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Trends in health expectancies: A systematic review of international evidence

Lookup NU author(s): Dr Gemma Frances SpiersORCiD, Patience KunongaORCiD, Fiona Beyer, Professor Dawn CraigORCiD, Professor Barbara Hanratty, Emerita Professor Carol Jagger



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2021 BMJ Publishing Group. All rights reserved.Objectives A clear understanding of whether increases in longevity are spent in good health is necessary to support ageing, health and care-related policy. Design We conducted a systematic review to update and summarise evidence on trends in health expectancies, in Organisation for Economic Co-operation and Development (OECD) high-income countries. Data sources Four electronic databases (MEDLINE, 1946-19 September 2019; Embase 1980-2019 week 38; Scopus 1966-22 September 2019, Health Management Information Consortium, 1979-September 2019), and the UK Office for National Statistics website (November 2019). Eligibility criteria English language studies published from 2016 that reported trends in healthy, active and/or disability-free life expectancy in an OECD high-income country. Data extraction and synthesis Records were screened independently by two researchers. Study quality was assessed using published criteria designed to identify sources of bias in studies reporting trends, and evidence summarised by narrative synthesis. Findings Twenty-eight publications from 11 countries were included, covering periods from 6 to 40 years, between 1970 and 2017. In most countries, gains in healthy and disability-free life expectancy do not match the growth in total life expectancy. Exceptions were demonstrated for women in Sweden, where there were greater gains in disability-free years than life expectancy. Gains in healthy and disability-free life expectancy were greater for men than women in most countries except the USA (age 85), Japan (birth), Korea (age 65) and Sweden (age 77). Conclusion An expansion of disability in later life is evident in a number of high-income countries, with implications for the sustainability of health and care systems. The recent COVID-19 pandemic may also impact health expectancies in the longer term.

Publication metadata

Author(s): Spiers GF, Kunonga TP, Beyer F, Craig D, Hanratty B, Jagger C

Publication type: Article

Publication status: Published

Journal: BMJ Open

Year: 2021

Volume: 11

Issue: 5

Online publication date: 25/05/2021

Acceptance date: 06/05/2021

Date deposited: 14/06/2021

ISSN (print): 2044-6055

ISSN (electronic): 2044-6055

Publisher: BMJ Publishing Group


DOI: 10.1136/bmjopen-2020-045567

PubMed id: 34035101


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