Health at advanced age: social inequality and other factors potentially impacting longevity in nine high-income countries.

This article surveys the evolution of health at advanced age in nine high-income countries over the last three decades, and the variables that might explain that evolution. Life expectancy at age 65 for males and females is used as summary indicator to conceptualize "health at advanced age." A comparison of the nine countries - Canada, Denmark, France, Japan, Spain, Sweden, Switzerland, the United Kingdom, and the United States - reveals excellent health performance for Japan, which has the greatest proportion of elderly people in the population and also the best health indicators for both males and females; the United States and Denmark perform poorly. Of all nine countries, the United States has the youngest population, the highest income per capita, and the greatest expenditure on health care, but also the highest levels of income inequality and relative poverty, and lacked universal health care coverage during the study period. Experts have considered that these three factors have probably contributed to the poor progress in the health of the elderly in the United States in recent decades. Tobacco consumption appears to be a key influence on the health of the elderly and probably explains to a large extent - with a lag of several decades - the differential evolution of health in these countries.