Zusammenfassung
Im 20. Jahrhundert stieg die Lebenserwartung kontinuierlich an, dabei kam der Zugewinn an Lebensjahren in den letzten Jahrzehnten aus den hohen und höchsten Altersgruppen. Im europäischen Sterblichkeitsgeschehen lassen sich zwei Phasen der Divergenz und Konvergenz identifizieren, eine dritte Phase deutet sich in einer neuen Divergenz der Sterblichkeit unter den Höchstaltrigen ab. Frauen haben eine höhere Lebenserwartung als Männer, was auf biologische Faktoren, Unterschiede im Lebensstil und in der Inanspruchnahme medizinischer Versorgung, aber auch auf die Einstellung zur Gesundheit zurückgeführt werden kann. Die Ergebnisse zu Trends in der Gesundheit sind uneinheitlich. Ursache sind die verschiedenen Dimensionen von Gesundheit genauso wie eine unzureichende Datenlage. Generell gilt, dass die Prävalenz von Erkrankungen und Symptomen angestiegen ist, funktionelle Beeinträchtigungen und ADL (Activities of Daily Living, Aktivitäten des täglichen Lebens)-Behinderungen jedoch rückläufig sind. Keine Aussagen können aufgrund fehlender Daten über Trends im Alter von 80 Jahren und danach gemacht werden. In absoluten Werten steigt mit der Lebenserwartung auch die Zahl der Jahre, die ohne Beeinträchtigungen verbracht werden. Der Anteil an gesunden Lebensjahren entwickelt sich stabil bis leicht positiv. Eine Expansion der Morbidität als Resultat einer steigenden Lebenserwartung kann damit verworfen werden.
Abstract
During the 20th century, life expectancy has been continuously increasing with the majority of the additional years resulting from decreasing mortality among the old and oldest old in the last few decades. Two phases of convergence and divergence in European mortality have been identified, with a possible new phase of divergence taking place among the oldest old. Over this period, women have always been living longer than men. Explanations for this phenomenon include not only biological factors and differences in lifestyle and health care utilization, but also differences in reporting patterns. Trends in health do not follow a clear direction. Reasons are the different dimensions of health as well as inadequate data. In general, the prevalence of morbidity has been increasing, while functional limitations and ADL disabilities have been decreasing. Due to a lack of data, no information exists for trends among the oldest old at age 80 and above. In absolute terms, the number of healthy years has been increasing with increasing life expectancy. In relative terms, they have been stable, probably slightly increasing in some countries. These trends suggest that increasing life expectancy does not result in an increase in morbidity.
Notes
Für die anderen Länder (Schweiz, Dänemark, USA und Japan) finden sich keine entsprechenden Daten in den beiden Surveys der Europäischen Union.
Niveauunterschiede zwischen ECHP und SILC können nur eingeschränkt interpretiert werden, da es leichte Unterschiede in der Frageformulierung gibt.
Literatur
Oeppen J, Vaupel JW (2002) Broken limits to life expectancy. Science 296(5570):1029–1031
Christensen K, Doblhammer G, Rau R, Vaupel JW (2009) Ageing populations: the challenges ahead. Lancet 374:1196–1208
Rau R, Soroko E, Jasilionis D, Vaupel JW (2008) Continued reductions in mortality at advanced ages. Population Development Rev 34:747–768
Janssen F, Mackenbach J, Kunst A, NEDCOM (2004) Trends in old-age mortality in seven European countries, 1950–1999. J Clin Epidemiol 57(2):203–216
Janssen F, Kunst A (2005) Cohort patterns in mortality trends among the elderly in seven European countries, 1950–99. Int J Epidemiol 34(5):1149–1159
Vallin J, Meslé F (2001) Trends in mortality in Europe since 1950: age-, sex- and cause-specific mortality. In: Council of Europe (Hrsg) Trends in mortality and differential mortality. Council of Europe Publishing, Population studies 36
Vallin J (2005) Disease, death, and life expectancy. Genus 61:279–296
Meslé F, Vallin J (2002) Mortality in Europe: the divergence between East and West. Population 57(1):157–197
Robine JM, Le Roy S, Jagger C, EHEMU team (2005) Changes in life expectancy in the European Union since 1995: similarities and differences between the 25 EU countries. Europe blanche XXVI. Budapest, Hungary
Omran AR (1971) The epidemiological transition: a theory of the epidemiology of population change. Milbank Memorial Fund Quarterly 49(4):509–538
Carlson P (1998) Self-perceived health in East and West Europe: another European health devide. Soc Sci Med 46(10):1355–1366
Cockerham WC (1999) Health and social change in Russia and Eastern Europe. Routledge, New York London
Vallin J, Meslé F (2004) Convergences and divergences in mortality. A new approach to health transition. Demogr Res Special Collection 2:11–44
Stuckler D, King L, McKee M (2009) Mass privatisation and the post-communist mortality crisis: a cross-national analysis. Lancet 373(9661):399–407
Nusselder WJ, Mackenbach JP (2000) Lack of improvements of life expectancy at advanced ages in the Netherlands. Int J Epidemiol 29:140–148
