Socio-Economic Factors Affecting Life Expectancy:

A Cross-sectional Analysis

Submitted in partial fulfilment of the requirements for the degree of

B.A. (Hons) Business Economics

Sri Guru Gobind Singh College of Commerce

University of Delhi

14th November 2019

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 ACKNOWLEDGEMENT

We would like to express the deepest appreciation to our teacher Ms Nitya Chutani who has
shown the attitude and the substance of a genius: she continually and persuasively conveyed a
spirit of adventure in regards to research and excitement in regards to teaching. Without her
supervision and constant help, this project report would not have been possible. We would
also like to express our gratitude to Mrs Jaswinder Kaur, who gave us permission to access
the lab computers and internet for the research purpose. We also thank our other teaching
staff for their precious guidance which was extremely valuable for our study both
theoretically and practically.

Submitted by:
Vanshika Gupta (175011)
Abhijeet Singh Ranhotra
(175025) Arushi Singh (175029)
Shweta Kansal (175032)

Submitted to:
Ms Nitya Chutani

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 TABLE OF CONTENTS

S.No. Particulars

1 Abstract

2 Introduction

3 Literature review

4 Data and Methodology

5 Results

6 Conclusion and Policy Implications

7 References

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ABSTRACT

Life expectancy at birth is a well-known demographic measure of population longevity. The

paper attempts to understand and analyze the influence of various socio-economic factors
namely, GDP per capita, healthcare expenditure, literacy rate, alcohol use disorder, the share
of the obese adult population, and smoking prevalence, on life expectancy across the globe
for the year 2011. Logistic regression is used to examine the relationship among variables.
Cross- sectional data for 72 countries globally has been used. We then performed a K-Means
Cluster Analysis to group similar countries into two clusters - Developed economies and
Emerging economies on the basis of human development score. The results show healthcare
expenditure, GDP per capita and literacy rate have a positive relationship with life
expectancy. On the other hand, Alcohol use disorder, share of obese population and smoking
prevalence have a negative relationship with life expectancy. Furthermore, cluster and
correlation analysis helped us get a better understanding, while not all inclusive, which will
help public officials and world health policy makers more effectively appropriate resources in
an effort to increase global life expectancy.

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1. INTRODUCTION

This study aims to investigate the impact of socio-economic factors on life expectancy in 72
countries in the year 2011. Life Expectancy measures the average age of death of a
population. Further, the well-being of an individual is determined by this term “Life
Expectancy” as he/she hopes to live holistically fuller and longer lives. It can be considered
as one of the indicators of the Human Resource Development of a country and it is safe to say
that it reflects the physical quality of life of a specific area. Normally life expectancy is used
for over viewing the living standard and human well-being of a nation, as it is attached with
socio-economic development (Lomborg, 2002).

Life expectancy has increased rapidly since the Age of Enlightenment. In the early 19th
century, life expectancy started to increase in the early industrialized countries while it stayed
low in the rest of the world. This led to very high inequality in how health was distributed
across the world. Good health in rich countries and persistently bad health in those countries
that remained poor. Over the last decades, this global inequality has decreased. No country in
the world has a lower life expectancy than the countries with the highest life expectancy in
1800. Many countries that not long ago were suffering from bad health are catching up
rapidly.

Historically, the improvement in life expectancy is an important topic of population studies

but there are many studies like that of Preston (1975,1980) Grosse and Aufiey (1989) and
Kakwani (1993) which focus that socioeconomic factors play an important role in
determining life expectancy. While studying the determinants of life expectancy much focus
is given on income inequality, economic growth and health care (Preston, 1975).

The motivation for this research comes from the various studies involving income, health and
consumption pattern in explaining a country’s health and well-being. As life expectancy is a
great measure of a country’s health, we then decided to see what factors would lead to a
change in the average death age of a country. This study will investigate the impact of health
expenditure, GDP per capita, population with alcohol use disorder, obese population share,
literacy rate and percentage of the smoking population on life expectancy in case of 69
countries. This type of exercise is hardly done in case of the various small countries we have
chosen and be a healthy contribution to the respective literature.

