Artículo de revista: PERMANYER, Iñaki; TRIAS-LLIMÓS; Sergi; SPIJKER, Jeroen (2021) “Best- practice healthy life expectancy vs. life expectancy: Catching up or lagging behind?”. Proceedings of the National Academy of Sciences of the U.S.A-PNAS (Letter), 118 (46), e2115273118: 1-3 (ISSN: 0027-8424). https://doi.org/10.1073/pnas.2115273118 LETTER Best-practice healthy life expectancy vs. life LETTER expectancy: Catching up or lagging behind? naki Permanyera,b,1 I~ osa , Sergi Trias-Llim , and Jeroen J. A. Spijkera Vaupel et al. (1) update previous important work on healthy life expectancy (HLE), that is, an indicator demographic perspectives on longevity and life that measures the number of years individuals are expectancy (LE) based on the steady increase in expected to live free of disease or disability (3, 4). best-practice life expectancy (BPLE) since 1840 (2). We argue here that the slower pace at which best- In those studies, Vaupel and coworkers state that practice healthy life expectancy (BPHLE) increases BPLE has been steadily increasing 0.25 y per annum paints a less optimistic picture than the one obtain- since 1840 and speculate that most children born in ing after inspecting BPLE trends alone. low-mortality countries since 2000 will celebrate While death is retreating to increasingly higher their 100th birthday. We aim to revisit the previous ages, it is unclear whether the onset of disease and analyses, shifting our attention to the trends in disability are doing the same, an issue that could Downloaded from https://www.pnas.org by 158.109.137.56 on January 27, 2023 from IP address 158.109.137.56. Fig. 1. BPLE (Top) and BPHLE (Bottom) for females and males between 1990 and 2019 (excluding Kuwait, San Marino, and Andorra). Source is authors’ elaboration based on the Global Burden of Disease Study 2019 data (9, 11). a Centre d’Estudis Demogr onoma de Barcelona, Bellaterra 08193, Spain; and bInstituci afics, Centres de Recerca de Catalunya, Universitat Aut o Catalana de Recerca i Estudis Avançats (ICREA), Barcelona 08010, Spain Author contributions: I.P. designed research; and I.P., S.T.-L., and J.J.A.S. performed research, analyzed data, and wrote the paper. The authors declare no competing interest. Published under the PNAS license. 1 To whom correspondence may be addressed. Email: ipermanyer@ced.uab.es. Published November 11, 2021. PNAS 2021 Vol. 118 No. 46 e2115273118 https://doi.org/10.1073/pnas.2115273118 j 1 of 3 Fig. 2. Fraction of life expectancy spent with disability for Iceland, Japan, Singapore, and Switzerland in 1990, 2000, 2010, and 2019. Source is authors’ elaboration based on the Global Burden of Disease Study 2019 data (9, 11). Downloaded from https://www.pnas.org by 158.109.137.56 on January 27, 2023 from IP address 158.109.137.56. endanger the proper functioning of contemporary societies lend support to the “expansion side” of the debate; that is, mor- (e.g., by threatening the sustainability of pension systems, or tality seems to decline at a faster pace than morbidity does when the provision of health care to increasingly older populations). focusing on best-practice countries. The so-called “compression vs. expansion of morbidity” The expected future rises of longevity, perhaps even to an debate, which tries to elucidate whether morbidity retreats to LE of 100 y (1), represent major social challenges, as they may older ages at higher or lower speed than mortality does (5–7), be accompanied by rising morbidity (as suggested here) as well has been raging for a long time. So far, the evidence supporting as widespread comorbidity (10). This urges the need to mobilize the different hypotheses is mixed, as the extent to which HLE resources toward reducing morbidity, either through preventive compares with LE trends depends on the morbidity measures policies that delay the onset of disease and disability (e.g., pro- used to calculate HLE and country and time contexts (e.g., refs. moting healthy lifestyles and environments) or through treat- 3 and 8). ments and/or technological innovations reducing the burden of Here we investigate the trends in BPHLE and BPLE using the disease and disability among individuals already living in mor- 1990–2019 estimates from the Global Burden of Disease Study (9). bid states. For females, BPHLE increases at a slower pace than BPLE (Fig. 1), and the fit is very high (R2 ≈ 0:97). The regression slopes are 0.15 Data Availability. Data used in this study can be easily down- and 0.19, respectively—the latter being clearly lower than the 0.25 loaded at Global Health Data Exchange, http://ghdx.healthdata. presented in refs. 1 and 2. For males, the BPLE slope is again org/gbd-results-tool (11). higher than the one for BPHLE (0.24 vs. 0.21) (R2 ≈ 0:98). BPLE and BPHLE therefore increase at a faster pace for men, although Acknowledgments they start at considerably lower levels than is observed for women. The study is supported with funding provided by the European Research Council (ERC-2019-COG Grant Agreement 864616, HEALIN). S.T.-L. and J.S. acknowl- Fig. 2 shows how the fraction of life expectancy spent in less-than- edge research funding from the Juan de la Cierva-Formaci on (Grant FJC-2019- good health for the four countries featuring as best performers in 039314-I) and Ram on y Cajal I3 (Grant RYC-2013-14851) programs of the Spanish Fig. 1 tends to increase between 1990 and 2019. 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Downloaded from https://www.pnas.org by 158.109.137.56 on January 27, 2023 from IP address 158.109.137.56. Permanyer et al. PNAS j 3 of 3 Best-practice healthy life expectancy vs. life expectancy: Catching up or lagging behind? https://doi.org/10.1073/pnas.2115273118