Comparative Methodologic and Practical Considerations for Life Expectancy as a Public Health Mortality Measure.

INTRODUCTION: Life expectancy is a public health metric used to assess mortality. We describe life expectancy calculations for US counties and present methodologic considerations compared with years of potential life lost before age 75 (YPLL-75) and premature age-adjusted mortality (PAAM), 2 commonly used length-of-life metrics. METHODS: We used death data from the National Center for Health Statistics for 2015-2017 and other health measures from the 2019 County Health Rankings & Roadmaps. We calculated life expectancy from birth at the county level using an abridged life table and the Chiang method of variance. Studentized residuals identified counties with discordant life expectancy and YPLL-75 or PAAM values. Correlations tested associations of life expectancy with key health measures (eg, smoking, child poverty, uninsured). RESULTS: Among 3073 US counties, life expectancy ranged from 62.4 to 98.0 years, with a mean of 77.4 years. Life expectancy was strongly and negatively correlated with YPLL-75 (r = -0.91) and PAAM (r = -0.95) at the county level. Life expectancy was also associated with other key health metrics, such as smoking, employment, and education rates, where an improvement in the health factor indicated improvement in the respective length-of-life measure. Counties with discordant life expectancy and YPLL-75 or PAAM values had differing age structures. PRACTICE IMPLICATIONS: Commonly used length-of-life metrics in population health settings are differentiated by methodological matters, such as computation complexity, data availability, and differential risk among age groups, especially among the very old or very young. The choice of metric should consider these factors, in addition to practical concerns, such as the communication needs of the audience.

Deaths of Despair(ity) in Early 21st Century America: The Rise of Mortality and Racial/Ethnic Disparities.

INTRODUCTION: Recent media coverage and research have emphasized increasing mortality rates for middle-aged white Americans. A concern is that this has shifted focus away from the health burden of other population subgroups. This cross-sectional study compares the magnitude of racial/ethnic mortality disparities across age groups and investigates how changing mortality trends have affected these disparities. METHODS: Mortality data from 2007 to 2016 by race/ethnicity and age were obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database in 2018‒2019. Absolute and relative racial/ethnic mortality disparities by age groups were determined by calculating between-group variance and mortality rate-adjusted between-group variance, respectively. Trends in disparities were analyzed using joinpoint regression modeling. Annual percentage change in rate-adjusted between-group variance was calculated for each trend segment as well as the relative contribution of each racial/ethnic group to the change. RESULTS: The largest relative and absolute disparities were found in the youngest and oldest age groups, respectively. Trend analysis detected an inflection point between 2009 and 2012 for most age groups where a period of decreasing disparities changed to one of increasing disparities. Three quarters of the decreasing disparities in Period 1 were resultant of lowering mortality among the black subgroup. During Period 2, the increase in child disparities were due to increased mortality among blacks, whereas increased adult disparities were due to increased mortality among whites shifting the overall mean away from subgroups with lower rates. CONCLUSIONS: Racial/ethnic mortality disparities persist and are widening for some age groups. It is imperative to maintain focus on the age groups where those with historically poorer health are contributing most to the increase.

Adherence to physical activity guidelines in mid-pregnancy does not reduce sedentary time: an observational study.

BACKGROUND: Physical activity (PA) interventions designed to prevent prenatal complications have focused on increasing moderate PA yielding conflicting results. Minimal attention has focused on the evaluation of sleep, sedentary behavior (SB), light activity or total daily PA during pregnancy. The purpose of this prospective, longitudinal study was to 1) objectively quantify and compare habitual PA and SB during the 2nd and 3rd trimester; and 2) evaluate differences in activity patterns for women meeting prenatal PA guidelines versus those that did not. METHODS: Forty-six participants wore 2 PA monitors (SenseWear Mini and activPAL) during week 18 and week 35 of pregnancy. We compared differences in sleep duration, postural allocation, daily steps, and PA between the 2nd and 3rd trimester and for women who met and did not meet PA guidelines. RESULTS: During the 2(nd) trimester, 30% of the women's day (24-hours) was total sleep; 52% SB; 13% light; 3% moderate; and 0% vigorous PA. Light (P = 0.05), vigorous (P = 0.02), and moderate-vigorous PA (MET-minutes; P = 0.02), decreased with a trend in increased SB (P = 0.07). Activity of other intensities and sleep duration did not significantly change. Only 39% and 37% of participants slept between 7-9 hours/night at week 18 and 35, respectively. Forty-six percent (n = 21) and 28% (n = 13) of participants met prenatal PA guidelines during the 2(nd) and 3(rd) trimester, respectively. At week 18, no differences in total sleep, SB, or light PA existed for women who met PA guidelines versus those who did not; total PA was significantly greater for women who met guidelines. At week 35, women that met PA guidelines had significantly less SB (P < 0.005) than women who did not. CONCLUSIONS: This study demonstrates that pregnant women spend the majority of their day in SB. Significant reductions in total activity across pregnancy may be attributed, in part to shifts in light PA and increased SB. Based on the lifestyle of our sample, regardless of meeting PA guidelines in mid-pregnancy, no significant difference exists in time spent in SB, however meeting PA recommendations in late pregnancy may reduce SB. Future interventions should target reducing SB by increasing light and moderate PA beyond volitional exercise.