“A universal challenge’: Increasing lifespan dulled by nearly a decade of disease effects

Key takeaways:

• The mean healthspan-lifespan gap among WHO member states rose from 8.5 to 9.6 years from 2000 to 2019.
• The gap in healthspan-lifespan were greater among women, both in the U.S. and globally.

Global increases in life expectancy have been accompanied by a similar rise in the number of years living with the effects of disease.

This difference between life expectancy and disability-free healthy living, what researchers called the healthspan-lifespan gap, has grown to almost 10 years over the last 2 decades, the results of a cross-sectional analysis of WHO member states published in JAMA Network Open showed.

The data “underscore that around the world, while people live longer, they live a greater number of years burdened by disease,” the researchers wrote.

Several recent reports have highlighted concerning trends and disparities in life expectancy, both globally and in the United States.

According to Armin Garmany, BS, an MD-PhD candidate at the Mayo Clinic, and Andre Terzic, MD, PhD, director of the Mayo Clinic Center for Regenerative Medicine, gains in life expectancy are seen as a societal achievement.

“Increased lifespan, however, does not necessarily mean a longer healthy life,” they explained. “In considering quality of life, healthy longevity is increasingly underscored. To this end, characterizing healthspan — years lived in good health — would be valuable.”

In the analysis, the researchers examined changes in the healthspan-lifespan gap — the difference in life expectancy and health-adjusted life expectancy that represents the number of years lived with disease or disability — and its associations with mortality and morbidity across 183 WHO member states.

Garmany and Terzic found that global life expectancy increased 6.5 years over the last 2 decades, which was greater than the 5.4-year increase in health-adjusted life expectancy, the number of years people live free from disease.

Results showed a mean health-adjusted life expectancy (63.3 years) also less than the mean global life expectancy (72.5 years) across the WHO member states, “underpinning a pangeographic lag in healthspan,” the researchers wrote.

Overall, the mean healthspan-lifespan gap rose from 8.5 years in 2000 to 9.6 years in 2019, for a growth of 13%.

The researchers observed sex differences, with women showing a mean healthspan-lifespan gap 2.4 years longer than men.

The U.S. had the largest healthspan-lifespan gap, with a gap 24% greater than its life expectancy.

This gap, driven by the largest noncommunicable disease burden, increased from 10.9 years in 2000 to 12.4 years in 2019, resulting in a 29% longer gap than the global mean.

Consistent with global trends, U.S. women showed a 2.6-year wider healthspan-lifespan gap vs. men, which may be contributed to noncommunicable disease burden from musculoskeletal, neurological and genitourinary diseases and “smaller contributions from communicable, maternal, perinatal, and nutritional conditions and injuries,” Garmany and Terzic wrote.

The healthspan-lifespan across the WHO member states was positively tied to morbidity burden and negatively associated with mortality burden (both P > .001).

The increasingly widening gap in healthspan-lifespan is “a universal challenge requiring transnational consideration” and one that “points to the need for an accelerated pivot to proactive wellness-centric care systems,” the researchers wrote.

“Strategies to address the healthspan-lifespan gap are multifaceted, leveraging preventative and curative solutions,” they added. “To identify drivers of the healthspan-lifespan gap, associated demographic, health, and economic characteristics need to be investigated by geography.”