4 must read genomics studies from 2019 @ Ageing as a Risk Factor for Disease – Current Biology Volume 22, Issue 17, 11 September 2012, Pages R741-R752 ´´Age is the main risk factor for the prevalent diseases of developed countries: cancer, cardiovascular disease and neurodegeneration.´´ & Article: Population Aging and Cancer: A Cross-National Concern – The Cancer Journal: November-December 2005 – Volume 11 – Issue 6 – p 437-441 @ Article: Population aging. Current issues – Article: Population aging in Brazil: current and future social challenges and consequences & World Population Ageing 2015 @ World Population Ageing 2019 – Highlights @ Links, Article and Images & https://en.wikipedia.org/wiki/Genomics

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Pathol Res Pract. 2012 Jul 15;208(7):377-81. doi: 10.1016/j.prp.2012.04.006. Epub 2012 Jun 8.

The influence of physical activity in the progression of experimental lung cancer in mice

Renato Batista Paceli 1Rodrigo Nunes CalCarlos Henrique Ferreira dos SantosJosé Antonio CordeiroCassiano Merussi NeivaKazuo Kawano NagaminePatrícia Maluf Cury


Impact_Fator-wise_Top100Science_Journals

GRUPO_AF1GROUP AFA1 – Aerobic Physical Activity – Atividade Física Aeróbia – ´´My´´ Dissertation – Faculty of Medicine of Sao Jose do Rio Preto

GRUPO AFAN 1GROUP AFAN1 – Anaerobic Physical ActivityAtividade Física Anaeróbia – ´´My´´ Dissertation – Faculty of Medicine of Sao Jose do Rio Preto

GRUPO_AF2GROUP AFA2 – Aerobic Physical ActivityAtividade Física Aeróbia – ´´My´´ Dissertation – Faculty of Medicine of Sao Jose do Rio Preto

GRUPO AFAN 2GROUP AFAN 2 – Anaerobic Physical ActivityAtividade Física Anaeróbia´´My´´ Dissertation – Faculty of Medicine of Sao Jose do Rio Preto

Slides – mestrado´´My´´ Dissertation – Faculty of Medicine of Sao Jose do Rio Preto

CARCINÓGENO DMBA EM MODELOS EXPERIMENTAIS

DMBA CARCINOGEN IN EXPERIMENTAL MODELS

Avaliação da influência da atividade física aeróbia e anaeróbia na progressão do câncer de pulmão experimental – Summary – Resumo´´My´´ Dissertation Faculty of Medicine of Sao Jose do Rio Preto

https://pubmed.ncbi.nlm.nih.gov/22683274/

Abstract

Lung cancer is one of the most incident neoplasms in the world, representing the main cause of mortality for cancer. Many epidemiologic studies have suggested that physical activity may reduce the risk of lung cancer, other works evaluate the effectiveness of the use of the physical activity in the suppression, remission and reduction of the recurrence of tumors. The aim of this study was to evaluate the effects of aerobic and anaerobic physical activity in the development and the progression of lung cancer. Lung tumors were induced with a dose of 3mg of urethane/kg, in 67 male Balb – C type mice, divided in three groups: group 1_24 mice treated with urethane and without physical activity; group 2_25 mice with urethane and subjected to aerobic swimming free exercise; group 3_18 mice with urethane, subjected to anaerobic swimming exercise with gradual loading 5-20% of body weight. All the animals were sacrificed after 20 weeks, and lung lesions were analyzed. The median number of lesions (nodules and hyperplasia) was 3.0 for group 1, 2.0 for group 2 and 1.5-3 (p=0.052). When comparing only the presence or absence of lesion, there was a decrease in the number of lesions in group 3 as compared with group 1 (p=0.03) but not in relation to group 2. There were no metastases or other changes in other organs. The anaerobic physical activity, but not aerobic, diminishes the incidence of experimental lung tumors.

´´Genomics is an interdisciplinary field of biology focusing on the structure, function, evolution, mapping, and editing of genomes. A genome is an organism’s complete set of DNA, including all of its genes.´´ Genes may direct the production of proteins with the assistance of enzymes and messenger molecules.´´Genomics is an interdisciplinary field of biology focusing on the structure, function, evolution, mapping, and editing of genomes. A genome is an organism’s complete set of DNA, including all of its genes. In contrast to genetics, which refers to the study of individual genes and their roles in inheritance, genomics aims at the collective characterization and quantification of all of an organism’s genes, their interrelations and influence on the organism.[1] Genes may direct the production of proteins with the assistance of enzymes and messenger molecules. ´´

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https://www.ncbi.nlm.nih.gov/pubmed/15688758

https://journals.lww.com/journalppo/Abstract/2005/11000/Population_Aging_and_Cancer__A_Cross_National.2.aspx

https://www.sciencedirect.com/science/article/pii/S0960982212008159

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4 must read genomics studies from 2019

By Katherine Lawless on Wed, Feb 05, 2020 @ 11:02 AM

Top genomics articles blog2019 was a big year for genomics research. Topics like pharmacogenomics, mental health, population studies and multiomics dominated the discussion of most genetic conferences. In this blog, we are highlighting a few genomics research studies from 2019 that we found interesting.

1. Saliva micro-RNA differentiates children with Autism from peers

Many scientists are testing the utility of salivary micro-RNAs with various diseases. Quadrant Biosciences specializes in research of many diseases, including children with Autism. [1]

In March 2019, Hicks et al. published their research on saliva microRNA patterns among children with autism spectrum disorder (ASD) and how salivary microRNA can be used for differentiating children with ASD from peers with typical development (TD) and non-autism development delay (DD). [1]

“Since the multifactorial genetic and environmental risk factors that have been identified in [autism spectrum disorder], it is possible that at least 1 epigenetic mechanism might play a role in ASD pathogenesis. Among these potential mechanisms are microRNA (miRNAs).”[1]

Their study enrolled 443 children between the ages of 2 to 6 years who were in the early stages of diagnosis of Autism. They collected saliva samples from this cohort using an RNA saliva collection kit prototype from DNA Genotek.[1]

(Working with RNA and interested in more information about RNA from saliva? email us at info@dnagenotek.com.)

miRNA and autism: highlighted study results

  • 14 salivary miRNAs were identified with varying levels in children with autism and their peers with TD and DD.
    • 4 miRNAs were distinguished in children with autism
    • A subset of miRNAs were associated with measures of adaptive and autistic behaviours
  • Salivary miRNA differs in children with autism compared to healthy control participants.
  • They found 8 miRNAs associated with social affect and 10 miRNAs associated with restricted/repetitive behaviour in children with autism [1]

The study provides evidence that salivary miRNA could be used to differentiate children with autism from their peers. Salivary miRNA is correlated with autistic behaviours and target pathways that are involved in autism pathogenesis[1]

Related content:

The SPARK project – Fueling the fire on autism research

Could microRNA from saliva be a predictor of concussion symptoms in children?

2. Genes and PTSD in U.S. service members deployed to Iraq and Afghanistan

“Posttraumatic stress disorder (PTSD) is a chronic and debilitating condition with a prevalence of more than 7% in the US population and 12% in the military.”[2]

Through previous studies involving families and twins, there has been an established genetic component in the development of PTSD. Lifetime trauma incidences are the most commonly known contributors of PTSD, however, children whose parents have PTSD have higher rates of development than the general population.[2]

According to Zhang et al. at the Uniformed Services University of Health Science in Bethesda, MD, genetic influences account for 1/3 of the risk of developing PTSD. The range of developing PTSD from a lifetime trauma in the general population is between 40-90%.

In 2004, Binder et al. discovered that those in the general population carrying the FKBP gene have a higher chance of developing adult PTSD if they experience childhood trauma.[3]

Zhang et al. published a paper on Jan 3rd 2020, studying the FKBP5 gene with a high-risk PTSD population: US service members deployed to Iraq and Afghanistan. Even though their paper was published in 2020, we decided to include it in this list since the paper itself was submitted in August 2019. [2]

FKPB5 a risk factor for PTSD

Dr. Ursano and his team collected saliva using Oragene·Discover from 3890 US service members ages 18 to 62 years, who served during the combat operations in Afghanistan and/or Iraq from 2008-2016.[2]

  • Probable PTSD patients were more likely to carry the 4 single nucleotide polymorphisms (SNPs) markers covering the FKPB5 gene
  • The data of combat exposure and trauma history suggest that gene-environment interactions may play a role in PTSD development in the US military population.
    • Service members with different FKBP5 genotypes are affected differently by exposure to the same environmental factors – meaning the gene-environment interactions can result in different phenotypes.
    • The AGCC haplotype carriers have the highest risks of PTSD development.[2]

Related content:

Genetics and post traumatic stress disorder

Saliva DNA enables pharmacogenetic testing for psychiatric medication

3. Genetics of complex behaviour traits in dogs and how they relate to humans

Man’s best friend is as genetically complex as we are. According to scientists like Boyko et al., dogs are a very useful animal model for identifying genetic basis of various phenotypes because of their favourable genetic structure. [4] Complex behaviours in canines are known to have a genetic component which can be useful when gaining insights into genetic mechanisms underlying conditions that are relevant in humans, such as obsessive compulsive disorders (OCD). [5]

Friedrich et al. from the University of Edinburgh, published a study in May 2019 focusing on the genetic structure of complex behaviours traits in German Shepherds and how some of these genes can be linked to humans. They extracted DNA from 768 German Shepherd dogs from saliva using PERFORMAgene (UK cohort) and blood (Swedish cohort). They analysed the influence of genetic factors on behaviour traits.

They found genes that are associated with specific behaviour traits from German Shepherds that also are affiliated with humans. Below are some examples of their findings:[5]

GeneGerman ShepherdHumans
CFA1Separation anxietyTwo genes in that same region (HIVEP2 and AIG2) are affiliated with social behaviours
BRWD1Dog-directed fearAssociated with cognitive function, intelligence and temperament in people with bipolar disorder
B3GALT5Dog-directed fearLinked to suicide attempts and obsessive-compulsive symptoms
ARNTStranger directed interestLinked to the severity of autism

 “Understanding the genetics of dog behaviour and the interaction with non-genetic factors can give general insights into animal and human behaviour and is relevant for animal welfare.” [5]

This study is just one example of the value canine studies have as a resource for studying the genetics of behavioural characteristics.[5]

(If you are interested in learning more about collecting DNA from canines or other animals, click here to request free samples of PERFORMAgene saliva collection kits or email us at info@dnagenotek.com for more information).

Related content:

Podcast: Multiomics methods investigate aging process in man’s best friend

4. Thinness is a heritable genetic trait just like obesity

Have you ever wondered why some people are particularly susceptible to obesity and others to thinness? Approximately 40-70% of the variation in body weight can be attributed to heritable factors. Studies in the past have mostly focused on the genetic characteristics of the body mass index (BMI) of obesity, however, little is known about the genetic characteristics of thinness. [1]

There have been only a few studies that show thinness to be a trait that is at least as stable and heritable as obesity.

In January 2019, Riveros-McKay F et al.  from the University of Bristol, published their research on the genetic architecture of human thinness compared to severe obesity. To-date, they are the newest and largest genome-wide association study GWAS focused on healthy thinness in contrast with severe early-onset obesity. 

“We explored whether the genetic loci influencing thinness are the same as those influencing obesity.”[6]

Thinness vs obesity: how do they compare genetically?

Riveros-McKay et al.  genotyped data for 1,622 thin and healthy individuals (using saliva samples via Oragene·DNA), 1,985 severe childhood onset obesity cases (using whole-blood samples), and 10,433 population-based individuals used as controls (samples taken from the UK Bio-bank).[6]

  • Genotyping results show that healthy thinness is a heritable trait just like obesity
  • Persistent healthy thinness and severe obesity are negatively correlated and share a number of genetic risk loci (likely due to the degree of extremeness of the two cohorts)
    • One gene found to be shared is CEP120 which has been previously associated in other studies with height and weight circumference[6]

Related content:

Obesity, Hypertension and Cardiovascular Risk in Italian Youth

Losing weight – do your genes play a role?

What will genomics research look like in 2020?

Let us know in the comments section about what research topics you found interesting from 2019 and what research trends you think will dominate 2020.

To request free samples of DNA or RNA collection kits, please email us at info@dnagenotek.com.

References

[1] Riveros-McKay F et al. Genetic architecture of human thinness compared to severe obesity. PLOS Genet. 15(1):e1007603.

[2]Zhang L et al. Genetic associations of FKBP5 with PTSD in US service members deployed to Iraq and Afghanistan. J Psych Research. 122: 48-53 (2020).

[3] Binder EB et al. Polymorphisms in FKBP5 are associated with increased recurrence of depressive episodes and rapid response to antidepressive episodes and rapid response to antidepressive treatment. Nat Genet. 36(12):1319-1325 (2004).

[4] Boyko AR et al. The domestic dog: man’s best friend in the genomic era. Genome Biol. 12:216 (2011).

[5] Friedrich J et al. Genetic complex behaviour traits in German Shepherd dogs. Heredity. 123:746-758 (2019).

[6] Riveros-McKay F et al. Genetic architecture of human thinness compared to severe obesity. PLOS Genet. 15(1):e1007603.

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  2. Acknowledgments
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Volume 22, Issue 17, 11 September 2012, Pages R741-R752

Journal home page for Current Biology

ReviewAgeing as a Risk Factor for Disease

Author links open overlay panelTeresaNiccoli1LindaPartridge12Show morehttps://doi.org/10.1016/j.cub.2012.07.024Get rights and contentUnder an Elsevier user licenseopen archive

Age is the main risk factor for the prevalent diseases of developed countries: cancer, cardiovascular disease and neurodegeneration. The ageing process is deleterious for fitness, but can nonetheless evolve as a consequence of the declining force of natural selection at later ages, attributable to extrinsic hazards to survival: ageing can then occur as a side-effect of accumulation of mutations that lower fitness at later ages, or of natural selection in favour of mutations that increase fitness of the young but at the cost of a higher subsequent rate of ageing. Once thought of as an inexorable, complex and lineage-specific process of accumulation of damage, ageing has turned out to be influenced by mechanisms that show strong evolutionary conservation. Lowered activity of the nutrient-sensing insulin/insulin-like growth factor/Target of Rapamycin signalling network can extend healthy lifespan in yeast, multicellular invertebrates, mice and, possibly, humans. Mitochondrial activity can also promote ageing, while genome maintenance and autophagy can protect against it. We discuss the relationship between evolutionarily conserved mechanisms of ageing and disease, and the associated scientific challenges and opportunities.

Main Text

Introduction

Better medical care and living conditions in developed countries have increased both health and life expectancy, from around 50 years in the early 1900s to over 80 at the present time. However, age is the main risk factor for major debilitating and life-threatening conditions, including cancer, cardiovascular disease and neurodegeneration (Figure 1), all of which are therefore increasing in prevalence. Understanding exactly how ageing increases risk of disease is needed to help to tackle this growing problem.

Not long ago, ageing was assumed to be an intractably complex process, resulting from accumulation of multiple forms of damage and pathology in different tissues as a result of failure of cellular maintenance pathways. Evolutionary analysis also tended to confirm the intractability of ageing for experimental analysis or medical intervention. Natural selection acts against ageing, because an organism that does not age would leave more offspring. However, the force of natural selection weakens with age 123 because extrinsic hazards such as disease and accidents means that most individuals do not survive to be old: deleterious mutations with an advanced age of onset, such as those causing Huntington’s disease (HD), can therefore accumulate 12, and natural selection can favour mutants with beneficial effects in youth but at the cost of a subsequently higher rate of ageing (pleiotropy) [4]. Both routes lead to the evolution of ageing as a side effect, rather than a selected trait, and both suggest a complex genetic basis for ageing 35.

Surprisingly, however, mutations in single genes were found to extend healthy lifespan in the nematode worm Caenorhabditis elegans 678. Subsequently, mutations in components of the nutrient-sensing insulin/insulin-like growth factor (IIS)/Target of Rapamycin (TOR) signalling network proved to extend healthy lifespan in the budding yeast Saccharomyces cerevisiaeC. elegans, the fruit fly Drosophila and mice 910. Recent genetic association studies suggest that this network may also play a role in human ageing 111213, implying strong evolutionary conservation. Drugs targeting nutrient-sensing networks, like rapamycin and metformin, can also extend lifespan (see Box 1 for details). These are licensed for human use, raising the possibility of modulating ageing in humans pharmacologically; however, both have side effects, which will need to be minimised when developing long-term treatment regimes to improve health during ageing.Box 1

Drugs extending lifespan.

Rapamycin

Rapamycin inhibits mTOR, and can increase lifespan in worms, flies and mice 49118. By inhibiting mTOR, rapamycin induces autophagy, which is required for lifespan extension in flies, worms and yeast [104]. Other mechanisms of action include inhibition of S6 kinase, essential for its lifespan effect in flies [25], and inhibition of growth and proliferation [45].

Metformin

Metformin is an AMPK activator that can extend lifespan in mice and C. elegans [119]. Multiple mechanisms could be at work. Metformin reduces hyperglycaemia in several ways and boosts insulin sensitivity, which has been associated with mammalian, including human, longevity [28]. For metformin to extend lifespan in C. elegans, AMPK activity and SKN-1/Nrf2 (nuclear factor, erythroid derived 2), an oxidative stress-responsive transcription factor that has itself been linked to ageing [119], are both required. Metformin also inhibits mTOR and boosts mitochondrial function, which could also contribute to its effect on lifespan [120].

Importantly, interventions that prolong lifespan can also decrease morbidity and improve health during ageing 1415. For example, nutrient-sensing mutants in C. elegans are resistant to tumours [16] and IIS mutant mice are resistant to Alzheimer disease (AD) pathology [15]. Rapamycin treatment of AD mouse models can also improve pathology [17] and dietary restriction (DR), the best-studied longevity-promoting intervention 1418, provides a broad spectrum of health benefits (see Box 2 for details). Interestingly, lifespan extension and improvement in pathology don’t always correlate 1519, suggesting that amelioration of pathology may require particular modulations of pathway activity, or alterations within specific cell types.Box 2

Dietary restriction.

Dietary restriction (DR), the best-studied longevity-promoting intervention [18], can increase lifespan in diverse species from yeast to primates [14]. It also provides a broad spectrum of health benefits. DR mice are protected against multiple age-associated diseases, including cancer, diabetes, atherosclerosis, cardiomyopathy, respiratory diseases and neurodegeneration [14]. These health benefits of DR extend to primates: DR rhesus monkeys have reduced incidence of diabetes, cancer, cardiovascular disease, and brain atrophy [14]. Indeed, humans on a DR diet for a limited period of time show a decrease in risk factors associated with coronary heart disease [14], an improvement in glucocorticoid function and increased insulin sensitivity [14]. However, DR does not protect against all disease-related pathology: although it increases lifespan, it does not ameliorate neuronal dysfunction in a Drosophila model of AD [19] and in humans DR does not improve muscle and bone function [121]. Moreover, DR has a detrimental effect on some aspects of immunity; DR mice can show increased susceptibility to infection [14] and impaired wound healing that can be restored upon full feeding [14], indicating that its practice in a real-life environment might have drawbacks.

As well as nutrient-sensing pathways, several other conserved traits, including mitochondrial activity, DNA damage response and telomeres, and autophagy are associated with ageing, and also play a surprisingly prominent role in disease development (Table 1). Deleterious mutations affecting predominantly later ages may play a role in disease aetiology. In addition, processes that are beneficial to the young, for instance because they increase fecundity, may contribute to later disease development, either because the activities that they promote in the young generate damage [20], or because the same activities that were beneficial in youth are harmful to the old; for instance, pathways that promote cell growth and proliferation potentially contribute to cancer [21]. Components of ageing pathways could therefore provide both novel, disease-relevant therapeutic targets, and also candidates for a broad-spectrum, protective effect.

Table 1. Role of ageing pathways in disease.

PathwayEffects on cardiovascular diseaseEffects on neurodegenerationEffects on cancer
IIS/TOR
AMPK
Insulin resistance is associated with diabetes and cardiac dysfunction. Insulin, TOR and AMPK have cardio-protective role. TOR and IIS downregulation can sometimes also be protectiveIncreased signalling might be protective; however, long lived IIS mutants with reduced signalling improve pathologyNegative regulators of IIS and TOR signalling are tumour suppressors
Mitochondrial functionDefective mitochondria lead to cardiomyocyte apoptosis, and cell loss in the heartImpairment in function and morphology is associated and appears to promote pathology, especially in PDmtDNA mutations are oncogenic.
Mitochondria via ROS production can drive malignancy progression
DNA damage response (DDR) and telomeresHigh DNA damage and telomere shortening increase endothelial senescence leading to atherosclerosis; however, telomerase is active in later stages of atherosclerosis. Could also contribute to cell loss in the heartAttempted re-entry into the cell cycle following DNA damage can lead to neuronal cell death in neurodegenerative diseases
Telomere role uncertain
Defects in DDR allow cancer cells to accumulate mutations and grow uncontrollably
Telomere shortening leading to replicative senescence is one of the main breaks on tumour progression
AutophagyDefects in autophagy lead to cardiomyopathy and cardiac hypertrophy. Defects in autophagy also protective for cardiac remodelling following overloadDefects in autophagy lead to accumulation of toxic protein aggregates and defective mitochondria, contributing to pathologyAutophagy is protective to early stages of tumour growth; however, it helps cancer cells spread in later stages

Several conserved mechanisms are implicated in ageing. Some, such as nutrient-sensing pathways and mitochondria, maintain metabolic and energy homeostasis; others, such as DNA repair and autophagy, repair damage. We will focus on a few key examples and consider their role in aetiology of disease, exemplified by cardiovascular disease, neurodegeneration and cancer (Box 3Table 2). Some relationships have been examined in great detail, such as DNA repair and cancer, while others have barely been touched on, like autophagy and cardiovascular disease.Box 3

Diseases of old age.

Cardiovascular disease

Cardiovascular disorders are the leading cause of death in the western world [122]. The term encompasses any disease affecting the heart or the circulatory system, the two most prominent forms being coronary heart disease and stroke. The main common cause of cardiovascular disease is atherosclerosis, caused by the localised accumulation of cholesterol within the walls of arteries, leading to the formation of hard plaques and the narrowing of the arterial lumen and, occasionally, the break-off of a clot. Both can lead to a blockage, cutting-off vital oxygen supply and causing downstream tissue death. In the heart this leads to an acute myocardial infarction (AMI) and in the brain to a stroke.

The other main risk factors for cardiovascular disease are obesity, HDL/LDL ratio, type II diabetes, high blood pressure [62] and, mostly, age (Figure 1). In fact, older people are not only more likely to develop AMI, but also more likely to die from it [62]. This is possibly because even healthy heart function declines with age due to cardiomyocyte loss, decrease in contractility, decrease in stress resistance, cardiac hypertrophy and fibrosis [35].

Neurodegeneration

Neurodegenerative diseases are characterised by the progressive death of neurons and loss of brain structures. There are a number of these disorders, with AD and PD being the most common. Although these conditions can affect different parts of the brain and present with different symptoms (Table 2), age is the main common risk factor. Also in common is the abnormal deposition and mis-localisation of insoluble protein aggregates, associated with progressive, age-related decline in neuronal function.

Exactly how age acts as the chief risk factor for these diseases is not clear. Insoluble, toxic proteins may accumulate with time, and older neurons may be more vulnerable to toxic effects. Abnormalities in protein turnover and processing might also make older neurons less able to degrade toxic proteins.

