (2015-16) and 707 districts from NFHS-5 (2019-21) for the total, male and female population in India. METHODS: This study calculated annual age-specific mortality rates from NFHS-4 and NFHS-5 for India and all 36 states for the total, male and female population. This paper constructed the abridged life tables and estimated life expectancy at birth [Formula: see text] and further estimated the model parameters for all 36 states. This study linked state-specific parameters to the respective districts for the estimation of life expectancy at birth [Formula: see text]for 640 districts from NFHS-4 and 707 districts from NFHS-5 for the total, male and female population in India. RESULTS: Findings at the state level showed that there were similarities between the estimated and calculated [Formula: see text] in most of the states. The results of this article observed that the highest [Formula: see text] varies in the ranges of 70 to 90 years among the districts of the southern region. [Formula: see text] falls below 70 years among most of the central and eastern region districts. In the northern region districts [Formula: see text] lies in the range of 70 years to 75 years. The estimates of life expectancy at birth [Formula: see text] shows the noticeable variations at the state and district levels for the person, male, and female populations from the NFHS (2015-16) and NFHS (2019-21). In the absence of age-specific mortality data at the district level in India, this study used the indirect estimation method of relating state-specific model parameters with the IMR of their respective districts and estimated [Formula: see text] across the 640 districts from NFHS-4 (2015-16) and 707 districts from NFHS-5 (2019-21). The findings of this study have similarities with the state-level estimations of [Formula: see text] from both data sources of SRS and NFHS and found the highest [Formula: see text] in the southern region and the lowest [Formula: see text] in the eastern and central region districts. CONCLUSIONS: In the lack of [Formula: see text] estimates at the district level in India, this study could be beneficial in providing timely life expectancy estimates from the survey data. The findings clearly shows variations in the district level [Formula: see text]. The districts from the southern region show the highest [Formula: see text] and districts from the central and eastern region has lower [Formula: see text]. Females have higher [Formula: see text] as compared to the male population in most of the districts in India.

[Health expenditure and health outcomes in Latin America and the CaribbeanGastos em saúde e resultados de saúde na América Latina e no Caribe]. / Gasto en salud y resultados en salud en América Latina y el Caribe.

Objective: To determine the effect of public and private health expenditure on health outcomes in Latin American and Caribbean countries from 2000 to 2019. Methods: A health production function was used, wherein life expectancy at birth and infant mortality rate were considered as indicators of health outcomes. Panel data econometrics were applied, using data from a 33-country sample for the period from 2000 to 2019. Results: According to estimates, a 1% increase in public health expenditure is associated with a 0.019% increase in life expectancy, and a 1% increase in private health expenditure increases life expectancy by 0.023%. At the same time, a 1% increase in public health expenditure reduces the infant mortality rate by -0.168%, whereas the effect of private health expenditure on infant mortality is not statistically significant. Conclusions: The results provide evidence of the effect of public health expenditure in reducing infant mortality and increasing life expectancy, while private health expenditure has a positive effect only on the latter metric. The findings have important political implications for the countries of the Region in the post-pandemic context of limited fiscal space.

Objetivo: Determinar os efeitos dos gastos públicos e privados em saúde sobre os resultados de saúde nos países da América Latina e do Caribe no período de 2000 a 2019. Métodos: Utilizamos uma função de produção da saúde, na qual a expectativa de vida ao nascer e a taxa de mortalidade infantil foram consideradas como indicadores dos resultados de saúde. Usando dados de uma amostra de 33 países no período de 2000 a 2019, aplicamos a técnica econométrica de dados em painel. Resultados: De acordo com as estimativas, um aumento de 1% nos gastos públicos em saúde está associado a um aumento de 0,019% na expectativa de vida. Da mesma forma, um aumento de 1% nos gastos privados em saúde resulta em um aumento de 0,023% na expectativa de vida. No que diz respeito ao segundo indicador, um aumento de 1% nos gastos públicos em saúde reduz a taxa de mortalidade infantil em -0,168%. Por outro lado, o efeito dos gastos privados em saúde sobre a mortalidade infantil não é estatisticamente significativo. Conclusões: Os resultados geram evidências sobre os efeitos dos gastos públicos em saúde na redução da mortalidade infantil e no aumento da expectativa de vida, enquanto que os gastos privados em saúde têm um efeito positivo apenas na expectativa de vida. Estes resultados têm implicações políticas importantes para os países da região, diante de um cenário pós-pandemia com espaço fiscal limitado.

