Life expectancy has been steadily increasing in the United States, but it has been unclear how this longer life span impacts quality of life for aging Americans. In order to take into account quality of life, researchers have come up with a measurement called quality-adjusted life expectancy (QALE). The measurement of QALE takes into account groups of questions on functioning and symptoms from a variety of national health surveys.
Recently, in an article in the American Journal of Public Health, researchers evaluated trends in QALE to systematically track the health of the US adult population. They also broke QALE down into the components of life expectancy, impairments, symptoms, smoking, and body mass index. These researchers also examined both elderly and non-elderly populations.
Overall, between 1987 and 2008, the average QALE increased by 2.4 years (6 percent) for a typical 25-year-old, and by 1.7 years (14 percent) for a typical 65-year-old. Declining mortality contributed the greatest amount to this increase in QALE, but quality of life improvements also contributed. In particular, for both ages, the most important quality of life improvements came in energy levels, depressive moods, self-care, pain, and routine needs.
Changes in smoking and obesity are also important factors contributing to the quality of life estimates. Among individuals between 25 and, 64, there was a 12.9 percent decrease in the number of current smokers between 1987 and 2008. For individuals over 65, there was a 4.6 percent decrease in the number of smokers. Even though, taken together, overall trends led to an increased QALE, increases in obesity were the main factor examined that prevented the increase in QALE from being even larger. Between 1987 and 2008, there was a 12 percent increase in the number of individuals classified as obese for both elderly and non-elderly individuals.
Gender and race also significantly impacted QALE. For both elderly and non-elderly adults, Caucasian women had the highest QALE, while African American men had the lowest QALE. At age 25, white males had a higher QALE than African American females. However, at age 65, African American females had a greater average QALE than Caucasian males. Yet, it should still be noted that all race and gender groups examined did exhibit an increase in QALE between 1987 and 2008, and the gaps between races and genders did narrow over this period. The greatest percentage increase in QALE was observed in African American males at 25 years of age. The smallest increase in QALE was seen among Caucasian women at 25 and 65 years of age.
Lastly, the authors note that while there have been improvements overall between 1987 and 2008, some of the positive trends observed flattened out during the 2000s, particularly among the non-elderly. In particular, improvements in anxiety and vision problems were not seen after 2000 for non-elderly adults.
Stewart ST, Cutler DM, and Rosen AB. US trends in quality-adjusted life expectancy from 1987 to 2008: combining national surveys to more broadly track the health of the nation.American Journal of Public Health. (2013). DOI: 10.2105/AJPH.2013.301250