Changing demographics of the elderly in the general population

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Urothelial cancer is likely to affect a more elderly population. The increasing life expectancy in the general population and an increased and more prolonged exposure to urothelial carcinogens could produce a substantial increase in the number of muscle-invasive bladder cancers we will see in the elderly in the future.

The magnitude of this problem could be substantial. During the past century, women in the United States experienced an increase in survival to age 65 from 58% in 1900 to 89% in 1990.6 Survivals to age 85 increased from 26% in 1900 to 55% in 1990. Corresponding figures for men were comparable, albeit approximately 10% lower in each category. In addition, the risk of death at younger ages has decreased such that the proportion of a birth cohort surviving to old age has increased. Thus a growth rate of 1% will permit a doubling of the population in 70 years.7 Both birth rates and death rates have shifted to more stable lower levels, resulting in population ageing and increased longevity.

Since 1900 the population of the United States has tripled from 76 million to 255 million, and persons above the age of 65 now comprise 13% of the population (versus 4% in 1900).6 More than 70% of people now live to be 65 years or older (versus 25% in 1900) and more than 30% live to the age of 80. Of the 65+ population, the number of people 85 years or older has increased from 4% to 10%. Sixty percent of those older than 65 years are female. The ratio of females to males over 85 years is 2.5 : 1.

Between 1900 and 1992, females had a 25% decrease in death rates, while males had a 33% decrease.6 Since 1900, age-adjusted death rates have decreased by 40% in males and by 60% in females. Life expectancy was 48 years for females and 46 years for males in 1900. In 1992 it was 79.5 years for females and 72.5 years for males. Persons reaching age 65 can now expect to live an additional 17 years on average (15 years for men and 19 years for women).

At the same time, there has been a 17% increase in age-adjusted death rates from malignancies, an increase (100-200% in males and over 400% in females) largely due to respiratory cancer death rates and clearly reflecting the timing and development of smoking habits.7 The same may become true of bladder cancer, given its strong association with cigarette-smoking, and may well account for an increasing risk as the population ages, particularly in younger cohorts, unless smoking habits change.

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