Impacts of the COVID-19 pandemic on life expectancy at birth in Asia.

OBJECTIVE: To investigate the impact of the COVID-19 pandemic on life expectancy at birth (e0) for 51 Asian countries and territories from January 1, 2020 to December 31, 2021. METHOD: Based on age-sex-specific mortality used for estimating the changes in e0 for years 2019, 2020, and 2021 from the 2022 revision of the World Population Prospects, we employed Arriaga's discrete method to decompose changes in e0 into both absolute and relative contributions of changes in age-specific death rate, and further obtained the age-sex-specific contribution to changes in e0 by country/territory and period (i.e., 2019-2020 and 2020-2021) for Asia. FINDINGS: The COVID-19 pandemic reduced 1.66 years in e0 of the Asian population from 2019 to 2021, slightly lower than the world average of 1.74 years. South Asia had a high loss of 3.01 years, whereas Eastern Asia had almost no changes. Oman, Lebanon, India, Armenia, Azerbaijan, Indonesia, and the Philippines experienced a high loss of above 2.5 years in e0. Despite significant national and territorial variations, the decline of e0 in Asia was mostly from the age group of 60-79 years, followed by age groups of 80 + and 45-59 years; and age groups of children contributed little (i.e., 0-4 and 5-14 years old). Males suffered more losses than females in this pandemic. Asian nations saw less loss in e0 in the second year of the pandemic, i.e., 2020-2021, than in the first year, i.e., 2019-2020, but this recovery trend was not observed in Southern Asia and South-Eastern Asia. Countries from Central Asia and Western Asia, such as Kazakhstan, Armenia, Azerbaijan, Lebanon, and Oman, had extraordinarily more losses in e0 in the first year at ages around 70. CONCLUSION: The COVID-19 pandemic had significantly affected e0 of Asian populations, and most contribution to the reduction of e0 came from the three older age groups, 60-79 years, 80 + years, and 45-59 years, with great variations across countries/territories. Our findings could have important implications for development of more resilient public health systems in Asian societies with better policy interventions for vulnerable demographic groups.

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.

Although in shortage, nursing workforce is still a significant contributor to life expectancy at birth.

OBJECTIVES: Previous studies have not fully reported the strength and independency of the correlation of nursing workforce to life expectancy. This study advances that nursing workforce is a major independent contributor to life expectancy at birth (LEB) globally and regionally. DESIGN: A cross-sectional study was conducted at population level. SAMPLE: Ecological data were extracted from the United Nations agencies for 215 populations. Each population is considered a research subject. MEASUREMENTS: The correlation between nursing workforce and LEB was analyzed with scatter plots, bivariate correlation, partial correlation, and multiple linear regression analyses, Analysis of Variance post hoc and independent T-test. Economic affluence, urban lifestyle and obesity were included as the potential confounders in this study. INTERVENTION: Not applicable RESULTS: Nursing workforce correlated to LEB and this relationship remained regardless of the competition of economic affluence, urbanization, and obesity. Second to economic affluence, nursing workforce showed the greatest influence on LEB. In total, 64.50% of LEB was explained in this study. Nursing workforce was a determinant of regional variations of LEB. CONCLUSIONS: Nursing workforce may be a significant contributor to LEB globally and regionally. This contribution was independent of the potential confounding effects of economic affluence, urbanization, and obesity.

Gasto en salud y resultados en salud en América Latina y el Caribe / Health expenditure and health outcomes in Latin America and the Caribbean / Gastos em saúde e resultados de saúde na América Latina e no Caribe

