Emmanuelle Cambois’s research while affiliated with National Institute for Demographic Studies and other places

Purpose The growth in life expectancy (LE) slows down recently in several high-income countries. Among the underlying dynamics, uneven progress in LE across social groups has been pointed out. However, these dynamics has not been extensively studied, partly due to data limitations. In this paper, we explore this area for the 2010 decade using recent French data. Methods We utilize the recent change in French census mortality follow-up data (EDP) and apply P-spline models to estimate LEs across five occupational classes (OCs) and indicators of lifespan heterogeneity (edagger) within these OCs, for seven triennial periods (2011-2013 to 2017-2019). Results First, we found a similar ranking of OCs along the LE gradient over time and across sexes, from manual workers to higher-level OCs. Noteworthy, the lowest LE in women overlaps with the highest one in men drawing a sex-OC gradient. Second, we observe varying progress of LEs. In women, LE increases in higher-level OCs meanwhile it levels off in manual workers, so that the OCs gap widens (up to 3.4 years in 2017-2019). Conversely, in men LE stalls in higher-level OCs and increases in manual workers so that the gap, which is much larger than in women (+5.7 years in 2017-2019), is tending to narrow. Finally, the lifespan homogenizes in OCs only when LE is low. Conclusion Overall, the limited LE progress in France results from LE stalling in the middle of the sex-OC gradient, though LE increases at both ends. At the lower end, LE progress and lifespan homogenization suggest that laggards benefit recently improvements achieved earlier in other OCs. At the upper end, LE progress may come from a vanguard group within higher-lever OC, benefiting new sources of improvements. These findings underscore the need for further research to explore the diverse mortality dynamics coexisting in the current health landscape.

Health expectancies (HEs) have become a key indicator for monitoring healthy aging. So far, they have mainly been calculated based on functional rather than subjective health measures. Yet, by integrating several dimensions (medical, social, and cultural), subjective health is also an important measure of an older person’s health status. In this study, we first estimated HEs using self-rated health (SRH), by age and sex. Second, we compared these results to those obtained when using a disability measure. We used pooled data from three prospective population-based cohorts including adults aged 65 years and over, living in Southwestern France (N = 4468). SRH was assessed using a single question and disability was measured using the Lawton scale. Healthy/Unhealthy Life Expectancies (HLE/UHLE) and Disability/Disability-Free Life Expectancies (DLE/DFLE) were estimated using the Interpolated Markov Chain program (IMaCh), separately in men and women. Women lived longer than men, with similar HLE but longer UHLE at all ages. The proportion of HLE in total LE decreased with age for both sexes and for women, it became smaller than the proportion of UHLE from age 73 onward. In both sexes, while the DLE was shorter than the UHLE in the youngest, a reversal was observed with advancing age. This change occurred earlier in women. Our study supports that SRH and disability showed different aging patterns, with sex and age differences. From a public health perspective, SRH and disability indicators appeared not interchangeable as they uncovered complementary but different information on the needs of aging people.

Objective: Previous research in various countries has found that employment–family trajectories characterized by early or single motherhood, or weak ties to employment, are associated with poor well-being among older women. Our paper explores whether this differs (1) in France, characterized by a high female employment rate and supportive family policies; (2) across dimensions of well-being. Method: We used the Health and Occupational Itinerary survey to identify 10 common patterns of employment–family trajectories (derived from multi-channel sequence analysis) and analysed their association with six indicators of well-being in 2010 (N = 2882 50–78 years old women). Results: Continuous full-time employment is associated with better well-being, except for women who had a first child around 24 years old, who reported increased anxiety and lack of support. Discussion: Employed mothers’ well-being seems to be protected in a context of family friendly policies, but we identified one group with lower well-being, which merits further study.

In the known history of humanity, life expectancy scarcely exceeded 30 years, with half of newborns dying before age five, up to the 18th century. However, from the 18th century onward, major epidemics were combatted more efficiently, famines became less frequent, and life expectancy thus began to increase, first in Northwest Europe, then spreading to North America, Australia, Japan, and to the rest of Europe. The health transition reached Latin America, the rest of Asia, and Africa only in the 20th century. In 2015–2020, worldwide life expectancy at birth reached 72.5 years. However, differences remained large between regions and countries. The Japanese experienced the highest level at 84.4 years, thanks to their increasingly effective noncommunicable disease (NCD) control and an especially dramatic decrease in cardiovascular mortality. On average, life expectancy was 80.9 years in high income countries, 71.4 in middle income countries and 63.4 in low income countries. It was only 60 years in sub-Saharan Africa, with some countries barely exceeding 50. High mortality countries suffer a heavy burden from both infectious and NCDs. Due to increasing life expectancy, deaths shifting to older ages, and changing cause-of-death patterns, questions arise concerning the health of populations. The health expectancies made available mainly in high income countries are indicators that combine mortality and health data. Although it seems that severe disability has not increased in the early 21st century, the results for less severe disabilities diverge from one country to the other. Along their longer life expectancy, females live more unhealthy years than males; in some countries they even live fewer healthy years than males. The future may see life expectancy surpassing 90 years in the most advanced countries, likely before the end of the 21st century. However, achieving this requires that humanity face major challenges, especially in overcoming infectious diseases, impeding NCDs, reducing poverty and socioeconomic inequalities, and combating the deterioration of our environment.