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2. LITERATURE REVIEW

The first and the foremost topic of concern emerges as the Health Expenditure incurred to
achieve high Life Expectancy. Many types of research have tried to answer the question of
whether the expenditure incurred, both public and private, bring more improvements in the
health status of the country. One such extensive research, “Health expenditure, longevity, and
child mortality: dynamic panel data approach with global data, 2019” by Devdatta Ray and
Mikael Linden, high-income countries’ private and public expenditures correlate positively
with each other much more strongly than in low-income countries but public expenditures
reduce infant mortality in non-poor countries, but similar effects were not found for private
expenditure.

Effect of GDP Per Capita on Life Expectancy has been an open debate for a long time now.
Many studies have been conducted and more to follow. Serious relationships between the two
have been established and one such is the research published by Samuel H Preston in “The
Changing Relation between Mortality and Level of Economic Development”, 1975 which
reveals how the GDP per capita affects Life Expectancy up to a certain level. However, later
on, after reaching a certain level GDP, the correlation weakens, which means it affects the
Life Expectancy less after the achievement of over-median GDP, also backed up by A
Deaton in his “Health in an Age of Globalization”, 2004 and Gokce Dayanikli et al, 2016.

Research by the National Literacy Trust (NLT) in 2018 found that a boy growing up in a
place most likely to have literacy problems has a life expectancy of around 28 years shorter
than a boy living somewhere that is among the least likely. The analysis also reveals that the
inequalities between the literacy level and the life expectancy level in a community aredeeply
rooted and thus the solution to this issue can only be resolved when a localized-community
driven ideology is adopted and implemented.

R Sakata and P Mcgale in their paper, “Impact of smoking on mortality and life expectancy
in Japanese smokers” showcase how there has been a downfall in Life Expectancy in by
about 10 years in people who have been smoking lifelong than a non-smoker. On the
contrary, four studies conducted in Japan show that life expectancy has been reduced by only
4 years. However, it has also been noticed that how the age when started smoking has
considerably fallen over time and there is also an increase in the number of cigarettes smoked

6
per day. One

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such habit falls under the same radar, which is alcohol consumption. Alcohol consumption
can be categorized under the term of Alcohol Use Disorder (AUD). As stated in “Mortality
and life expectancy of people with alcohol use disorder in Denmark, Finland and Sweden,
2014” by J Westman et al, showed at people with AUD displayed 4 times greater the risk of
premature death than the general population and people with AUD died on average 24–28
years earlier than people in the general population.

Streppel MT et al (2007) examined the relationship between life expectancy and long-term
cigarette, cigar and pipe smoking. The results of the study reveal that there is a positive
relationship between the duration of cigarette smoking and mortality from cardiovascular
disease, lung cancer and chronic obstructive pulmonary disease. Moreover, average cigarette
smoking reduced the total life expectancy by 6.8 years, whereas heavy cigarette smoking
reduced the total life expectancy by 8.8 years. The number of total life-years lost due to cigar
or pipe smoking was 4.7 years.

3. DATA AND METHODOLOGY

3.1 Independent and Dependent Variables

3.1.1 Dependent Variable

Life Expectancy Rate

Life expectancy rate refers to the average number of years that a newborn is expected to live
if current mortality rates continue to apply. The age we live to depends primarily on where
and how we live. People die earlier in countries that are badly affected by hunger and armed
conflict and that have only poor health care facilities. Here, an infectious disease can rapidly
become fatal, and women also die much more frequently during childbirth. On the other hand,
people live longer if they are prosperous and educated and have access to health care services.
But affluence also carries its own risks that reduce life expectancy – if people smoke, abuse
alcohol and drugs, eat an unhealthy diet, don’t take enough exercise or are overweight.

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3.1.2 Independent Variables

Selection of the independent variables was guided by current literature on Life Expectancy.
They were (1) Healthcare expenditure as a percentage of GDP (2) Alcohol Use Disorder (3)
GDP per capita (4) Literacy Rate (5) Share of Obese Adult population and (6) Share of
Population who smoke.

Healthcare Expenditure

Total health expenditure is the sum of public and private health expenditure. It covers the
provision of health services (preventive and curative), family planning activities, nutrition
activities, and emergency aid designated for health but does not include provision of water
and sanitation. The relationship between life expectancy and health care expenditure seems to
follow a pattern of ‘diminishing returns’: the increase in life expectancy associated with an
increase in healthcare expenditure decreases as expenditure increases. This means the
proportional highest gains are achieved in countries with low baseline levels of spending.
This pattern is similar to that observed between life expectancy and per capita GDP.