RESUMEN Objetivo. Determinar el efecto del gasto público y privado en salud sobre los resultados en salud en los países de América Latina y el Caribe durante el periodo 2000-2019. Métodos. Se emplea una función de producción de la salud, donde se consideró a la esperanza de vida al nacer y la tasa de mortalidad infantil como indicadores del resultado en salud. Con datos para una muestra de 33 países para el periodo 2000-2019, se aplicó la técnica econométrica de datos panel. Resultados. Según las estimaciones, un incremento del 1% en el gasto público en salud está asociado a un aumento del 0,019% de la esperanza de vida. Del mismo modo, un incremento del 1% del gasto privado en salud aumenta en 0,023% la esperanza de vida. Para el caso del segundo resultado en salud, un incremento del 1% en el gasto público en salud reduce en -0,168% la tasa de mortalidad infantil. Sin embargo, el efecto del gasto privado en salud sobre la mortalidad infantil no es estadísticamente significativo. Conclusiones. Los resultados brindan evidencia del efecto del gasto público en salud para reducir la mortalidad infantil e incrementar la esperanza de vida, mientras que el gasto privado en salud presenta un efecto positivo solo sobre este último. Los hallazgos tienen importantes implicancias políticas para los países de la región ante un escenario postpandemia de limitado espacio fiscal.

ABSTRACT Objective. To determine the effect of public and private health expenditure on health outcomes in Latin American and Caribbean countries from 2000 to 2019. Methods. A health production function was used, wherein life expectancy at birth and infant mortality rate were considered as indicators of health outcomes. Panel data econometrics were applied, using data from a 33-country sample for the period from 2000 to 2019. Results. According to estimates, a 1% increase in public health expenditure is associated with a 0.019% increase in life expectancy, and a 1% increase in private health expenditure increases life expectancy by 0.023%. At the same time, a 1% increase in public health expenditure reduces the infant mortality rate by -0.168%, whereas the effect of private health expenditure on infant mortality is not statistically significant. Conclusions. The results provide evidence of the effect of public health expenditure in reducing infant mortality and increasing life expectancy, while private health expenditure has a positive effect only on the latter metric. The findings have important political implications for the countries of the Region in the post-pandemic context of limited fiscal space.

RESUMO Objetivo. Determinar os efeitos dos gastos públicos e privados em saúde sobre os resultados de saúde nos países da América Latina e do Caribe no período de 2000 a 2019. Métodos. Utilizamos uma função de produção da saúde, na qual a expectativa de vida ao nascer e a taxa de mortalidade infantil foram consideradas como indicadores dos resultados de saúde. Usando dados de uma amostra de 33 países no período de 2000 a 2019, aplicamos a técnica econométrica de dados em painel. Resultados. De acordo com as estimativas, um aumento de 1% nos gastos públicos em saúde está associado a um aumento de 0,019% na expectativa de vida. Da mesma forma, um aumento de 1% nos gastos privados em saúde resulta em um aumento de 0,023% na expectativa de vida. No que diz respeito ao segundo indicador, um aumento de 1% nos gastos públicos em saúde reduz a taxa de mortalidade infantil em -0,168%. Por outro lado, o efeito dos gastos privados em saúde sobre a mortalidade infantil não é estatisticamente significativo. Conclusões. Os resultados geram evidências sobre os efeitos dos gastos públicos em saúde na redução da mortalidade infantil e no aumento da expectativa de vida, enquanto que os gastos privados em saúde têm um efeito positivo apenas na expectativa de vida. Estes resultados têm implicações políticas importantes para os países da região, diante de um cenário pós-pandemia com espaço fiscal limitado.

Effects of globalization, energy consumption and ICT on health status in Australia: the role of financial development and education.

BACKGROUND: The outbreak of COVID-19 has alerted governments around the world, including Australia, to think seriously about the health issues. Life expectancy is one of such issues. Therefore, this study tries to reveal the effects of globalization, energy consumption, information and communication technology, financial development, education rate, and economic growth on life expectancy at birth in Australia. METHODS: Using the data period of 1990-2018, a series of econometric techniques: the Dickey-Fuller generalized least square test, Autoregressive Distributive Lag bounds test, fully modified ordinary least square method and the pairwise Granger causality test, are applied. RESULTS: The findings disclose that globalization, renewable energy use, information and communication technology, per capita gross domestic product, education rate, and financial development increased during this period but non-renewable energy use reduced life expectancy at birth. Unidirectional causal associations of the studied variables with life expectancy at birth are also revealed. CONCLUSIONS: All the outcomes are relevant and useful for articulating an innovative policy in the health sector. The prime policy implication of this work is: the effective, efficient, and inclusive policies considering globalization, renewable and non-renewable energy consumption, information and communication technology, financial development, education rate, and economic growth should be formulated and executed for guaranteeing health status.

