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Data on aging and health is crucial to better understand older adults’ health status as well as their social and economic contributions and social capital. This is why strengthening data, research and innovation to accelerate implementation is one of the enablers of the Decade of Healthy Aging.

Data available on this observatory can provide a snapshot of the current available information that can be useful for prioritization and evaluation of public health interventions. Older people are not a homogenous group, nor does the aging process happen in the same way and speed in every country. Therefore, providing disaggregated data can help countries to prepare to the demographic shift and better address older adults needs.

GBD in older adults in the region of the Americas 2019

Source: Global Burden of Disease Study 2019 (GBD 2019)

Disability-adjusted life years lost (DALYs) is a measure that represents the loss equivalent to one year of healthy life. This measure is considered a synthetic indicator of health since it is calculated as the sum of Years of Life Lost due to Premature Death (YLLs) plus Years Lived with Disability (YLDs).

The higher the rate of DALYs per country, the greater the loss of healthy years of life for the population group under analysis. Therefore, a higher DALY means worse health conditions.

The visualization shows that, in the Region of the Americas (2019), the countries with the highest DALYs are Guyana, Haiti and Suriname; while Canada has the lowest DALY, which means that this country is where the fewest years of healthy life are lost due to premature death or disability in the region of the Americas.

Proportional mortality in older adults and leading causes of death 2019

Source: WHO Global Health Estimates 2019

As a result of the epidemiological transition, chronic non-communicable diseases have replaced communicable diseases (communicable, maternal, perinatal conditions) in becoming the leading cause of death (87.2%) of older persons, regardless of age group, country, or sex.

Among the first 25 causes of death in older persons of both sexes, in 2019, in the region were: ischemic heart disease (20.87%), cerebrovascular accident (9.15%), Alzheimer's disease, and other dementias (8.55%).

The order of frequency of the diseases will change according to the country selected. The differences between nations and the prevalence of causes of death are related to socioeconomic factors, habits, and lifestyles, which can be very heterogeneous in the region of the Americas.

Ageing level and trends of population in the Americas 1950 to 2100

Source: United Nations World population prospects 2019

As part of a global phenomenon, the region of the Americas has experienced a demographic transition, evidenced by gradual changes in population size according to the different age groups.

In the 0-14 age group, population size had a (slow) upward trend from 1950 to 2000. After this date, the growth trajectory shows a decreasing trend, and there is no change in the projected direction to 2100. This trend also means a continuous decrease in the number of children at the regional level.

In the 15-59 age group, the population size increased from 1950 to 2040. From this date, the growth trajectory shows a decreasing trend, and there is no change in the projected trend to 2100. This correlation also means a continuous decrease in the number of adolescents, young adults, and adults at the regional level.

In the 60-79 age group, the population size has a growing trend throughout the observed and projected period (1950-2100), considering that around 2060, growth will stabilize at a value of approximately 200 million.

In the 80 and over age group, the population size has an increasing trend throughout the observed and projected trajectory (1950-2100), which will reflect a gradual increase in the number of people in this age group.

Although the results follow a normal distribution throughout the period analyzed, this behavior of absolute values of the population size in each age group will lead in 2100 to a notable decrease in the relative percentage of people aged 0-14 years and an increase in the groups of 60-79 years and 80 and over. This is directly reflected in the change of the behavior of the curve containing the aging index considered in this graph, as the number of adults aged 60 years and over per 100 children under 15 years of age.

Life expectancy: a key driver in ageing, Americas 1990-2019

Source: Global Burden of Disease Study 2019 (GBD 2019)

Life expectancy is an indicator that expresses the average number of years a person would live, considering their year of birth and the level of mortality determined for that population group.

During 1990-2019, life expectancy maintained an upward trend in all the subregions that make up the region of the Americas, with North America being the subregion that had the most significant influence on this behavior. As of 2010, this region is approaching the trajectory of the rest of the subregions, which is explained by a slowdown in the growth of this indicator in North America, concurrent with a change in life expectancy in the rest of the subregions.

As for life expectancy at age 60, the trajectories maintained an upward trend, albeit with moderate fluctuations over the period, but which did not lead to a long-term change in the tendency.

In the 80-year age group, it seems that the period 1990-2019 is where the most significant fluctuations in the trajectory of the regions and between regions are found and that the most remarkable changes occurred in the group of women. These variations result from multiple factors, among which are: the higher survival rate and better life habits of women.

Trends of older adults in the Americas

Source: United Nations World population prospects 2019

The Aging Index expresses the ratio between the number of older people and people under 15 years of age living in a country. This value is multiplied by 100.

When the value of this index is more significant than 100, the country has an aging population. There are ten countries in the Americas region classified as such. These countries face several challenges in the design of public policies. In this group there is great heterogeneity among the countries in terms of income levels and population size. These differences will lead to differences in the management and results of this condition in the medium term.

The remaining 40 countries in the region are classified as countries with young populations. Being in this classification, they have more opportunities to manage public policies on aging, long-term care, and health and social welfare policies, among others. However, the demographic transition is a fact that requires immediate and timely actions in these 40 countries in the region that will continue to age in the coming years.

Ageing and Health. Persons are living longer, but are all those extra years in good health?

Source: Global Burden of Disease Study 2019 (GBD 2019)

Aging is a process that should be experienced with health in all years of life.

However, this is not a reality in the Americas, according to data from 2019.

The chart shows a linear relationship between the variables, with an increasing trend trajectory. As life expectancy increases, the number of years of unhealthy life increases. These variables express a greater correlation strength in the sections of the curve in which there is a greater concentration of countries.

In the case of men, the results are concentrated, in most countries, between 70 and 75 years of age. Women's highest concentration of unhealthy life years is around 77 and 82. In the case of men, the causal relationship between these variables is strongest than in the case of women, as evidenced by a lower data dispersion.

The visualization showing the relationship between the proportion of healthy life years and life expectancy for both sexes shows that the correlation is lower, indicating that the increase in unhealthy life years is not proportional to the rise in the number of years of life expectancy. In the case of men, the correlation is more considerable, while, in the case of women, there could be other variables explaining the behavior of the data.

These results demonstrate the need to incorporate health as a priority and cross-cutting issue in the public policies of the region's countries.

Are the life expectancy and healthy life expectancy gaps increasing over time?

Source: Global Burden of Disease Study 2019 (GBD 2019)

The chart shows not only the significant gap between life expectancy and healthy life expectancy but also that, in a discrete but sustained manner, this gap has been widening in the 1990-2018 period. It is also evidenced by the lack of convergence in the trajectories of the curves representing both indicators.

There is a marked difference between men and women in terms of the trajectory of life expectancy and healthy life expectancy curves. The first difference is in terms of level, with women having had a higher life expectancy and healthy life expectancy than men throughout the period analyzed. However, the gap between life expectancy and healthy life expectancy for women is not only more comprehensive but has widened more than for men.

In terms of desired outcomes, public policy should focus on bringing about a level change (increase) in the values of healthy life expectancy and modifying the trend of the trajectory of healthy life expectancy, which shows, in the visualization, a strong possibility of becoming a decreasing trend.

Sources of information:

Death estimates by cause, sex and country: WHO Global Mortality Estimates
Website

Population: United Nations, Department of Economic and Social Affairs, Population Division.
World Population Prospects: 2019 Revision
Website

Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Results
Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2019.
Available here

All data was uploaded to PAHO data servers domains, links and reference available at data tab of each workbook

All visualizations are under PAHO Tableau Server domain