Alcohol Use Disorder

Alcohol dependence is defined by the International Classification of Diseases as the presence

of three or more indicators of dependence for at least a month within the previous year. It’s
estimated that globally around 1.4 percent of the population have an alcohol use disorder.
When we look at the variance in prevalence across age groups, we see that globally the
prevalence is highest in those aged between 25 and 34 years old (for which around 2.5
percent of the population have an alcohol use disorder). At the extreme of country-level
figures, prevalence amongst Russians aged 30-34 years old is just under 10 percent. This
means 1-in-10 Russians in this age group has an alcohol dependency.

GDP per capita

Measure of real GDP per capita accounts for inflation, i.e. changes in the price level, and this
per capita GDP is suitable for cross-country income comparisons. The starting point of any
discussion about health and income is Samuel Preston’s (1975) investigation into the
changing relation between mortality and level of economic development. He pointed out
several reasons
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for using national income as one of the indicators saying it is probably the best single
indicator of living standards in a country since it comprises the value of all final products
(goods and services) produced in a certain period. As the leading index of the level of
economic development, income per head is the focus of growth models from which policy
measures are derived. The cross-sectional relationship between life expectancy and per capita
income is known as the Preston Curve. In the chart below we plot the cross-sectional
relationship forthe year 2011.

Figure 1: Preston Curve showing the relationship between Life Expectancy and GDP per capita for
the year 2011

Source: Author’s calculations based on Ourworldindata

Share of Adults who are Obese

Obesity is defined as having a body-mass index (BMI) equal to or greater than 30. BMI is a
person's weight in kilograms divided by his or her height in metres squared. It can be
classified as a worldwide epidemic, with the United States the undisputed leader in obesity
prevalence. With the spread of obesity has come an increased incidence of cardiovascular
disease, type 2 diabetes, hypertension, certain cancers, and other obesity-related morbidities,
ultimately causing a decrease in life expectancy. There has been an increase in the availability
of food, especially high-fat and/or high-calorie food, at the same time that there has been a
decrease in
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the amount of individual physical activity. Simply put, more people are consuming more
calories than they are using, i.e., their energy consumption is greater than their energy
expenditure.

Literacy

The literacy rate is the percentage of a country's population over the age of 15 who can read
and write. It has prevalently been linked to Life Expectancy many times before. The literacy
rate has been duly approached and widely considered as a factor of Life Expectancy.
Countries with High Literacy Rate almost always had a High Life Expectancy. This also led
to inequalities among literacy rates, a highly concerned topic which was thus proved when
taken up by the National Literacy Trust, which has closely worked with a local organisation
to tackle illiteracy at the grass-root level. A shocking 28-year gap was found between the life
expectancy of two boys who lived in places with lowest literacy levels and highest literacy
levels which was revealed in a study by the National Literacy Trust, thereby confirming that
low literacy levels of a place pose to be a threat to the people in the particular area.

Smoking prevalence

Prevalence of smoking is the percentage of men and women ages 15 and over who currently
smoke any tobacco product on a daily or non-daily basis. It excludes smokeless tobacco use.
It is the most common form of tobacco use and the prevalence of smoking is, therefore, a
good measure of the tobacco epidemic. One-in-five (20%) adults in the world smoke tobacco.
Many studies have assessed the increase in the risk of death associated with cigarette
smoking, and smoking is thought to have a direct causal role in diseases such as respiratory
disease, coronary heart disease, stroke, and lung cancer leading to a negative effect on life
expectancy.

3.2 Data and Descriptive Statistics

The purpose of this paper is to evaluate the socio-economic variables that affect life
expectancy across the world. National entities are the units of our analysis . For each national
entity, we collected data on life expectancy at birth for the year 2011. The primary source of

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our data has been the OurWorldinData Database. IBM SPSS and Stata were used to
perform the data

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 analysis. The descriptive statistics of our study showed that the life expectancy of the
countries averaged 73.5 (sd = 7.855) and the median value was 75.07. Healthcare expenditure
was highest in Sierra Leone (12% of GDP) and minimum in Congo at just 3% of GDP.
Similarly, data for other variables was analysed. It sought to explore the relationship between
selected independent variables and life expectancy. To achieve the main objective of the
study, binary logistic regression was performed on selected six independent variables to
assess their impact on the likelihood that entities would fall into higher life expectancy
category, the predicted outcome variable.