Cancer

Unlike cardiovascular and neurodegenerative diseases, which are characterized by cellular senescence, apoptosis and decreased mitosis, cancer is characterized by uncontrolled cellular proliferation, where cells become unresponsive to the usual check-points, leading to tumour growth and metastasis.

Age, a family history of disease and an unhealthy lifestyle increase the risk of developing cancer. However, environmental exposure to specific factors, such as tobacco, sunlight, viruses and certain hormones, seems to play a much greater role, which varies with different types of cancer: tobacco for lung cancer, sunlight for melanoma and papillomavirus for cervical cancer, to give some examples.

Why older people are more susceptible to cancer is not totally understood: cells might need time to accumulate enough mutations to become cancerous or older individuals might be more susceptible to oncogenic mutations [123].

Table 2. Characteristics of neurodegenerative disorders.

DiseaseInitial brain area affectedPresentationHistological hallmarksGenetic factors
Alzheimer’s diseaseEntorhinal cortex, spreading to temporal lobe and frontal cortexMemory loss and behavioural disturbancesExtracellular plaques composed of Aß protein and intracellular neurofibrillary tangles composed of Tau proteinAPP, PS1 PS2, ApoE4, PICALM, BIN1, PICALM, CLU, CR1
Parkinson’s diseaseDopaminergic neurons of the substantia nigraResting tremor, postural instability, gait disturbances, bradykinesia and rigidityCytoplasmic inclusion called Lewy bodies containing aggregated alpha synuclein proteinα-synuclein, LRRK2, PINK1, parkin and DJ-1
Huntington’s diseaseGABAergic neurons in striatum and cortexChorea, psychiatric disturbances and cognitive impairmentMutant Htt protein aggregatesHtt
Amyotrophic lateral sclerosisLower motor neurons in the spinal cord and in the brain stem; corticospinal upper motor neurons in the precentral gyrus; and, frequently, prefrontal motor neuronsProgressive muscle weakness, muscular atrophy, spasticity and eventual paralysisCytoplasmic aggregates of SOD1, FUS or TDP-43SOD1, ALS2, FUS/TLS, ALS10, TDP-43

Nutrient-Sensing Pathways

The IIS [22], TOR and AMP kinase (AMPK) signalling cascades sense the nutritional state of the organism and relay this information to cells, which modulate their metabolism accordingly (Figure 2). Nutrient-sensing pathways promote growth during development and contribute to fecundity [23]; however, their down-regulation can increase lifespan in yeast, C. elegans, Drosophila and mice 591015. Genetic variants in a key IIS transcriptional effector, FOXO3A, are also consistently associated with human longevity [12]. Candidate mediators of this effect are reduced cell growth and proliferation at later ages, altered mitochondrial activity and increased cellular detoxification and/or autophagy.

Autophagy is regulated both by AMPK and TOR, and is required for lifespan-extension by rapamycin in flies, worms and yeast 2425. Mitochondrial homeostasis and respiration are enhanced by activation of AMPK [26] and inhibition of TOR [27]. Detox pathway components are up-regulated in IIS mutants in flies, worms and mice, and can extend lifespan in worms and flies [5]. However, the relative contribution of each component is unknown. The mechanisms by which the network contributes to ageing-related disease may be the same as those that cause ageing, or may be to some extent disease-specific.

Cardiovascular

IIS/TOR signalling plays a systemic role in cardiovascular disease, by regulating metabolism, and a cell-autonomous one in cardiac function itself. Insulin regulates sugar and fat metabolism, and facilitates uptake of glucose by insulin-responsive tissues to be stored as fat. The nutritional conditions prevailing in nature and during the early evolution of humans would have led to strong selection for the ability to store calories during periods of food abundance for use during food scarcity. However, the ready availability of food for many modern humans combined with reduced energy expenditure on activities, including exercise, immune response and thermoregulation, can cause excessive food intake and insulin secretion and hence accumulation of visceral fat and insulin resistance, major risk factors for cardiovascular disease 2829. Inhibition of IIS in the fat body of a Drosophila model of high-fat-diet-induced obesity prevents lipid accumulation and protects the heart from pathology [30], underscoring the role of IIS in obesity and disease development.

Obesity triggers insulin resistance through several mechanisms. Adipocytes secrete free fatty acids and adipokines, which can inhibit IIS in peripheral tissues, leading to insulin resistance, hyperglycaemia (because sugar is no longer cleared from the blood) and type II diabetes [29]. Insulin resistance and hyperglycaemia can contribute directly to the formation and progression of atherosclerotic lesions (for details see [31]), a major cause of cardiovascular disease (Box 3). Accordingly, individuals who maintain high insulin sensitivity are less at risk of cardiovascular disease [28]. Strikingly, centenarians maintain high insulin sensitivity [28], whereas genetic variants associated with decreased insulin signalling are associated with insulin resistance and diabetes [31], suggesting systemic IIS pathway activation itself confers protection from cardiovascular disease in the absence of obesity.

TOR also links obesity and heart disease, through several mechanisms [29]. IIS can activate mTORC1, which, via S6K1, phosphorylates and down-regulates Insulin Receptor Substrate 1 (IRS1). Mice null for S6K1 lack this negative feedback and do not develop diet-induced insulin resistance [29]. In a Drosophila model of diet-induced cardiac dysfunction, inhibition of TOR signalling, especially in the heart and fat body, rescues cardiac pathology and increases insulin sensitivity 2732.

Nutrient-sensing pathways also act directly on the heart to influence its function. The heart is insulin-responsive and can develop obesity-induced insulin resistance [33], associated with cardiac remodelling and systolic dysfunction [29]. Both IIS and AMPK activation improve outcome following infarction 33343536. IIS promotes vascular reperfusion and increases glucose availability [33], whereas AMPK stimulates glycolysis and maintains energy homeostasis when oxygen supply decreases 3536, thus protecting the heart from ischaemic damage. However, long-term IIS activation can lead to pathological hypertrophy and heart failure [37] and in Drosophila reducing IIS signalling systemically or specifically in the heart rescues age-related cardiac functional decline [38].

TOR function also seems beneficial: cardiac-specific over-expression of TOR protects against dysfunction following overload [29] and loss of TOR is detrimental. TOR also induces cardiac hypertrophy, which is important in young fit adults in order to increase cardiac output in response to exercise, but in later life TOR-mediated pathological cardiac hypertrophy can lead to heart failure, which can be ameliorated by rapamycin [29], suggesting that quantitative and context-specific modulation of TOR is important.

Nutrient-sensing pathways therefore act in multiple, sometimes opposing, manners to modulate cardiovascular disease development and their effects are context-specific.

Neurodegeneration

Nutrient-sensing pathways act indirectly via cardiovascular disease to affect AD because the risk of AD is related to cardiovascular disease risk profile, and AD may indeed have a strong vascular component [39]. IIS signalling also plays a direct role in neuronal development, maintenance and pathology [40], albeit not a simple one. Reduced IIS specifically in neurons extends lifespan in C. elegansDrosophila and mice [41], and also ameliorates proteotoxicity and neurodegenerative disease in animal models [42]. However, insulin can also be neuroprotective: insulin resistance impairs memory, is a risk factor for AD and exacerbates Aß deposition in mice [43], and AD patients show reduced insulin signalling, associated with increased tau phosphorylation, a hallmark of AD [43]. Knock-out of the Irs2 gene in mice also leads to increased phosphorylation of Tau but, surprisingly, it ameliorates Aß pathology [15], suggesting that insulin signalling might have opposing effects on different aspects of AD aetiology. Acute insulin administration can promote memory in rodents, humans [43] and, possibly, in patients with early AD [44], although the effects on disease development are unknown. Hence, IIS can have both positive and negative effects on neuronal decline, possibly depending on the level or mechanism of pathway alteration.

TOR also plays a complex role in neurodegenerative disease. TOR signalling is enhanced in AD neurons, where it may promote tau-mediated neurodegeneration, but it is reduced in cultured cells exposed to Aß, while the TOR inhibitor RTP801 is elevated in the brains of Parkinson’s disease (PD) patients [45]. Inhibition of TOR with rapamycin ameliorates toxicity in fly and mouse models of PD, HD, AD and amyotrophic lateral sclerosis (ALS) [45], mostly by activating autophagy, but also by decreasing translation and inhibiting apoptosis [45]. Pharmacological inhibition of TOR is hence a possible therapeutic avenue for neurodegenerative disorders.

Cancer

Cancer, unlike cardiovascular disease and neurodegeneration, is characterised by unwanted cell replication rather than cell death (Box 3). Nutrient-sensing pathways generally stimulate growth in response to nutrient availability. Accordingly, hyperinsulinaemia stimulates cell division and can induce cancer [46] and positive regulators of IIS signalling are usually oncogenic whereas negative regulators are tumour suppressors [47]. Mutations extending lifespan in C. elegans, Drosophila and mice can hence also be tumour suppressors [48]. Drugs targeting nutrient-sensing pathways, such as rapamycin derivatives and metformin, are promising anti-cancer treatments in humans. Rapamycin is already in clinical use as a cancer chemotherapeutic [49] and epidemiological analysis has implicated metformin in protection against cancer [50]. Whether down-regulating IIS/TOR signalling affects tumour progression by inhibiting growth or by other mechanisms remains to be clarified. For example, it may boost immunity 1551, because cancer development is promoted in immunodeficient mouse models [52]; however, rapamycin is an immunosuppressant, so this is unlikely to be its mechanism of action.

Cancer cells switch from oxidative phosphorylation, active in post-mitotic, differentiated cells, to aerobic glycolysis, usually active in highly proliferating cells, thus diverting glucose into production of biomass to support the high level of cellular proliferation [53]. Glycolysis also allows cells to proliferate in hypoxic conditions, common in tumours [54]. This switch is regulated by components of nutrient signalling pathways, such as phosphoinositide 3-kinase (PI3K)/Akt [53], TOR [55] and oncogenic Ras [54]. Therefore, inhibiting these pathways could also inhibit this metabolic switch and reduce tumour cell proliferation.

Mitochondria

Mitochondria produce most of the cell’s energy, in the form of ATP, through respiration. As a by-product, reactive oxygen species (ROS) are generated. Until recently, ROS were considered a leading cause of ageing. However, direct experimental evidence for this hypothesis is lacking 5657, because reduced activity of antioxidant enzymes can increase susceptibility to oxidative stress without affecting lifespan [58], while increased protection by over-expression of antioxidant enzymes does not generally increase lifespan 5859, or does so by means other than reduced production of ROS [60].

Mitochondria, however, probably do play an important role in ageing. Transcription of genes encoding mitochondrial proteins declines with age [42], and impaired mitochondrial fission leads to disorganized mitochondrial morphology [61]. Whether these changes are purely a result of age-specific genetic effects or are a consequence of events beneficial earlier in life remains to be seen. Moderately reduced mitochondrial activity can increase lifespan in yeast, worms, flies and mice [10], although the exact mechanisms at work await discovery.

The role of mitochondria in disease development is not well explored, with notable exceptions such as PD. However, evidence is emerging that they have an important role in cardiovascular disease and as a driver for cancer progression.

Cardiovascular

Cardiomyocytes contract constantly, and hence require highly efficient mitochondria to meet their energy demands. Dysfunctional mitochondria accumulate in ageing cardiomyocytes [62], leading to reduced energy production and impaired contractility. Excessive accumulation of defective mitochondria triggers apoptosis, and the resulting cell loss can contribute to heart failure [63]. ROS production from mitochondria can stimulate cellular events, leading to pathological myocardial remodelling and consequent heart failure [64]. A mouse model with increased mitochondrial (mt)DNA mutation rate shows traits characteristic of premature ageing and an enlarged heart [65], suggesting that normal mitochondrial function is important for heart function.

Neurodegeneration

Neurons also have a high oxygen consumption and rely on efficient mitochondria. Indeed, genetic disorders of mitochondria predominantly impair neuronal and muscle function, and occur in many neurodegenerative diseases [66].

Several mutations causing autosomal recessive PD are directly or indirectly involved in mitochondrial metabolism [67]. In particular, PINK1 and Parkin affect mitochondrial morphology and turnover in Drosophila and mouse models [68]. In PD brains, the activity of the mitochondrial electron transport chain (ETC) complex I is often reduced, and exposure to an ETC complex I inhibitor causes PD-like symptoms in both animals and humans [67]. Mitochondria may thus be important in the aetiology of sporadic PD, although the precise mechanisms are an area of current research focus.

In AD, Aß accumulation in mitochondria is associated with reduced activity of ETC complexes III and IV and of COX [67]. Human AD brains and animal and cellular models of AD display defects in mitochondrial transport and morphology, possibly mediated by Drp1, a dynamin-related protein important for mitochondrial fission [67]. Whether these mitochondrial defects are a cause or consequence of AD aetiology remains controversial.

Impairment of mitochondrial function in AD and PD could be caused by mtDNA ROS damage; in both AD and PD, deletions, mutations and fragmentation of mtDNA are observed [67]. This could trigger apoptosis, thus contributing to neurodegeneration [66]. The mitochondria-targeted antioxidant MitoQ prevents loss of spatial memory and early neuropathology in a transgenic AD mouse model [69], indicating a possible causal link between ROS-induced mtDNA damage and neurodegeneration.

Mitochondrial defects also occur in HD, and modulating mitochondrial function can ameliorate the pathological phenotypes of fly [70], and mouse [71] models, suggesting that targeting mitochondrial function could be a viable therapeutic approach, at least in some neurodegenerative disorders.

Cancer

In cancer cells, mtDNA can be highly mutated, and numerous polymorphisms and mtDNA mutations have been linked to increased cancer susceptibility [72], suggesting that mtDNA alterations, like nuclear genomic alterations, play an important role in cancer development.

When cancerous cells up-regulate aerobic glycolysis, mitochondrial activity is reduced. For example, the catalytic subunit of mitochondrial ATP synthase is down-regulated in human carcinomas [73]. The shift to glycolysis also makes the mitochondria more stable and less able to activate apoptosis, thus helping cancer cells to proliferate [73]. Recently, mitochondria have also emerged as a driver of malignant transformation, through ROS production. In early tumours, as mitochondrial activity is impaired, ROS production increases, leading to further mtDNA damage, and decreased mitochondrial function. This vicious circle of increased ROS, mitochondrial and nuclear DNA damage eventually leads to the accumulation of enough oncogenic mutations to allow the tumour to metastasize [54]. Transferring mtDNA from a highly metastatic cell line can make a poorly metastatic cell line highly metastatic, and inhibition of ROS blocks this metastatic potential [74], implicating it in driving cancer progression. Defects in mitochondrial function therefore not only impair tissue function (for example, in neurons and cardiomyocytes) but also, through ROS production, can act as a driver of disease development.

Pathways involved in metabolism and energy homeostasis can clearly have substantial effects on disease development; however, the relationship is not a straightforward one, where interventions that increase lifespan improve pathology across the board. On the contrary, a complex picture emerges, where the activity of these pathways has to be modified in particular ways, to particular extents and in specific tissues to confer protection against disease.

DNA Damage Response Pathway and Telomeres

Both environmental factors, such as UV irradiation and the cell’s own metabolic processes (generating ROS) can lead to DNA damage, which tends to accumulate with time [75]. The DNA damage response (DDR) pathway plays a crucial role in maintaining the integrity of an organism’s DNA, by monitoring and repairing any damage and, if the damage is too extensive, by triggering cellular senescence and apoptosis.

The integrity of chromosome ends is ensured by specific structures called telomeres, replicated by the telomerase complex. In adult cells telomerase is only partially active, and as the organism ages and cells divide, telomeres shorten. Once telomeres become critically short, the DNA damage checkpoint is activated, triggering replicative senescence [76]. This system limits the number of times a cell can divide and is one of the main brakes on tumour development. Mutations in DDR components, such as p53 or Rb (retinoblastoma), lead to cancers in early life [77]. In later life, however, telomere shortening and accumulation of senescent cells may contribute to ageing; an example of ageing occurring as a result of an activity that helps to prevent cancer at younger ages. Telomere shortening reduces the regenerative potential of stem cells [76] and clearance of senescent cells in a mouse model of premature ageing delays ageing-associated pathologies [78]. Moreover, some p53 alleles that confer cancer resistance induce early ageing in both humans and mice [79], suggesting that the earlier cancer-resistance function does indeed, as a side effect, induce ageing.

Defects in the DNA repair and telomerase pathway components in humans and mice can result in premature ageing [80], underscoring their importance in early life. Whether this equates to a causal role in ageing is more controversial [81]. Manipulation of DNA repair and telomere pathways can extend lifespan under certain conditions. Polymorphisms in telomerase reverse transcriptase (hTERT) [12] have been associated with longevity in humans, while increased telomerase activity can increase lifespan in cancer-resistant mice [15]. However, mice have much longer telomeres than humans, and any connection between telomere length and rate of ageing across species is highly complex and does not suggest any simple causal relationship [82].

Over-expression of p53, a powerful tumour suppressor involved in DNA repair, can extend lifespan in Drosophila and mice. However, a reduction of p53 activity is also associated with lifespan extension in C. elegansDrosophila and humans [83]. Moreover, it is unclear whether p53’s role in longevity is due to its interaction with the IIS and TOR pathways [83], or its roles in cellular senescence [75] or DNA repair [83]. Given the varied evidence, more work is needed to clarify the importance of genomic maintenance in ageing. Better established is its role in cancer, and recent evidence points to a role in cardiovascular disease and neurodegeneration (Figure 3).

Cardiovascular

Increased DNA damage and decreased telomere length are associated with atherosclerosis, coronary artery disease and heart failure 8485. The high levels of DNA damage and shortened telomeres in the vascular endothelium are thought to promote cellular senescence, which feeds the inflammatory cycle, leading to plaque deposition 8586. The internal mammary artery, which is protected from atherosclerosis, has longer telomeres than other arteries [87] and increasing telomerase activity can protect from endothelial senescence [87], whereas reducing DDR by mutation of the ataxia telangiectasia mutated (ATM) protein worsens the vascular phenotype of a mouse model of atherosclerosis [84], suggesting that DDR and telomeres play a protective role in atherosclerosis. However, late atherosclerotic lesions induce proliferation of vascular smooth muscle cells, which requires telomerase activity, and mice with shortened telomeres are protected from aortic atherosclerosis [87], suggesting a complex relationship.

DNA damage and short telomeres in ageing cardiomyocytes may lead to cell loss by increasing cellular senescence and apoptosis, and limiting the proliferative potential of cardiac progenitor cells, thus contributing to heart failure 6287. Mutations in DDR genes, including ATM and BRAP2, increase the risk of developing ischaemic heart disease in humans [84]. In mice, short telomeres halve cardiomyocyte numbers and increase heart dysfunction, whereas increased telomerase activity reduces apoptosis and improves function following ischemic injury [87], indicating a protective role for telomeres and DDR in cardiac function.

Neurodegeneration

Post-mitotic neurons are both metabolically active and long-lived, and over the course of a lifetime gradually accumulate DNA damage. This initially compromises the expression of subsets of genes important for neuronal function [88] and eventually triggers cell cycle re-entry, which in neurons leads to apoptosis and neurodegeneration [11]. DNA damage and markers of cell cycle re-entry accumulate in brains of patients with AD or PD and in disease models 1189 and inhibiting cell cycle re-entry blocks apoptosis in these models [90]. Cdk5, p53 and ATM have all been implicated in cell cycle re-entry in both AD and PD, and blocking Cdk5 activation inhibits tau hyperphosphorylation, cell-cycle re-entry, synaptic loss and neuronal death triggered by Aß in mice [90]. Recently, two DNA damage biomarkers, chitinase (chitotriosidase activity) and stathmin protein, were found to be significantly increased in AD and non-AD dementia, although any causal link between these biomarkers, DNA damage and AD development is yet to be demonstrated [91].

Telomerase expression is high in neuronal stem cells and is important for brain development [92]; it decreases in differentiated neurons, but can be reactivated in response to stress, where it may play a protective role, because inhibiting telomerase increases neurons’ susceptibility to apoptosis [93]. The role of telomeres in neurodegeneration is much less clear. Telomere shortening seems to play no role in PD development [94] and, surprisingly, seems to be protective in AD [95]. Further work will be required to clarify mechanisms.

Cancer

The main hallmark of cancer is genomic instability leading to uncontrolled cell proliferation, and most cancer risk factors cause DNA damage. Many DDR components were first identified as tumour suppressors and patients harbouring DDR mutants are highly susceptible to cancer [96]. In cancer cells, DDR pathway components, such as ATM and BRCA1, have to be impaired for a tumour to develop [97], allowing cells to proliferate regardless of their damaged DNA, and without repairing it, which leads to further DNA damage and, eventually, to a highly proliferating and mutagenized cellular population that can escape its local environment and metastasise.

The induction of senescence in response to DNA damage is mediated by well known tumour suppressors such as p53 or Rb1 [98] and limits the proliferative potential of damaged cells, providing the main protection an organism has against cancer. Accordingly, an activated DDR, inducing cellular senescence, has been observed in early, benign lesions with accumulated DNA damage 99100. The importance of p53 has been underscored by two studies showing that re-activation of p53 in tumours leads to their clearance; however, this was at least partly due to induction of an innate immune response that targeted the tumour cells in vivo 101102.

Limiting proliferative potential of useful cells (such as stem cells) could, however, contribute to ageing phenotypes. But p53 can also protect against both cancer and ageing; mice with increased expression of p53 and Arf were resistant to both [103], suggesting that cancer resistance and longevity are not mutually exclusive.

Another mechanism that helps to prevent cancer development is replicative senescence induced by telomere shortening. To overcome this barrier cancer cells either activate telomerase or have found a way to replicate their telomeres in the absence of telomerase [98]. Confirming the role of telomeres, mice with short telomeres are resistant to tumours whereas transgenic mice with increased TERT (the catalytic subunit of telomerase) activity are susceptible to cancers [76]. However, activation of telomerase in cancer-resistant mice does increase lifespan [76], again demonstrating that cancer resistance and longevity can co-exist.

DDR and replicative senescence due to telomere shortening therefore provide an efficient barrier to cancer development throughout life, and would probably have come under selective pressure for this role but, in later life, might also induce cell loss in post-mitotic tissues such as the heart and brain, contributing to cardiovascular disease, neurodegeneration and ageing.

Autophagy

Autophagy allows digestion of cytoplasmic material and organelles by lysosomes [104]. This contributes to cellular maintenance by eliminating and recycling damaged components, and provides biofuel for the cell. Its role in aging has gained prominence in recent years. Autophagy plays a crucial role in youth, since both elevation of and defects in autophagic activity can impair fitness [104]. Expression of the proteins required for autophagy declines in ageing tissues and in age-related disorders [104], and correcting this deficiency in mouse liver can ameliorate age-related phenotypes [104]. The exact reasons for the age-related decline in expression of autophagy genes are unknown. Such defects in gene expression are a more general feature of ageing [105], but why the reduced intensity of natural selection should lead to this outcome is not clear.

Many lifespan-extending interventions require autophagy [104]. For example, rapamycin cannot extend lifespan if autophagy is inhibited [104]. Moreover, in Drosophila, brain-targeted overexpression of Atg8, a component of the autophagy pathway, is sufficient to extend lifespan [104].

