International Population Reports

An Aging World: 2015

International Population Reports

By Wan He, Daniel Goodkind, and Paul Kowal

Issued March 2016

P95/16-1

U.S. Department of Health and Human Services

National Institutes of Health

NATIONAL INSTITUTE ON AGING

Acknowledgments

In Memory of Dr. Richard M. Suzman

The Population Division of the U.S. Census Bureau wishes to express our deep

gratitude and pay tribute to Dr. Richard M. Suzman, director of Division of

Behavioral and Social Research, National Institute on Aging, who passed away

on April 16, 2015. A pioneer and champion for the science of population aging,

Dr. Suzman played a critical role in developing the aging research program in the

Population Division. For over three decades he steadfastly supported numerous

Census Bureau publications focused on population aging trends and demographic,

socioeconomic, and health characteristics of the older populations in the United

States and the world. Enormously popular report series such as 65+ in the United

States and An Aging World are a remarkable testimony to Dr. Suzman¡¯s dedication

to research on population aging which, in his words, is reshaping our world.

This report was prepared by Wan He and Daniel Goodkind of the U.S. Census Bureau,

and Paul Kowal of the World Health Organization's (WHO) SAGE, under the direction

of Loraine A. West, Chief, Demographic and Economic Studies Branch, and general

direction of Glenn Ferri, Assistant Division Chief, International Programs and James

D. Fitzsimmons, former Acting Assistant Division Chief, International Programs Center

for Demographic and Economic Studies, Population Division. Karen Humes, Chief,

Population Division provided overall direction.

The authors wish to give special acknowledgment to the following researchers who

graciously contributed to text boxes that focus on special and frontier research topics

in population aging: Martina Brandt, TU Dortmund University; Robert Cumming,

University of Sydney; Christian Deindl, University of Cologne; Karen I. FredriksenGoldsen, University of Washington; Mary C. McEniry, University of Wisconsin-Madison;

Joel Negin, University of Sydney; and Kirstin N. Sterner, University of Oregon.

Research for and production of this report were supported under an interagency

agreement with the Division of Behavioral and Social Research, National Institute on

Aging (NIA).

The authors are grateful to many people within the Census Bureau who made this publication possible by providing literature and data search, table and graph production, verification, and other general report preparation: Samantha Sterns Cole, Laura M. Heaton,

Mary Beth Kennedy, Robert M. Leddy, Jr., Lisa R. Lollock, Andrea Miles, Iris Poe,

and David Zaslow.

The authors give special thanks to Joshua Comenetz, Population Division, for his

thorough review. Reviewers from NIA provided valuable comments and constructive

suggestions, including: David Bloom, Harvard University; David Canning, Harvard

University; Somnath Chatterji, World Health Organization; Eileen Crimmins, University

of Southern California; Ronald D. Lee, University of California, Los Angeles, Berkeley;

Alyssa Lubet, Harvard University; Angela M. O¡¯Rand, Duke University; John Romley,

University of Southern California; Amanda Sonnega, University of Michigan; and anonymous reviewers from NIA.

Statistical testing review was conducted by James Farber, Demographic Statistical

Methods Division. For cartographic work, the authors thank Steven G. Wilson and

John T. Fitzwater, Population Division.

Christine E. Geter of the Census Bureau¡¯s Public Information Office and Linda Chen

and Faye Brock of the Center for New Media and Promotion provided publication

management, graphics design and composition, and editorial review for print and electronic media. George E. Williams of the Census Bureau's Administrative and Customer

Services Division provided printing management.

An Aging World: 2015

Issued March 2016

P95/16-1

U.S. Department of Commerce

Penny Pritzker,

Secretary

Bruce H. Andrews,

Deputy Secretary

Economics and Statistics Administration

Justin Antonipillai,

Counselor, Delegated Duties of

Under Secretary for Economic Affairs

U.S. CENSUS BUREAU

John H. Thompson,

Director

Suggested Citation

Wan He, Daniel Goodkind, and Paul Kowal

U.S. Census Bureau,

International Population Reports, P95/16-1,

An Aging World: 2015,

U.S. Government Publishing Office,

Washington, DC,

2016.

ECONOMICS

AND STATISTICS

ADMINISTRATION

Economics and Statistics

Administration

Justin Antonipillai,

Counselor, Delegated Duties of

Under Secretary for Economic Affairs

U.S. CENSUS BUREAU

John H. Thompson,

Director

Nancy A. Potok,

Deputy Director and Chief Operating Officer

Enrique Lamas,

Associate Director for Demographic Programs

Karen Humes,

Chief, Population Division

For sale by the Superintendent of Documents, U.S. Government Printing Office

Internet: bookstore. Phone: toll-free 866-512-1800; DC area 202-512-1800

Fax: 202-512-2250 Mail: Stop SSOP, Washington, DC 20402-0001

Contents

Chapter 1. Introduction???????????????????????????????????? 1

Chapter 2. Aging Trends ?????????????????????????????????? 3

Growth of world's older population will continue to outpace that

of younger population over the next 35 years???????????????? 3

Asia leads world regions in speed of aging and size of older

population???????????????????????????????????????????? 6

Africa is exceptionally young in 2015 and will remain so in the

foreseeable future?????????????????????????????????????? 6

World¡¯s oldest countries mostly in Europe today, but some Asian

and Latin American countries are quickly catching up?????????? 9

The two population billionaires, China and India, are on drastically

different paths of aging????????????????????????????????? 10

Some countries will experience a quadrupling of their oldest

population from 2015 to 2050??????????????????????????? 11

U.S. Census Bureau

Chapter 3. The Dynamics of Population Aging???????????????

Total fertility rates have dropped to or under replacement level

in all world regions but Africa ???????????????????????????

Fertility declines in Africa but majority of African countries still

have above replacement level fertility in 2050???????????????

Some countries to experience simultaneous population aging

and population decline?????????????????????????????????

Composition of dependency ratio will continue to shift toward

older dependency?????????????????????????????????????

Median ages for countries range from 15 to near 50 ???????????

Sex ratios at older ages range from less than 50 to over 100?????

15

Chapter 4. Life Expectancy, Health, and Mortality ???????????

Deaths from noncommunicable diseases rising ???????????????

Life expectancy at birth exceeds 80 years in 24 countries while

it is less than 60 years in 28 countries?????????????????????

Living longer from age 65 and age 80???????????????????????

Yes, people are living longer, but how many years will be lived

in good health????????????????????????????????????????

Big impacts, opposite directions? Smoking and obesity ?????????

Change is possible! ?????????????????????????????????????

What doesn¡¯t kill you, makes you . . . possibly unwell???????????

Presence of multiple concurrent conditions increases with age ???

Trend of age-related disability varies by country???????????????

Frailty is a predisabled state???????????????????????????????

The U-shape of subjective well-being by age is not observed

everywhere??????????????????????????????????????????

31

31

Chapter 5. Health Care Systems and Population Aging???????

Increasing focus on universal health care and aging????????????

Health systems in response to aging?????????????????????????

Health system¡¯s response to aging in high-income countries ?????

Health system¡¯s response to aging in low- and middle-income

countries ???????????????????????????????????????????

Healthcare cost for aging populations???????????????????????

Cost is one thing... ?????????????????????????????????????

...Ability to pay is another?????????????????????????????????

Long-term care needs and costs will increase ?????????????????

Quantifying informal care and care at home???????????????????

Other care options: Respite, rehabilitative, palliative, and

end-of-life care ???????????????????????????????????????

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An Aging World: 2015 iii

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