Physician care access plays a significant role in extending global and regional life expectancy.

BACKGROUND: Previous cross-sectional studies generally did not fully consider the potential confounding factors associated with physician impact on overall population health. This ecological study controlled for health, demographic and socioeconomic confounders while using total physician density for predicting overall population health globally and regionally. METHODS: Ecological data were extracted from the United Nations agencies for 215 populations. Considering the competing effects of economic affluence, urban advantages and obesity, correlations between physician density and life expectancy at birth (LEB) were analysed with scatter plots, bivariate correlation, partial correlation and multiple linear regression analyses. Countries are also grouped for exploring the regional correlations between physician density and LEB. RESULTS: Physician density correlates to LEB and this relationship remains regardless of the competition of the individual confounders, economic affluence, urbanization and obesity, or their combination. Physician density has the greatest influence on LEB, while economic affluence is second. Physician density explains 64.89% of LEB in this study. Together with constant bivariate correlations in country groupings, power correlation without a plateau or U shape in the trendline of the scatterplots, suggests that a shortage of physicians is a worldwide issue. CONCLUSIONS: Physician density is a major independent contributor for LEB both globally and with special regard to the developing world. Telehealth may be an alternative to increase physicians' capacity while funding for increasing physician employment is desirable.

Corruption and Population Health in the European Union Countries-An Institutionalist Perspective.

Even though the European Union (EU) is considered one of the best performers in the world in fighting corruption, the situation changes when the analysis is shifted to the national dimension of its member states, with significant differences concerning the effects of corruption on population health. Using the theory of New Institutional Economics as a complementary tool that provides additional representativeness to this phenomenon, the aim of this paper is to empirically investigate the impact of corruption on population health, considering also other demographic and socio-economic determinants. Using data collected at the EU level registered between 2000-2019, we employ panel date models to validate the ongoing effect of perceived corruption on population health. Our empirical findings fully validate the institutionalist perspective, according to which countries with inclusive institutions better control the anomaly of corruption while benefitting from higher life expectancy and reducing child mortality rates. Conversely, the EU countries with rather extractive institutions suffer in terms of both longevity of population and infant mortality. Our study emphasizes that in tackling corruption pressure on population health, the most effective way is to improve the quality of governance in countries with fragile institutions.

[The life-span of population of the Irkutsk Oblast].

The indicator of average life expectancy at birth is widely used as systemic indicator of population quality of life and health. The purpose of the study is to identify, to evaluate quantitative and structural changes of indicator of life expectancy at birth in population of the Irkutsk Oblast during 1990-2019. The data of life expectancy at birth was obtained from the Rosstat websites. The original calculations of survival tables were carried out using the databases of the Center for Demographic Research at the New Economic School. The analysis of trends was carried out using linear regression analysis. The analysis of role of exogenous and endogenous determination of mortality in formation of average life expectancy was carried out. In 1990-2005, in the Irkutsk Oblast, occurred change in ranking of causes of death that determined the greatest irrecoverable losses of population and reduction of indicator of average life expectancy at birth. The essence of this change is in abnormally high proportion of exogenous causes of mortality, especially class of external causes of mortality, in the structure of irreversible demographic losses. In the Irkutsk Oblast, in 2006-2019, occurred favorable changes in the structure of irrecoverable losses, testifying returning to modern type of mortality. During the same period, indicator of average life expectancy at birth increased. It is established that changes occurred since 2006 in the quantitative and structural indices of mortality and average life expectancy at birth are very positive. However, during demographic processes in 2020, the COVID-19 pandemic intervened. This factor is bringing negative impact on economy, and after that on social sphere and public health. The further course of development of social demographic situation in the Irkutsk Oblast, in particular, dynamics of indicator of average life expectancy at birth, will depend on success of activities of authorities of all levels in struggle with pandemic and overcoming crisis events in social economic development.

The macro-level effect of religiosity on health.

