Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Suite 241-2, Columbia, SC, 29208, USA.
Pediatric Hematology-Oncology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02215, USA.
Qual Life Res. 2021 Aug;30(8):2187-2195. doi: 10.1007/s11136-021-02809-1. Epub 2021 Mar 17.
Since the end of the industrial revolution, advances in public health and clinical medicine have contributed to dramatic decreases in infant and childhood mortality, improvements in health-related quality of life (HRQoL), increases in overall life expectancy (LE), and rectangularization of survival curves.
In this article, we focus on disability that has occurred with the overall lengthening of LE in many populations and the implications this has for decreased HRQoL.
We utilize the concept of rectangularization of population survival to depict the rising prevalence of disability associated with increased LE, especially among racial and ethnic minorities and people of low socioeconomic status (SES) and relate this to HRQoL.
Disability-free life expectancy (DFLE) and healthy life expectancy (HLE) are defined in terms of HRQoL. Specific attention is focused on disability experienced by disparate populations around the globe. By focusing on disparities in DFLE, and the need to expand LE to include HLE as a central component of HRQoL, this work provides an important counterpoint to the attention that has been paid to LE disparities according to race, gender, ethnicity, education, and SES.
By calling attention to those factors that appear to be the most important drivers of the differences in quality and length of DFLE between different groups (i.e., the components of the social gradient, exposure to chronic stress, systemic inflammation, and the psychological and biological mechanisms associated with the gut-brain axis) and, by logical extension, HRQoL, we hope to promote research in this arena with the ultimate goal of improving DFLE, HLE, and overall HRQoL, especially in disparate populations around the globe.
自工业革命末期以来，公共卫生和临床医学的进步极大地降低了婴儿和儿童死亡率，改善了与健康相关的生活质量（HRQoL），提高了总体预期寿命（LE），并使生存曲线变平。
本文重点关注许多人群 LE 整体延长所导致的残疾问题，以及这对 HRQoL 下降的影响。
我们利用人口生存的矩形化概念来描述与 LE 增加相关的残疾患病率上升，特别是在种族和族裔少数群体以及社会经济地位（SES）较低的人群中，并将其与 HRQoL 联系起来。
无残疾预期寿命（DFLE）和健康预期寿命（HLE）是根据 HRQoL 定义的。特别关注全球不同人群所经历的残疾情况。通过关注不同人群的 DFLE 差异，以及将 HLE 纳入 LE 以作为 HRQoL 的核心组成部分的必要性，这项工作为关注根据种族、性别、族裔、教育和 SES 存在的 LE 差异提供了一个重要的对比。
通过关注那些似乎是导致不同群体之间 DFLE 质量和长度差异的最重要因素（即社会梯度的组成部分、慢性压力暴露、系统性炎症以及与肠道-大脑轴相关的心理和生物学机制），并通过逻辑延伸到 HRQoL，我们希望促进这一领域的研究，最终目标是改善 DFLE、HLE 和整体 HRQoL，特别是在全球不同人群中。
