Improvements in Life Expectancy Past Present and Future

Improvements in Life Expectancy: Past, Present and Future John R. Iacovino, M. D. , F. A. C. P. Medical Director / Senior Consultant Consistency • Accuracy • Professionalism © Fasano Associates September 2009 1 Longevity Conference 2009

Overview • Mortality Improvements By Period – 1900 to 1940 – 1940 to 1960 – 1960 /1980 to 2000 – 2000 and forward • The Aging Process • Effect of Eliminating Cancer and Heart Disease on Life Expectancy © Fasano Associates September 2009 2 Longevity Conference 2009

Source: Centers for Disease Control and Prevention, National Center for Health Statistics (US) © Fasano Associates September 2009 3 Longevity Conference 2009

Future life expectancy can be calculated for any starting age Life expectancy for both sexes, US, 1900 -2002 Year At birth At age 65 At age 75 1900 47. 3 13 1950 68. 2 (45%) 13. 9 10. 9 2000 77. 0 (13%) 18. 0 (29%) 11. 4 US Vital Statistics 2004 © Fasano Associates September 2009 4 Longevity Conference 2009

Life expectancy at birth 1900 to 2000 79 74 Source: U. S. Vital Statistics, 2004 © Fasano Associates September 2009 5 Longevity Conference 2009

Mortality Improvements. Time period % annual improvement % of improvement by age Reason 1900 to 1940 1 80% in those under age 45 Better nutrition and public health measures 1940 to 1960 2 Even across ages Declining infectious diseases, vaccines and antibiotics 1 to 1. 5 65% in those over age 45 Reduction in CV events and decline in preemie deaths ? Greatest at oldest ages ↑ LE: Health Care Genetics ↓ LE: Allocation of Resources Obesity Epidemic 1960 to present 2000 forward ? ? Cutler and Meara, Sept 2001, Changes in the Age Distribution of Mortality Over the 20 th Century © Fasano Associates September 2009 6 Longevity Conference 2009

Phase 1: 1900 to 1940 Life expectancy increased 16 years • Decline in infant deaths contributed 4 ½ years • Decline in childhood mortality contributed 4 ½ years • Decline in young adult mortality contributed 3 ½ years • Other improvements contributed 3 ½ years Cutler and Meara, Sept 2001, Changes in the Age Distribution of Mortality Over the 20 th Century © Fasano Associates September 2009 7 Longevity Conference 2009

Phase 1: 1900 to 1940 Explanations for declining death rate • In 1900, infections accounted for 32% of all deaths. By 1940, infections were only 8% of deaths. • Deaths from pneumonia and influenza fell 2. 4% annually between 1900 and 1940 • Deaths from TB fell 3 to 6% annually—and fell by 50% after anti-TB drugs were introduced. • Deaths from vaccine preventable diseases fell 3 to 6% annually. © Fasano Associates September 2009 8 Longevity Conference 2009

Phase 1: 1900 to 1940 Classic public health improvements for whole society • Sanitation and safe drinking water • Refrigeration and safe food • Better housing • Better quality air © Fasano Associates September 2009 9 Longevity Conference 2009

Phase 1: 1900 to 1940 On the downside, heart disease and cancer increased • Heart disease rose from 22% in 1900 to 44% of all deaths in 1940. • Cancer deaths rose from 5% in 1900 to 11% of all deaths in 1940. © Fasano Associates September 2009 10 Longevity Conference 2009

Phase 2: 1940 to 1960 Life expectancy increased 6. 4 years • Infections as a cause of death declined faster between 1940 and 1960 than in the first 40 years of the century. • Much of this decline was due to medical care: new diagnostic tests and medications Cutler and Meara, Sept 2001, Changes in the Age Distribution of Mortality Over the 20 th Century © Fasano Associates September 2009 11 Longevity Conference 2009