En 2018, l’espérance de vie à 35 ans des hommes cadres est de près de 50 ans, contre 44 ans pour les ouvriers, soit presque 6 ans d’écart. Ces écarts d’espérance de vie sont encore importants à 62 ans : 3 ans et 6 mois ans chez les hommes, 2 ans et 8 mois chez les femmes. En dépit d’un départ à la retraite plus précoce, les ouvriers passent 2 années de moins à la retraite que les cadres et 3,4 années de plus au chômage ou en inactivité. Par ailleurs, les années de chômage ou d’inactivité sont fréquentes dans les années précédant l’âge légal pour les ouvriers. Les femmes passent de 3 à 4 ans de plus à la retraite que les hommes de catégorie sociale similaire, mais aussi plus d’années qu’eux en inactivité.

The substantial increase in the proportion of very old people in the population has not given rise to a large increase in institutional long-term care (LTC) in France. In this article, we aim to analyse the contribution of individual factors to this trend: age, level of education, gender, type of disability and the family environment. Based on data from the Handicap-Santé 2008-2009 survey and Capacités et Aides et REssources des seniors (CARE) 2015-2016 survey, we estimate the change in the probability that an individual aged 75 or over will be living in an institution based on these various factors. A decomposition shows that the increase in the proportion of very old people and those with severe limitations brings about an increase in overall use, but that the increase is offset by a concomitant increase in family resources to be helped at home. The level of use associated with the various factors did not change significantly. The limited increase in LTC use is explained by a composition effect, linked to an increase in family resources to provide in-home care, but not to a reduced level of LTC use.

Objective The COVID-19 pandemic is characterized by successive waves that each developed differently over time and through space. We aim to provide an in-depth analysis of the evolution of COVID-19 mortality during 2020 and 2021 in a selection of countries. Methods We focus on five European countries and the United States. Using standardised and age-specific mortality rates, we address variations in COVID-19 mortality within and between countries, as well as demographic characteristics and seasonality patterns. Results Our results highlight periods of acceleration and deceleration in the pace of COVID-19 mortality, with substantial differences across countries. Periods of stabilization were identified during summer (especially in 2020) among the European countries analysed, but not in the United States. The latter stands out as the study population with the highest COVID-19 mortality at young ages. In general, COVID-19 mortality is highest at old ages, particularly during winter. Compared to women, men have higher COVID-19 mortality rates at most ages and in most seasons. Conclusions There is seasonality in COVID-19 mortality for both sexes at all ages, characterized by higher rates during winter. In 2021, the highest COVID-19 mortality rates continued to be observed at ages 75+, despite vaccinations having specifically targeted those ages.

En dépit de la féminisation du marché du travail, l’inactivité professionnelle est un statut d’emploi surreprésenté dans les parcours de vie féminins, dont le lien avec l’état de santé reste insuffisamment compris. En combinant méthodes quantitatives à partir de deux bases de données longitudinales (SIP, Constances) et méthodes qualitatives à partir de 30 récits de vie, cette thèse vise à identifier dans quels cas l’inactivité professionnelle est liée à un vieillissement en bonne ou mauvaise santé chez les femmes, en distinguant ses temporalités, et les configurations professionnelles, familiales, sociales dans lesquelles elle s'inscrit. Je montre d’abord que les trajectoires d’emploi marquées par des périodes d’inactivité professionnelle longues, définitives, ou répétées, accompagnent une moins bonne santé mentale après 50 ans. En revanche, les femmes qui ont connu des interruptions temporaires, même longues, sont en meilleure santé que celles qui ont connu des trajectoires d’emploi continues, mais instables, caractérisées par des expositions professionnelles ou par des difficultés d’articulation travail/famille. À côté de ces caractéristiques de l’emploi, l’histoire conjugale et la position sociale définissent aussi les trajectoires d’emploi critiques, en jouant sur les arbitrages entre inactivité professionnelle et emploi, et sur les coûts économiques et symboliques de l’inactivité professionnelle. L’absence de conjoint aux âges élevés, un faible niveau de revenus ou de diplôme, renforcent le désavantage de santé mentale lié à l’inactivité professionnelle longue ou définitive, et aux allers-retours dans l’emploi.