An issue that has not yet been explored in the religiosity-health literature is the macro-level effect of religiosity on health-the effect of the religiosity of a society on the absolute health of the population of that society as a whole. We address this issue using two panel datasets: The first is a time-series cross-sectional panel dataset for 17 countries from 1925 to 2000. The second is a cross-sectionally dominated panel dataset of up to 92 countries for the period 1981-2016. Our main findings are as follows: first, religiosity has a significant negative causal effect on health at the macro level; second, a substantial part of this effect can be attributed to an indirect effect via public health expenditures; and third, changes in population health do not cause significant changes in societal religiosity.

Non-linear relations between life expectancy, socio-economic, and air pollution factors: a global assessment with spatial disparities.

Influential factors of socio-economic and air pollution on life expectancy (LE) show complexity. The investigations of non-linear functions of LE, socio-economic, and air pollution factors have not been largely conducted, and spatial and temporal differences of the linear or non-linear relations between LE and the influential factors have been obscured across countries in the world. In this study, the non-linear relations between LE and factors of per capita gross national income (GNIpc), urban population rate (UPR), and fine-particulate (PM2.5) were estimated from 2000 to 2015 by using a generalized additive model (GAM). The collected data included the 219 countries and regions with sufficient data and covers the period 2000-2015. The results demonstrate that at the global level, the GNIpc plays a stable and significant non-linear role in LE, while the non-linear relationships between UPR, PM2.5, and LE are not significant. The temporal variation was further investigated that the non-linear effect of PM2.5 on LE is gradually strengthened, and the non-linear effect of UPR on LE shows a weakened trend. However, GNIpc always plays a significantly non-linear role in the LE level. Furthermore, the spatial difference in the non-linear relations among different continents is detected. In sum, it cannot be ignored the non-linear effects of socio-economic and air pollution factors on LE at a global scale and across different continents.

Does the augmentation of monetary and non-monetary factors prerequisite for the improvement of health outcomes? Evidence from the Indian states.

The present study was conducted in Indian states to examine the effect of monetary and non-monetary factors on Infant Mortality Rate (IMR) and Life Expectancy at Birth (LEB) by using the panel regression model. In addition, an attempt was also made to analysis the unequal pattern of health infrastructure and services across states over time with the help of a composite index on health infrastructure and services. It was found that the index value of the best performing state Chhattisgarh is more than fourth six times that of the worst performing state. The study also showed that, despite the higher level of average per capita public health expenditure and moderately better health infrastructure, the COVID 19 induced death rate was high in Punjab, Sikkim, Delhi and Goa. The panel regression results revealed that, an average increase of 1% in the monetary factor, public health expenditure to Gross State Domestic Product ratio (PHEGSDPR), would decrease the average of IMR by about 10%. Moreover, the elasticity of IMR with respect to non-monetary factor, health infrastructure and services per 0.1 million population (HISPLP), was negative and significant. Likewise, the explanatory variables, HISPLP and PHEGSDPR have a positive and significant effect on the LEB.

Spatiotemporal trends in life expectancy and impacts of economic growth and air pollution in 134 countries: A Bayesian modeling study.

Life expectancy (LE) varies across countries in space and time, and economic growth and air pollution are two important influence factors to LE. This study mainly aims to investigate spatiotemporal trends in LE in 134 countries from 1960 to 2016 by using Bayesian spatiotemporal modeling. Further, the relations between per capita gross domestic product (GDPpc) and population-weighted fine particulate matter (pwPM2.5) and LE are investigated from a global perspective from 1998 to 2016 by using the Bayesian regression model. The results illustrated the heterogeneity of spatiotemporal trends in LE globally. Specifically, Africa and South-East Asia show much lower LE levels, and the Americas, European, and Western Pacific exhibit a relatively higher LE level compared to the overall level. The countries with low overall levels of LE show a relatively stronger upward trend than the overall upward trend and vice versa. In addition, this study demonstrates that the spatial differences in effects of influence factors on LE in the six WHO regions in the 134 countries. Africa shows the highest positive regression coefficient of GDPpc and lowest negative regression coefficient of pwPM2.5 on LE than other regions in the world. Furthermore, it shows the complexity of the interaction between economic growth and air pollution on LE across six WHO regions. Our findings suggest the public policies to reduce the health damage caused by air pollution, especially in Africa, Eastern Mediterranean, and Europe where the pwPM2.5 negatively affect the LE benefits from economic growth.