Phase 3: 1960 to 1990 • By 1960, infectious disease mortality is already so low that their further decreases do not materially impact life expectancy. • Decline in infant mortality adds only 1 ¼ years • Decline in deaths in those over age 45 added 3 ½ years. Cutler and Meara, Sept 2001, Changes in the Age Distribution of Mortality Over the 20 th Century © Fasano Associates September 2009 12 Longevity Conference 2009

Phase 3: 1960 -1990 • Virtually all of the mortality gain since 1965 is due to decrease in cardiovascular mortality. • Since 1965, cardiovascular disease mortality begins to decline at about 2% per year © Fasano Associates September 2009 13 Longevity Conference 2009

Major reasons for CV decline—which has the greatest impact? • Technology (coronary care units, angiography, coronary interventions, etc. ) – 1967 First bypass – 1977 First angioplasty • Pharmaceutical gains (BP and cholesterol meds, post heart attack protocols) • Behavioral life style interventions (better diet, more exercise, less smoking) © Fasano Associates September 2009 14 Longevity Conference 2009

Phase 4: 1981 to 2000 • Cardiovascular mortality fell by 54% • Smoking fell by 35% • Population total cholesterol fell 4. 2% – Introduction of statins • Population BP fell 7. 7% • Note the gain despite increasing obesity and inactivity at the same time. An even greater future opportunity. Unal, B, Am J. Pub Health, 2005 Jan; 95(1): 103 -108 © Fasano Associates September 2009 15 Longevity Conference 2009

Phase 4: 1981 to 2000 • The improvements in cardiovascular risk-factors account for four times more life-years gained than did all of cardiovascular treatments for known disease. – Diet – Exercise – Smoking Unal, B, Am J. Pub Health, 2005 Jan; 95(1): 103 -108 © Fasano Associates September 2009 16 Longevity Conference 2009

Phase 5: 2000 forward Life expectancy is increasing, but • Americans lag behind the rest of the world. • America ranks about 30 th in life expectancy – U. S. LE 81 years – Japan / China 84 years - #1 – Swaziland 33 years - last • Immigrants to the US live 3 years longer than their American born relatives. © Fasano Associates September 2009 17 Longevity Conference 2009

Phase 5: 2000 forward Continuing and future challenges • Smoking • Obesity • Inactivity © Fasano Associates September 2009 18 Longevity Conference 2009

Trends in Cigarette Smoking Prevalence* (%) by Gender, Adults 18 and Older, US, 1965 -2002 *Redesign of survey in 1997 may affect trends. Source: National Health Interview Survey, 1965 -2002, National Center for Health Statitics, Centers for Disease Control and Prevention, 2004. © Fasano Associates September 2009 19 Longevity Conference 2009

Phase 5: 2000 forward Recent health loses - Obesity rises • 15% of Americans were obese in 1976 -80, but up to 31% in 1999 -2000 • Between 1988 and 2002, percent of overweight adults climbed from 56 to 65% and percent of obese adults went from 23 to 30%. – Normal – BMI 18. 5 – 24. 9 – Overweight – BMI 25 – 29. 9 – Obese – BMI 30 and greater © Fasano Associates September 2009 20 Longevity Conference 2009

Opportunities for improvement: Trends in Overweight* Prevalence (%), Children and Adolescents, by Age Group, US, 1971 -2002 *Overweight is defined as at or above the 95 th percentile for body mass index by age and sex based on reference data. Source: National Health and Nutrition Examination Survey, 1971 -1974, 1976 -1980, 1988 -1994, 1999 -2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, 2004. © Fasano Associates September 2009 21 Longevity Conference 2009

Phase 5: 2000 forward Diabetes increasing • In 1997, 5. 1% of Americans had diabetes, in 2002, the number was 6. 5%. • 12 million Americans now have type 2 diabetes – Exercise can prevent and/or delay onset of diabetes – On average diabetes decreases life expectancy by about one third © Fasano Associates September 2009 22 Longevity Conference 2009