Human Mortality Database (2011) Datenbank der University of California, Berkeley (USA) und des Max-Planck-Instituts für demografische Forschung, Rostock (Deutschland). http://www.mortality.org oder http://www.humanmortality.de (Februar 2011)
Eurostat (2011) Datenbank des Statistischen Amtes der Europäischen Kommission. http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=demo_mlexpec&lang=de (Februar 2011)
Meslé F, Vallin J (2006) Diverging trends in female old-age mortality: The United States and the Netherlands versus France and Japan. Popul Dev Rev 32(1):123–145
Staetsky L (2009) Diverging trends in female old-age mortality: a reappraisal. Demogr Res 21(30):885–914
Juel K, Sørensen J, Brønnum-Hansen H (2008) Risk factors and public health in Denmark. Scand J Public Health 36(Suppl 1):11–227
Fries JF (1980) Aging, natural death, and the compression of morbidity. N Engl J Med 303(3):130–135
Kalben B (2000) Why younger men die younger: causes of mortality differences by sex. North Am Acturial J 4(4):83–111
Waldron I (1985) What do we know about causes of sex differences in mortality? A review of literature. Popul Bull United Nations 18:59–76
Oksuzyan A, Juel K, Vaupel JW, Christensen K (2008) Men: good health and high mortality. Sex differences in health and aging. Aging Clin Exp Res 20(2):91–102
Pampel FC (2002) Cigarette use and the narrowing sex differential in mortality. Popul Dev Rev 28(1):77–104
Pampel FC (2003) Declining sex differences in mortality from lung cancer in high-income nations. Demography 40(1):45–65
Preston S, Wang H (2006) Sex mortality differences in the United States: the role of cohort smoking patterns. Demography 43(4):631–646
Finucane MM, Stevens GA, Cowan MJ et al (2011) National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 377(9765):557–567
Manolopoulos KN, Karpe F, Frayn KN (2010) Gluteofemoral body fat as a determinant of metabolic health. Int J Obes (Lond) 34:949–959
Heitmann BL, Frederiksen P, Lissner L (2004) Hip circumference and cardiovascular morbidity and mortality in men and women. Obes Res 12(3):482–487
Prattala R, Paalanen L, Grinberga D et al (2006) Gender differences in the consumption of meat, fruit and vegetables are similar in Finland and the Baltic countries. Eur J Public Health 17(5):520–525
Simpson E, O’Connor J, Livingstone M et al (2005) Health and lifestyle characteristics of older European adults: the ZENITH study. Eur J Clin Nutr 59:13–21
Geldas PM, Cheater F, Marshall P (2005) Men and help-seeking behaviour: literature review. J Adv Nurs 49(6):616–623
Gerland P (2005) From divergence to convergence in sex differentials in adult mortality in developed countries. Paper presented at the IUSSP 2005 Conference
Constanza M, Salamun J, Lopez A, Morabia A (2006) Gender differentials in the evolution of cigarette smoking habits in a general European adult population from 1993–2003. BMC Public Health 6:130
Pampel FC (2005) Forecasting sex differences in mortality in high income nations: the contribution of smoking. Demogr Res 13(18):455–484
Verbrugge LM, Jette AM (1994) The disablement process. Soc Sci Med 38(1):1–14
Saß AC, Wurm S, Scheidt-Nave C (2010) Alter und Gesundheit. Eine Bestandsaufnahme aus Sicht der Gesundheitsberichterstattung. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 53(5):404–416
Ziegler U, Doblhammer G (2009) Prävalenz und Inzidenz von Demenz in Deutschland. Eine Studie auf Basis von Daten der gesetzlichen Krankenversicherungen von 2002. Gesundheitswesen 71(5):281–290
Spalton D, Koch D (2000) The constant evolution of cataract surgery. BMJ 321:1304
Ziegler U, Doblhammer G (2008) Reductions in the incidence of care need in West Germany between 1986 and 2005. Eur J Popul 24(4):347–362
Hoffmann E, Nachtmann N (2010) Old age, the need of long-term care and healthy life expectancy. In Doblhammer G, Scholz R (Hrsg) Ageing, care need and quality of life. VS Verlag, Wiesbaden, S 163–176
Doblhammer G, Ziegler U (2006) Future ederly living conditions in Europe: demographic insights. In: Backes G M, Lasch V, Reimann K (Hrsg) Gender, health and ageing. European perspectives on life course. Health issues and social challenges. Alter(n) und Gesellschaft, Bd. 13. Verlag für Sozialwissenschaften, Wiesbaden, S 267–292
EHEMU (2011) Datenbank der European Health Expectancy Monitoring Unit. http://www.ehemu.org (Februar 2011)
Klein T, Unger R (1999) Aktive Lebenserwartung in der Bundesrepublik. Gesundheitswesen 61:168–178
Klein T, Unger R (2002) Aktive Lebenserwartung in Deutschland und den USA. Z Gerontol Geriatrie 35(6):528–539
Unger R (2006) Trends in active life expectancy in Germany between 1984 and 2003 – a cohort analysis with different health indicators. J Public Health 14(3):155–163
Dinkel RH (1999) Demographische Entwicklung und Gesundheitszustand. Eine empirische Kalkulation der Healthy Life Expectancy für die Bundesrepublik auf der Basis von Kohortendaten. In: Häfner H (Hrsg) Gesundheit – unser höchstes Gut? Springer, Berlin, S 61–83
Interessenkonflikt
Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Doblhammer, G., Kreft, D. Länger leben, länger leiden?. Bundesgesundheitsbl. 54, 907–914 (2011). https://doi.org/10.1007/s00103-011-1315-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00103-011-1315-0