Table 1 Summary statistics for the variables

Statistics
Health_GDP% GDP AL_D% Obese% LR% Smoking% Life_exp
.
N Valid 72 72 72 72 72 69 72
Missing 0 0 0 0 0 3 0
Mean 7.39 20579.4 2.00 18.48 90.06 25.07 73.45
4
Median 7.06 17130.2 1.76 19.80 98.05 26.40 75.07
7
Mode 3a 802a 0a 18 99 24a 80
Std. Deviation 2.320 17143.6 1.150 5.968 16.968 10.356 7.855
49
Variance 5.385 2.939E8 1.324 35.617 287.91 107.251 61.701
5
Skewness .056 1.430 1.487 -1.023 -2.219 -.162 -1.239
Std. Error of Skewness .283 .283 .283 .283 .283 .289 .283
Kurtosis -.826 3.101 1.897 .575 4.118 -.462 1.103
Std. Error of Kurtosis .559 .559 .559 .559 .559 .570 .559
Minimum 3 802 0 3 29 2 50
Maximum 12 92005 5 29 100 48 83
a. Multiple modes exist. The smallest value is shown
Source: Author’s calculations done using IBM SPSS

3.3 Logistic Regression Analysis

Logistic regression, also called a logit model, is the appropriate regression analysis to conduct
when the dependent variable is dichotomous (binary). Like all regression analyses, logistic
regression is a predictive analysis. Logistic regression is used to describe data and to explain

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the relationship between one dependent binary variable and one or more nominal, ordinal,
interval or ratio-level independent variables. Our dependent variable (life expectancy) is a
dichotomous variable coded as:

0 - life expectancy below 75

1 - life expectancy above 75

From Table 1, after finding descriptive statistics, we have chosen 75 as the threshold value
because it is the median value of Life Expectancy(ages). Extreme values (outliers) do not
affect the median as strongly as they do the mean.
The six predictor variables were healthcare expenditure as a percentage of GDP, alcohol use
disorder, literacy rate, GDP per capita, the share of the adult obese population, the share of
the population who smoke.
The logistic model is written in terms of the odds of an event occurring, defined as the ratio of
the probability that an event will occur to the probability that it will not. Factors with values
greater than one indicate that the odds are increased, and those with values less than one
indicate that the odds are decreased.

3.4 Interpretation

Of the six independent variables available to the regression solution, only three bear a
statistically significant relationship to the prediction of a country lying in the higher life
expectancy category. These coefficients indicate the change of the log odds of higher life
expectancy at a unit increase in the predictor variable.

Health_GDP% = Total Healthcare Expenditure as Share of National GDP by country

GDP_percapita = GDP per capita

AL_D% = Share of population with Alcohol Use Disorder Obese

% = Share of the adult population who are obese

LR% = Literacy rate (percentage of the population over the age of 15 who can read and write)

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 Smoking% = Percentage of the smoking population (15+)

Table 2 Logistic Regression

Life_expectancy Coef. Std. Err. z P>|z| [95% Conf. [95% Conf.

Interval] Interval]
Health_GDP% 0.46768 0.252218 1.85 0.064 -0.0266576 0.9620182
GDP_percapita 0.000241 9.99E-05 2.41 0.016 0.0000454 0.000437
AL_D% -0.90703 0.400934 -2.26 0.024 -1.692841 -0.1212096
Obese% -0.00842 0.09863 -0.09 0.932 -0.2017306 0.1848919
LR% 0.031044 0.04943 0.63 0.53 -0.0658361 0.1279245
Smoking% -0.01881 0.041503 -0.45 0.65 -0.1001521 0.0625355
_cons -7.54411 4.26075 -1.77 0.077 -15.89503 0.8068039
Source: Author’s calculations done using STATA

The coefficient of healthcare expenditure as a percentage of GDP is significant at 10%

confidence level. The coefficient of the variable health care expenditure as a share of GDP
shows that the log odds of life expectancy being higher than 75 increases by 0.46768 as we
increase it by one unit.

GDP per capita is known to have a positive effect on life expectancy only till a certain
threshold according to the existing literature. The coefficient has significant value at 5%
significance level. For a unit increase in GDP per capita, the log odds of life expectancy being
higher than 75 increases by 0.00024.

