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Do new drugs increase life expectancy? A critique of a Manhattan Institute paper.

ABSTRACT: A recent study published by the Manhattan Institute, "Why Has Longevity Increased More in Some States than in Others? The Role of Medical Innovation and Other Factors," purported to show that the more rapid adoption of new drugs has substantial benefits in the form of increased life expectancy, higher productivity and lower non-drug health care expenditures. This study has been cited as evidence supporting the more rapid acceptance of new drugs in Medicaid, Medicare, and other public programs and has helped to shape public debate on the value of new drugs. This analysis questions the key conclusions of the study. It points out that the key statistical regressions appear to be misspecified, since they show anomalies such as a negative correlation between income growth and life expectancy and find no relationship between education and productivity growth. Methodological flaws addressed include lack of adjustment for infant mortality rates; inadequate proxy measures of health status; lack of adjustment for ages of individuals and other sociodemographic factors; inherent problems with the definition of drug age, or 'vintage;' and the failure to consider reverse causation as an obvious explanation for several findings. The Manhattan Institute study does not provide reliable evidence for favoring adoption of newer drugs in either public or private health care programs.

SUBMITTER: Baker D

PROVIDER: S-EPMC2669876 | biostudies-other | 2009 May

REPOSITORIES: biostudies-other

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Meeting the Institute of Medicine's 2030 US Life Expectancy Target.

Project description:ObjectivesTo quantify the improvement in US life expectancy required to reach parity with high-resource nations by 2030, to document historical precedent of this rate, and to discuss the plausibility of achieving this rate in the United States.MethodsWe performed a demographic analysis of secondary data in 5-year periods from 1985 to 2015.ResultsTo achieve the United Nations projected mortality estimates for Western Europe in 2030, the US life expectancy must grow at 0.32% a year between 2016 and 2030. This rate has precedent, even in low-mortality populations. Over 204 country-periods examined, nearly half exhibited life-expectancy growth greater than 0.32%. Of the 51 US states observed, 8.2% of state-periods demonstrated life-expectancy growth that exceeded the 0.32% target.ConclusionsAchieving necessary growth in life expectancy over the next 15 years despite historical precedent will be challenging. Much all-cause mortality is structured decades earlier and, at present, older-age mortality reductions in the United States are decelerating. Addressing mortality decline at all ages will require enhanced political will and a strong commitment to equity improvement in the US population.

| S-EPMC5719677 | biostudies-literature

Life expectancy and human capital: New empirical evidence.

Project description:This paper re-examines a well-established hypothesis postulating that life expectancy augments incentives for human capital accumulation, leading to global income differences. A major distinguishing feature of the current study is to estimate heterogeneous panel data models under a common factor framework, which explicitly accounts for parameter heterogeneity, unobserved common factors (UCFs), and variables' non-stationarity. In sharp contrast to most previous studies, I find that the impact of health improvements on human capital accumulation turns out to be imprecisely estimated at conventionally accepted levels of statistical significance. I demonstrate that conventional estimates of the educational returns to rising longevity are derived from estimating misspecified models at least partially due to parameter heterogeneity and the presence of UCFs.

| S-EPMC10092450 | biostudies-literature

Circulating microRNAs and life expectancy among identical twins

Project description:Objective: To characterize miRNAs in 41-year archived plasma in relation to life expectancy independent of genes. Method: Plasma miRNAs from nine identical male twins were profiled using next-generation sequencing. Results: The average absolute difference in the minimum life expectancy was 9.68 years. Intra-class correlation coefficients were above 0.4 for 50% of miRNAs. Comparing deceased twins with their alive co-twin brothers, the concentrations were increased for 34 but decreased for 30 miRNAs. Conclusion: Identical twins discordant in life expectancy were unlike in the majority of miRNAs, suggesting that environmental factors are pivotal in miRNAs related to life expectancy.

2016-12-30 | GSE80730 | GEO

Trends in cancer-free working life expectancy based on health insurance data from Germany-Is the increase as strong as in working life expectancy?