Autophagy could promote longevity by a number of mechanisms. It helps to clear toxic proteins and defective mitochondria, it suppresses oncogenic transformation and could help maintain stem cells, boost immune function and possibly regulate insulin homeostasis [104]. Any of these downstream effectors could mediate its lifespan effect, and the exact mechanisms await further clarification.

Its role in disease development is also gaining increasing attention.

Cardiovascular

Autophagy plays an important role in cellular maintenance in the myocardium. During ageing, autophagic flux is slowed, leading to accumulation of damaged and toxic organelles and proteins, which can lead to cardiac dysfunction and heart failure [106]. Patients with mutations in lysosomal associated membrane protein 2 (LAMP2), which is required for lysosome-autophagosome fusion, have defects in autophagy leading to severe cardiomyopathy [106], strongly implicating autophagy in the maintenance of a healthy heart. Experimental models confirm the importance of autophagy, which is induced in response to cardiac injury in a number of animal models [107]. Decreasing autophagy — for example, by decreasing the level of autophagy protein 5 (atg5) — leads to hypertrophy and heart failure in a mouse model [106]. However, decreasing Beclin-1 function reduces autophagy induction and decreases maladaptive cardiac remodelling following overload [106]. This suggests that whereas autophagy is required for myocardial homeostasis, excessive induction following a cardiac insult might be detrimental.

Neurodegeneration

Because autophagy can remove protein aggregates, which are associated with most neurodegenerative diseases (Table 2), it is perhaps unsurprising that it plays a protective role [104]. In AD, PD and HD brains autophagic and lysosomal vesicles accumulate, suggesting a blockage in the autophagy process [108]. The toxic proteins associated with neurodegeneration might directly inhibit autophagy. For instance, human Aß inhibits autophagy in a Drosophila model [109], pathogenic alpha-synuclein can inhibit chaperone-mediated autophagy, and mutation of Htt perturbs ER function leading to an increase in autophagosomes [108]. Genetic or pharmacological enhancement of autophagy can ameliorate phenotypes in a number of neurodegenerative disease models in Drosophila [42] and mice [110], whereas inhibition of autophagy by hyperactivation of TOR [111] or mutants in autophagy itself promote protein aggregation and neurodegeneration in various model organisms 104112.

Autophagy also removes defective mitochondria, especially important in post-mitotic cells such as neurons [104] and PD-associated PINK1 and Parkin selectively target defective mitochondria to autophagic degradation, with defects in these genes resulting in accumulation of defective mitochondria, leading to PD 108113. Autophagy’s protective role in neurodegeneration could therefore also be due to its role in mitochondrial clearance.

Cancer

Oncogenes tend to inhibit and tumour suppressors activate autophagy, suggesting that autophagy needs to be down-regulated for cancer proliferation 98114. However, abrogation of autophagy in mouse models (by atg5 or atg7 deletions) leads to an increase only in benign tumours, suggesting that total lack of autophagy promotes the initial stages of cancer development but prevents tumour metastasis [114].

Partial impairment of autophagy, on the other hand, promotes malignancy: human breast and ovarian cancers often show loss of one copy of the BECN1 gene, which only partly decreases autophagy, and mice heterozygous for BECN1 show an increase in benign and malignant tumours [114]. This could be because once a tumour is established, autophagy becomes re-activated and promotes cancer survival [114]. ROS, hypoxia and nutrient deprivation, all experienced by cancer cells, stimulate autophagy. Also, the initial conditions promoting mutagenesis and allowing cell transformation, such as DNA instability and ROS, would hinder rapid growth. Autophagy re-activation helps reduce damaged organelles and proteins allowing the tumour cells to thrive while providing amino acids and fatty acids to fuel the growth and the metabolic reactions of these highly proliferating cells. A number of cancers, such as Ras-positive ones, show a high level of basal autophagy and its down-regulation impairs cancer cell metabolism and tumour growth [114]. Chemotherapy drug combinations that include autophagy inhibitors have shown promise in pre-clinical trials and animal models 114115. Further studies will be needed to establish the true efficacy of this approach in cancer therapy and whether it is indeed attributable to altered autophagy, rather than some other, as yet unknown, function.

Conclusions

With age, the disease burden increases. Interestingly, the same pathways that modulate longevity affect the development of multiple, age-related pathologies. Ageing as a disease risk factor can be thought of as the accrued effect of a finite number of evolutionarily conserved pathways. These pathways either have been selected for a specific beneficial function in earlier life, for instance DNA repair, and, as a side effect, actively contribute to the ageing process, or come under weakening evolutionary pressure later in life and therefore accumulate mutations with deleterious effects in aged organisms. Interestingly, interventions that extend lifespan in model systems often appear to lead to a broad spectrum improvement in health 915. However, the effect on specific disease models often appears more complex. Conflicting reports in the literature might suggest that the efficacy of a particular intervention is specific to the experimental approach used. The exact molecular component targeted may be important. For example, insulin or IGF1 receptors, usually assumed to be involved in IIS, have a pro-apoptotic function independent of IIS [116], suggesting that some outcomes may be mediated by another, unidentified, role of the particular protein targeted. With these considerations in mind, however, the consistent association between processes involved in ageing and ageing-related disease aetiology suggests that it should be possible to modulate these processes to improve the cellular and systemic environment of older individuals and provide a broad-spectrum health improvement (Figure 4).

This approach is not as far-fetched as it may first appear. Drugs often affect more than one disease, metformin and rapamycin being key examples (Table 3). Lifestyle choices affect multiple diseases: smoking and obesity are risk factors for most ageing disorders and a good cardiovascular risk factor profile reduces the overall mortality risk from any disease [117]. Recent research provides a reason: the same conserved signalling pathways are involved in most if not all diseases of old age. These pathways may have been selected to provide an evolutionary advantage to organisms in situations of limited resources and exposure to numerous pathogens, where few individuals reach old age. In laboratory animals or western society these conditions no longer exist, opening the possibility of re-tuning these pathways to fit new circumstances. Direct manipulation of these pathways therefore could offer a more comprehensive, and possibly cost-effective, way of improving health in later life.

Table 3. Lifespan- and disease-specific effects of rapamycin and metformin.

 RapamycinMetformin
LifespanExtends lifespan in mice, worms and fliesExtends lifespan in mice and worms
CardiovascularDecreases pathological cardiac hypertrophy
Reduces restenosis following stent procedure
Reduces type II diabetes and its associated complications
NeurodegenerationProtects flies and mice models of AD, PD, HD and ALSNo effect on male and harmful in female ALS mice model
CancerUsed therapeutically for renal cell carcinomaReduces incidence of some cancers

Acknowledgments

The authors apologise to all whose work was not cited owing to space constraints, and acknowledge funding by the Wellcome Trust and the Max Planck Society. We thank J. Castillo, F. Kerr and N. Alic, J. Regan and K. Kinghorn for comments on the manuscript.

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Rev Med Chir Soc Med Nat Iasi. 2004 Jan-Mar;108(1):61-5.

[Population aging. Current issues].

[Article in Romanian]Zanoschi G1Iliescu ML.

Author information

1Universitatea de Medicină şi Farmacie Gr.T. Popa Iaşi, Facultatea de Medicină, Disciplina de Sănătate Publică şi Management.

Abstract

The aging process of the population, obviously in developed countries, involves many socio-economic and political changes. This demographic trend is due to the decreasing of birth rate and fertility rate on one hand, and, on the other hand, to the decrease of crude mortality and infant mortality rate. These mean that the rising proportion of the old people is greater cause of concern, because most of these people require considerable support, frequently in institutions, and often at public expense. Taking demographic data and trends as the starting point, the society has to focus on social protection and health policies in order to improve the quality of life for the elderly.PMID: 15688758[Indexed for MEDLINE]

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Revista Brasileira de Geriatria e Gerontologia

On-line version ISSN 1981-2256

Rev. bras. geriatr. gerontol. vol.19 no.3 Rio de Janeiro May/June 2016

http://dx.doi.org/10.1590/1809-98232016019.150140 

ORIGINAL ARTICLES

Population aging in Brazil: current and future social challenges and consequences

Gabriella Morais Duarte Miranda1 

Antonio da Cruz Gouveia Mendes1 

Ana Lucia Andrade da Silva1 

1Fundação Oswaldo Cruz, Centro de Pesquisas Aggeu Magalhães, Departamento de Saúde Coletiva. Recife, Pernambuco, Brasil.


ABSTRACT

Objective:

To analyze the current and future challenges related to the planning of public policies and population aging.

Method:

A case study was conducted using quantitative and qualitative data from secondary data information systems and interviews with actors of social policy and the country’s health.

Results:

In 2010, there were 39 elderly persons for every 100 young people, while in 2040 there will be an estimated 153 elderly persons for every 100 young people. For those interviewed, Brazil is not prepared for the needs generated by such population aging, due to challenges such as the adequacy of the social security and health system. The growing number of elderly persons and increasing morbidity and mortality profiles worsen the heterogeneous epidemiological situation with disease, disability and sequelae that require the health system to be a continuous and multidisciplinary organization. The present study identified a reduction of beds and hospitalizations, which may reflect the improvement of primary care and quality of life, with a complexification of hospitalizations.

Conclusion:

With population aging and a lack of necessary support, society must be aware of the price that it must pay and the state must be prepared to provide specific policies to ensure comprehensive care, recognizing the characteristics of aging and preserving quality of life.

Key words: Transition; Demographic Aging; Public Policies

RESUMO

Objetivo:

Analisar os desafios atuais e futuros relacionados ao planejamento das políticas públicas e ao envelhecimento populacional.

Método:

Foi realizado um estudo de caso utilizando dados quantitativos e qualitativos por meio de dados secundários dos sistemas de informações e entrevistas com atores da política social e de saúde do país.

Resultados:

Em 2010, existiam 39 idosos para cada grupo de 100 jovens, em 2040, estima-se 153 idosos para cada 100 jovens. Para os entrevistados, o país não está preparado para as necessidades geradas por esse envelhecimento populacional, tendo como desafios as adequações da previdência social e sistema de saúde. O crescimento do número de idosos, seu perfil de morbidade e mortalidade agrava o heterogêneo quadro epidemiológico com doenças, incapacidades e sequelas que exigem do sistema de saúde uma organização contínua e multidisciplinar. O estudo demonstrou uma redução dos leitos e das internações, o que pode ser reflexo da melhoria da atenção básica e qualidade de vida, com uma complexificação das internações.

Conclusão:

Com o envelhecimento populacional e a carência de suporte necessário, a sociedade deve estar consciente do preço que terá de pagar e o Estado deve estar preparado para prover políticas específicas que assegurem uma atenção integral, reconhecendo as características do envelhecimento e consagrando a qualidade de vida.

Palavras-chave: Demográfica; Envelhecimento da População; Políticas Públicas

INTRODUCTION

From 1970 onwards, the demographic profile of Brazil transformed from a mostly rural and traditional society with large families and a high infant mortality rate to a mostly urban society with fewer children and a new structure in Brazilian families.1 From a predominantly young population in the not so distant past, today an increasingly significant number of people aged 60 or older can be observed.2

Demographic transition begins with a fall in mortality rates which is soon followed by falling birth rates, resulting in significant changes in the age structure of the population.3

These changes have occurred rapidly, requiring a quick and appropriate response that cannot take place without the intervention of the State through the establishment and implementation of fundamental public policies.4

Projections indicate that by 2050 “the Brazilian population will be 253 million, the fifth largest population in the world, smaller only than India, China, USA and Indonesia”. This will be only 40 years after 2005, when the country’s total fertility rate reached 2.1 children per woman (the level that represents sustainable zero population growth) and the true period of zero growth of the Brazilian population.5

Population aging increases health problems which in turn put pressure on healthcare and social security systems. Getting older does not necessarily mean becoming sick. Unless there are associated illnesses, aging is associated with a good level of health. Moreover, advances in the fields of health and technology allow people with access to adequate public or private services to have a better quality of life at this stage of life. In addition, it is essential to invest in preventive actions throughout the course of life due to their potential to “solve the challenges of today and, increasingly, those of tomorrow”.6

It is for this reason that countries are increasingly seeking to understand the process of population aging and searching for alternatives to “keep their elderly citizens socially and economically integrated and independent”.6 This is because the growing presence of elderly people in society imposes the challenge of including population aging in public policies and implementing actions of prevention and care to target their needs, thereby supporting a network with the capacity to offer services and actions of social protection.7

The proposal of the present study was to analyze the current and future challenges related to the planning of public policies and population aging, in a context of demographic transition and transformation of the demographic profile in the decades to come.

METHOD

A case study on population aging and its relation with the planning and formulation of public policies was carried out.

To characterize the scenario, secondary data from the main information systems in Brazil was utilized. To analyze the planning of public policies in the context of these transformations, eight people occupying relevant positions in social politics, health management and the legislative authorities were interviewed (a former national Health Minister, former secretaries of the Ministry of Health, and former state and municipal secretaries of health) in addition to intellectuals and planners from the area of health.

This study is an excerpt from a doctoral thesis on Public Health, which, as selection criteria to select participants, chose participants who had built their reputations in defense of the right to health, and who had been included in the political context and the organization of the country’s health system since its inception.

In addition to the population data, three demographic indicators relating to the period 1920-2040 were analyzed. Data on population, life expectancy at birth, the dependency ratio and the aging index were calculated based on the estimates and censuses conducted by the Instituto Brasileiro de Geografia e Estatística – IBGE (Brazilian Institute of Geography and Statistics).

For the dependency ratio and aging index, calculations proposed by the Rede Interagencial de Informações para a Saúde (Interagency Network of Information for Health)8 were used, considering the ratio between the number of people age 60 or above for every 100 people under 15 years of age and the ratio between the age segment of the population defined as economically dependent (people under 15 years of age and those aged 60 or more) and the potentially productive age segment (between 15 and 59 years of age), respectively.

According to the Interagency Network,8 it is common for the calculation of these indexes to consider elderly people as those aged 65 and over and the potentially productive to be between 15 and 64 years of age. However, to maintain consistency with the other indicators and to comply with the National Policy for the Elderly (Law no. 8842, of January 4, 1994), the parameters of 60 and over for the elderly population and 15 to 59 years of age for the potentially productive population were utilized.

The information regarding the number of active elderly beneficiaries and the value of benefits, over the period 2002 to 2012, were extracted from the Ministério da Previdência Social (Ministry of Social Security) (MPS). Active benefits were analyzed, meaning those considered by the MPS to actually generate monthly payments to the beneficiary. To analyze the variation of the amounts paid, a calculation of public spending was carried out considering the devaluation of the currency, using the Índice Nacional de Preços ao Consumidor Amplo (National Index of Consumer Prices) (IPCA) from 2012, as a basis for calculation.

For the analysis of morbidity and mortality, standardized rates were calculated per 100,000 elderly people in each year studied. The five main chapters were chosen from the 10ª Revisão da Classificação Internacional de Doenças (10th Revision of the International Classification of Diseases) (CID-10), among the causes of hospitalization and death of the elderly. The technique of direct standardization by age was applied (60 to 69, 70 to 79 and 80 years and over), considering the resident population in the country in 2010 as standard.

The number of hospitalizations was obtained from the total of Autorização de Internação Hospitalar (Hospitalization Authorizations) (AIH) paid and registered in the Sistema de Informações Hospitalares (Hospital Information System) (SIH) of the Sistema Único de Saúde (National Health System) (SUS). The information is only related to hospitalizations in the SUS network and therefore, does not include hospitalizations that occurred in the supplementary system. Average values were calculated by means of the ratio between the amount paid by AIH and the number of hospitalizations, and were updated according to the IPCA (National Index of Consumer Prices) of the year, 2013.

The number of hospital beds available through the SUS (National Health System) only was obtained from the monthly records of the Ministry of Health, and an annual average was calculated from this data. For the years 1998 – 2003, data recorded in the SUS archived records (Cadastro Hospitalar-CH) (Hospital Registry) was used, provided by the IT Department of SUS (Datasus). For the other years of the series, data was acquired from the Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Facilities) (CNES).

To verify the seasonal tendency of the variables, linear trend analysis was used. Simple linear regression models were estimated, defined as Y= α + β year, α being the mean coefficient in the analyzed period and β the mean increment (increase or decrease) in the period. The coefficient of determination R2 indicated the explanation capacity of the model. All decisions were made considering a statistical significance level of 5.0%.

To conduct, carry out and analyze the interviews that took place between June and July of 2015, the seven stages of research proposed by Kvale were applied.9 The content of the interviews was defined based on the conceptual framework of universalization, social control, financing of needs and the decentralization of the SUS (National Health System).

The analysis of each question in the interviews was carried out using the meaning condensation technique, where formulations were constructed based on the responses of each of the respondents, the units of natural meanings are determined based on the content expressed by each subject, the core issues are determined in relation to the natural units and an essential description of the themes identified in the interview is performed, as defined by Kvale.9

The research complied with ethical standards and the databases are public domain, requiring publication of the source of data. In addition, the doctoral thesis project that resulted in this article was submitted to and obtained approval from the Research Ethics Committee of the Aggeu Magalhães Research Center of the Oswaldo Cruz Foundation in Recife, Pernambuco (Registration no: CAAE: 21258713.0.0000.5190).

RESULTS AND DISCUSSION

The elderly population is rising dramatically in Brazil, based on the concept of the World Health Organization which considers a person to be elderly at 60 years of age or older if residing in a developing country. In 1920, life expectancy was only 35.2 years and the elderly accounted for just 4.0% of the total population of the country. With this profile, for every 100 children (0 to 14 years of age), Brazil had approximately 11 elderly people (table 1).

Table 1 Estimate of the Brazilian population and demographic characteristics between the years 1920 and 2040. Recife-PE, 2015. 

Age group19201950198020102040
0 to 4 years4.593.1638.370.88016.423.70013.796.15911.267.417
5 to 9 years4.575.5307.015.52714.773.74114.969.37511.813.256
10 to 14 years3.909.6306.308.56714.263.32217.166.76112.360.437
15 to 19 years4.217.9175.502.31513.575.97116.990.87013.019.512
20 to 24 years2.139.3644.991.13911.513.22017.245.19013.717.223
25 to 29 years2.487.4314.132.2719.442.21717.104.41314.514.616
30 to 39 years3.560.2256.286.05214.039.10929.633.09331.914.624
40 to 49 years2.401.2004.365.35910.377.27424.842.71832.893.266
50 to 59 years1.451.3192.650.3147.250.09418.416.62132.447.959
60 to 69 years800.8661.451.4684.474.51111.349.92925.811.887
70 years or more433.310753.8732.741.5069.240.67028.393.007
Life expectancy at birth35.252.364.773.979.9
Dependency rate89.085.679.655.264.7
Aging index10.610.215.939.3152.9

Source: IBGE (2015).

In 2010 (table 1), with the doubling of life expectancy (almost 74 years of age), 10.8% of the population was 60 years of age or above, gradually increasing the relative proportion of elderly people in the age composition of the country. Associated with this, there is an increase in the aging index and a reduction in the dependency ratio.

Population estimates by the IBGE (Brazilian Institute of Geography and Statistics) indicate that the participation of elderly people will reach approximately 23.8% of the population in the fifth decade of the 21st century. With the number of elderly people increasing in relation to the young, it is estimated that there will be an inversion of the relation between young and old, with 153 elderly people for every 100 people under 15 years of age (table 1).

The transition in birth and mortality rates, from high to low, made major changes in population structure part of the demographic transition debate.2 These changes have occurred quickly, “requiring rapid and adequate adaptations that will not take place without State intervention through fundamental public policies”.4

The country is aging at an alarming pace. Changes in population structure are clear and irreversible. Since the 1940s, the highest rates of population growth have been observed among the elderly.10 This growth of the elderly population generates a series of changes in society, related to the economic sector, the labor market, the health systems and services and family relations.11,12

Contrary to what has occurred in many developed countries, in Brazil, as seen in this text, the aging process has been extremely rapid. In the interviews carried out, it was affirmed that the country is not prepared to meet the needs generated by this aging of the population. According to one of the interviewees, only in recent years has the country directed its efforts to long-term policies, while being faced with emergency demands at the same time.

“In fact, Brazil started to have a vision and a concern for the long term…to plan ahead, following the installation of the Lula government, which on the other hand found itself dealing with a contingency that resulted in an emergency strategy to promote social inclusion […]”. (Interviewee 7)

According to the World Health Organization,13 the aging of the population is one of the greatest triumphs of humanity and yet also one of the major challenges to be faced by society. In the 21st century, aging will increase social and economic demands across the world. However, despite being greatly ignored, the elderly should be considered essential to the structure of societies.

In its report on aging in the 21st century, the United Nations Population Fund14 stressed that although many countries have made substantial progress in adapting their policies and laws, it is necessary to direct more efforts to ensure that older people can reach their potential.

There was consensus among the interviewees that an aging population requires the urgent introduction of policies appropriate to their needs. The growth of the elderly population and increased life expectancy at birth, already discussed, represent major challenges for the country. Some interviewees pointed out, for example, the challenge to be faced by the social security system to adapt to the new demographic reality of Brazil.

“[…] probably we will be called upon to promote major reforms in the structure of the Brazilian state, especially in the area of social security, in relation to health. For the system to better adapt to the process of aging of the population”. (Interviewee 7)

“[…] surely changes will be demanded from society in terms of retirement schemes. Brazil has already implemented some changes and these are objects of great political debates, but surely, you can’t maintain the same social security system created for a society in which life expectancy was 55 years, for a society with a life expectancy of 75 years of age […]”. (Interviewee 2)

The number of elderly grew 40.3% between 2002 and 2012. In the same period, the number of active benefits, with the exception of pensions granted by the Ministry of Welfare, expanded by 55.3%. In current values, the significant increase (p<0.05) represented an expansion of nearly 146.0% in public spending in the period (table 2).

Table 2 Evolution of population, number and updated values of active benefits of Brazilian elderly between 2002 and 2012. Recife-PE, 2015. 

YearElderly People
 PopulationActive benefitsUpdated values (R$)*
200214,887,34810,112,8875.52
200315,050,49210,526,4806.27
200415,212,53211,184,3576.68
200515,581,26011,652,4787.29
200615,769,16912,165,9608.18
200718,204,82912,674,9638.74
200818,761,03913,288,6449.31
200919,428,08613,890,63110.25
201020,590,59914,495,96011.73
201120,742,22615,045,85812.33
201220,889,84915,707,68513.57

*Value updated in billions.

Source: IBGE (2015), Ministry of Social Security (2015).

This scenario of rapid aging has generated considerable pressure on the pension system, which had been organized to meet a demand represented by the increase in official employment and the brevity of the retirement period. The changes that have taken place in the demographic structure, have increased the pressure on social protection systems, mainly due to the fall in the number of the contributing population in relation to the increasing number of those who retire.7

According to Costa et al.15 it is “essential to restructure the pension system in order to ensure its sustainability”, due to the increase of the beneficiary population and the aging and reduction of the workforce.

In 2010, as previously mentioned, there were 20.5 million elderly people in the country, approximately 39 for every 100 young people. It is estimated that in 2040, this number will have doubled, representing 23.8% of the population and a ratio of almost 153 elderly people for every 100 young people. This new demographic reality, with a constantly growing number of elderly people, also requires that the health system has the capacity to respond to current and future demands.