The coefficient of Literacy Rate has a positive relationship with Life Expectancy. Thus, for a
unit increase in literacy rate, the log odds of life expectancy being higher than 75 are
increased by 0.03104. As discussed above, the literacy rate of a particular area proves to be a
humongous factor in determining the Life Expectancy. Low literacy rate not only points out
the inequalities but also allows us to witness the underlying implications, which most often is
the reason for low Life Expectancy. Low literacy levels ultimately affect the individual’s
standard of living wherein, he/she is unable to maintain his/her own standards regarding their
education, nutrition, healthcare, financial position and conclusively forcing and affecting the
life expectancy.

The coefficient of alcohol use disorder has a negative relationship with life expectancy. For a
unit increase in the share of the population with alcohol use disorder, the log odds of life
15
 expectancy being higher than 75 are reduced by 0.90703. Deaths from alcohol dependence
can occur both directly or indirectly. Indirect deaths from alcohol use disorders can occur
indirectly through suicide. The life expectancy of a country is therefore negatively impacted
by the increase in the population of people with alcohol use disorder in a country.

The share of the obese population influences life expectancy, obese people having fewer
chances to live longer. For a unit increase in obesity, the log odds of life expectancy being
higher than 75 decreases by 0.0084. Adults with extreme obesity have increased risks of
dying at a young age from cancer and many other causes including heart disease, stroke,
diabetes, and kidney and liver diseases, thus leading to a decrease in life expectancy.

Similarly, the percentage of the smoking population has an inverse relationship with life
expectancy. For a unit increase in the smoking population, the log odds of life expectancy
being higher than 75 decreases by 0.0188. Smoking is a major cause of cancers and
cardiovascular and other diseases and consequently increases the risk of death, and therefore
has a negative relationship with life expectancy.

Link Test

Table 3 Linktest

Life_expectancy Coef. Std. Err. z P>|z| [95% Conf. [95% Conf.

Interval] Interval]

_hat 1.0026 .27671 3.62 0.000 .46028 1.5449

_hatsq -.02665 .07686 -0.35 0.729 -.17732 .12400

_cons .05949 .45005 0.13 0.895 -.8225 .94157

Source: Author’s calculations done using STATA

When we built the logit regression model, we assumed that we have included all the relevant
variables and that we have not included any variables that should not be in the model. To
confirm this, we check for any specification errors by performing a link test. The variable
_hat should be a statistically significant predictor since it is the predicted value from the
model. In table 3 we see _hat is significant. Also, _hatsq should not have much predictive
power except

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by chance for our model to be specified correctly. In table 3 we can see _hatsq not being
significant. Thus, we can say that our model is free of specification errors.

4. MORE EMPIRICAL EVIDENCES

4.1 Cluster Analysis

Cluster analysis has been done to better understand the countries chosen and to see if the
logistic regression result is applicable for all the countries. Data used for clustering are the six
socio-economic factors in our model that are taken as independent variables for logistic
regression analysis. In order to group similar countries according to chosen variables, K-
means clustering method is used which groups countries with closest means and 2 clusters
were formed from our data. After studying the clusters, we found Cluster 1 consists of 17
countries that had a very high human development score in the “Human Development Report
2011” by the United Nations. The second cluster comprises of the remaining 52 countries
that have a lower human development score and hence clubbed in a separate group.

While we divided the countries according to the life expectancy of a country, here we see
how countries differ based on the variables chosen.

Table 4 K-means Cluster Analysis

CLUSTER 1 CLUSTER 2
Austria Sweden Algeria Niger Ecuador Turkey
Belgium Switzerland Argentina Pakistan El Salvador Ukraine
Cyprus United Armenia Panama Estonia Uruguay
Kingdom
Denmark Belarus Paraguay Georgia Zimbabwe
Finland Benin Peru Greece Senegal
France Bolivia Poland Guatemala Sierra Leone
Germany Bosnia and Portugal Honduras Slovakia
Herzegovina
Iceland Brazil Romania Hungary Slovenia
Ireland Bulgaria Russia India South Africa
Italy Chad Kyrgyzstan Kazakhstan Tanzania
Luxembourg Chile Lebanon Latvia Thailand
Netherlands Colombia Moldova Lithuania Togo
Norway Congo Mongolia Montenegro Croatia
Spain Costa Rica Czech Dominican
Republic Republic
Source: Author’s calculations done using IBM SPSS