Value of Preventive Life Style • A 35 -year-old who burns 2, 000 calories through exercise each week gains, on average, more than six years of life expectancy. • Inverse relationship between cardiovascular fitness and coronary heart disease and all-cause mortality in healthy men and women – Increase in 1 MET higher level of maximal aerobic capacity resulted in a 14% decrease in the history of coronary heart disease and/or all-cause mortality – Fitness is better correlated with mortality improvement than simple physical activity © Fasano Associates September 2009 23 Longevity Conference 2009

Decline in elderly mortality is accelerating • Between 1900 and 1940, mortality in the elderly (over age 65) declined to only 0. 3% per year. • Between 1960 and 1990, mortality in the elderly declined 1. 1% per year. © Fasano Associates September 2009 24 Longevity Conference 2009

Who lives the longest? • Best socio-economic class and education • Best genes • Best medical care and risk factor reduction © Fasano Associates September 2009 25 Longevity Conference 2009

Years of Life Remaining at Age 65 19 15 Source: U. S. Vital Statistics, 2004 © Fasano Associates September 2009 26 Longevity Conference 2009

Years of Life Remaining at Age 85 6. 5 5. 8 Source: U. S. Vital Statistics, 2004 © Fasano Associates September 2009 27 Longevity Conference 2009

Aging Process Causes • Free radicals – Antioxidants • • Mutations DNA repair failure Waste product accumulation Telomere shortening © Fasano Associates September 2009 28 Longevity Conference 2009

Telomeres • Long chains of DNA at the ends of chromosomes • Protect the integrity of the chromosome • Shorten at the end of each cell division Exercise Physiology, Brown, Miller and Eason © Fasano Associates September 2009 29 Longevity Conference 2009

http: //science. nasa. gov/headlines/y 2006/images/telomeres/caps. gif 30 © Fasano Associates September 2009 Longevity Conference 2009

The Future: Are telomeres the best life expectancy calculator? • Aging process – Probably genetically preprogrammed – We lose the ability to repair aging organs – Damage increases as we age • “Hayflict Limit” on life expectancy • Life style and behaviors profoundly affect the genetic profile © Fasano Associates September 2009 31 Longevity Conference 2009

Hayflict Limit • Cells divide freely to a predetermined number of divisions • Then cell division enters a senescence phase – Each division produces a telomere shortening • This creates a ticking back of the genetic inner clock for each subsequent cell division-Replicative Senescence • Stress Induced Premature Senescence © Fasano Associates September 2009 32 Longevity Conference 2009

Telomeres • The length of the telomere may determine longevity – Progeria • Very short telomeres – Cancer Cells • Produce an enzyme that prevents shortening – cell “immortality” Exercise Physiology, Brown, Miller and Eason © Fasano Associates September 2009 33 Longevity Conference 2009

Effect of Disease Elimination on Life Expectancy Correlations: • Positive elimination correlation – Eliminating cancer or heart disease renders death from other causes in the future more probable • Independent elimination correlation – Eliminating cancer or heart disease has no effect on the probability of death from other causes • Negative elimination correlation – Eliminating cancer or heart disease renders death from other causes in future years less probable Source: Centers for Disease Control and Prevention, National Center for Health Statistics (US) © Fasano Associates September 2009 34 Longevity Conference 2009

Source: Centers for Disease Control and Prevention, National Center for Health Statistics (US) US Population Decennial Life Table 1989 -1991 © Fasano Associates September 2009 35 Longevity Conference 2009

Source: Centers for Disease Control and Prevention, National Center for Health Statistics (US) US Population Decennial Life Table 1989 -1991 © Fasano Associates September 2009 36 Longevity Conference 2009

Fasano Associates 6 th Annual Life Settlement Conference 26 October 2009 Washington, DC Michael Fasano Associates 1201 15 th Street, NW – Suite 250 Washington, DC 20005 202 -457 -8188 202 -457 -8198 (fax) mfasano@fasanoassociates. com www. fasanoassociates. com © Fasano Associates September 2009 37 Longevity Conference 2009