“[…] A population that lives longer and with low quality of life tends to put pressure on the health system by demanding more expensive, more specialized services, and we are not preparing for this”. (Interviewee 1)

“[…] now is the time for the health system to structure itself for this growing demand of the elderly population. […] because you are presented with a growth in the number of degenerative diseases that require coordinated actions by different professionals. So the preparation of the health system as a whole to meet this growing demand is a major challenge”. (Interviewee 3)

In addition, elderly people can acquire disease, disabilities and sequelae that require integrated actions in the health system. As previously analyzed, the results related to morbidity and mortality rates show part of the complex epidemiological profile experienced by Brazilian society (table 3).

Table 3 Morbidity and mortality rates* of elderly Brazilians according to chapters of the CID-10 between 1998 and 2013. Recife-PE, 2015. 

Chapter CID-10Morbidity**Mortality
199820012004200720102013199820012004200720102013
Cardiovascular diseases4,704.54,429.74,437.63,580.53,165.42,995.91,574.31,374.71,471.11,302.91,230.91,231.6
Cancer (tumors)767.7754.41,111.01,124.61,010.81,195.4555.0545.3601.9577.3573.4608.3
Respiratory disease3,639.12,908.82,919.82,198.41,949.61,876.2544.1466.5540.6450.8462.2517.9
Nutritional and metabolic endocrine dis.773.8805.2743.9637.9648.5574.9225.0238.5265.4257.6266.5271.7
External causes632.1653.7728.4693.1732.7852.7107.7100.6113.1104.3114.7123.6

* Standardized rates per 100,000 elderly; ** calculated based on admissions made by SÚS (National Health System).CID-10= 10th Revision of the International Classification of Diseases

Source: Sistema de Informações sobre Mortalidade (Information on Mortality System) / Ministry of Health (2015).

Although they are still the cause of a significant number of hospital morbidities among the elderly in Brazil, a reduction in hospitalizations due to cardiovascular illnesses, respiratory and nutritional and metabolic endocrine diseases can be observed. This decrease may reflect the expansion and improved quality of primary care services in the country. On the other hand, a significant and growing number of hospitalizations due to cancer and external causes was identified, demonstrating the heterogeneous epidemiological scenario of Brazil.

The variation in mortality rates also showed a significant trend (p<0.05), however, only deaths from cardiovascular and respiratory diseases presented a decrease during the study period, with an increase in deaths from cancer, external causes and endocrine and nutritional diseases. This profile represents a major challenge, especially with rapid population aging, as according to Omram,16 in the third stage of the epidemiological transition, the main causes of death are non-communicable chronic diseases such as heart and cerebrovascular diseases and cancers that tend to cause death close to the age believed to be the end of the biological life limit.

According to Schimdt et al.,17 non-communicable chronic diseases are currently the main priority for the health sector in Brazil. The country has introduced significant policies related to preventative actions, but due to the behavior and history of most risk factors, the challenge remains to carry out timely actions and introduce policies to deal with this problem.

Dealing with this complex profile of necessities requires a continuous and multidisciplinary organization of care from the health system, updating the work process, ensuring that health services and actions are carried out that promote the health and well-being of this elderly population on a permanent basis. This is mainly because of the association between the aging population and the increased demand for specialist and high cost care.

Among the elderly, although there are those who are healthy, many others have chronic illnesses and/or disabilities, resulting in an increase in the demand for health care, which due to their needs, is more expensive and specialized. The elderly population requires specific care, often specialized and directed towards the peculiarities that arise from the aging process, without segregating them from the society.1820

One of the types of assistance, hospital care, should therefore be organized to meet the needs generated by this aging population. The analysis of bed usage and hospital admissions presented a significant variation (p<0.05), verifying the tendency of increasing demand for surgical care and a reduction in demand for internal medicine over the years. (table 4).

Table 4 Registered beds and hospitalizations between 1998 and 2013 in SUS*. Recife-PE, 2015.  

Variable199820012004200720102013
Total beds490.4486.5362349.2336.5323.0
ICU beds10.111.113.511.815.818.8
Total admissions12,248.6012,227.2011,953.9011,739.3011,724.8011,520.80
Internal medicine beds147.3146.8103.3108.2105.6105.8
Internal medicine admissions4,216.504,123.103,878.103,806.904,097.104,021.6
Surgical care beds93.195.377.175.876.575.8
Surgical care admissions2,398.702,644.003,021.803,214.303,330.303,455.5

*Beds and admissions per thousand.

Source: Hospital Information System/Ministry of Health (2015); National Register of Health Facilities/Ministry of Health (2015).

The total number of beds and hospital admissions underwent a reduction in the period analyzed. While the total number of beds decreased 34.1% between 1998 and 2013, there was also a decrease of 5.9% in hospital admissions, during a period when there was a population growth of 24.3% (39 million) and 54.3% of the elderly population. The exception was the growth in ICU beds (86.1%) and admissions for surgical care.

In relation to internal medicine, a reduction of 4.6% was registered in the number of admissions and a decrease of 28.2% in the number of beds, although the elderly population increased during this the period. In relation to the number of surgical admissions, there was an increase of 44.1% throughout the period, accompanying the growth of the population, although there was a reduction of 18.6% in the number of beds.

Despite the population growth, especially in the elderly population, the study found a reduction of beds and admissions. This data points to a possible explanation: the reduction of admissions may be related to the improvement in the quality of life of the elderly and consequently, the reduction in the need for hospitalization of this population. One complicating factor, however, is the increase in the average cost of hospitalization (table 5).

Table 5 Characteristics of hospital admissions of elderly Brazilians in SUS between 1998 and 2013. Recife-PE. 2015. 

Variables199820012004200720102013
Admissions2,139,0072,240,4182,324,5732,385,3682,518,0022,664,080
Total value (R$)*845.151,216.571,672.592,019.723,062.433,971.82
Admissions /1,000 elderly168.37152.18152.81131.03122.29120.67
Average updated value (R$)1,027.771,139.921,143.711,180.541,447.801,490.88
Proportion of values paid **22.223.925.426.528.631.6

*Total value (R$) in millions; **proportion of values paid: considered as the proportional relation between the total value paid related to elderly admissions and the total value paid for all SUS admissions.

Source: Hospital Information System/Ministry of Health (2015).

In a study of the health tendencies of the Brazilian elderly population using data from the Pesquisa Nacional por Amostra de Domicílios (National Survey by Sample of Households), Lima-Costa et al.21 identified improvements in some aspects of the health of the elderly, such as the reduction of hospitalizations. For the authors, the results corroborate the expansion of primary care in the country.

In 2013, hospital care for the elderly accounted for 31.6% of public spending on admissions (table 5). Despite the relative increase in the cost of hospital care, it is a small growth, considering the rapid increase in the population, which as seen in this text, can present chronic disease, disability and sequelae that require continuous, specialized and qualified attention and care.

Between 1998 and 2013 there were almost 38 million hospital admissions of elderly people in the SUS, approximately 152 hospitalizations for every group of 1,000 elderly. Despite the absolute growth, a reduction was seen in the number of hospitalizations per thousand elderly persons in this period.

In the assessed period, all the hospitalizations represented a cost of more than R$33 billion to the public health system in the country. In addition, the average cost of admissions increased significantly, demonstrating the expansion of spending and suggesting greater complexity of care. When compared with the first year studied, the average cost of admissions, corrected according to inflation, increased by more than 45.0%.

This greater complexity reinforces the need for greater investment in the health system, as according to interviewee 1, “the manner that the country will deal with this population, from a public health point of view, will depend a lot on additional ‘heavy’ expenditure in the system”.

This scenario demonstrates the need to carry out actions to promote health and the prevention of illness, in order to prevent or delay chronic diseases and disabilities. One interviewee also pointed out the fragility of actions promoting health in the SUS, by recalling the concept of healthy cities and how they could promote the quality of life of the population.

“We don’t have, for example, public health campaigns, or else they are insufficient to strongly encourage the population to adopt healthy life styles, to adhere to healthy public health policies, policies that promote health […] The promotion of health some years ago, seven or eight years ago, was more effective in the context of the health policies of the country than today”. (Interviewee 1)

From the point of view of health policy, it is essential that the health system carries out actions covering all levels of care, considering both the prevention and treatment of chronic diseases that can affect the elderly. Thus, it is necessary that the health model goes beyond biological characteristics and through social determination, considers care in a broader perspective, including all the factors involved in the profile of the health of the elderly.

Preventive actions are effective at any level, even if carried out in the later stages of life. Therefore, “a model of health care for the elderly that intends to be effective and efficient must strengthen all levels of prevention”.11

However, according to Küchemann,10 coverage is still insufficient in relation to services and accommodation for long-term care. There are few spaces that offer full-time care, such as homes or recreation centers and these are restricted to higher socioeconomic sectors, able to afford such services.

This means that to meet the demand generated by this aging population, it is necessary to establish mechanisms to strengthen the model of health care for the elderly, including investing in the workforce and the training of professionals so they will have the skills necessary for the prevention, care and comprehensive health care of the elderly.

“The care of these elderly people depends on human care, health depends on health professionals, education depends on [professionals], and so on, rehabilitation depends on equipment, but also on people. So, we need a policy of appropriate personnel, we need to have adequate performance from these professionals, who are not bureaucrats, not aggressive, but who invest in the autonomy of the elderly […]”. (Interviewee 7)

“For this we have to prioritize the study of Geriatrics, Gerontology in higher education institutions and it is not prioritized. So there is a lot to do, before reality comes and overwhelms us and we are forced to chase after better conditions”. (Interviewee 4)

Queiroz et al.22 recognized that there is a lack of specialized human resources to adequately meet the needs of this population, showing the importance of essential training projects aimed at professionals working in services and care for the elderly.

This deficiency justifies the need for investment in quantitative and qualitative training of professionals able to attend this population. The training of health professionals should consider an overall interdisciplinary approach in an integrated manner with the other practices of the social care network.23

The issue demands urgent attention. According to Wong & Carvalho,24 “investments in human resources training for geriatric and gerontological services take considerable time to show results”.

Rather than being treated as a problem, the increase of human longevity should be a cause for celebration.25 The data demonstrates that Brazil’s demographic transition represents both an achievement and a responsibility for public administration and society. It is essential to make investments that strengthen autonomy and promote healthy lives for elderly people, as well as ensuring adequate care for their needs. In order to do this, it is vital to direct the planning of policies and services. After all, from today onwards, the elderly population will increase until the year 2050.26

The question, therefore, is not related to the interpretation of from what age the health system should intensify its intervention, but what kind of life the health system should protect and wants to protect.27 After all, we should celebrate aging and “the increase in life expectancy is a triumph of development”.28

Studies that utilize secondary data as their source may have limitations due to issues related to data processing. The richness of the discussions was only possible because the data was related to the perception of important social players, who experience the struggle for social justice in their day-to-day lives.

It is important that further studies are carried out to analyze the evolution of socioeconomic conditions and health care, the current demographic transition and the new epidemiological profile and the demands it presents for the country.

CONCLUSION

The challenge of aging must be urgently confronted. The country already has a significant percentage of elderly people, which will increase in the coming years, demanding specialized public services that will reflect the current planning and priorities of public social policies. It is essential, therefore, that these policies have integrated interventions that ensure the necessary care for chronic diseases, but which strengthen the promotion of healthy aging.

The country must, in addition to reorganizing levels of care to meet these necessities, also innovate and use as a base experiences from other countries that have experienced the aging process.

With an aging population and a lower ratio between the active and dependent population, without family networks capable of supporting the elderly and lacking support structures for this population, society must be aware of the price it will have to pay and the increasing cost of care of the elderly population. Moreover, the State should be prepared for the provision of specific policies for the financing of support structures as well as for monitoring its own activities. This will ensure comprehensive care, recognizing the characteristics and specificities of the elderly and consecrating their quality of life. This is the challenge for society and government in the coming decades.

REFERENCES

1. Leone ET, Maia AG, Baltar PE. Mudanças na composição das famílias e impactos sobre a redução da pobreza no Brasil. Econ Soc 2010;19(1):59-77. [ Links ]

2. Vasconcelos AMN, Gomes MMF. Transição demográfica: a experiência brasileira. Epidemiol Serv Saúde 2012;21(4):539-48. [ Links ]

3. Alves JED. A transição demográfica e a janela de oportunidade. São Paulo: Instituto Fernand Braudel de Economia Mundial; 2008. [ Links ]

4. Brito F. A Transição demográfica e as políticas públicas no Brasil: crescimento demográfico, transição da estrutura etária e migrações internacionais [Internet]. Brasília, DF: SAE; 2007 [acesso em 16 abr 2013]. Disponível em: www.sae.gov.br/site/wp-content/uploads/07demografia1.pdf Links ]

5. Brito F. Transição demográfica e desigualdades sociais no Brasil. Rev Bras Estud Popul 2008; 25(1):5-26. [ Links ]

6. Kalache A. O mundo envelhece: é imperativo criar um pacto de solidariedade social. Ciênc Saúde Coletiva 2008;13(4):1107-11. [ Links ]

7. Batista AS, Jaccoud LB, Aquino L,El-Moor PD. Envelhecimento e dependência: desafios para a organização da proteção social. Brasília, DF: MPS, SPPS; 2008. [ Links ]

8. Rede Interagencial de Informação para a Saúde. Indicadores e dados básicos para a Saúde no Brasil (IDB) [Internet]. Brasília, DF: Ministério da Saúde; 2014 [acesso em 20 jun. 2014]. Disponível em: http://tabnet.datasus.gov.br/cgi/idb2012/matriz.htm [ Links ]

9. Kvales S. An introdution to qualitative research interview. Thousand Oaks: SAGE Publications; 1996. [ Links ]

10. Küchemann BA. Envelhecimento populacional, cuidado e cidadania: velhos dilemas e novos desafios. Soc Estado 2012; 27(1):165-80. [ Links ]

11. Veras R. Envelhecimento populacional contemporâneo: demandas, desafios e inovações. Rev Saúde Pública 2009;43(3):548-54. [ Links ]

12. Veras RP, Caldas CP. Promovendo a saúde e a cidadania do idoso: o movimento das universidades da terceira idade. Ciênc Saúde Coletiva 2004;9(2):423-32. [ Links ]

13. Organização Mundial da Saúde. Envelhecimento ativo: uma política de saúde. Brasília, DF: OPAS; 2005. [ Links ]

14. Fundo de população das nações unidas. Resumo Executivo. Envelhecimento no Século XXI: celebração e Desafio. New York; 2012. [ Links ]

15. Costa CKF, Mesquita RA, Porto SS Junior, Massuda EM. Envelhecimento populacional e a necessidade de reforma da saúde pública e da previdência social brasileiras. Econ Rev 2011;19:121-31. [ Links ]

16. Omram AR. The epidemiologic transition: a theory of the epidemiology of population change. Milbank Q 2005; 83(4):731-57. [ Links ]

17. Schimdt MI, Duncan BB, Azeedo e Silva G, Menezes AM, Monteiro CA, Barreto SM, et al. Doenças crônicas não transmissíveis no Brasil: carga e desafios atuais. Lancet 2011;377:61-74. [ Links ]

18. Bergmark A, Parker MG, Thorslund M. Priorities in care and services for elderly people: a path without guidelines? J Med Ethics 2000;26:312-8. [ Links ]

19. Mendes MRSSB, Gusmão JL, Mancussi e Faro AC, Leite RCBO. A situação social do idoso no Brasil: uma breve consideração. Acta Paul Enferm 2005;18:422-6. [ Links ]

20. Ribeiro CDM, Schramm FR. A necessária frugalidade dos idosos. Cad Saúde Pública 2004;20(5):1141-59. [ Links ]

21. Lima- Costa MF, Matos DL, Camargos VP, Macinko J. Tendências em dez anos das condições de saúde de idosos brasileiros: evidências da Pesquisa Nacional por Amostra de Domicílios (1998, 2003, 2008). Ciênc Saúde Coletiva 2011;16:3689-96. [ Links ]

22. Queiroz ZPV, Ruiz CR, Ferreira VM. Reflexões sobre o envelhecimento humano e o futuro: questões de ética, comunicação e educação. Rev Kairós 2009;12:21-37. [ Links ]

23. Motta LB, Aguiar AC. Novas competências profissionais em saúde e o envelhecimento populacional brasileiro: integralidade, interdisciplinaridade e intersetorialidade. Ciênc Saúde Coletiva 2007;12:363-72. [ Links ]

24. Wong LLR, Carvalho JA. O rápido processo de envelhecimento populacional do Brasil: sérios desafios para as políticas públicas. Rev Bras Estud Popul 2006;23:5-26. [ Links ]

25. Lloyd- Sherlock PL, MCKee M, Ebrahim S, Gorman M, Greengross S, PRINCE M, et al. Population ageing and health. Lancet 2012;379:1295-6. [ Links ]

26. Minayo MCS. O envelhecimento da população brasileira e os desafios para o setor saúde. Cad Saúde Pública 2012;28:208-9. [ Links ]

27. Diniz D, Medeiros M. Envelhecimento e alocação de recursos em saúde. Cad Saúde Pública 2004;20:1154-5. [ Links ]

28. Help Page International. Índice Global del Envejecimiento: Resumen [Internet]. Madrid; 2013 [acesso em 18 set. 2014]. Disponível em: http://www.helpage.es/noticias/helpage-international-presenta-el-primer-ndice-global-del-envejecimiento/ [ Links ]

1This article is based on the thesis by the first author entitled: “Health and inequality: challenges for Brazil in a context of demographic and epidemiological transition and social change”, defended in 2014, as part of the Post Graduate Program in Public Health of the Centro de Pesquisas Aggeu Magalhães da Fundação Oswaldo Cruz (the Aggeu Magalhães Research Center of the Oswaldo Cruz Foundation).”

Received: July 03, 2015; Revised: January 14, 2016; Accepted: March 21, 2016

Correspondence Gabriella Morais Duarte Miranda E-mail: gabymduarte@yahoo.com.br

 This is an open-access article distributed under the terms of the Creative Commons Attribution License Rua São Francisco Xavier, 524 – Bloco F
20559-900 Rio de Janeiro – RJ Brasil
Tel.: (55 21) 2334-0168

revistabgg@gmail.com

2015
[report]
World
Population
Ageing
United Nations

ST/ESA/SER.A/390

Department of Economic and Social Affairs
Population Division
World Population Ageing
2015
United Nations • New York, 2015
The Department of Economic and Social Affairs of the United Nations Secretariat is a vital interface between global
policies in the economic, social and environmental spheres and national action. The Department works in three
main interlinked areas: (i) it compiles, generates and analyses a wide range of economic, social and environmental
data and information on which States Members of the United Nations draw to review common problems and take
stock of policy options; (ii) it facilitates the negotiations of Member States in many intergovernmental bodies on
joint courses of action to address ongoing or emerging global challenges; and (iii) it advises interested Governments
on the ways and means of translating policy frameworks developed in United Nations conferences and summits into
programmes at the country level and, through technical assistance, helps build national capacities.
The Population Division of the Department of Economic and Social Affairs provides the international community
with timely and accessible population data and analysis of population trends and development outcomes for all
countries and areas of the world. To this end, the Division undertakes regular studies of population size and
characteristics and of all three components of population change (fertility, mortality and migration). Founded in
1946, the Population Division provides substantive support on population and development issues to the United
Nations General Assembly, the Economic and Social Council and the Commission on Population and Development.
It also leads or participates in various interagency coordination mechanisms of the United Nations system. The
work of the Division also contributes to strengthening the capacity of Member States to monitor population trends
and to address current and emerging population issues.
Notes
The designations employed in this report and the material presented in it do not imply the expression of any opinions
whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory,
city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.
This report is available in electronic format on the Division’s website at http://www.unpopulation.org. For further
information about this report, please contact the Office of the Director, Population Division, Department of
Economic and Social Affairs, United Nations, New York, 10017, USA, by Fax: 1 212 963 2147 or by e-mail at
population@un.org.
Suggested citation:
United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Ageing
2015 (ST/ESA/SER.A/390).
Official symbols of United Nations documents are composed of capital letters combined with numbers, as illustrated
in the above citation.
Cover photo: “Streets of Dhaka: Taming the Future” by Inkiad Hasin, 2011
(https://flickr.com/photos/ragefeast/6117446784/), used under CC BY 2.0, cropped from original
Published by the United Nations
Copyright © United Nations, 2015
All rights reserved
United Nations Department of Economic and Social Affairs ǀ Population Division iii
Preface
In the area of population ageing, the Population Division of the Department of Economic and Social
Affairs of the United Nations Secretariat prepares national, regional and global estimates and projections
of older populations, monitors levels and trends in population ageing and collects and analyses
information on the relationship between population ageing and development. The Population Division
also organizes expert group meetings on various aspects of population ageing.
This report is the fifth in the series World Population Ageing. The first report was released in 2002 in
conjunction with the Second World Assembly on Ageing. The present report, which updates the 2007,
2009 and 2013 editions, provides a description of global trends in population ageing and includes new
features on the socio-economic and health aspects of ageing. This report is accompanied by an interactive
database on the Profiles of Ageing 2015.
This report was prepared by a team led by Jorge Bravo, including Sara Hertog, Yumiko Kamiya and
Mun Sim Lai, who carried out research and drafted chapters. Ivan Prlincevic contributed programming
and data processing and Donna Culpepper provided formatting and editorial support. Barney Cohen and
John Wilmoth provided key guidance and useful comments on the draft report.
The present report has been issued without formal editing. Responsibility for the World Population
Ageing 2015 report rests with the Population Division.
iv World Population Ageing 2015
Explanatory notes
The following symbols have been used in the tables throughout this report:
Two dots (..) indicate that data are not available or are not separately reported.
An em dash (—) indicates that the amount is nil or negligible.
A hyphen (-) indicates that the item is not applicable.
A minus sign () before a figure indicates a decrease.
A point () is used to indicate decimals.
A slash () indicates a crop year or financial year, for example, 2010/15.
Use of a hyphen (-) between dates representing years, for example, 2010-2015, signifies the full period
involved, including the beginning and end years.
Details and percentages in tables do not necessarily add to totals because of rounding.
Reference to “dollars” ($) indicates United States dollars, unless otherwise stated.
The term “billion” signifies a thousand million.