Project description:BackgroundAgainst the backdrop of population ageing, governments are facing the need to raise the statutory retirement age. In this context, the question arises whether these extra years added to working life would be spent in good health. As cancer represents a main contributor to premature retirement this study focuses on time trends and educational inequalities in cancer-free working life expectancy (WLE).MethodsThe analyses are based on the data of a large German health insurer covering annually about 2 million individuals. Cancer-free WLE is calculated based on multistate life tables and reported for three periods: 2006-2008, 2011-2013, and 2016-2018. Educational inequalities in 2011-2013 were assessed by two educational levels (8 to 11 years and 12 to 13 years of schooling).ResultsWhile labour force participation increased, cancer incidence rates decreased over time. Cancer-free WLE at age 18 increased by 2.5 years in men and 6.3 years in women (age 50: 1.3 years in men, 2.4 years in women) between the first and third period while increases in WLE after a cancer diagnosis remained limited. Furthermore, educational inequalities are substantial, with lower groups having lower cancer-free WLE. The proportion of cancer-free WLE in total WLE remained constant in women and younger men, while it decreased in men at higher working age.ConclusionThe increase in WLE is accompanied by an increase in cancer-free WLE. However, the subgroups considered have not benefitted equally from this positive development. Among men at higher working age, WLE increased at a faster pace than cancer-free WLE. Particular attention should be paid to individuals with lower education and older men, as the general level and time trends in cancer-free WLE are less favourable.

| S-EPMC10370751 | biostudies-literature

Increase in the Life Expectancy of Patients with Cancer in the United States.

Project description:BackgroundCancer is becoming more of a chronic disease due to improvements in treatment and early detection for multiple cancer sites. To gain insight on increased life expectancy due to these improvements, we quantified trends in the loss in expectation of life (LEL) due to a cancer diagnosis for six cancer sites from 1975 through 2018.MethodsWe focused on patients diagnosed with female breast cancer, chronic myeloid leukemia (CML), colon and rectum cancer, diffuse large B-cell lymphoma (DLBCL), lung cancer, or melanoma between 1975 and 2018 from nine Surveillance, Epidemiology, and End Results cancer registries. Life expectancies for patients with cancer ages 50+ were modeled using flexible parametric survival models. LEL was calculated as the difference between general population life expectancy and life expectancy for patients with cancer.ResultsOver 2 million patients were diagnosed with one of the six cancers between 1975 and 2018. Large increases in life expectancy were observed between 1990 and 2010 for female breast, DLBCL, and CML. Patients with colon and rectum cancer and melanoma had more gradual improvements in life expectancy. Lung cancer LEL only began decreasing after 2005. Increases in life expectancy corresponded with decreases in LEL for patients with cancer.ConclusionsThe reported gains in life expectancy largely correspond to progress in the screening, management, and treatment of these six cancers since 1975.ImpactLEL provides an important public health perspective on how improvements in treatment and early detection and their impacts on survival translate into changes in cancer patients' life expectancy.

| S-EPMC10872878 | biostudies-literature

Paper New species

Project description:Publications of new species

| PRJEB51300 | ENA

Factors Associated With Subjective Life Expectancy: Comparison With Actuarial Life Expectancy.

Project description:Subjective life expectancy (SLE) has been found to show a significant association with mortality. In this study, we aimed to investigate the major factors affecting SLE. We also examined whether any differences existed between SLE and actuarial life expectancy (LE) in Korea.A cross-sectional survey of 1000 individuals in Korea aged 20-59 was conducted. Participants were asked about SLE via a self-reported questionnaire. LE from the National Health Insurance database in Korea was used to evaluate differences between SLE and actuarial LE. Age-adjusted least-squares means, correlations, and regression analyses were used to test the relationship of SLE with four categories of predictors: demographic factors, socioeconomic factors, health behaviors, and psychosocial factors.Among the 1000 participants, women (mean SLE, 83.43 years; 95% confidence interval, 82.41 to 84.46 years; 48% of the total sample) had an expected LE 1.59 years longer than that of men. The socioeconomic factors of household income and housing arrangements were related to SLE. Among the health behaviors, smoking status, alcohol status, and physical activity were associated with SLE. Among the psychosocial factors, stress, self-rated health, and social connectedness were related to SLE. SLE had a positive correlation with actuarial estimates (r=0.61, p<0.001). Gender, household income, history of smoking, and distress were related to the presence of a gap between SLE and actuarial LE.Demographic factors, socioeconomic factors, health behaviors, and psychosocial factors showed significant associations with SLE, in the expected directions. Further studies are needed to determine the reasons for these results.

| S-EPMC5541275 | biostudies-other

Religious activity, life expectancy, and disability-free life expectancy in Taiwan.

