Healthy life expectancy for 187 countries, 1990—2010: a systematic analysis for the Global Burden Disease Study 2010

Healthy life expectancy for 187 countries, 1990—2010: a systematic analysis for the Global Burden Disease Study 2010

The Lancet, Volume 380, Issue 9859, Pages 2144 - 2162, 15 December 2012

Joshua A Salomon, Haidong Wang, Michael K Freeman, Theo Vos, Abraham D Flaxman, Alan D Lopez, Christopher JL Murray

Background
Healthy life expectancy (HALE) summarises mortality and non-fatal outcomes in a single measure of average population health. It has been used to compare health between countries, or to measure changes over time. These comparisons can inform policy questions that depend on how morbidity changes as mortality decreases. We characterise current HALE and changes over the past two decades in 187 countries.

Methods
Using inputs from the Global Burden of Disease Study (GBD) 2010, we assessed HALE for 1990 and 2010. We calculated HALE with life table methods, incorporating estimates of average health over each age interval. Inputs from GBD 2010 included age-specific information for mortality rates and prevalence of 1160 sequelae, and disability weights associated with 220 distinct health states relating to these sequelae. We computed estimates of average overall health for each age group, adjusting for comorbidity with a Monte Carlo simulation method to capture how multiple morbidities can combine in an individual. We incorporated these estimates in the life table by the Sullivan method to produce HALE estimates for each population defined by sex, country, and year. We estimated the contributions of changes in child mortality, adult mortality, and disability to overall change in population health between 1990 and 2010.

Findings
In 2010, global male HALE at birth was 58·3 years (uncertainty interval 56·7—59·8) and global female HALE at birth was 61·8 years (60·1—63·4). HALE increased more slowly than did life expectancy over the past 20 years, with each 1-year increase in life expectancy at birth associated with a 0·8-year increase in HALE. Across countries in 2010, male HALE at birth ranged from 27·9 years (17·3—36·5) in Haiti, to 68·8 years (67·0—70·4) in Japan. Female HALE at birth ranged from 37·1 years (26·9—43·7) in Haiti, to 71·7 years (69·7—73·4) in Japan. Between 1990 and 2010, male HALE increased by 5 years or more in 42 countries compared with 37 countries for female HALE, while male HALE decreased in 21 countries and 11 for female HALE. Between countries and over time, life expectancy was strongly and positively related to number of years lost to disability. This relation was consistent between sexes, in cross-sectional and longitudinal analysis, and when assessed at birth, or at age 50 years. Changes in disability had small effects on changes in HALE compared with changes in mortality.

Interpretation
HALE differs substantially between countries. As life expectancy has increased, the number of healthy years lost to disability has also increased in most countries, consistent with the expansion of morbidity hypothesis, which has implications for health planning and health-care expenditure. Compared with substantial progress in reduction of mortality over the past two decades, relatively little progress has been made in reduction of the overall effect of non-fatal disease and injury on population health. HALE is an attractive indicator for monitoring health post-2015.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2961690-0/abstract

Press Release: Study finds years living with disease, injury increasing globally

http://ht.ly/gb91w

 

Weekend links

1. PNAS paper questioning the causal link between cannabis use and IQ change. Questioning general methodology also (via Michael)

2. Stephen Kinsella (UL) hiring RA

3. Thoughts by recent ERC advanced investigator winner Rob Kitchin on what it takes to win them  

4. New freakonomics website asks people to make life decisions on which they are undecided by flipping a coin

5. This looks like it will be a very interesting journal. New APA journal coming out "Decision"

6. Cass Sunstein's new book "Simpler: The Future of Government" due out in April 2013

7. Full details now of our MSc in Behavioural Science starting (subject to final approval) in September

8. The google consumers surveys site is impressive at first glance

Structuring undergraduate research experience

One feature that is lacking in the UK and Ireland (and probably across Europe) is the presence of well-structured, paid undergraduate research internships at universites. I wrote a short briefing note on this a few years ago as part of background work for a study with the Irish Universities Association. It is clear that existing studies find a strong link between partaking in research internships and a range of positive student outcomes though there is much work to be conducted to establish precise causality. Furthermore, internships are generally good experiences for both the student and the research group they are placed into. As noted by many, the present system is largely based around unpaid internships which clearly is biased toward candidates without the need to use their summers to finance their study (see e.g. Guardian article, Ben Goldacre). This might have effects in terms of the type of people who break through into academic and other research posts.