United Nations Department of Economic and Social Affairs ǀ Population Division v
Sources, methods and classifications
Data on demographic trends used in the present report are taken from the 2015 Revision of the official
United Nations world population estimates and projections (United Nations, Department of Economic and
Social Affairs, Population Division, 2015). In addition, data on the levels of older persons’ consumption
and the sources of financing for that consumption are from the National Transfer Accounts database
(2015). Data on labour force participation were obtained from the International Labour Organization
(2015) and data on statutory retirement age from the United States Social Security Administration (2013
and 2014). Data on healthy life expectancy, causes of morbidity and mortality, and burden of disability
were obtained from the World Health Organization (2014).
The population estimates and projections, which are prepared biennially by the Population Division
of the Department of Economic and Social Affairs of the United Nations Secretariat, provide the standard
and consistent set of population figures that are used throughout the United Nations system as the basis
for activities requiring population information. In the 2015 Revision of the World Population Prospects,
standard demographic techniques were used to estimate the population by age and sex, as well as trends in
total fertility, life expectancy at birth, infant mortality and international migration for the years 1950
through 2015, from data available from censuses and post-enumeration surveys; demographic and health
surveys; population and vital registration systems; scientific reports and data collections; and from data
and estimates provided by international agencies. The resulting estimates provided the basis from which
the population projections follow. In the 2015 Revision, the population projections are based on a
probabilistic (Bayesian) method for projecting total fertility and life expectancy at birth. This method is
based on empirical fertility and mortality trends estimated for all countries of the world for the period
1950 to 2015. The present report draws on the medium variant population projections through the year
2050.1
The countries and areas identified as statistical units by the Statistics Division of the United Nations
and covered by the above estimates and projections, are grouped geographically into six regions: Africa;
Asia; Europe; Latin America and the Caribbean; Northern America; and Oceania. The countries are also
summarized, for statistical convenience, into two general groups―more developed and less
developed―on the basis of demographic and socio-economic characteristics. The less developed regions
include all regions of Africa, Asia (excluding Japan), Latin America and the Caribbean, and Oceania
(excluding Australia and New Zealand). The more developed regions include all other regions plus the
three countries excluded from the less developed regions. The group of least developed countries, as
defined by the United Nations General Assembly in its resolutions (59/209, 59/210 and 60/33) in 2015
comprises 48 countries. In addition, the countries are summarized within four groups defined by the
World Bank according to the gross national income (GNI) per capita in 2014: high-income countries are
those with GNI per capita of $12,736 or more; upper-middle income countries are those with GNI per
capita of more than $4,125 but less than $12,736; lower-middle income countries are those with GNI per
capita of more than US$1,045 but less than $4,125; and low-income countries are those with GNI per
capita of $1,045 or less. See Annex II for further detail on composition of the above mentioned groupings.

1
Further information about data sources and methods underlying the estimates and projections of population can be found on the
website of the Population Division at http://esa.un.org/unpd/wpp/.

United Nations Department of Economic and Social Affairs ׀ Population Division vii
Contents Page
Preface …………………………………………………………………………………………………………………….. iii
Explanatory notes ……………………………………………………………………………………………………… iv
Sources, methods and classifications …………………………………………………………………………… v
Chapters
I. INTRODUCTION AND KEY FINDINGS ………………………………………………………………… 1
II. LEVELS AND TRENDS IN POPULATION AGEING …………………………………………………. 9
A. TRENDS IN THE NUMBERS OF OLDER PERSONS …………………………………………….. 9
B. DEMOGRAPHIC CHARACTERISTICS OF THE OLDER POPULATION …………………….. 18
C. TRENDS IN THE PERCENTAGE OF OLDER PERSONS ………………………………………… 23
D. DEPENDENCY AND SUPPORT RATIOS ………………………………………………………….. 34
III. DEMOGRAPHIC DRIVERS OF POPULATION AGEING ……………………………………………… 41
A. FERTILITY AND MORTALITY AS DETERMINANTS OF TRENDS IN THE
NUMBERS OF OLDER PERSONS …………………………………………………………………… 41
B. FERTILITY TRENDS ………………………………………………………………………………….. 46
C. TRENDS IN LIFE EXPECTANCIES AND PROBABILITIES OF SURVIVAL TO OLD AGE 48
D. FERTILITY AND MORTALITY AS DETERMINANTS OF TRENDS IN THE
PERCENTAGE OF OLDER PERSONS ………………………………………………………………. 57
E. INTERNATIONAL MIGRATION AND POPULATION AGEING ……………………………… 61
IV. POPULATION AGEING AND SUSTAINABLE DEVELOPMENT……………………………………. 67
A. AGEING, POVERTY AND ECONOMIC GROWTH ………………………………………………. 67
B. POPULATION AGEING AND SOCIAL PROTECTION …………………………………………… 77
C. POPULATION AGEING AND HEALTH …………………………………………………………….. 90
D. CONCLUSIONS …………………………………………………………………………………………. 99
REFERENCES…………………………………………………………………………. 103

Annexes
I. Glossary of terms related to population ageing …………………………………………………. 111
II. Classification of regions and income groups …………………………………………………….. 115
III. Summary data tables ……………………………………………………………………………………… 122

viii World Population Ageing 2015
Page
Figures
II.1. Population aged 60-79 years and aged 80 years or over by development group,
2000, 2015, 2030 and 2050 …………………………………………………………………………….. 11
II.2. Population aged 60 years or over and aged 80 years or over by region, 1980-2050 … 13
II.3. Population aged 60-79 years and aged 80 years or over by income group, 2000,
2015, 2030 and 2050 ……………………………………………………………………………………… 14
II.4. Projected change in the population aged 60 years or over between 2015 and 2030
versus the level of gross national income per capita in 2014 ……………………………….. 15
II.5. Population aged 60 years or over and aged 80 years or over by country, 2015 ………. 17
II.6. Share of the global older population by age group and sex, 2015 and 2050 …………… 18
II.7. Sex ratios of the population aged 60 years or over and aged 80 years or over for the
world and regions, 2015 and 2050 …………………………………………………………………… 19
II.8. Percentage of oldest-old (aged 80 years or over) among the older population (aged 60
years or over) by region, 1980-2050 ………………………………………………………………… 20
II.9. Percentage change in the population aged 60 years or over between 2000 and 2015 for
the world and regions, by urban/rural area……………………………………………… 21
II.10. Percentage urban by age group and region, 2015 ………………………………………………. 22
II.11. Percentage of population aged 60 years or over and aged 80 years or over residing in
urban areas by region, 2000 and 2015………………………………………………………………. 23
II.12. Increase in world population relative to 2000 by broad age group, 2000-2050 ………. 24
II.13. Global population by broad age group, 1950-2050 …………………………………………….. 25
II.14. Global population by broad age group, 2000, 2015, 2030 and 2050 ……………………. 25
II.15. Percentage aged 60 years or over in 2015 versus gross national income per capita in
2014 ……………………………………………………………………………………………………………. 28
II.16. Percentage aged 60 years or over projected in 2030 versus gross national income per
capita in 2014 ……………………………………………………………………………………………….. 28
II.17. Percentage point change in the proportion aged 60 years or over for the world and
regions, 2000-2015 and 2015-2030 ………………………………………………………………….. 30
II.18. Percentage of the population aged 60 years or over for the world and regions, 1980-
2050 …………………………………………………………………………………………………………….. 31
II.19. Maps of percentage of population aged 60 years or over in 2000, 2015 and 2050 ….. 33
II.20. Total dependency ratio for the world and regions, 1950-2050 …………………………….. 35
II.21. Children and young people aged under 20 years and older persons aged 65 years or
over as a percentage of the global population in the dependent ages, 1950-2100 …… 36
II.22. Average annual change in the economic support ratio, selected countries, 1980-2015
and 2015-2050 ………………………………………………………………………………………………. 38
III.1. Average annual percentage change in the population aged 60 years or over in
2010-2015 and total fertility in 1950-1955 ……………………………………………………….. 42
III.2. Average annual percentage change in the population aged 60 years or over in 2010-
2015 and probability of survival to age 60 among the 1950-1955 birth cohort ………. 43
III.3. Average annual rate of change of the global population aged 60 years or over and
aged 80 years or over, 1980-2050 ……………………………………………………………………. 45
III.4. Total fertility rate for the world and regions, 1950-2050 …………………………………….. 46
III.5. Average annual rate of change of the population aged 60 years or over, by region,
1980-2050 ……………………………………………………………………………………………………. 47
United Nations Department of Economic and Social Affairs ׀ Population Division ix
Page
III.6. Life expectancy at birth for the world and regions, 1950-2050 ……………………………. 49
III.7. Contribution of mortality decline at different ages to improvements in the life
expectancy at birth between 1995-2000 and 2010-2015, for the world and regions .. 49
III.8. Contribution of increased longevity after age 60 to total improvement in the life
expectancy at birth, 1995-2000 to 2010-2015 ……………………………………………………. 51
III.9. Life expectancy at age 60, by sex and region, 1950-2050 …………………………………… 53
III.10. Probabilities of survival to ages 60 and 80 years among the 1950-1955
and 2000-2005 birth cohorts, by sex and region ………………………………………………… 55
III.11. Population age structure in Germany, Brazil and the United Republic of Tanzania,
1950, 2015 and 2050 ……………………………………………………………………………………… 59
III.12. Percentage aged 60 years or over under three fertility projection scenarios, and total
fertility rate (TFR), Japan, Pakistan and Nigeria, 1950-2050 ………………………………. 60
III.13. Distribution of countries according to the policy on immigration and level of concern
about population ageing, 2005 and 2013 …………………………………………………………. 62
IV.1. Poverty rate of older persons versus the poverty rate for the total population, recent
estimates for selected countries ……………………………………………………………………….. 69
IV.2. Levels of consumption per capita among older persons (aged 60 years or over) relative
to the levels of consumption among those aged 30-49 years ……………………………….. 73
IV.3. Components of older persons’ (aged 60 years or over) consumption, by income
group …………………………………………………………………………………………………………… 74
IV.4. Ratio of older persons’ (aged 60 years or over) consumption to that of persons
aged 30-49 years and public transfers as a share of total consumption ………………… 75
IV.5. Economic support ratio and demographic dividends in China, 1950-2050 ……………. 76
IV.6. Labour force participation of persons aged 65 years or over, by sex, 2015 ……………. 79
IV.7. Labour force participation of persons aged 65 years or over, by sex and region,
1990, 2000, 2015 and 2030 ……………………………………………………………………………. 81
IV.8. Distribution of countries according to the statutory retirement age, by sex and region,
2006 and 2015 ………………………………………………………………………………………………. 83
IV.9. Ratio of projected population aged 60 years or over in 2030 to estimated population
aged 60 years or over in 2015 by level of pension coverage in 2010 ……………………. 85
IV.10. Potential support ratio (persons aged 20-64 years per person aged 65 years or over), by
region, 2015, 2030 and 2050 ………………………………………………………………………….. 87
IV.11. Pension expenditure (percentage of GDP) and potential support ratio by the size of the
pension replacement rate for selected countries, 2015 ……………………………………….. 88
IV.12. Life expectancy at birth and healthy life expectancy at birth, by WHO region, 2013.. 92
IV.13. Healthy years of life lost and life expectancy at birth, by country and sex, 2013 ……. 93
IV.14. Changes in the population aged 60 years or over and NCD-related disability (YLDs)
between 2000 and 2012 ………………………………………………………………………………….. 95
IV.15. Years of life lost per capita due to disability and percentage of population aged 60
years of over in 2012 ……………………………………………………………………………………… 96
IV.16. Change in percentage of older persons versus change in health care expenditures per
capita, 2000-2013 ………………………………………………………………………………………….. 99

x World Population Ageing 2015
Tables Page
II.1 Population aged 60 years or over and aged 80 years or over for the world,
development groups, regions and income groups, 2000, 2015, 2030 and 2050 ……… 10
II.2 Percentage aged 60 years or over and aged 80 years or over for the world, development
groups, regions and income groups, 2000, 2015, 2030 and 2050 ………………………… 26
II.3 Ten countries or areas with the most aged populations, 2000, 2015 and 2030 ……….. 29
II.4 Ten countries or areas with the largest percentage point changes in the proportion
of the population aged 60 years or over, 2000-2015 and 2015-2030 ………………….. 32
III.1 Older population size and growth rate, and past fertility and mortality levels for the
world and regions ………………………………………………………………………………………….. 44
III.2 Life expectancy at birth and at age 60, by sex, for the world and regions, 2010-2015 52
III.3 Life expectancy at age 60, by sex , for the world and regions, 1950-1955, 2010-2015
and 2045-2050 ………………………………………………………………………………………………. 54
III.4 Ten leading causes of death of those aged 60 years or over globally, by sex, 2012 … 56
III.5 Countries or areas where international migration is projected to slow population
ageing by at least 1 percentage point by 2030 …………………………………………………… 64
III.6 Countries or areas where international migration is projected to accelerate population
ageing by at least 1 percentage point by 2030 …………………………………………………… 65
IV.1 Ten leading causes of disability globally among persons aged 60 years or over,
by sex, 2012 …………………………………………………………………………………………………. 97
Annex tables
A.III.1. Population aged 60 years or over, percentage of population aged 60 years or
over and median age, 2015, 2030 and 2050 ……………………………………………………. 122
A.III.2. Fertility, life expectancy at birth and at age 60, and healthy life expectancy ………. 127
A.III.3. Dependency and support ratios, pension coverage, labour force participation and
statutory retirement ages ……………………………………………………………………………… 132
A.III.4. Ranking of countries or areas according to the estimated percentage of population
aged 60 years or over, 2000 and 2015 …………………………………………………………… 138
A.III.5. Ranking of countries or areas according to the projected percentage of population
aged 60 years or over, 2030 and 2050 …………………………………………………………… 142
A.III.6. Ranking of countries or areas according to the percentage point change in the
proportion of the population aged 60 years or over, 2000-2015 and 2015-2030 ….. 146
United Nations Department of Economic and Social Affairs ǀ Population Division 1
I. Introduction and key findings
The world’s population is ageing: virtually every country in the world is experiencing growth
in the number and proportion of older persons in their population. Population ageing—the
increasing share of older persons in the population—is poised to become one of the most
significant social transformations of the twenty-first century, with implications for nearly all
sectors of society, including labour and financial markets, the demand for goods and services,
such as housing, transportation and social protection, as well as family structures and intergenerational ties. Preparing for the economic and social shifts associated with an ageing
population is thus essential to ensure progress in development, including towards the
achievement of the goals outlined in the 2030 Agenda for Sustainable Development. Population
ageing is particularly relevant for the goals on poverty eradication, ensuring healthy lives and
well-being at all ages, promoting gender equality and full and productive employment and decent
work for all, reducing inequalities between and within countries, and making cities and human
settlements inclusive, safe, resilient and sustainable. The 2002 Madrid International Plan of
Action on Ageing (MIPAA), adopted during the Second World Assembly on Ageing,
highlighted the need to consider older persons in development planning, emphasizing that older
persons should be able to participate in and benefit equitably from the fruits of development to
advance their health and well-being, and that societies should provide enabling environments for
them to do so. As populations become increasingly aged, it is more important than ever that
governments design innovative policies and public services specifically targeted to older persons,
including those addressing, inter alia, housing, employment, health care, infrastructure and
social protection.
This report details the important changes that are taking place in the age structures of
populations around the world. Chapter II describes recent and projected future levels and trends
in the numbers and share of older persons in the population. It also presents trends in the
demographic characteristics of the older population with respect to age, sex and urban/rural
residence. Chapter III explores the demographic determinants—trends in fertility, mortality and
migration—of changes to the size and age structure of the population. By adopting a historical
perspective, this chapter identifies the major demographic shocks, as well as the more gradual
demographic shifts, that shape current trends in population ageing. Chapter IV discusses the
challenges posed by the growth in the number and share of older persons in the population for
efforts to eradicate poverty and grow economies, to ensure the sustainability of pension systems,
and to promote health and well-being at all ages. The issues highlighted in this chapter
underscore just how critical the concerns of older persons are for progress in implementing the
2030 Agenda. The key findings of each of these chapters are summarized below:
A. LEVELS AND TRENDS IN POPULATION AGEING
According to data from World Population Prospects: the 2015 Revision (United Nations,
2015), the number of older persons—those aged 60 years or over—has increased substantially in
recent years in most countries and regions, and that growth is projected to accelerate in the
coming decades.
2 World Population Ageing 2015
 Between 2015 and 2030, the number of people in the world aged 60 years or over
is projected to grow by 56 per cent, from 901 million to 1.4 billion, and by 2050,
the global population of older persons is projected to more than double its size in
2015, reaching nearly 2.1 billion.
 Globally, the number of people aged 80 years or over, the “oldest-old” persons, is
growing even faster than the number of older persons overall. Projections indicate
that in 2050 the oldest-old will number 434 million, having more than tripled in
number since 2015, when there were 125 million people over age 80.
 Over the next 15 years, the number of older persons is expected to grow fastest in
Latin America and the Caribbean with a projected 71 per cent increase in the
population aged 60 years or over, followed by Asia (66 per cent), Africa (64 per
cent), Oceania (47 per cent), Northern America (41 per cent) and Europe (23 per
cent).
 Globally, during 2010-2015, women outlived men by an average of 4.5 years. As
a result, women accounted for 54 per cent of the global population aged 60 years
or over and 61 per cent of those aged 80 years or over in 2015. In the coming
years, average survival of males is projected to improve and begin to catch up to
that of females so that the sex balance among the oldest-old persons becomes
more even. The proportion of women at age 80 years or over is projected to
decline to 58 per cent in 2050.
 Both improved longevity and the ageing of larger cohorts, including those born
during the post-World War II baby boom, mean that the older population is itself
ageing. The proportion of the world’s older persons who are aged 80 years or over
is projected to rise from 14 per cent in 2015 to more than 20 per cent in 2050.
 The older population is growing faster in urban areas than in rural areas. At the
global level between 2000 and 2015, the number of people aged 60 years or over
increased by 68 per cent in urban areas, compared to a 25 per cent increase in
rural areas. As a result, older persons are increasingly concentrated in urban areas.
In 2015, 58 per cent of the world’s people aged 60 years or over resided in urban
areas, up from 51 per cent in 2000. The oldest-old are even more likely to reside
in urban areas: the proportion of people aged 80 years or over residing in urban
areas increased from 56 per cent in 2000 to 63 per cent in 2015.
Globally, the number of older persons is growing faster than the numbers of people in any
other age group. As a result, the share of older persons in the total population is increasing
virtually everywhere. While population ageing is a global phenomenon, the ageing process is
more advanced in some regions than in others, having begun more than a century ago in
countries that developed earlier, and getting underway only recently in many countries where the
development process has occurred later, including the decline of fertility.
United Nations Department of Economic and Social Affairs ǀ Population Division 3
 In 2015, one in eight people worldwide was aged 60 years or over. By 2030, older
persons are projected to account for one in six people globally. By the middle of
the twenty-first century, one in every five people will be aged 60 years or over.
 By 2030, older persons will outnumber children aged 0-9 years (1.4 billion versus
1.3 billion); by 2050, there will be more people aged 60 years or over than
adolescents and youth aged 10-24 years (2.1 billion versus 2.0 billion).
 The ageing process is most advanced in high-income countries. Japan is home to
the world’s most aged population1
: 33 per cent were aged 60 years or over in

  1. Japan is followed by Germany (28 per cent aged 60 years or over), Italy (28
    per cent) and Finland (27 per cent).
     The pace of world population ageing is accelerating. Projections indicate that the
    proportion aged 60 years or over globally will increase more than 4 percentage
    points over the next 15 years, from 12.3 per cent in 2015 to 16.5 per cent in 2030,
    compared to the 2.3 percentage point increase in the share of older persons that
    occurred between 2000 and 2015.
     By 2030, older persons are expected to account for more than 25 per cent of the
    populations in Europe and in Northern America, 20 per cent in Oceania, 17 per
    cent in Asia and in Latin America and the Caribbean, and 6 per cent in Africa.
     In 2050, 44 per cent of the world’s population will live in relatively aged
    countries, with at least 20 per cent of the population aged 60 years or over, and
    one in four people will live in a country where more than 30 per cent of people
    are above age 60.
     The pace of population ageing in many developing countries today is substantially
    faster than occurred in developed countries in the past. Consequently, today’s
    developing countries must adapt much more quickly to ageing populations and
    often at much lower levels of national income compared to the experience of
    countries that developed much earlier.
    B. DEMOGRAPHIC DRIVERS OF POPULATION AGEING
    Population ageing is in many ways a demographic success story, driven by changes in
    fertility and mortality that are associated with economic and social development. Progress in
    reducing child mortality, improving access to education and employment opportunities,
    advancing gender equality, and promoting reproductive health and access to family planning
    have all contributed to reductions in birth rates. Moreover, advancements in public health and
    medical technologies, along with improvements in living conditions, mean that people are living
    longer and, in many cases, healthier lives than ever before, particularly at advanced ages.