Project description:Research has implicated religious activity as a health determinant, but questions remain, including whether associations persist in places where Judeo-Christian religions are not the majority; whether public versus private religious expressions have equivalent impacts, and the precise advantage expressed as years of life. This article addresses these issues in Taiwan. 3,739 Taiwanese aged 53+ were surveyed in 1999, 2003, and 2007. Mortality and disability were recorded. Religious activities in public and private settings were measured at baseline. Multistate life-tables produced estimates of total life expectancy and activity of daily living (ADL) disability-free life expectancy across levels of public and private religious activity. There is a consistent positive gradient between religious activity and expectancy with greater activity related to longer life and more years without disability. Life and ADL disability-free life expectancies for those with no religious affiliation fit in between the lowest and highest religious activity groups. Results corroborate evidence in the West. Mechanisms that intervene may be similar in Eastern religions despite differences in the ways in which popular religions are practiced. Results for those with no affiliation suggest benefits of religion can be accrued in alternate ways.

| S-EPMC5549130 | biostudies-other

Contributions of the life expectancy gap reduction between urban and rural areas to the increase in overall life expectancy in South Korea from 2000 to 2019.

Project description:BackgroundThis study aimed to quantify the contribution of narrowing the life expectancy gap between urban and rural areas to the overall life expectancy at birth in Korea and examine the age and death cause-specific contribution to changes in the life expectancy gap between urban and rural areas.MethodsWe used the registration population and death statistics from Statistics Korea from 2000 to 2019. Assuming two hypothetical scenarios, namely, the same age-specific mortality change rate in urban and rural areas and a 20% faster decline than the observed decline rate in rural areas, we compared the increase in life expectancy with the actual increase. Changes in the life expectancy gap between urban and rural areas were decomposed into age- and cause-specific contributions.ResultsRural disadvantages of life expectancy were evident. However, life expectancies in rural areas increased more rapidly than in urban areas. Life expectancy would have increased 0.3-0.5 less if the decline rate of age-specific mortality in small-to-middle urban and rural areas were the same as that of large urban areas. Life expectancy would have increased 0.7-0.9 years further if the decline rate of age-specific mortality in small-to-middle urban and rural areas had been 20% higher. The age groups 15-39 and 40-64, and chronic diseases, such as neoplasms and diseases of the digestive system, and external causes significantly contributed to narrowing the life expectancy gap between urban and rural areas.ConclusionPro-health equity interventions would be a good strategy to reduce the life expectancy gap and increase overall life expectancy, particularly in societies where life expectancies have already increased.

| S-EPMC10375755 | biostudies-literature

Understanding the rapid increase in life expectancy in shanghai, China: a population-based retrospective analysis.

Project description:BackgroundLife expectancy at birth (LE) is a comprehensive measure that accounts for age-specific death rates in a population. Shanghai has ranked first in LE in China mainland for decades. Understanding the reasons behind its sustained gain in LE provides a good reflection of many other cities in China. The aim of this study is intended to explore temporal trend in age- and cause-specific gains in LE in Shanghai and the probable reasons lay behind.MethodsJoinpoint regression was applied to evaluate temporal trend in LE and the long time span was then divided accordingly. Contributions to change in LE (1973-2015) were decomposed by age and cause at corresponding periods.ResultsLE in Shanghai could be divided into four phases ie., descent (1973-1976), recovery (1976-1998), rapid rise (1998-2004) and slow rise (2004-2015). The growing LE was mainly attributed to reductions in mortality from the elderly populations and chronic diseases such as cerebrovascular disease, chronic lower respiratory disease, and gastrointestinal cancers (stomach, liver and esophageal cancer).ConclusionsThe four-decade sustained gain in LE in Shanghai is due to the reductions in mortality from the elderly and chronic diseases such as cerebrovascular disease, chronic lower respiratory disease, and gastrointestinal cancers. Further growth momentum still comes from the elderly population.

| S-EPMC5813363 | biostudies-literature

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