The number of older adults is increasing in high-income countries as survival chances continue to improve. We investigate changes in survival at older ages in high-income countries and show that although survival chances have improved, these improvements are concentrated at the top of the survival distribution where there is a small share of the population. Among females who survive to age 85 in the most recently birth cohort (1925), for example, about half die within 8 years while those in the top 25% of the survival distribution live at least 50% longer (12 years or more). Importantly, these results indicate that having some individuals reach exceptionally old age does not imply that the majority of the population is living longer. In addition, estimates of lifespan inequality at older ages suggests that years of life lost because of death have increased in recent times and among recently born cohorts leading to an increase uncertainty in the age at death at older ages. Thus, slow survival improvements at ages 65+ suggest that most of the population is unlikely to reach long life expectancies in the near future, which may lead to lower than expected fraction of adults reaching older ages.

Background As originally proposed by Fries, conceptualizing morbidity solely through associated functional limitation/disability (FL/D) remains the most widely accepted metric to assess whether increases in longevity have been accompanied by a compression of morbidity. Objective To propose a departure from a highly restrictive FL/D-based definition of "morbidity" to a broader view that considers the burden of chronic diseases even when no overt FL/D occur. Design We outline three reasons why the current framework of compression of morbidity should be broadened to also consider morbidity to be present even when there are no overtly measurable FL/D. We discuss various scenarios of morbidity compression and morbidity expansion under this broader rubric of morbidity. Conclusion The rationale to go beyond a purely FL/D-based definition of morbidity includes: (1) substantial damage from chronic disease that can develop prior to overt FL/D symptoms occurring; (2) multiple costs to the individual and society that extend beyond FL/D, including medication costs, health care visits, and opportunity costs of lifelong treatment; and (3) psychosocial and stress burden of being labeled as diseased and the consequence for overall well-being. Adopting this broader definition of morbidity suggests that increases in longevity have been possibly accompanied by an expansion of morbidity, in contrast to Fries' original hypothesis that morbidity onset (based on only FL/D) would be delayed to a greater extent than increases in survival. There is an urgent need for better data and more research to document morbidity onset and its link with increases in longevity and assess the important question on whether populations while living longer are also healthier.

Background

As originally proposed by Fries, conceptualizing morbidity solely through associated functional limitation/disability (FL/D) remains the most widely accepted metric to assess whether increases in longevity have been accompanied by a compression of morbidity.

Objective

To propose a departure from a highly restrictive FL/D-based definition of "morbidity" to a broader view that considers the burden of chronic diseases even when no overt FL/D occur.

Design

We outline three reasons why the current framework of compression of morbidity should be broadened to also consider morbidity to be present even when there are no overtly measurable FL/D. We discuss various scenarios of morbidity compression and morbidity expansion under this broader rubric of morbidity.

Conclusion

The rationale to go beyond a purely FL/D-based definition of morbidity includes: (1) substantial damage from chronic disease that can develop prior to overt FL/D symptoms occurring; (2) multiple costs to the individual and society that extend beyond FL/D, including medication costs, health care visits, and opportunity costs of lifelong treatment; and (3) psychosocial and stress burden of being labeled as diseased and the consequence for overall well-being. Adopting this broader definition of morbidity suggests that increases in longevity have been possibly accompanied by an expansion of morbidity, in contrast to Fries' original hypothesis that morbidity onset (based on only FL/D) would be delayed to a greater extent than increases in survival. There is an urgent need for better data and more research to document morbidity onset and its link with increases in longevity and assess the important question on whether populations while living longer are also healthier.

In 2017, the Joint Monitoring Programme estimated that 520 million people in India were defecating in the open every day. This is despite efforts made by the government, Non-Governmental Organizations (NGOs), and multilaterals to improve latrine coverage throughout India. We hypothesize that this might be because current interventions focus mostly on individual-level determinants, such as attitudes and beliefs, instead of considering all possible social determinants of latrine ownership. Given this, we ask two questions: what is the association between the amount of dwelling space owned by households in rural India and their likelihood of toilet ownership and what proportion of the variation in household latrine ownership is attributable to villages and states? We used multilevel modeling and found significant associations between the amount of household dwelling space and the likelihood of latrine ownership. Furthermore, considerable variation in latrine ownership is attributable to villages and states, suggesting that additional research is required to elucidate the contextual effects of villages and states on household latrine ownership. Thus, sanitation interventions should consider household dwelling space and village and state context as important social determinants of latrine ownership in rural India. Doing so could bolster progress towards Sustainable Development Goal (SDG) 6.

Existing evidence on stress and asthma prevalence has disproportionately focused on pregnancy and postpregnancy early life stressors, largely ignoring the role of childhood adversity as a risk factor. Childhood adversity (neglect, stressful living conditio

Background

Increases in life expectancy are hypothesised to be associated with shorter proportional time spent with morbidity (compression of morbidity). We assessed whether this has occurred among older adults in the USA during the 1990s and 2000s.

Methods

We used data from the Health and Retirement Study to estimate a morbidity score based on eight chronic conditions and compare it (1) prospectively between two age-matched cohorts in 1992 and 2004 over a 6-year follow-up, and (2) retrospectively in the three waves prior to death among respondents who die in (1998-2004) and (2004-2010).

Results

Prospective assessment shows significantly higher prevalence in 6 of eight chronic conditions in the 2000s, with 37% higher diabetes prevalence. A retrospective evaluation shows significantly higher prevalence in 7 of eight chronic conditions in the three waves prior to death for (2004-2010) versus (1998-2004), with 41% higher prevalence of arthritis. Importantly, the farther away from time of death, the higher the average number of chronic conditions in (2004-2010).