1
Of the 201 countries or areas with at least 90,000 inhabitants in 2015.
4 World Population Ageing 2015
Together, these declines in fertility and increases in longevity are producing substantial shifts in
the population age structure, such that the share of children is shrinking while that of older
persons continues to grow.
 The growth rate of the population of older persons today is a function of the levels
of fertility prevailing some 60 years ago when today’s new cohorts of older
persons were born, together with changes in the likelihood that members of those
birth cohorts survived to older ages. Because fertility rates in the mid-twentieth
century were higher in many parts of Africa, Asia and Latin America and the
Caribbean—above five children per woman, on average—the growth rates of the
older populations in those regions today are significantly faster than in Europe,
where fertility in 1950-1955 had already fallen below three children per woman in
many countries.
 Trends in the growth rate of the population of older persons reveal the powerful
influence of major historical events in shaping the age composition of the
population. The cohorts that entered their 80’s during the late-1990’s are those
who were born during World War I, a time of depressed fertility in many
countries that resulted in smaller birth cohorts. As a result, growth of the global
population aged 80 years or over during 1995-2000 was slow relative to previous
decades and has accelerated more recently as the cohorts born during the post-war
fertility rebound reached their 80s.
 The fertility impact of World War II is evident in population ageing patterns as
well. The growth rate of the global population aged 60 years or over has peaked in
2010-2015 and the rate of growth of the population aged 80 years or over is
projected to peak in 2030-2035, marking the periods during which those born
during the post-war baby boom reach older ages.
 Past and current regional levels of fertility predict the present and future rates of
growth of their older populations. In Asia, the growth rate of the population of
older persons is projected to decline precipitously after 2025, reflecting the rapid
decline in fertility that began in the mid-1960s in that region. In Africa, the pace
of growth of the population aged 60 years or over is projected to accelerate from
just over 3 per cent per year in 2010-2015, reaching nearly 3.9 per cent per year in
2040-2045, reflecting the relatively high fertility rates of the region during the
second half of the twentieth century. The pace of growth of the older population
of Africa projected for the 2040s is faster than any region has experienced since
1950, when the data series begins.
 The immediate cause of population ageing is fertility decline. However, improved
longevity contributes as well, first by eliminating the demographic necessity of
high fertility and second by increasing the number of survivors to older ages. By
2050, life expectancy at birth is projected to surpass 80 years in Europe, Latin
America and the Caribbean, Northern America and Oceania; and it will approach
80 years in Asia and 70 years in Africa.
United Nations Department of Economic and Social Affairs ǀ Population Division 5
 Improvements in survival at age 60 years or over have accounted for half of the
total improvement in life expectancy in Europe, Northern America and Oceania
over the past two decades. Reduced mortality at younger ages was more
influential in improving the life expectancy at birth in Africa, Asia and Latin
America and the Caribbean.
 In 2010-2015, 60-year-old persons globally could expect to live an additional 20.2
years, on average. Across the six regions, life expectancy at age 60 years was
highest in Oceania and Northern America, at 23.7 years and 23.5 years,
respectively, and lowest in Africa, at 16.7 years.
 Among today’s young people, survival to age 80 is expected to be the norm
everywhere but in Africa. Worldwide, 60 per cent of women and 52 per cent of
men born in 2000-2005 are expected to survive to their eightieth birthdays,
compared to less than 40 per cent of the women and men born in 1950-1955.
 While declining fertility and increasing longevity are the key drivers of
population ageing globally, international migration has also contributed to
changing population age structures in some countries and regions. However, in
most countries, international migration is projected to have only small effects on
the pace of population ageing. Between 2015 and 2030, net migration is projected
to slow population ageing by at least 1 percentage point in 24 countries or areas,
and to accelerate population ageing by at least 1 percentage point in 14 countries
or areas.
C. POPULATION AGEING AND SUSTAINABLE DEVELOPMENT
Growth in the numbers and proportions of older persons can be expected to have far reaching
economic, social and political implications. In many countries the number of older persons is
growing faster than the number of people in the traditional working ages, leading many
governments to consider increasing the statutory ages at retirement in an effort to prolong the
labour force participation of older persons and improve the financial sustainability of pension
systems. At the same time, population ageing and growth in the number of persons at very
advanced ages, in particular, puts pressure on health systems, increasing the demand for care,
services and technologies to prevent and treat non-communicable diseases and chronic
conditions associated with old age. Countries can address these and other challenges by
anticipating the coming demographic shifts and enacting policies proactively to adapt to an
ageing population.
Ageing, poverty and economic growth
 In general, poverty rates among older persons tend to mirror fairly closely those
of the population overall, although disparities are evident in some countries and
regions. In many countries where pension systems are not in place or fail to
6 World Population Ageing 2015
provide adequate income, including several in sub-Saharan Africa and in Asia,
older persons are more likely to live in poverty than people at younger ages.
Conversely, in countries with adequate pension systems with broad coverage,
including several in Latin America and in Europe, poverty rates among older
persons are essentially the same as or lower than those of the general population.
 Age patterns of consumption behaviour provide an additional indication of the
level of welfare among older persons. In low-income and middle-income
countries, levels of consumption tend to decline at older ages, indicating that older
persons are faring less well than adults in other age groups in these countries. In
contrast, in many high-income countries, the average levels of consumption
among older persons are higher than among adults in other age groups—by as
much as one third or more in some countries—indicating that older persons are
comparatively well off in these countries.
 Public transfers, particularly for health care, play an important redistributive role
to bolster the levels of consumption among older persons in many high-income
countries. Conversely, in low-income and lower-middle-income countries, older
persons finance most of their health care consumption through out-of-pocket
expenditures. The low levels of public health expenditure in these countries
contribute to a lack of health security and inferior care for older persons.
 Older persons’ welfare is related to the share of consumption financed by public
transfers. In many low-income countries where older persons are less well off
than adults in other age groups, public transfers finance less than 15 per cent of
total old-age consumption, compared to the 30 per cent or more of older persons’
consumption that is financed by public transfers in many high-income countries,
where older persons tend to be better off than adults in other age groups.
 Population ageing need not impede continued economic growth. Countries with
increasing economic support ratios—thus, a rise in the ratio of producers to
consumers in the population—benefit from a “first demographic dividend”. In
societies where investments in human capital and savings accompany low fertility
and increasing longevity motivates people to accumulate assets for old age, the
increased volume of savings can further enhance economic growth, leading to a
“second demographic dividend.” The second dividend is likely to be more
significant in societies that do not rely solely on public or familial transfers to
finance older persons’ consumption, but also promote retirement savings.
Ensuring social protection for older persons and the sustainability of pension systems
 Current demographic trends mean that each successive cohort of older persons
can expect to live longer and possibly also have fewer adult children as potential
sources of support in old age. In 2015, there were 7 people in the traditional
working ages, 20-64 years, for each older person aged 65 years or over in the
world. By 2050, there will be 3.5 working-aged people for each older person in
United Nations Department of Economic and Social Affairs ǀ Population Division 7
the world, and all major regions except Africa are expected to have potential
support ratios of 3.2 or lower.
 Among people aged 65 years or over globally in 2015, 30 per cent of men and 15
per cent of women were active in the labour force. Older men and women in
developing regions were more likely to be active in the labour force than their
peers in the developed regions, due in part to differences in the structure and
availability of pension systems across regions.
 In Europe, Oceania and Northern America, the labour force participation of older
men has increased gradually since 1990, and it is projected to continue to increase
in the future. In contrast, in Asia, Latin America and the Caribbean, and Africa,
the labour force participation of older men has declined steadily. Among older
women, labour force participation has increased since 1990 in all regions.
 In response to recent trends in population ageing, many low-income and middleincome countries have expanded the coverage of their contributory pension
schemes and established non-contributory social pensions. Many high-income
countries have undertaken fiscal consolidation reforms to their pension systems
by raising the statutory pensionable age, reducing benefits or increasing
contribution rates.
 At the global level, nearly half of all people who have reached statutory
pensionable ages do not receive a pension, and for many of those who do receive
a pension, the levels of support may be inadequate. Pension coverage is typically
lower among women than among men owing to their lower rates of attachment to
the labour market, their over-representation in the informal sector, or their work
as self-employed or unpaid family workers. In many countries, the survivor’s
benefits paid through a husband’s contributory pension benefits are the sole
sources of income for older women.
Promoting health and well-being at older ages
 Changes are needed around the globe to continue to adapt health systems to
serve a growing number and proportion of older persons and to maximize health
and well-being at all ages. The World Health Organization emphasizes that these
changes need not imply exorbitant increases in national health budgets, even in
countries with rapidly ageing populations. Indeed, technology-related changes in
health care, growth in personal incomes and cultural norms and attitudes
surrounding end-of-life care are far more influential than shifts in population age
structure in driving increases in health care expenditures.
 Older persons are tremendously diverse with respect to their health and wellbeing. Understanding levels and trends in the prevalence and severity of
disability is key to assessing the implications of ageing for population health. For
the world as a whole in 2013, people lost an average of approximately nine years
8 World Population Ageing 2015
of healthy life due to disability. In general, the number of healthy life years lost
due to disability tends to be greater in countries with a higher life expectancy at
birth. However, people living in countries with longer average lifespans tend to
spend a smaller proportion of their lives with disability compared to countries
where life expectancy is shorter. In Europe, the average nine years of healthy life
lost due to disability in 2013 accounted for just under 12 per cent of the average
76-year lifespan, whereas in Africa the average eight years of healthy life lost
due to disability accounted for nearly 14 per cent of the average 58-year lifespan.
 Whether the growing numbers of older persons are living their later years in
good health is a crucial consideration for policy development. If the added years
of life expectancy are spent with disability, then demographic trends could
portend substantially increased demand for health care. If the onset or severity of
ill health is instead postponed as life expectancy increases, then the pressures
exerted on the health system by a growing population of older persons may be
attenuated. So far, evidence of trends in the health status of older persons is
mostly limited to high-income countries and points to different conclusions
depending on the study or context, making it difficult to draw clear conclusions
about the fundamental questions.
 Given the projected growth of the older population, which will occur in virtually
every country of the world over the coming decades, health systems should
prepare now to address the specific health concerns of older persons. Unipolar
depressive disorders are the leading cause of disability among women aged 60
years or over, followed by hearing loss, back and neck pain, Alzheimer’s disease
and other dementias, and osteoarthritis. Among older men, hearing loss is the
leading cause of disability, followed by back and neck pain, falls, chronic
obstructive pulmonary disease and diabetes mellitus.
As populations continue to grow older during the post-2015 era, it is imperative that
governments design innovative policies specifically targeted to the needs of older persons,
including those addressing housing, employment, health care, social protection and other forms
of intergenerational support. Because the coming demographic shifts are foreseeable with much
clarity over the next few decades, governments are afforded the opportunity to adopt a proactive
approach to align their policies to the evolving needs of an ageing population.
United Nations Department of Economic and Social Affairs ǀ Population Division 9
II. Levels and trends in population ageing
A. TRENDS IN THE NUMBERS OF OLDER PERSONS
The number of older persons in the world has increased substantially in recent years and
that growth is projected to accelerate in the coming decades.
Worldwide, there were 901 million people aged 60 years or over in 2015, an increase of 48
per cent over the 607 million older persons globally in 2000 (table II.1; figure II.1). By 2030, the
number of people in the world aged 60 years or over is projected to grow by 56 per cent, to 1.4
billion, and by 2050, the global population of older persons is projected to more than double its
size in 2015, reaching nearly 2.1 billion.
Globally, the number of people aged 80 years or over, the “oldest-old” persons, is growing
even faster than the number of older persons overall. In 2000, there were 71 million people aged
80 or over worldwide. Since then, the number of oldest-old grew by 77 per cent to 125 million
in 2015, and it is projected to increase by 61 per cent over the next 15 years, reaching nearly 202
million in 2030. Projections indicate that in 2050 the oldest-old will number 434 million
globally, having more than tripled in number since 2015.
Two thirds of the world’s older persons live in the developing regions and their numbers
are growing faster there than in the developed regions.
The more developed regions were home to 38 per cent of the world’s older persons in 2000,
but that percentage fell to 33 per cent in 2015 and is projected to continue to fall, such that, in
2030, 27 per cent of the world’s population aged 60 years or over will reside in the more
developed regions. The growth rate of the older population of the more developed regions is
projected to slow in the coming decades. While the number of people aged 60 years or over in
developed regions grew by 29 per cent between 2000 and 2015, from 231 million to 299 million,
it is projected to grow by 26 per cent over the next 15 years, reaching 375 million in 2030.
In contrast, in the developing regions, the growth of the population aged 60 years or over is
accelerating. The number of older persons in the less developed regions grew from 376 million
in 2000 to 602 million in 2015—an increase of 60 per cent—and it is projected to grow by 71 per
cent between 2015 and 2030, when a projected 1 billion people aged 60 years or over will reside
in the less developed regions. Projections indicate that 1.7 billion people aged 60 years or over—
nearly 80 per cent of the world’s older population—will live in the less developed regions in
2050.
In the recent past, the older population of the least developed countries was growing more
slowly than in the other less developed countries. Between 2000 and 2015, the number of
persons aged 60 years or over in the least developed countries increased by 54 per cent,
compared to 61 per cent in the other less developed countries. However, growth in the number of
older persons is accelerating more quickly in the least developed countries, such that, between
2015 and 2030, the projected 70 per cent increase in the population aged 60 years or over is
10 World Population Ageing 2015
TABLE II.1. POPULATION AGED 60 YEARS OR OVER AND AGED 80 YEARS OR OVER FOR THE WORLD, DEVELOPMENT GROUPS,
REGIONS AND INCOME GROUPS, 2000, 2015, 2030 AND 2050
Persons aged 60 years or over
(millions)
Percentage
change
Distribution of older
persons (percentage)
2000 2015 2030 2050
2000-
2015
2015-
2030 2000 2015 2030 2050
World 607.1 900.9 1402.4 2092.0 48.4 55.7 100.0 100.0 100.0 100.0
Development groups
More developed regions 231.3 298.8 375.2 421.4 29.2 25.6 38.1 33.2 26.8 20.1
Less developed regions 375.7 602.1 1027.2 1670.5 60.3 70.6 61.9 66.8 73.2 79.9
Other less developed countries 341.9 550.1 938.7 1484.9 60.9 70.6 56.3 61.1 66.9 71.0
Least developed countries 33.9 52.1 88.5 185.6 53.8 70.0 5.6 5.8 6.3 8.9
Regions
Africa 42.4 64.4 105.4 220.3 51.9 63.5 7.0 7.2 7.5 10.5
Asia 319.5 508.0 844.5 1293.7 59.0 66.3 52.6 56.4 60.2 61.8
Europe 147.3 176.5 217.2 242.0 19.8 23.1 24.3 19.6 15.5 11.6
Latin America and the Caribbean 42.7 70.9 121.0 200.0 66.1 70.6 7.0 7.9 8.6 9.6
Oceania 4.1 6.5 9.6 13.2 56.2 47.4 0.7 0.7 0.7 0.6
Northern America 51.0 74.6 104.8 122.7 46.4 40.5 8.4 8.3 7.5 5.9
Income groups
High-income countries 230.8 309.7 408.9 483.1 34.2 32.0 38.0 34.4 29.2 23.1
Upper-middle-income countries 195.2 320.2 544.9 800.6 64.0 70.2 32.1 35.5 38.9 38.3
Lower-middle-income countries 159.7 237.5 393.9 692.5 48.8 65.9 26.3 26.4 28.1 33.1
Low-income countries 21.2 33.2 54.0 114.8 56.2 63.0 3.5 3.7 3.9 5.5
Persons aged 80 years or over
(millions)
Percentage
change
Distribution of oldest-old
persons (percentage)
2000 2015 2030 2050
2000-
2015
2015-
2030 2000 2015 2030 2050
World 71.0 125.3 201.8 434.4 76.5 61.1 100.0 100.0 100.0 100.0
Development groups
More developed regions 36.5 59.1 85.2 127.8 61.8 44.1 51.5 47.2 42.2 29.4
Less developed regions 34.4 66.2 116.6 306.7 92.1 76.3 48.5 52.8 57.8 70.6
Other less developed countries 32.0 61.4 108.2 285.9 91.6 76.3 45.1 49.0 53.6 65.8
Least developed countries 2.4 4.8 8.4 20.7 99.2 75.4 3.4 3.8 4.2 4.8
Regions
Africa 3.0 5.7 9.3 22.2 85.7 64.3 4.3 4.5 4.6 5.1
Asia 30.9 60.0 103.7 255.7 94.0 73.0 43.6 47.9 51.4 58.8
Europe 21.2 34.6 46.1 71.0 63.0 33.2 29.9 27.6 22.8 16.4
Latin America and the Caribbean 5.1 10.3 18.7 44.8 101.4 81.4 7.2 8.2 9.3 10.3
Oceania 0.7 1.1 2.0 3.6 69.8 76.8 1.0 0.9 1.0 0.8
Northern America 10.0 13.6 22.0 37.2 36.1 61.7 14.1 10.9 10.9 8.6
Income groups
High-income countries 37.0 60.9 90.9 145.4 64.5 49.3 52.2 48.6 45.0 33.5
Upper-middle-income countries 19.0 37.2 66.6 182.5 96.2 79.0 26.7 29.7 33.0 42.0
Lower-middle-income countries 13.5 24.4 39.3 94.8 80.9 61.1 19.0 19.5 19.5 21.8
Low-income countries 1.5 2.7 4.9 11.3 83.6 80.9 2.1 2.2 2.4 2.6
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
United Nations Department of Economic and Social Affairs ǀ Population Division 11
nearly identical to that projected in the other less developed countries (71 per cent). Despite such
rapid growth however, the least developed countries collectively are projected to account for just
6.3 per cent of the global population aged 60 years or over in 2030 and 8.9 per cent in 2050, up
from 5.8 per cent in 2015.
Figure II.1.
Population aged 60-79 years and aged 80 years or over by development group, 2000, 2015, 2030 and 2050
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
In 2050, two out of every three oldest-old persons will live in developing regions.
The cohorts born during World War II will enter their 80s during 2015-2030. Because
fertility was depressed during the war, resulting in smaller birth cohorts, the population aged 80
years or over is projected to grow more slowly over the coming 15 years than over the previous
15 years.2
In the more developed regions, the number of oldest-old persons grew by 62 per cent
over the previous 15-year period, from 37 million in 2000 to 59 million in 2015, but it is
projected to grow by 44 per cent over the next 15 years, reaching 85 million in 2030. The
number of oldest-old persons residing in the less developed regions in 2000, 34 million, was very
similar to the number in the more developed regions. However, the population aged 80 years or
over is growing faster in the less developed regions than in the more developed regions: it
increased by more than 92 per cent between 2000 and 2015 and is projected to grow further by
76 per cent between 2015 and 2030. Consequently, the world’s oldest-old persons are
increasingly concentrated in the developing regions, from 49 per cent in 2000 to 53 per cent in
2015, and that proportion is projected to rise further to 58 per cent in 2030 and to 71 per cent in
2050.
The number of oldest-old persons in the least developed countries nearly doubled between
2000 and 2015, from 2.4 million to 4.8 million persons aged 80 years or over, and their number

2
See chapter III for a discussion of the historical drivers of trends in the size of the older population.
0
500
1000
1500
2000
2000 2015 2030 2050 2000 2015 2030 2050 2000 2015 2030 2050 2000 2015 2030 2050
World More developed regions Less developed regions Least developed
countries
Population (millions)
80 or over
60-79
12 World Population Ageing 2015
is projected to continue to grow, albeit at a somewhat slower pace than in the past, reaching 8.4
million in 2030. In 2015, the least developed countries were home to 3.8 per cent of the global
population aged 80 years or over, and by 2050 their share of the world’s oldest-old persons is
projected to rise to 4.8 per cent.
Over the next 15 years, the number of older persons is expected to grow fastest in Latin
America and the Caribbean with a projected 71 per cent increase in the population aged 60
years or over, followed by Asia (66 per cent) and Africa (64 per cent).
With 508 million people aged 60 years or over in 2015, Asia was home to 56 per cent of the
global older population, and, in 2030, Asia’s share of the world’s older persons is projected to
increase to 60 per cent when a projected 845 million people aged 60 years or over will reside in
the region (table II.1; figure II.2). According to projections, by 2030, Asia will be home to more
than half of the world’s oldest-old persons as well, up from 48 per cent in 2015. Moreover,
projections indicate that in 2050, nearly 62 per cent of people aged 60 years or over and 59 per
cent of people aged 80 years or over will reside in Asia.
Latin America and the Caribbean’s 71 million older persons in 2015 accounted for 7.9 per
cent of the global total. The share of the world’s older persons residing in this region is expected
to grow to 8.6 per cent in 2030, when a projected 121 million people aged 60 years or over will
live there. Africa was home to a relatively small number of people aged 60 years or over, with 64
million in 2015, representing 7.2 per cent of the global total. In 2030, Africa’s projected 105
million older persons could account for 7.5 per cent of the older population worldwide.
Latin America and the Caribbean is expected to see the fastest growth in the number of
oldest-old persons as well, with an increase of 81 per cent between 2015 and 2030, which is a
legacy of high fertility rates some 80 years prior, as well as increased longevity. The region is
followed by Oceania, with a 77 per cent projected increase in the number of oldest-old over the
same period, Asia (73 per cent) and Africa (64 per cent).
Europe and Northern America are projected to see substantial increases in the numbers of
older persons, but growth will be slower there than in the other regions.
The share of the world’s older persons residing in Europe and Northern America is expected
to decline. In 2000, Europe’s 147 million people aged 60 years or over accounted for close to
one in four older persons globally and while their numbers grew to 177 million in 2015, their
share of the world’s older population fell to just under 20 per cent. Europe’s older persons are
projected to grow in number to 217 million in 2030, representing a 23 per cent increase over
2015, but given that this growth is slower than in the other regions, the share of the world’s older
persons residing in Europe in 2030 is projected to fall below 16 per cent. By 2050, the projected
242 million older persons in Europe would account for just 12 per cent of the global population
aged 60 years or over.
In a trend similar to Europe’s, the number of people aged 60 years or over in Northern
America has grown from 51 million in 2000 to 75 million in 2015 and is projected to rise further
to 105 million in 2030 and 123 million in 2050, while the share of the world’s older persons
United Nations Department of Economic and Social Affairs ǀ Population Division 13
residing in Northern America is projected to decline from 8.3 per cent in 2015 to 7.5 per cent in
2030 and to 5.9 per cent in 2050.
Figure II.2.
Population aged 60 years or over and aged 80 years or over, by region, 1980-2050

Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
From 2000 to 2015, the number of oldest-old persons in Europe grew much faster than the
overall number of older persons (63 per cent versus 20 per cent), but the rate of increase of the
population aged 80 years or over is projected to slow in the coming years, growing by 33 per
cent between 2015 and 2030, compared to 23 per cent for the overall population aged 60 years or
over. Again, these trends are highly influenced by excess mortality and reduced fertility during
World War II, when the coming cohorts of oldest-old persons were born. In contrast, the growth
in the number of people aged 80 years or over in Northern America is projected to accelerate: the
population of oldest-old persons grew by 36 per cent between 2000 and 2015, from 10 million to
13.6 million and it is projected to rise by 62 per cent between 2015 and 2030, when a projected
22 million people aged 80 years or over will reside in Northern America.
Growth in the number of older persons was fastest in upper-middle-income countries
between 2000 and 2015, and this group of countries is expected to see the fastest growth in
the older population between 2015 and 2030 as well.
The 320 million people aged 60 years or over in upper-middle-income countries in 2015
represented a 64 per cent increase over 2000 when older persons in those countries numbered
0
500
1000
1500
2000
1980
1990
2000
2010
2020
2030
2040
2050
Population aged 60 years or over (millions)
Africa
Asia
Latin America
and the
Caribbean
Oceania
Europe
Northern
America
2015
0
500
1000
1500
2000
1980
1990
2000
2010
2020
2030
2040
2050
Population aged 80 years or over (millions)
2015
14 World Population Ageing 2015
195 million (table II.1; figure II.3). Between 2015 and 2030, upper-middle-income countries are
anticipated to continue to experience rapid growth in the number of older persons: the projected
545 million people aged 60 years or over in 2030 marks a 70 per cent increase over the number
in 2015.
Figure II.3.
Population aged 60-79 years and aged 80 years or over by income group, 2000, 2015, 2030 and 2050
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
The older populations of lower-middle-income countries and low-income countries grew at a
slower average pace between 2000 and 2015, increasing by 49 per cent and 56 per cent,
respectively. The growth rates are projected to accelerate in both groups of countries in the
coming years. Between 2015 and 2030, the older population in lower-middle-income countries is
projected to increase by 66 per cent, from 238 million to 394 million, while that in low-income
countries is projected to grow by 63 per cent, from 33 million to 54 million.
Owing to longer average survival in the high-income countries relative to the other income
groups, a plurality of the world’s oldest-old persons are concentrated in this group of countries.
In 2015, close to 49 per cent of the global population aged 80 years or over lived in high-income
countries, and, while the proportion is projected to decline somewhat, by 2030 high-income
countries are expected to continue to account for 45 per cent of the oldest-old persons in the
world. Of the four income groups, the number of oldest-old persons is projected to grow most
rapidly in low-income countries, where the coming cohorts of oldest-old persons were born
within contexts of very high fertility around the middle of the twentieth century. The low-income
countries as a group are expected to see an 81 per cent increase in the number of oldest-old
persons between 2015 and 2030, followed by upper-middle-income countries, with a 79 per cent
increase in the population aged 80 years or over projected for the same period.
Virtually every country in the world will experience a substantial increase in the size of the
population aged 60 years or over between 2015 and 2030.
0
100
200
300
400
500
600
700
800
2000 2015 2030 2050 2000 2015 2030 2050 2000 2015 2030 2050 2000 2015 2030 2050
Low-income countries Lower-middle-income
countries
Upper-middle-income
countries
High-income countries
Population (millions)
80 or over
60-79
United Nations Department of Economic and Social Affairs ǀ Population Division 15
Within each of the development groups, regions and income groups there is a great deal of
heterogeneity in the growth rates of the older population. Figure II.4 shows the projected
percentage change in the number of older persons between 2015 and 2030 plotted according to
the level of gross national income (GNI) per capita in 2014 for the 190 countries with at least
90,000 inhabitants in 2015 and for which GNI information was available, with regions
distinguished by colour. The chart illustrates that while growth in the population aged 60 years or
over is expected across all major income groups and regions of the world, the projected growth
rates vary considerably from country to country.
Figure II.4.
Projected change in the population aged 60 years or over between 2015 and 2030 versus the level of gross
national income per capita in 2014
Data sources: United Nations (2015). World Population Prospects: The 2015 Revision and World Bank (2015). World
Development Indicators (http://data.worldbank.org/indicator/NY.GNP.PCAP.CD), accessed 26 August 2015.
Among the 29 low-income countries depicted in figure II.4, most of which are located in subSaharan Africa, the projected growth in the population aged 60 years or over between 2015 and
2030 ranges from 41 per cent in the Central African Republic to 88 per cent in Rwanda. In just
over half of the low-income countries, growth in the number of older persons is projected to
exceed 60 per cent between 2015 and 2030.
16 World Population Ageing 2015
Middle-income countries are anticipating similarly rapid growth in the numbers of older
persons between 2015 and 2030. Of the 100 middle-income countries depicted in figure II.4, 67
per cent are projected to see greater than 60 per cent growth in the number of older persons
during that period and one in four middle-income countries are projected to experience increases
of more than 80 per cent. In India, for example, the number of older persons is projected to grow
by 64 per cent between 2015 and 2030, while in China it is projected to grow by 71 per cent over
the same period. In Tajikistan, Mongolia, the Maldives and Libya, the number of older persons is
projected to more than double by 2030. In each of these four countries, total fertility exceeded
six children per woman during the 1960s and 1970s, when the coming cohorts of older persons
were born.3
Projected growth of the population aged 60 years or over also exceeds 90 per cent in
nine other middle-income countries or areas: Azerbaijan, Bangladesh, Belize, Guyana, Iran,
Kiribati, Kyrgyzstan, the State of Palestine and Viet Nam.
Projected growth rates tend to be slower, on average, for the older populations of highincome countries. Among the 61 high-income countries depicted in figure II.4, less than one
third are projected to see greater than 60 per cent growth in the number of older persons between
2015 and 2030, while the projected growth is between 20 and 60 per cent in another one third of
countries. Within the high-income group, projected growth in the older population tends to be
higher in countries of Asia. Examples include Singapore, which is expected to see a 97 per cent
increase in the population aged 60 years or over between 2015 and 2030, and the Republic of
Korea with a projected 77 per cent increase over the same period. Projected growth tends to be
lower, on average, in high-income countries of Europe and in Latin America and the Caribbean.
Examples include Finland, with a 20 per cent projected increase in the population aged 60 years
or over between 2015 and 2030, and Uruguay, with a 21 per cent projected increase.
Of the 201 countries or areas with 90,000 inhabitants or more in 2015, only 9 are expected to
see a less than 10 per cent increase in the population aged 60 years or over between 2015 and