New life expectancy forecasts are too optimistic.

Life expectancy at birth (e0) forecasts are used to estimate future pension costs. Previous French official forecasts have often overestimated e0. Recent forecasts published by demographers provide higher e0 estimates than official forecasts for France, Sweden, Japan and the USA, and do not consider that e0 could decrease, as in previous years because of flus, heatwaves, or other outbreaks. Too optimistic forecasts make that governments may overestimate future pension needs.

Cluster analysis of health systems in Europe according to life expectancy at birth.

PURPOSE: The aim of this study was to group European countries according to life expectancy at birth and to determine the impact of economic growth and financial indicators on European country groups. METHOD: This study planned and conducted by using life expectancy at birth time series, economic growth and financial development indicators data for the period of 1980 to 2015. European countries are classified in terms of life expectancy (LE) at birth time series data from 1980 to 2015 by using hierarchical clustering analysis method. Random Forest and Classification and Regression Tree (CART) algorithm was used to examine predictors of European country groups in terms of long-term LE time series data by using economic growth and financial development indicators. RESULTS: The results of this study show that Eastern and Western countries are mostly in two different clusters in terms of long-term LE time series. This study sheds light on the difference between Eurosceptic countries and other European countries. This study revealed that inflation in consumer prices, which is an indicator of economic growth, outperforms financial development indicators to predict country groups in terms of long-term life expectancy at birth data. CONCLUSION: Countries in the same cluster may have similar problems and solutions in their health care systems. Priority should be given to health problems that adversely affect the life expectancy of the countries in the same cluster in order to raise the quality of life and extend life expectancy in the European continent.

From income inequality to social inequity: impact on health levels in an international efficiency comparison panel.

BACKGROUND: Health equity, although addressed in several publications dealing with health efficiency analysis, is not easily translated into the operationalization of variables, mainly due to technical difficulties. Some studies provide evidence that it does not influence health outcomes; others demonstrate that its effect is an indirect one, with the hegemony of material living conditions over its social connotation. The aim of this article is to evaluate the role of health equity in determining health outcomes, in an international comparative analysis of the effectiveness and efficiency of health systems. METHOD: Fixed Effects Model Panel and Data Envelopment Analysis, a dynamic and network model, in addition to comparative analysis between methods and health impacts. The effect variables considered in the study were life expectancy at birth and infant mortality, in 2010 and 2015, according to the sociocultural regions of the selected countries. Inequity was assessed both economically and socially. The following dimensions were considered: physical and financial resources, health production (access, coverage and prevention) and intersectoral variables: demographic, socioeconomic, governance and health risks. RESULTS: Both methods demonstrated that countries with higher inequity levels (regarding income, education and health dimensions), associated or not with poverty, are the least efficient, not reaching the potential for effective health outcomes. The outcome life expectancy at birth exhibited, in the final model, the following variables: social inequity and per capita health expenditure. The outcome infant mortality comprehended the level of education variable, in association with the following healthcare variabels: care seeking due to diarrhea in children under five, births attended by skilled health professionals and the reduction in the incidence of HIV. CONCLUSION: The dissociation between the distribution of health outcomes and the overall level of health of the population characterizes a devastating political choice for society, as it is associated with high levels of segregation, disrespect and violence from within. Countries should prioritize health equity, adding value to its resources, since health inequties affect society altogether, generating mistrust and reduced social cohesion.

The Relative Importance of Globalization and Public Expenditure on Life Expectancy in Europe: An Approach Based on MARS Methodology.

BACKGROUND: There has been a widespread debate about the overall impact of globalization on population, not just economically, but also in terms of health status. Moreover, the current health crisis is going to force governments to review the structure of the public budget to most effectively alleviate the negative economic and health effects on the population. OBJECTIVE: The aim of this paper is to analyze the relative importance of globalization and the public budget composition-specifically the participation of public expenditure on healthcare, social services and environment in gross domestic product (GDP)-on life expectancy at birth in European countries during the period 1995-2017. METHODS: The Multivariate Adaptive Regression Splines (MARS) methodology was applied to analyze the socioeconomic determinants of life expectancy at birth. RESULTS: Our findings show that globalization has no relative importance as an explanatory variable of life expectancy in European countries, while government expenditure on social protection is the most relevant followed by public expenditure on health, gross national income per capita, education level of the population and public expenditure on environmental protection. CONCLUSION: European strategies intended to impact on health outcome should spend more attention to the composition of public budget.