There are some alternatives to the full summer internship model. For example, many research groups offer students the chance to gain research experience by helping out in the process of rolling out studies. These are generally structured timetabled unpaid jobs conducted during term and allow students to gain similar experience to a summer internship. They may also have an advantage over a summer internship if the main investigators spend significant times away during the summer. Though, a similar socio-economic skew potentially arises if such experience is not credit-bearing and students are working part-time. Another alternative (or perhaps more a complement) is a full research thesis. There is variation across degrees and universities on the nature and extent of research conducted as part of the degree requirements. A properly supervised undergraduate research dissertation would have many similar features to a research internship.

Another major alternative is to have competitive paid summer internship positions. Some research groups and universities do this on an ad hoc basis. On top of that, the possibility of centrally funded internship competitions is one that should be explored more fully. In the Irish case, the HRB runs a summer research internship funding competition (see also the SFI undergraduate scheme). Possibly the largest programme of its kind in the world is the NSF Research Experience for Undergraduates that funds students to take on paid summer-long internships across the American academic system. An extended and sustained national programme of that nature in the UK or Ireland would have a number of advantages including: development of solid structure on the internship process; meritocratic entry to internship posts; early identification of top researchers at undergraduate level; knowledge-sharing across internship sites; showcasing both research labs and talented undergraduates; range of transferable skills built up by the intern group; and many other potential benefits. Any such scheme would need, at the very least, a process evaluation and an element of tracking the experiences of interns and labs. A more ambitious model could even attempt to examine causal impacts of offers of paid internship on later student outcomes. The studies to date are very promising but none, to my knowledge, puts a hard causal estimate on the effects.

The cost of the scheme depends on the extent of payment provided to the interns and the extent to which facilities need to be provided. Libraries are obviously a lot quieter during the summer and this is one potential way to host students, who can then participate in research group meetings and so on as normal. Any model of this nature would require good-will on behalf of the funders and host sites in terms of how costing modesl are employed and it is probably best if the scheme requires research groups to apply to opt-in rather than it being seen as an obligation. Some research groups can host people at all levels as part of its natural organisation. For others, it would be pointless at best or a drain on resources and time and a bad experience for the intern at worst. The research groups themselves are probably in the best position to know this ex ante. In terms of funding, given the meritocratic entry, the clear potential benefits to development of science and related benefits, it is clearly something that philanthropic agencies interested in funding higher education should consider.

I would be interested in hearing people's thoughts on this and feel free to email. Having worked between psychology, economics and public health over the last 10 years, I have seen many models of providing environments for undergraduate research experience. Some of my favourite teaching experiences have involved final year research projects and presentations and I have also found the paid summer internship model a very good experience for everyone concerned. A lot of the current debate is centering around the potentially exploitative nature of unpaid internship models and their potential to exacerbate educational inequalities. This is fair enough but the potential of these models to provide deep-level experience for the students with the highest research potential shouldn't be lost in the argument.

Reference list from original briefing: 

Alexander, B. B., Foertsch, J., & Daffinrud, S. (1998).  The Spend a Summer with a Scientist Program: An evaluation of program outcomes and the essential elements for success.  Madison: University of Wisconsin-Madison. Spend a Summer with a Scientist Program website: http://www.crpc.rice.edu/CRPC/SaS/

Bauer, K. W. (2001).  The effect of participation in undergraduate research on critical thinking and reflective judgement.  AIR 2001 Annual Forum Paper. 

Hathaway, R. S., Nagda, B. A., & Gregerman, S. R. (2002).  The relationship of undergraduate research participation to graduate and professional education pursuit: an empirical study.  Journal of College Student Development, 43(5) 614-31.  UROP website: http://www.lsa.umich.edu/urop/

Hunter, A. B., Laursen, S. L., Seymour, E. (2006).  Becoming a scientist: the role of undergraduate research in students’ cognitive, personal, and professional development.  Science Education, 91, 36-74. 

Kardash, C. M. (2000).  Evaluation of an undergraduate research experience: perceptions of undergraduate interns and their faculty mentors.  Journal of Educational Psychology, 92(1) 191-201. 

Katkin, W. (2003).  The Boyer Commission Report and its impact on undergraduate research.  New Directions for Teaching and Learning, 93, 19-38. 

Kremer, J. F., Bringle, R. G. (1990).  The effects of an intensive research experience on the careers of talented undergraduates.  Journal of Research and Development in Education, 24(1) 1-5. 

Landrum, R. E., Nelson, L. R. (2002).  The undergraduate research assistantship: an analysis of the benefits.  Teaching of Psychology, 29(1) 15-19. 

Lopatto, D. (2003).  The essential features of undergraduate research.  Council on Undergraduate Research Quarterly, 23(2) 139-142. 

           

Lopatto, D. (2004).  Survey of Undergraduate Research Experiences (SURE): first findings.  Cell Biology Education, 3, 270-277. 