  1. This includes several Eastern European and Baltic States—Bulgaria, Estonia, Hungary,
    Latvia, Lithuania, Serbia and Ukraine—where multiple demographic factors result in little or no
    growth in the number of older persons, such as low levels of fertility at the time the coming
    cohorts of older persons were born, relatively high mortality among adults, and high rates of
    emigration in some countries. Outside of Eastern Europe, Japan is projected to see growth in the
    number of older persons of only 7 per cent between 2015 and 2030, owing to very low fertility
    rates over a number of decades. Lesotho, a country highly affected by excess mortality caused by
    HIV and AIDS, is projected to experience a small decline in the number of older persons of just
    over 1 per cent between 2015 and 2030.
    In 2015, just twenty countries accounted for three quarters of the world’s older population.
    Nearly one in four persons aged 60 years or over in the world in 2015 lived in China (figure
    II.5, left chart). Taken together, just five countries—China, India, the United States, Japan and
    the Russian Federation—accounted for half of the world’s population aged 60 years or over in
  2. The world’s population aged 80 years or over was similarly concentrated in a small
    number of countries. The five countries with the largest number of oldest-old persons—China,
    the United States, India, Japan and Germany—collectively accounted for 48 per cent of the

3
See chapter III for a discussion of the demographic drivers of the pace of growth of the older population.
United Nations Department of Economic and Social Affairs ǀ Population Division 17
world’s oldest-old in 2015 and 19 countries held three quarters of the global population aged 80
years or over (figure II.5, right chart).
Figure II.5.
Population aged 60 years or over and aged 80 years or over by country, 2015
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
Population aged 60 years or over (thousands)
China
India
United States
Japan
Russian Federation
Brazil
Germany
Indonesia
Italy
France
United Kingdom
Pakistan
Mexico
Spain
Bangladesh
Thailand
Ukraine
Viet Nam
Republic of Korea
Turkey
All other areas
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
Population aged 80 years or over (thousands)
China
United States
India
Japan
Germany
Russian Federation
Italy
France
Brazil
United Kingdom
Spain
Mexico
Viet Nam
Indonesia
Poland
Bangladesh
Ukraine
Canada
Thailand
All other areas
18 World Population Ageing 2015
B. DEMOGRAPHIC CHARACTERISTICS OF THE OLDER POPULATION
Women tend to live longer than men, on average, and thus comprise a majority of older
persons, especially at advanced ages.
Globally, women outlived men by an average of 4.5 years during the period 2010-2015.4
In
2015, women accounted for 54 per cent of the global population aged 60 years or over and 61
per cent of those aged 80 years or over (figure II.6).
Figure II.6.
Share of the global older population by age group and sex, 2015 and 2050
2015 2050

Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
The sex balance of the older population is projected to remain relatively unchanged at the
global level in the coming decades.
Projections indicate that in 2050, women will comprise 53 per cent of the world’s population
aged 60 years or over. Since average survival of males is projected to gradually move closer to
that of females, the sex balance among the oldest-old will become more even. The proportion of
women aged 80 years or over is projected to decline to 58 per cent in 2050.
The sex ratio—traditionally expressed as the number of men per 100 women—is a useful
measure for describing the sex balance of the older population and trends therein. At the global
level, there were 86 men for every 100 women aged 60 years or over in 2015 and 63 men for
every 100 women aged 80 years or over. Those ratios are projected to rise to 89 and 73,
respectively, in 2050 (figure II.7).

4
See chapter III for a discussion of trends in the life expectancies at birth and at older ages.
Men 60-
79
Women
60-79
Women
80+
Men 80+
Men 60-
79
Women
60-79
Women
80+
Men 80+
United Nations Department of Economic and Social Affairs ǀ Population Division 19
Figure II.7.
Sex ratios of the population aged 60 years or over and aged 80 years or over for the world and regions, 2015
and 2050
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
The sex ratio of the older population is lowest in Europe and highest in Asia.
In 2015, across the world’s regions, the sex balance of the older population was most uneven
(as indicated by low sex ratios) in Europe, where there were just 73 men per 100 women aged 60
years or over and 51 men per 100 women aged 80 years or over. The sex balance was most even
in Asia, where there were 91 men per 100 women aged 60 years or over and 70 men per 100
women aged 80 years or over.
Between 2015 and 2050, the sex balance of the population aged 60 years or over is projected
to become more even in Europe, Northern America, Latin America and the Caribbean and
Africa, as the female advantage in life expectancy at age 60 is expected to narrow somewhat in
these regions. At ages 80 or over, the sex balance of the population is projected to become more
even between 2015 and 2050 in all regions except Africa. In general, increasing sex ratios among
oldest-old persons reflect that improvements in the life expectancy at age 80 are occurring at a
faster pace among males than among females.
73
81
84
84
90
91
86
80
84
90
87
88
91
89
40 60 80 100
Europe
Latin America and the
Caribbean
Northern America
Africa
Oceania
Asia
World
Men per 100 women
60+ 2050
60+ 2015
51
61
62
68
70
71
63
65
67
77
75
76
68
73
40 60 80 100
Europe
Latin America and
the Caribbean
Northern America
Oceania
Asia
Africa
World
Men per 100 women
80+ 2050
80+ 2015
20 World Population Ageing 2015
The older population is itself ageing.
As a result of both improved longevity and the ageing of large cohorts (that is, the “baby
boomers” born during the post-World War II period), the world’s older population is projected to
become increasingly aged. Globally, the share of the older population that is aged 80 years or
over rose from 9 per cent in 1980 to 14 per cent in 2015 (figure II.8), and it is projected to
remain fairly stable between 2015 and 2030. Between 2030 and 2050 the proportion of the
world’s older persons that are aged 80 years or over is projected to rise from 14 per cent to more
than 20 per cent.
Figure II.8.
Percentage of oldest-oldest old (aged 80 years or over) among the older population (aged 60 years or over)
by region, 1980-2050
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
By 2040, the oldest-old are projected to account for one in four older persons in Europe,
Northern America and Oceania.
In 2015, Europe had the most aged population of older persons, with people aged 80 years or
over accounting for nearly one in five of those aged 60 years or over in the region. The older
populations of Latin America and the Caribbean, Asia and Africa were much younger by
comparison in 2015: people aged 80 years or over accounted for just 15 per cent, 12 per cent and
9 per cent, respectively, of the older populations in those three regions. According to projections,
the proportion of the older population aged 80 years or over will surpass 25 per cent by 2040 in
Europe, Northern America and Oceania. By 2050, the oldest-old are projected to account for 30
per cent of older persons in Northern America, 29 per cent of older persons in Europe and 27 per
cent of older persons in Oceania. The older populations of Latin America and the Caribbean and
Asia are projected to age considerably between 2030 and 2050, as well. In 2050, the oldest-old
are projected to account for 22 per cent of older persons in Latin America and the Caribbean and
20 per cent of older persons in Asia. The older population of Africa is projected to age more
slowly such that in 2050, people aged 80 years or over will account for 10 per cent of the overall
population of older persons in the region.
0
5
10
15
20
25
30
35
1980 1990 2000 2010 2020 2030 2040 2050
Percentage of older persons aged 80
years or over
World
Northern America
Europe
Oceania
Latin America and the
Caribbean
Asia
Africa
United Nations Department of Economic and Social Affairs ǀ Population Division 21
The older population is growing faster in urban areas than in rural areas.5
At the global level, between 2000 and 2015, the number of people aged 60 years or over
increased by 68 per cent in urban areas, compared to a 25 per cent increase in rural areas (figure
II.9). Growth in the number of older persons in urban areas outpaced that in rural areas in all
regions except Oceania, where the rapidly growing cohorts of older persons in the comparatively
rural populations of Melanesia, Micronesia and Polynesia exceed the pace of growth of the urban
older populations in the more urbanized countries of Australia and New Zealand. In Asia, the
number of people aged 60 years or over in urban areas in 2015 was more than double the number
in 2000 (a 106 per cent increase), while in Asia’s rural areas the number of older persons
increased by just 28 per cent over the same period. In Europe, the older population in rural areas
barely changed in size between 2000 and 2015, growing by just 2 per cent, at the same time the
older population in urban areas increased by 26 per cent. In general, the regions that are
urbanizing the fastest—Latin America and the Caribbean, Asia and Africa—saw the biggest
differentials in the growth of the number of older persons between urban and rural areas.
Figure II.9.
Percentage change in the population aged 60 years or over between 2000 and 2015 for the world and regions,
by urban/rural area
Data source: United Nations (2014a). Urban and rural population by age and sex (URPAS), 1980-2015 (version 3,
August 2014).
The faster growth of the older population in urban areas compared to rural areas is likely
attributable both to trends in the urbanization of the population across all age groups and to
differences in mortality risks, which tend to be lower in urban areas relative to rural areas (see

5
The data presented in this section are from United Nations (2014). Urban and rural population by age and sex (URPAS), 1980-2015 (version 3,
August 2014), which reflects estimates of population disaggregated by age, sex and urban and rural residence consistent with the 2012 Revision of
World Population Prospects.
2
38
60
34
39
28
25
26
48
53
73
82
106
68
0 20 40 60 80 100 120
Europe
Northern America
Oceania
Latin America and the Caribbean
Africa
Asia
World
Percentage change in the population aged 60 years or over between 2000 and 2015
Urban
Rural
22 World Population Ageing 2015
for instance: Singh and Siahpush, 2014; Zimmer, Kaneda and Spess, 2007; Van De Poel,
O’Donnell and Van Doorslaer, 2007).
Globally, the proportion of older persons residing in urban areas is higher than for other
age groups.
In 2015, 58 per cent of older persons globally lived in urban areas, compared to 46 per cent
of children aged 0 to 14 years, 54 per cent of adolescents and youth aged 15 to 24 years and 57
per cent of people aged 25 to 59 years (figure II.10). The age patterns of urban residence vary
somewhat across regions. In Africa, both children and older persons were less likely to live in
urban areas than people in the working ages (37 per cent versus 44 per cent). In Asia, Europe and
Latin America and the Caribbean, the share residing in urban areas was similar across the 15-24,
25-59 and 60 or over age groups. In Northern America, older persons were somewhat less likely
to reside in urban areas (78 per cent) compared to children (82 per cent), adolescents and youth
(85 per cent), and people aged 25-59 years (82 per cent). In Oceania, older persons were
substantially more likely to live in urban areas relative to children aged 0-14 years (81 per cent
versus 60 per cent), reflecting the region’s concentration of older persons in the highly urbanized
countries of Australia and New Zealand and the comparatively young age structures of the more
rural populations of Melanesia, Micronesia and Polynesia.
Figure II.10.
Percentage urban by age group and region, 2015
Data source: United Nations (2014a). Urban and rural population by age and sex (URPAS), 1980-2015 (version 3,
August 2014).
The older population is increasingly concentrated in urban areas.
0
10
20
30
40
50
60
70
80
90
World Africa Asia Oceania Europe Latin America
and the
Caribbean
Northern
America
Percentage urban
All ages 0-14 years 15-24 years 25-59 years 60 years or over
United Nations Department of Economic and Social Affairs ǀ Population Division 23
In 2015, 58 per cent of the world’s people aged 60 years or over resided in urban areas, up
from 51 per cent in 2000 (figure II.11). The oldest-old are even more likely to reside in urban
areas: the proportion of people aged 80 years or over residing in urban areas rose from 56 per
cent in 2000 to 63 per cent in 2015. In Oceania, more than 80 per cent of older persons resided in
urban areas and 90 per cent of the oldest-old resided in urban areas in 2015. In Northern America
and Latin America and the Caribbean, 76 per cent of older persons lived in urban areas in 2000
and the proportions rose to 78 per cent and 81 per cent in 2015 for the two regions, respectively.
More than 8 in 10 oldest-old persons in Northern America and Latin America and the Caribbean
resided in urban areas in 2015.
Figure II.11.
Percentage of population aged 60 years or over and aged 80 years or over residing in urban areas by region,
2000 and 2015
Data source: United Nations (2014a). Urban and rural population by age and sex (URPAS), 1980-2015 (version 3,
August 2014).
The share of older persons residing in urban areas in Europe rose from 68 per cent in 2000 to
72 per cent in 2015. Asia saw the largest increase in the proportion urban among its older
population: the percentage of those aged 60 years or over residing in urban areas increased from
37 per cent in 2000 to 49 per cent in 2015. The oldest-old population in Asia urbanized even
faster: 53 per cent of those aged 80 years or over lived in urban areas in 2015, up from 38 per
cent in 2000. In Africa, the world’s least urbanized region, close to 37 per cent of older persons
lived in urban areas in 2015, up from 31 per cent in 2000.
C. TRENDS IN THE PERCENTAGE OF OLDER PERSONS
While growth in the number of older persons is an important trend in itself, the process of
population ageing, by definition, refers to an increasing proportion of older persons in a
population. Thus, ageing is determined not only by the pace of growth of the older population,
but also by how that pace compares to the growth rates of the other age groups.
20
30
40
50
60
70
80
90
100
2000 2015 2000 2015
Population aged 60 or over Population aged 80 or over
Percentage residing in urban
areas
World
Oceania
Northern America
Latin America and
the Caribbean
Europe
Asia
Africa
24 World Population Ageing 2015
Globally, the number of older persons is growing faster than the numbers of people in any
other age group.
In 2015, there were 48 per cent more people aged 60 years or over worldwide than there were
in 2000, and by 2050, the number of older people is projected to have more than tripled since
2000 (figure II.12). In contrast, at the global level, the numbers of children under age 10 and
adolescents and youth aged 10-24 years will change very little: the projected numbers of children
and adolescents and youth in 2050 represents an 11 per cent increase over the year 2000. The
global number of adults aged 25-59 years is growing faster than the number of children, but not
as fast as the population aged 60 years or over. In 2015, there were 29 per cent more people aged
25-59 years than there were in 2000, and projections indicate that by 2050 there will be 62 per
cent more of them than in 2000.
Figure II.12.
Increase in world population relative to 2000, by broad age group, 2000-2050
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
Historically, the population of older persons has been much smaller than any other of these
age groups. In 1960, for example, children under age 10 outnumbered people aged 60 years or
over by more than 3 to 1, and there were nearly five times as many people aged 25-59 years as
older persons (figure II.13). By 2000, however, the ratio of children to older persons had fallen to
2 to 1 (1.2 billion versus 0.6 billion), while that of people aged 25-59 to older persons had fallen
close to 4 to 1 (2.6 billion versus 0.6 billion) (figure II.14). By 2030, older persons are projected
to outnumber children aged 0-9 years (1.4 billion versus 1.3 billion); by 2050, there will be more
people aged 60 years or over than adolescents and youth aged 10-24 years (2.1 billion versus 2.0
billion).
0.5
1.0
1.5
2.0
2.5
3.0
3.5
2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050
Population size relative to 2000
60 or over
25-59
10-24
0-9
United Nations Department of Economic and Social Affairs ǀ Population Division 25
Figure II.13.
Global population by broad age group, 1950-2050
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
Figure II.14.
Global population by broad age group, 2000, 2015, 2030 and 2050
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.

0
1
2
3
4
5
6
7
8
9
10
1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050
Population (billions)
60 or over
25-59
10-24
0-9
1.2 1.3 1.3 1.4
1.7 1.8 2.0 2.0
2.6
3.3
3.8
4.2
0.6
0.9
1.4
2.1
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
2000 2015 2030 2050
Population (billions)
0-9 10-24 25-59 60 or over
26 World Population Ageing 2015
TABLE II.2. PERCENTAGE AGED 60 YEARS OR OVER AND AGED 80 YEARS OR OVER FOR THE WORLD, DEVELOPMENT GROUPS, REGIONS
AND INCOME GROUPS, 2000, 2015, 2030 AND 2050
Percentage aged 60 years or over Percentage point change
2000 2015 2030 2050 2000-2015 2015-2030
World 9.9 12.3 16.5 21.5 2.3 4.2

Development groups
More developed regions 19.5 23.9 29.2 32.8 4.4 5.3
Less developed regions 7.6 9.9 14.2 19.8 2.3 4.4
Other less developed countries 8.0 10.7 15.9 22.7 2.7 5.2
Least developed countries 5.1 5.5 6.7 9.8 0.4 1.2

Regions
Africa 5.2 5.4 6.3 8.9 0.2 0.8
Asia 8.6 11.6 17.2 24.6 3.0 5.6
Europe 20.3 23.9 29.6 34.2 3.6 5.7
Latin America and the Caribbean 8.1 11.2 16.8 25.5 3.1 5.6
Oceania 13.4 16.5 20.2 23.3 3.1 3.7
Northern America 16.2 20.8 26.4 28.3 4.6 5.6

Income groups
High-income countries 18.0 22.1 27.7 31.9 4.1 5.6
Upper-middle-income countries 9.2 13.4 21.2 30.5 4.2 7.8
Lower-middle-income countries 6.9 8.1 11.2 16.5 1.2 3.0
Low-income countries 5.0 5.2 5.8 8.3 0.2 0.7
Percentage aged 80 years or over Percentage point change
2000 2015 2030 2050 2000-2015 2015-2030
World 1.2 1.7 2.4 4.5 0.5 0.7

Development groups
More developed regions 3.1 4.7 6.6 9.9 1.7 1.9
Less developed regions 0.7 1.1 1.6 3.6 0.4 0.5
Other less developed countries 0.7 1.2 1.8 4.4 0.4 0.6
Least developed countries 0.4 0.5 0.6 1.1 0.1 0.1

Regions
Africa 0.4 0.5 0.6 0.9 0.1 0.1
Asia 0.8 1.4 2.1 4.9 0.5 0.7
Europe 2.9 4.7 6.3 10.1 1.8 1.6
Latin America and the Caribbean 1.0 1.6 2.6 5.7 0.7 1.0
Oceania 2.2 2.9 4.3 6.4 0.7 1.4
Northern America 3.2 3.8 5.6 8.6 0.6 1.7

Income groups
High-income countries 2.9 4.3 6.2 9.6 1.5 1.8
Upper-middle-income countries 0.9 1.6 2.6 7.0 0.7 1.0
Lower-middle-income countries 0.6 0.8 1.1 2.3 0.3 0.3
Low-income countries 0.3 0.4 0.5 0.8 0.1 0.1
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
United Nations Department of Economic and Social Affairs ǀ Population Division 27
These shifts over time in the relative sizes of the various age groups have resulted in
increases in the proportion of the population at older ages. At the global level, the percentage of
older persons increased from close to 10 per cent in 2000 to over 12 per cent in 2015, when one
in every eight people worldwide was aged 60 years or over (table II.2). The proportion of older
persons globally is projected to continue to increase to more than 16 per cent in 2030 and over 21
per cent in 2050. Thus, by the middle of the twenty-first century, around one in every five
people globally will be aged 60 years or over.
Older persons already constitute a large share of the population in the more developed
regions. In 2015, close to one in four people living in developed regions was aged 60 years or
over, and it is projected to continue to rise such that, in 2050, older persons will account for one
in three people in the developed regions. People aged 60 years or over comprised nearly 10 per
cent of the population in developing regions in 2015, and that share is projected to increase to 14
per cent in 2030 and to 20 per cent in 2050. Among the least developed countries, older persons
accounted for a relatively small fraction of the total population—5.5 per cent in 2015—but the
share of older persons in the least developed countries is also projected to increase in the coming
decades, reaching nearly 10 per cent in 2050.
High-income countries tend to be the most aged.
Older persons comprised 22 per cent of the population of high-income countries in 2015, 13
per cent of upper-middle-income countries, 8 per cent of lower-middle-income countries and 5
per cent of low-income countries. Figure II.15 plots the percentage of the population aged 60
years or over in 2015 against each country’s gross national income per capita in 2014 for
countries with at least 90,000 inhabitants in 2015 and for which a GNI estimate was available.
The size of the bubbles is proportional to the size of the population aged 60 years or over in
2015.
Japan is home to the world’s most aged population: 33 per cent were aged 60 years or over
in 2015.
Japan is followed by Germany (28 per cent aged 60 years or over in 2015), Italy (28 per cent)
and Finland (27 per cent).6
Of the 62 high-income countries or areas with total population
greater than 90,000 in 2015, half had relatively aged populations in 2015, with 20 per cent of the
population aged 60 years or over. The proportion of older persons also exceeded 20 per cent
among several upper-middle-income European countries, such as Bulgaria (27 per cent aged 60
years or over in 2015) and Romania (22 per cent). Comparatively young age structures prevailed
among countries at the lower end of the income distribution: in every low-income country and 85
per cent of lower-middle-income countries in 2015, less than 10 per cent of the population was
aged 60 years or over.
By 2030 many middle-income countries will have aged considerably.
Within the next 15 years, several upper-middle-income countries are projected to become as
aged as many of today’s high-income countries. Between 2015 and 2030, the share of population

6
Of the 201 countries or areas with at least 90,000 inhabitants in 2015.
28 World Population Ageing 2015
Figure II.15.
Percentage aged 60 years or over in 2015 versus gross national income per capita in 2014
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
Figure II.16.
Percentage aged 60 years or over projected in 2030 versus gross national income per capita in 2014
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
United Nations Department of Economic and Social Affairs ǀ Population Division 29
aged 60 years or over is projected to increase from 15 per cent to 24 per cent in China, from 20
per cent to 32 per cent in Cuba, and from 16 per cent to 27 per cent in Thailand (figure II.16).
Some lower-middle-income countries are projected to age rapidly as well. For example, the
proportion aged 60 years or over is projected to increase from 13 per cent in 2015 to 20 per cent
in 2030 in Sri Lanka; from 10 to 18 per cent in Viet Nam; and from 8 to 14 per cent in Morocco.
The population ageing process is much slower in low-income countries: in 89 per cent of
low-income countries and 62 per cent of lower-middle-income countries, the share of older
persons is projected to remain below 10 per cent through 2030.
In 2000, of the world’s ten most aged populations all but one (Japan) were located in Europe
and the share of the population aged 60 years or over had not yet reached 25 per cent in any
country. In 2015 the share of older persons exceeded 25 per cent in all ten of the most aged
countries and, by 2030, older persons will comprise more than 32 per cent of the population in
each of the ten most aged countries or areas (table II.3). Europe is expected to account for 7 of
the 10 most aged countries in 2030. Projections indicate that in 2030, Martinique will be home to
the world’s most aged population, with 38.5 per cent aged 60 years or over. All three major
demographic processes have contributed to rapid population ageing in Martinique: sharp
reductions in total fertility, from 5.7 children per woman in the 1950s to 2.1 children per woman
in the 1980s; increasing longevity, with life expectancy at birth having risen from 56 years in
2010-2015 to around 81 years in 2010-2015; as well as net emigration of young people.
TABLE II.3. TEN COUNTRIES OR AREAS WITH THE MOST AGED POPULATIONS, 2000, 2015 AND 2030*
(SEE ANNEX TABLE A.III.4 FOR FULL LIST OF COUNTRIES OR AREAS RANKED ACCORDING TO THE PERCENTAGE AGED 60 OR OVER)
2000 2015 2030
Rank Country or area
Percentage
aged 60
years or
over Country or area
Percentage
aged 60
years or
over Country or area
Percentage
aged 60
years or
over
1 Italy 24.1 Japan 33.1 Martinique 38.5
2 Japan 23.3 Italy 28.6 Japan 37.3
3 Germany 23.1 Germany 27.6 Italy 36.6
4 Greece 22.8 Finland 27.2 Germany 36.1
5 Sweden 22.2 Portugal 27.1 Portugal 34.7
6 Bulgaria 22.2 Greece 27.0 China, Hong Kong SAR 33.6
7 Belgium 22.0 Bulgaria 26.9 Spain 33.5
8 Croatia 21.8 Martinique 26.2 Greece 33.2
9 Portugal 21.7 Croatia 25.9 Slovenia 32.7
10 Spain 21.4 Latvia 25.7 Austria 32.4
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.