Excess mortality and shortened life expectancy in people with major mental illnesses in Taiwan.

AIMS: Given the concerns of health inequality associated with mental illnesses, we aimed to reveal the extent of which general mortality and life expectancy at birth in people with schizophrenia, bipolar disorder and depressive disorder varied in the 2005 and 2010 nationally representative cohorts in Taiwan. METHODS: Two nationally representative samples of individuals with schizophrenia, bipolar disorder and depressive disorder were identified from Taiwan's national health insurance database in 2005 and 2010, respectively, and followed-up for consecutive 3 years. The database was linked to nationwide mortality registry to identify causes and date of death. Age-, gender- and cause-specific mortality rates were generated, with the average follow-up period of each age- and gender-band applied as 'weighting' for the calculation of expected number of deaths. Age- and gender-standardised mortality ratios (SMRs) were calculated for these 3-year observation periods with Taiwanese general population in 2011/2012 as the standard population. The SMR calculations were then stratified by natural/unnatural causes and major groups of death. Corresponding life expectancies at birth were also calculated by gender, diagnosis of mental disorders and year of cohorts for further elucidation. RESULTS: The general differential in mortality rates for people with schizophrenia and bipolar disorder remained wide, revealing an SMR of 3.65 (95% confidence interval (CI): 3.55-3.76) for cohort 2005 and 3.27 (3.18-3.36) for cohort 2010 in schizophrenia, and 2.65 (95% CI: 2.55-2.76) for cohort 2005 and 2.39 (2.31-2.48) for cohort 2010 in bipolar disorder, respectively. The SMRs in people with depression were 1.83 (95% CI: 1.81-1.86) for cohort 2005 and 1.59 (1.57-1.61) for cohort 2010. SMRs due to unnatural causes tended to decrease in people with major mental illnesses over the years, but those due to natural causes remained relatively stable. The life expectancies at birth for schizophrenia, bipolar disorder and depression were all significantly lower than the national norms, specifically showing 14.97-15.50 years of life lost for men and 15.15-15.48 years for women in people with schizophrenia. CONCLUSIONS: Compared to general population, the differential in mortality rates for people with major mental illnesses persisted substantial. The differential in mortality for unnatural causes of death seemed decreasing over the years, but that due to natural causes remained relatively steady. Regardless of gender, people with schizophrenia, bipolar disorder and depression were shown to have shortened life expectancies compared to general population.

[Examination of Factors Affecting Life Expectancy by Prefecture Based on the Criteria of the Organisation for Economic Co-operation and Development].

OBJECTIVES: We investigated the indicators affecting life expectancy at birth and life expectancy at age 65 by multiple regression analysis and principal component analysis, and examined the factors affecting the longevity. METHODS: We set indicators for health status, risk factors, access to care, quality of care and health care resources. Then, we conducted multiple regression analysis with life expectancy at birth and life expectancy at age 65 as the objective variables and 22 indicators as explanatory variables. Principal component analysis was also performed on the 22 indicators. RESULTS: Men's life expectancy at birth was positively affected by hospital admission ratio and national health insurance costs, and negatively by the rate of requirement of care certification and alcohol consumption. Men's life expectancy at age 65 was positively affected by income-to-medical expenses ratio and hospitalization treatment ratio, and negatively by requiring care certification rate, smoking rate and obesity rate. Women's life expectancy at birth was positively affected by population coverage and hospitalization treatment ratio, and negatively by women's heart disease mortality rate, requiring care certification rate and smoking rate. Women's life expectancy at age 65 was positively affected by late-stage elderly medical costs and the number of doctors, and negatively by requiring care certification rate and air pollution. Principal component 1 indicated "aging high-medical-resource society", principal component 2 indicated "high mortality from heart disease", and principal component 3 indicated the "degree of risk factor". CONCLUSIONS: On the basis of the indicators found to affect life expectancy at birth and life expectancy at age 65, it is necessary to take measures to ensure a long life.