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4.2 Correlations between Life Expectancy and Economic/Social indicators

Table 5 Correlation between Life Expectancy and Independent variables

Variable Life Expectancy Life Expectancy (emerging and
(developed countries) developing countries)
Per Capita GDP -0.009022109 0.713988773

Healthcare Expenditure (% of 0.244448833 0.259340269

GDP)
Literacy rate (% of total -0.204924144 0.735847781
population)
Alcohol Use Disorder (% of total -0.43690664 0.173012867
population)
Share of Adults who are Obese -0.122014035 0.689933976
(% of adult population)

Smoking Prevalence (% of total -0.274066718 0.371337797

population)
Source: Author’s calculations done using IBM SPSS

After the grouping of countries into the two clusters, we label Cluster 1 as Developed
Economies and Cluster 2 as Emerging Economies and check the correlation between Life
expectancy and various socio-economic factors. Looking at developed and emerging
economies separately reveals that not only GDP/life expectancy correlation is a lot stronger in
emerging countries, but also certain other indicators are a lot more important for developing
nations. Expenditure on health was also a lot more important in emerging economies, where
existing healthcare facilities are so basic that every extra dollar poured into the sector can
have a sizeable effect.

Meanwhile, in today’s developed countries, the negative side effects of income growth –
namely its detrimental impact on health after personal affluence reaches a certain level – can
partially outweigh wealth-facilitated improvements. Physical inertia, increased consumption
of automobiles, alcohol, tobacco, sugar and animal fats are all features of Western society
today, mainly because of high per capita income has made such consumption possible. In
particular, smoking, alcohol consumption and obesity are the major risk factors with
biological effects on health and demographic patterns. Studies have shown that on average
smokers experience a higher mortality rate than their similarly aged non-smoking
counterparts, while the obese,
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especially the morbidly obese, experience much greater risk of mortality from cardiovascular
disease and ischemic stroke. While low socioeconomic status (SES) has been associated with
a higher prevalence of obesity and chronic diseases in developed countries, previous studies,
in developing nations, have shown a positive SES-obesity relationship (Kumanyika S.,
Jeffery
R. W., Morabia A., Ritenbaugh C., Antipatis V. J.)

While the relationship between obesity/alcohol/smoking and average life expectancy in the
developed world is not particularly strong at the moment (r = -0.12, -0.43 and -0.27,
respectively), it is statistically significant and increases over time. This is especially evident if
we talk about healthy life expectancy as opposed to overall life expectancy.

5. CONCLUSION AND POLICY IMPLICATIONS

The objective of this study is to find the relationship between a country’s life expectancy at
birth with health care expenditure, GDP per capita, smoking population, literacy rate, obese
population and alcohol use disorder. This study was done for 72 countries across the world
for the year 2011. A binary logistic regression analysis was conducted to predict the chances
of a country’s life expectancy at birth being higher than 75. Health care expenditure had a
positive relationship with life expectancy and is significant at 10% confidence interval. GDP
per capita has a positive and significant relationship with life expectancy whereas the literacy
rate has a positive and insignificant relationship. Alcohol use disorder has a negative and
significant relationship with life expectancy, on the other hand, smoking population and
percentage of obese population has a negative and insignificant relationship with life
expectancy at birth. Next, Cluster analysis allowed us to examine our data and divide the
countries into similar groups, wherein we checked the correlation between the explanatory
variables and life expectancy. Here we saw a different relation for developed versus emerging
economies. While logit told us how life expectancy behaves with respect to the explanatory
variables, cluster and correlation analysis helped us find what exactly should a country do in
order to better the living age of its population.

On the bases of empirical results and discussion for increasing the life expectancy following
policy implications are suggested for the countries. Developed Countries should not follow a
linear approach of increasing life expectancy by augmenting it with increased economic
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activity or GDP. Rather a non-linear path be adopted as after a certain threshold GDP has
been surpassed, life expectancy shows an increase although at a decreasing rate. Next,
disorders like dependence on alcohol and cigarettes that result in various lives being lost,
need to be controlled by focusing on mental health issues. Moreover, such disorders are the
primary cause of suicides. Lastly, we believe emerging economies need to spend more on
health care as this can help them improve their life expectancy significantly.

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