Healthspan-lifespan gap differs in magnitude and disease contribution across world regions

Abstract

Longevity gains have not been matched by equivalent advances in healthy longevity, giving rise to the healthspan-lifespan gap. This study maps, by world region, the healthspan-lifespan gap; identifies gap-associated demographic, economic, and health indicators; and deciphers disease burden patterns contributing to gap profiles. World Health Organization (WHO) Global Health Observatory, United Nations World Population Prospects and Global Health Expenditure Database were interrogated. The healthspan-lifespan gap was quantified from estimates of life expectancy and health-adjusted life expectancy. Regression analysis evaluated healthspan-lifespan gap correlates with a spatial error model used to adjust for confounders arising from geographic proximity. Dimensionality reduction by principal component analysis and clustering by machine learning discriminated disease burden patterns linked to healthspan-lifespan gap identity. Supervised machine learning enabled validation of disease burden pattern distinctness. Charted for six WHO-designated regions, comprising 183 member states, the healthspan-lifespan gap differs in size across regions. Life expectancy, gross domestic product, and noncommunicable disease burden most consistently correlate with the healthspan-lifespan gap. Unsupervised machine learning identifies three clusters delineating global morbidity patterns. Cluster-informed stratification discerns inter- and intra-regional gap heterogeneity. Africa, although exhibiting the narrowest healthspan-lifespan gap, is overrepresented in countries with larger than predicted healthspan-lifespan gaps and shows the greatest gap expansion and disease burden pattern restructuring. In contrast, Europe is overrepresented in countries with healthspan-lifespan gaps smaller than anticipated. Projections into 2100 forecast continuous widening of the healthspan-lifespan gap across regions. The healthspan-lifespan gap is universal yet differs in magnitude and disease contribution among world regions. Gap identities imposed by distinct disease burden patterns caution against global generalization, necessitating region-informed solutions to maximize equitable healthy longevity. Life expectancy has increased, yet people do not necessarily live longer in good health. In fact, there has been an increase in the period of life lived with disease. The difference between the number of years lived (lifespan) and the number of years lived in good health (healthspan) is known as the healthspan-lifespan gap. In this study, we mapped the healthspan-lifespan gap by world regions encompassing 183 countries. We identified demographic, economic, and health contributors to the healthspan-lifespan gap. Our study shows that healthspan-lifespan gaps are universal, yet differ in size and disease contribution among regions. Africa exhibited the greatest gap expansion and the most rapid changes in disease burden. We applied artificial intelligence, which recognized three distinct clusters of disease burden underpinning healthspan-lifespan gaps around the globe. Our projections forecast a widening of the healthspan-lifespan gap into the next century. Our work highlights areas that could be targeted to reduce the healthspan-lifespan gap across and within different world populations. Garmany and Terzic measure, map, and decipher the healthspan lifespan gap across world regions. They trisect the world into three disease burden patterns, which underpin the distinct health span-lifespan profiles across geographies.

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