Lopatto, D. (2006).  Undergraduate research as a catalyst for liberal learning.  Peer Review, 8(1) 22-25. 

Nagda, B. A., Gregerman, R. S., Jonides, J., Von Hippel, W., & Lerner, J. S. (1998).  Undergraduate student-faculty research partnerships affect student retention.  The Review of Higher Education, 22(1) 55-72.  UROP website: http://www.lsa.umich.edu/urop/

Ruekert, (2006).  Council on Undergraduate Research biennial meeting.  Powerpoint presentation retrieved 20^th July 2007 from: http://www.neiu.edu/%7Elruecker/rsrchassess.ppt

Russell, S. (2006).  Evaluation of NSF support for undergraduate research opportunities: Draft Synthesis Report.  SRI International. 

Ryder, J., Leach, J., & Driver, R. (1999).  Undergraduate science students’ images of science, Journal of Research in Science Teaching, 32(2) 201-219. 

Seymour, E., Barrie-Hunter, A., Laursen, S. L., & Deantoni, T. (2004).  Establishing the benefits of research experiences for undergraduates in the sciences: first findings from a three-year study.  Science Education, 88(4) 493-534.  

Journal Club: Using Google Trends Data to Study Economic Events & Mental Health

On Monday 4th  of Februrary (11am) we will have a journal club on google search data and its use for measuring mental health and how psychological distress reacts to economic events.

Background:

The degree to which economic fluctuations have substantive mental health effects remains an open question. The difficulty in addressing this issue often stems from inadequate data. Although there are an increasing number of large scale surveys gauging mental health and well-being levels of representative samples of the population, these are often conducted at an annual or less frequent basis. However, researchers in psychology, economics, and other disciplines have begun to study internet search terms as a method for measuring mental health at a very high frequency level. With many countries approaching 80% internet penetration and with the internet acting as often the initial source of information for people who feel troubled with mental health problems, this strategy seems one worth thinking about. There are many internet tools that have been used for health surveillance (listed here). In particular, the tool Google Trends captures the magnitude of search volume of particular terms over the period from 2004 onwards. It adjusts for changes in the overall volume of internet search and allows both time and geographical changes to be examined. This tool has been used to track flu epidemics and touted as a method for its sensitivity in capturing rapid changes in prevalent conditions (described here , current flu trends here).

Journal club topics:

The first topic for discussion in the journal club will be the evidence for the validity of google mental health searches (e.g. searching for 'symptoms of depression', 'depression test', 'stress symptoms') as measures of psychological distress.

Previously, Google Trends data has been used in a widely cited paper by Choi & Varian to measure changes in economic indicators like car sales, when people claim unemployment, and are planning to go abroad. In this instance, highly accurate data is available but lags behind search data due to the process of collection and validation. Search therefore provides a clearer picture of the present than the older economic data that is available at a given time. Whether this is the case in the instance of changes in mental health is an important question that has not been fully addressed to date.

Three useful papers that aim to address the validity of search data in its application to mental health have recently been publised in the Journal of Affective Disorders and will be the first paper reviewed in the journal club. They show that the volume of searches for terms like 'Major depression' and 'Suicide' appear to coincide with statistics for completed suicides over time, though the strength of the relation may vary by age and whether temporal or geographic patterns are examined. Though a study by Page and colleagues (2011) failed to identify this relationship.


McCarthy, M.J. (2010). Internet monitoring of suicide risk in the population. Journal of Affective Disorders, 122, 377-379.

Yang, A.C. et al. (2011). Association of Internet search trends with suicide death in Taipei City, Taiwan, 2004–2009. Journal of Affective Disorders, 132, 179-184.

A recent paper by Gun III and Lester examined the differences in suicide searches and rates across the 50 American states and identified evidence for correspondence.

Gun III, J.F., & Lester, D. (in press). Using google searches on the internet to monitor suicidal behavior. Journal of Affective Disorders.


The Journal of Affective Disorders appears to be at the forefront in examining the link between internet search volumes for psychological distress and how these match to objectively verified data. There is other evidence to suggest search data may reflect changes in mental health. For instance, Yang and colleagues (2010) have shown seasonal variation in depression searches to occur, particularly at higher latitudes. Media reporting of suicide has also been reported to have a lagged effect on suicide deaths (Yang et al., 2012).

There is now growing evidence that the financial crisis may have had adverse effects on mental health as indexed by increases in suicide levels in the EU (e.g. Stuckler et al., 2011) and countries such as Greece (e.g. Kentikelenis et al., 2011) and Italy (De Vogli et al., 2012). In the most recent instance a rise in Italian suicides with the cause 'due to economic reasons' was identified.