Conclusions

Using the largest longitudinal ageing study in the USA, we found no clear evidence of compression of morbidity as measured by self-reported chronic disease. Older adults in the USA may be experiencing greater disease burden in recent times.

Background

No studies have examined the effects of local foreclosure activity on neighbors' blood pressure, despite the fact that spillover effects of nearby foreclosures include many known risk factors for increased blood pressure. We assessed the extent to which living near foreclosed properties is associated with subsequent systolic blood pressure (SBP) measurements.

Methods and results

We used 6590 geocoded observations collected from 1740 participants in the Framingham Offspring Cohort across 5 waves (1987-2008) of the Framingham Heart Study to create a longitudinal record of exposure to nearby foreclosure activity. We distinguished between real estate-owned foreclosures, which typically sit vacant, and foreclosures purchased by third-party buyers, which are generally put into productive use. Counts of lender-owned foreclosed properties within 100 m of participants' homes were used to predict measured SBP and odds of being hypertensive. We assessed whether self-reported alcoholic drinks per week and measured body mass index helped to explain the relationship between foreclosure activity and SBP. Each additional real estate-owned foreclosure located within 100 m of a participant's home was associated with an increase in SBP of 1.71 mm Hg (P=0.03; 95% confidence interval, 0.18-3.24) after adjustment for individual- and area-level confounders but not with odds of hypertension. The presence of foreclosures purchased by third-party buyers was not associated with SBP or with hypertension. Body mass index and alcohol consumption attenuated the effect of living near real estate-owned foreclosures on SBP in fully adjusted models.

Conclusions

Real estate-owned foreclosed properties may put nearby neighbors at risk for increased SBP, with higher alcohol consumption and body mass index partially mediating this relationship.

Sustainable Development Goal 6.2 aims to end open defecation by 2030 by ensuring universal access to private household toilets. However, private toilets might not be feasible for poor households. As a result, policy makers and academics have suggested well-managed shared sanitation facilities as an alternative solution. Less is known about the associations between shared sanitation use and health. Using data from the fifth round of the National Family Health Survey from 2019 to 2021, we estimated the association between usual defecation location and child anthropometry outcomes among children under 2 years in India. The primary exposure was usual defecation location at the household level. We compared both shared improved toilet use and open defecation to private, improved toilet use. We used linear regression to estimate the associations between the exposures and linear outcomes: height-for-age Z-score, weight-for-height Z-score, and weight-for-age Z-score. We used Poisson regression with a log link to estimate the prevalence ratios of stunting, wasting, and underweight. After controlling for environmental, maternal, socioeconomic, and child confounders, we found no differences in six child anthropometry outcomes when comparing shared toilet use or open defecation to private toilet use. This finding was consistent across both urban and rural households. Our findings confirm the null associations between private toilet use and child growth found in previous studies, and that this association does not vary if the toilet is being shared. Future research should examine these differences between private and shared toilets in the context of other health outcomes.

Background

While the "widowhood effect" is well known, there is substantial heterogeneity in the magnitude of effects reported in different studies. We conducted a meta-analysis of widowhood and mortality, focusing on longitudinal studies with follow-up from the time of bereavement.

Methods and findings

A random-effects meta-analysis was conducted to calculate the overall relative risk (RR) for subsequent mortality among 2,263,888 subjects from 15 prospective cohort studies. We found a statistically significant positive association between widowhood and mortality, but the widowhood effect was stronger in the period earlier than six months since bereavement (overall RR = 1.41, 95% CI: 1.26, 1.57) compared to the effect after six months (overall RR = 1.14, 95% CI: 1.10, 1.18). Meta-regression showed that the widowhood effect was not different for those aged younger than 65 years compared to those older than 65 (P = 0.25). There was, however, a difference in the magnitude of the widowhood effect by gender; for women the RR was not statistically significantly different from the null (overall RR = 1.04, 95% CI: 1.00, 1.08), while it was for men (overall RR = 1.23, 95% CI: 1.18, 1.28).

Conclusions

The results suggest that further studies should focus more on the mechanisms that generate this association especially among men.

Background

Past research shows that spousal death results in elevated mortality risk for the surviving spouse. However, most prior studies have inadequately controlled for socioeconomic status (SES), and it is unclear whether this 'widowhood effect' persists over time.

Methods

Health and Retirement Study participants aged 50+ years and married in 1998 (n = 12 316) were followed through 2008 for widowhood status and mortality (2912 deaths). Discrete-time survival analysis was used to compare mortality for the widowed versus the married.

Results

Odds of mortality during the first 3 months post-widowhood were significantly higher than in the continuously married (odds ratio (OR) for men = 1.87, 95% CI: 1.27, 2.75; OR for women = 1.47, 95% CI: 0.96, 2.24) in models adjusted for age, gender, race and baseline SES (education, household wealth and household income), behavioral risk factors and co-morbidities. Twelve months following bereavement, men experienced borderline elevated mortality (OR = 1.16, 95% CI: 1.00, 1.35), whereas women did not (OR = 1.07, 95% CI: 0.90, 1.28), though the gender difference was non-significant.

Conclusion

The 'widowhood effect' was not fully explained by adjusting for pre-widowhood SES and particularly elevated within the first few months after widowhood. These associations did not differ by sex.