Given the potential linkages between internet search volumes for mental health terms and suicide rates it follows that these searches may act as a sensitive measure of the psychological effects of economic changes. Recent articles have addressed this idea and will be reviewed in the journal club along with the three articles referenced above:

Ayers, J.W. et al. (2012). Novel surveillance of psychological distress during the great recession. Journal of Affective Disorders, 142, 323-330.

Tefft, N. (2011). Insights on unemployment, unemployment insurance, and mental health. Journal of Health Economics, 30, 258-264.

We ask the following questions:

1) What are the benefits of using mental health search data over existing data sources (rapid, spontaneously generated, sensitive, less incentives to misreport, potentially sensitive to micro-level changes, can be mapped onto rich geographical data, potential for integration with existing data sources).

2) What are the potential confounding factors associated with search data, in this instance for examining mental health (selected sample- though large internet penetration in many nations, search terms may not reflect the inferred concept (e.g. 'depression' could be psycholgical or economic), social events and media coverage may cause peaks in search, currently not possible to profile searchers by age, gender, income and so forth but this is potentially solvable as, temporal changes may reflect the impact of third variables like the availability of internet resources).

3) How should mental health/psychological distress search term dependent variables be formed? (e.g. multiple dependent variables, composite, latent factor).

4) What would a strong validation test of psychological distress search terms look like?

5) What are the counterfactual tests that can be used to assist in validating analyses linking search data and economic events or trends. For instance, whilst 'depression symptom' searches increases in line with global financial trends so do 'cancer symptom' trends (see below). The former is feasibly an effect of the financial crisis whereas the latter is most likely not.

6) Should control search terms be used and how?

7) Should time series or geographical data be used or a combination? What are the likely pitfalls or each approach and the analytic techniques that may benefit the examination (e.g. fixed-effects)?

8) Are the effects of the financial crisis identified in the articles above consistent? Are they feasible in magnitude?

9) What are the potential policy applications of mental health search data?

10) How should we think about the relationship between search terms at the group level and individual mental health problems? How does this interact with statistical/logical problems such as the ecological fallacy?

Blog Notes

Thanks for reading the blog. I am going to try to post a bit more frequently. I think there has been a substitution effect among many of us from blogging to tweeting information which is a pity as I am convinced there are a lot of people who still follow blogs like this but haven't made it over to twitter yet in any regular way. Currently, this blog is functioning well as a notice-board for things that are going on in the center;  a way of informing people about funding opportunities, seminars, conferences and so on, and also a good way of linking to particularly interesting and relevant new papers. It is also a good place to plan out workshops, journal clubs and so on. Feel free to email suggestions on posts and feel free to post yourself if you have access permission. It is not limited to Stirling contributors.

JEBO Special Issue on Empirical Behavioral Finance

Details below - link here 

"Guest editors:
Martijn J. van den Assem
(Erasmus University Rotterdam)
Remco C.J. Zwinkels (Erasmus University Rotterdam)
Doron Kliger (University of Haifa)

Submission deadline: February 28, 2013

The Journal of Economic Behavior & Organization (JEBO) will publish a special issue on empirical research in Behavioral Finance. For several decades now, Behavioral Finance has been integrating insights from the broad social science perspective into the research in financial economics. Along with enriching our understanding of human financial decision making and the resulting market dynamics, the interaction with other fields of study has also paved the way for the use of alternative data and methods in financial research.

The aim of the special issue is to advance our understanding of financial behavior by means of observation. We particularly seek and will give preference to empirical work that uses non-standard data, including papers reporting on innovative experiments, field data, qualitative or quantitative surveys, and other types of data which are not available in standard databases. We welcome papers that examine the financial decisions of individuals (in their role as consumers, investors, managers or advisors), the financial behavior of groups and organizations (in the public and private sectors), the dynamics of markets, and the interaction among these different forms of aggregation.

Submission. Please submit your manuscript via JEBO’s online submission and editorial system, and select “Behavioral Finance Special Issue”. To be considered for publication, manuscripts must be received by February 28, 2013. Please conform to the standard guidelines for submission to JEBO. Details can be found in the Guide for Authors section at the Journal’s website http://www.journals.elsevier.com/journal-of-economic-behavior-and-organization. We expect the special issue to appear in print in the first half of 2014. JEBO’s standard submission fee is waived for this special issue.

One-revision policy. To speed up the revision process, we will apply a one-revision policy. All publication decisions will be made after no more than one revision. Submissions are first screened by the editors, and those within the scope of the special issue are then sent to expert referees for evaluation."