  • Of 201 countries or areas with at least 90,000 inhabitants in 2015.
    The pace of world population ageing is accelerating.
    Over the 15 years between 2000 and 2015, the proportion of the global population that was
    aged 60 years or over increased by 2.3 percentage points, from 9.9 per cent to 12.3 per cent
    30 World Population Ageing 2015
    (table II.2; figure II.17). Projections indicate that over the next 15 years the proportion aged 60
    years or over globally will increase by 4.2 percentage points reaching 16.5 per cent in 2030.
    Between 2000 and 2015, the pace of population ageing was fastest in Northern America (4.6
    percentage point increase) and Europe (3.6 percentage points). The pace of population ageing is
    projected to accelerate in all six regions. Between 2015 and 2030 projected increases in the
    proportion aged 60 years or over are nearly identical for Asia (5.6 percentage point increase),
    Europe (5.7), Latin America and the Caribbean (5.6) and Northern America (5.6).
    Figure II.17.
    Percentage point change in the proportion aged 60 years or over for the world and regions, 2000-2015 and
    2015-2030
    Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
    By 2050, older persons are projected to account for 34 per cent of the population of Europe,
    28 per cent of Northern America, 26 per cent of Latin America and the Caribbean, 25 per cent of
    Asia, 23 per cent of Oceania, and 9 per cent of Africa (figure II.18).
    In many developing countries, population ageing is taking place much more rapidly than it
    did in the countries that developed earlier. For example, it took France 115 years, Sweden 85
    years, Australia 73 years, the United States 69 years and the United Kingdom and Spain 45 years
    each for the proportion of the population aged 60 years or over to increase from 7 to 14 per cent
    (Kinsella and Gist, 1995). In contrast, it has taken China only 34 years and Thailand only 23
    years to experience the same change in the share of older persons. Projections indicate that for
    Brazil, it will take just 25 years for the percentage of older persons to rise from 7 to 14 per cent
    and the same change in the proportion aged 60 years or over will take just 22 years in Colombia.
    0.8
    5.6
    5.6
    3.7
    5.7
    5.6
    4.2
    0.2
    3.0
    3.1
    3.1
    3.6
    4.6
    2.3
    0.0 1.0 2.0 3.0 4.0 5.0 6.0
    Africa
    Asia
    Latin America and the Caribbean
    Oceania
    Europe
    Northern America
    World
    Change in the proportion aged 60 years or over (percentage points)
    2000 to 2015
    2015 to 2030
    United Nations Department of Economic and Social Affairs ǀ Population Division 31
    Thus, today’s developing countries have to adapt much more quickly to population ageing, and
    often at much lower levels of national income compared to the past experience of many of the
    countries that developed earlier.
    Figure II.18.
    Percentage of the population aged 60 years or over for the world and regions, 1980-2050
    Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
    The pace of population ageing observed at the country level illustrates just how fast the age
    structures are shifting in many parts of the world. Table II.4 lists the ten countries with the
    largest percentage point changes in the share of older persons in 2000-2015 and projected for
    2015-2030. Of countries or areas with 90,000 inhabitants or more in 2015, the United States
    Virgin Islands experienced the fastest rise in the proportion of the population aged 60 years or
    over, with an increase of nearly 11 percentage points between 2000 and 2015. Japan was the
    next fastest (a 9.9 percentage point increase), followed by Malta (9.3), Finland (7.3) and the
    Republic of Korea (7.2). Over the coming 15 years, the most rapidly ageing countries are
    projected to experience increases in the proportion of older persons that are considerably faster
    than those observed over the previous 15-year period. Cuba and the Republic of Korea, two
    countries that have experienced both sharp declines in fertility and substantial gains in longevity
    since the mid-twentieth century, are projected to see the largest change in the proportion aged 60
    years or over between 2015 and 2030, with increases of nearly 13 percentage points. An
    additional seven countries or areas are also projected to experience increases in the proportion of
    older persons of more than 10 percentage points over the next 15 years.

0
5
10
15
20
25
30
35
1980 1990 2000 2010 2020 2030 2040 2050
Percentage aged 60 years or over
World
Europe
Northern America
Oceania
Latin America and
the Caribbean
Asia
Africa
32 World Population Ageing 2015
TABLE II.4. TEN COUNTRIES OR AREAS WITH THE LARGEST PERCENTAGE POINT CHANGES IN THE PROPORTION OF THE POPULATION
AGED 60 YEARS OR OVER, 2000-2015 AND 2015-2030
(SEE ANNEX TABLE A.III.5 FOR FULL LIST OF COUNTRIES OR AREAS RANKED ACCORDING TO THE PERCENTAGE POINT CHANGE IN THE
PROPORTION AGED 60 OR OVER)*
Rank Country or area
Percentage
point change
between 2000
and 2015 Country or area
Percentage
point change
between 2015
and 2030
1 United States Virgin Islands 10.9 Cuba 12.8
2 Japan 9.9 Republic of Korea 12.7
3 Malta 9.3 China, Hong Kong SAR 12.3
4 Finland 7.3 China, Taiwan Province of China 12.1
5 Republic of Korea 7.2 Curaçao 11.7
6 Aruba 7.0 China, Macao SAR 11.4
7 Martinique 6.9 Thailand 11.2
8 China, Hong Kong SAR 6.9 Martinique 11.0
9 China, Taiwan Province of China 6.7 Brunei Darussalam 11.0
10 Curaçao 6.6 Singapore 9.9
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.

  • Of 201 countries or areas with at least 90,000 inhabitants in 2015.
    In 2050, nearly half of the world’s population will live in countries or areas where at least
    20 per cent of the population is aged 60 years or over, and one in four people will live in
    countries or areas where older persons account for more than 30 per cent of the
    population.
    In 2000, the share of the population aged 60 years or over exceeded 20 per cent in only 23
    countries or areas7
    and these contained just 9 per cent of the global population. Projections
    indicate that the number of countries or areas where at least 20 per cent of the population is aged
    60 years or over is projected to grow from a minority of 53 in 2015 to a large majority of 145 in
    2050, and the share of the world’s people living in such countries or areas is projected to increase
    from 17 per cent to 44 per cent. In 74 countries or areas, older persons are projected to make up
    at least 30 per cent of the population in 2050, up from just 3 countries or areas8
    in 2015.
    Conversely, the number of countries with very young population age structures is shrinking over
    time. While in 2015 there were 37 countries or areas where less than 5 per cent of the population
    were aged 60 years or over, by 2050 the share of older persons is projected to be below 5 per
    cent in only one country (Niger).

7
Of the 233 countries or areas for which the United Nations estimates and projects total population. 8
The Holy See, Japan and Monaco.
United Nations Department of Economic and Social Affairs ǀ Population Division 33
Figure II.19.
Maps of percentage of population aged 60 years or over in 2000, 2015 and 2050
2000
2015
2050
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
Note: The boundaries and names shown and the designations used on this map do not imply official endorsement or
acceptance by the United Nations. Dotted line represents approximately the Line of Control in Jammu and Kashmir agreed upon
by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by the parties. Final boundary
between the Republic of Sudan and the Republic of South Sudan has not yet been determined.
34 World Population Ageing 2015
D. DEPENDENCY AND SUPPORT RATIOS
Population ageing, which is driven by both declining fertility and increasing longevity,
implies that successive cohorts can expect to live longer and have fewer adult children as
potential sources of support in their old age. This section discusses trends in various descriptive
measures of population ageing that are used often to examine the implications of shifting
population age structures for intergenerational support systems.
The total dependency ratio is a commonly used measure of potential support needs. It is
based on the notion of childhood and old age as periods of dependency during which persons
tend to rely upon the working-age population for financial support, which may be provided
directly through family transfers, or indicrectly through public transfer programmes. The total
dependency ratio is defined here as the ratio of the number of children and young people under
age 20 plus the number of persons aged 65 years or over, to the number of persons aged 20 to 64
years. The ratio provides an indication of how many dependents need to be supported by each
person of working age, on average. The actual ages of dependency vary considerably from
country to country and from one person to another, since factors like the pursuit of higher
education or youth unemployment often prolong the dependent period beyond age 20, while
personal preferences, as well as health and financial considerations, influence the age at which
people retire from the workforce. Despite these limitations, the choice of the age range 20 to 64
years for the working ages serves here as a starting point to facilitate comparisons of age
structures across populations and over time.
The global total dependency ratio has fallen to a historical minimum and is set to rise in the
post-2015 period.
At the global level, the total dependency ratio has fallen to a historical minimum in 2015
(figure II.20). From a peak of approximately 112 “dependents” per 100 working-age persons in
the early-1970s, the total dependency ratio declined steadily in response to sustained reductions
in global fertility, to reach 74 dependents per 100 working-age persons in 2015. The total
dependency ratio is projected to increase gradually over the coming decades together with the
growing proportion of older persons. By 2030, there will be 76 people in the dependent ages per
100 working-age people, and by 2050 the global total dependency ratio is projected to rise to 79
dependents per 100 working-age persons. A rising ratio indicates that there will be slightly more
dependents to be supported by each person of working ages.
The total dependency ratio is projected to increase in all regions except Africa.
The total dependency ratio is projected to rise the fastest in regions that have already seen
substantial increases in the proportion of older persons, such as Europe and Northern America.
As a result of several decades of comparatively low fertility, the total dependency ratios in
Europe and Northern America were lower than in the other regions in the second half of the
twentieth century. In 2015, the total dependency ratios in these two regions were 62 and 67
dependents per 100 working-age persons, respectively, which were similar to that in Asia at 66
dependents per 100 working-age persons, and slightly lower than in Latin America and the
Caribbean at 73 dependents per 100 working-age persons. By 2050, the total dependency ratio is
projected to increase to 91 in Europe and to 84 in Northern America, overtaking all other
United Nations Department of Economic and Social Affairs ǀ Population Division 35
regions. The increasing proportions of older persons in Asia and Latin America and the
Caribbean will also boost future increases in the total dependency ratio, which, in 2050, is
projected to reach 73 dependents per 100 working-age people in Asia and 74 per 100 in Latin
America and the Caribbean in 2050.
Figure II.20.
Total dependency ratio for the world and regions, 1950-2050
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
Fertility decline began more recently in Africa than in the other regions, and thus the
proportion of children is starting to fall and the share of working-age persons is beginning to
increase, while the proportion of older persons in the population remains fairly small. As a result,
the total dependency ratio in Africa is falling gradually, and that decline is projected to continue
into the second half of the twenty-first century. The dependency ratio in Africa fell from its peak
of 140 dependents per 100 working-age persons in the mid-1980s to 121 dependents per 100
working-age persons in 2015, and is projected to continue to decline to 91 dependents per 100
working-age persons in 2050.
The global increase in the total dependency ratio will be driven by a growing share of older
persons.
Changes in the total dependency ratio are driven by changes in the proportions of children
and of older persons. Figure II.21 illustrates the distribution of people in the dependent ages in
the world, distinguishing children and young people under 20 years of age and older persons
aged 65 years or over. In 1950, the vast majority of dependents worldwide were children, while
older persons accounted for just 10 per cent of the global dependent-age population. Since the
mid-1960s, however, the share of older persons among the world’s dependents has grown,
reaching 20 per cent in 2015, and is expected to continue to grow steadily into the future.
Projections indicate that in 2050 older persons will account for 36 per cent of people in the
dependent ages worldwide.
40
60
80
100
120
140
160
1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050
Persons aged 0-19 years and 65
years or over per 100 persons aged
20-64 years
World
Africa
Europe
Northern America
Oceania
Latin America and
the Caribbean
Asia
36 World Population Ageing 2015
Figure II.21.
Children and young people aged under 20 years and older persons aged 65 years or over as a percentage of
the global population in the dependent ages, 1950-2100
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
The economic support ratio takes into account the age patterns of production and
consumption to describe the number of effective workers in a population relative to the
number of effective consumers.
Rather than assuming a status of “dependency” at given ages, a better way to assess the
degree of dependency in a population is to consider the age patterns of production and
consumption. Age patterns of production reflect labour earnings and represent the economic
contribution of individuals at each age to their own sustenance and to the support of others. In
turn, the age patterns of consumption provide a measure of the population’s needs at each age.
While these economic factors are at best implicit in the conventional demographic dependency
ratios, the economic support ratio makes them explicit, and considers them together with the
population age structure.
The economic support ratio is defined as the effective number of workers divided by the
effective number of consumers in a given population (Lee and Mason, 2011; United Nations,
2013). The effective number of workers is obtained by the product of the labour income at each
age by the population in the corresponding age group, summed over all ages. Age variations in
labour force participation, hours worked, unemployment and wages are taken into account and
are reflected in the country-specific labour income profile. Similarly, the effective number of
consumers is calculated as the sum over all ages of the product of consumption at each age by
the population in that age group.
0
10
20
30
40
50
60
70
80
90
100
1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 2060 2070 2080 2090 2100
Percentage of “dependent-age” population
2015
0-19 years
65 years or over
United Nations Department of Economic and Social Affairs ǀ Population Division 37
Figure II.22 shows the average annual changes in the economic support ratio in different
countries, estimated for the period 1980-2015 and projected for 2015-2050, based on information
on the labour income and consumption age profiles for recent years compiled in the National
Transfer Accounts (NTA) database,9
together with United Nations estimates and projections of
population by age and sex. A rising economic support ratio, reflected in a positive growth rate in
figure II.22, means that, during the reference time period, each worker is supporting fewer
consumers, on average. This situation is favourable for economic development, since it frees up
resources that can be used to increase per capita consumption, savings and investment, thereby
fuelling further economic growth (Lee and Mason, 2011). Conversely, a declining support ratio,
reflected in a negative growth rate, means that there are fewer equivalent producers to support
each equivalent consumer, which constrains the present standard of living and future economic
growth.
Countries that underwent a rapid fertility decline between the 1970s and 1990s benefitted
from increasing economic support ratios during the period 1980-2015.
Growth of the economic support ratio over 1980-2015 was particularly high in several Asian
countries, such as China, the Republic of Korea, Thailand and Viet Nam, where the average
annual growth rate ranged from 0.7 to 0.9 per cent (figure II.22, top chart). The rate of growth of
the economic support ratio growth during that period was still significant in Brazil, Colombia
and South Africa, ranging from 0.5 to 0.7 per cent per year. In contrast, the growth rate was
comparatively modest in high-income countries that had already achieved low fertility: Australia,
France, Italy, the United Kingdom and the United States show growth rates of the economic
support ratio in the range of 0.1 to 0.2 per cent annually over 1980-2015. In countries with very
low fertility, such as Japan, the economic support ratio actually declined during that period.
Increasing economic support ratios are projected to contribute to future economic growth
in a number of middle-income and low-income countries.
Economic support ratios, projected under the assumption that age patterns of production and
consumption remain unchanged over 2015-2050, illustrate at the potential influence of
demographic changes on economic growth10 (figure II.22, bottom panel). For example, In India
and Indonesia, the economic support ratio is projected to continue growing over the period 2015-
2050, boosting economic growth by about 0.2 per cent per year. In Nigeria and Kenya, the
economic support ratios are expected to increase even faster, resulting in an addition to economic
growth of 0.3 per cent per year over the period 2015-2050, on average.11

9
http://www.ntaccounts.org/.
10 These results are obtained by multiplying the latest available age-specific patterns of production of consumption (see footnote 8), by the
population by age of the medium projection variant of the World Population Prospects: The 2015 Revision (United Nations, 2015). 11 If fertility declines faster than anticipated in the medium variant, if investment in human and physical capital increase, or labour markets
improve, then the actual future growth rate of the economic support ratio would be higher than shown in figure II.22.
38 World Population Ageing 2015
Figure II.22.
Average annual change in the economic support ratio, selected countries, 1980-2015 and 2015-2050
1980-2015
2015-2050
Data source: National Transfer Accounts database (http://www.ntaccounts.org/), accessed 1 September 2015.
Argentina
Australia
Austria
Brazil
Canada
Chile
China
Colombia
Costa Rica
Ecuador
Finland
France Germany
Hungary
India
Indonesia
Italy
Jamaica
Japan
Kenya
Mexico
Mozambique Nigeria
Peru Philippines
Senegal
Slovenia
South Africa
Republic of Korea
Spain
Sweden
Thailand
United Kingdom
Uruguay
USA
Viet Nam
-1.0
-0.8
-0.6
-0.4
-0.2
0.0
0.2
0.4
0.6
0.8
1.0
6 7 8 9 10 11 12
Growth rate of the economic support ratio
(average annual percenrage change)
Gross Domestic Product per capita (logarithmic scale)
Argentina Australia
Austria
Brazil
Canada
Chile
China
Colombia
Costa Rica
Ecuador
Finland France
Germany
Hungary
India
Indonesia
Italy
Jamaica
Japan
Kenya
Mexico
Mozambique
Nigeria
Peru
Philippines
Senegal
Slovenia
South Africa
Republic of Korea
Spain
Sweden
Thailand
United Kingdom
Uruguay
USA
Viet Nam
-1.0
-0.8
-0.6
-0.4
-0.2
0.0
0.2
0.4
0.6
0.8
1.0
6 7 8 9 10 11 12
Growth rate of the economic support rato
(average annual percentage change)
Gross Domestic Product per capita (logarithmic scale)
United Nations Department of Economic and Social Affairs ǀ Population Division 39
Many high-income and upper-middle-income countries will experience declining economic
support ratios, especially where populations are already aged.
Other things being equal, the declining economic support ratios projected between 2015 and
2050 would contribute to dampen economic growth in Japan and in Spain, for example, by about
0.5 per cent per year and 0.8 per cent per year, respectively. In the United States, where the
ageing process is less advanced due to somewhat higher fertility and mortality than in other highincome countries as well as to significant inflow of migrants, the projected changes in the
economic support ratio is smaller, of less than 0.3 per cent per year. The support ratios in
Argentina, Colombia, Mexico and Uruguay are projected to decline slightly, with ensuing lesser
effects on economic growth, of only -0.05 per cent per year during 2015-2050.
In many upper-middle-income countries, the share of the working-age population is presently
reaching a peak. In the coming decades, these countries are expected to experience accelerated
population ageing and declining economic support ratios, reaching levels similar to those of the
high-income countries today. The decline in the support ratio is projected to be more pronounced
in countries with more aged populations, such as China, Germany, Italy, the Republic of Korea,
Spain, Slovenia and Thailand, where the economic support ratios are projected to decline by
more than 0.5 per cent per year over 2015-2050.

United Nations Department of Economic and Social Affairs ǀ Population Division 41
III. Demographic drivers of population ageing
The size and age composition of a population are determined jointly by three demographic
processes: fertility, mortality and migration. Fertility levels and trends determine the size of each
birth cohort; while mortality levels and trends determine what proportion of those cohorts
eventually survive to old age. Age patterns of immigration and emigration also influence the age
distribution of the population, although to a lesser extent than fertility and mortality in most
countries. This chapter describes the relationships between the three main demographic
processes and population ageing, drawing primarily upon United Nations population estimates
and projections from World Population Prospects: the 2015 Revision.

A. FERTILITY AND MORTALITY AS DETERMINANTS OF TRENDS IN THE NUMBERS OF
OLDER PERSONS
The present growth rate of the population of older persons is a function of the levels of
fertility prevailing some 60 years ago when today’s new cohorts of older persons were born,
together with the likelihood that members of those birth cohorts survived to older ages. Figure
III.1 shows the growth rate of the population aged 60 or over in 2010-2015 versus the total
fertility rate (expressed as the average number of children per woman) 60 years earlier, in 1950-
1955, for countries or areas with at least 500,000 residents aged 60 years or older in 2015.12
In general, countries that had high fertility 60 years ago saw faster growth in the number
of older persons during 2010-2015.
In the Philippines, for example, the total fertility rate was 7.4 children per woman in 1950-
1955, and today, the number of older people (aged 60 years or over) is growing rapidly, at an
average 3.6 per cent per year in 2010-2015. By contrast, in Italy, total fertility was only 2.4
children per woman in 1950-1955, and today’s older population is growing much slower than in
the Philippines, at an average annual rate of 1.4 per cent during 2010-2015. Because fertility
rates in the mid-century were high—above five children per woman—in many parts of Africa,
Asia and Latin America and the Caribbean, the growth rates of the older populations in those
regions are significantly higher than in Europe, where fertility in 1950-1955 had already fallen
below three children per woman in many countries.
The association between past fertility rates and the present rates of growth of the numbers of
older persons across countries shown in Figure III.1 is tempered by variation in mortality risks
across countries with similar levels of fertility. For example, in Mexico, where total fertility was
6.8 children per woman in 1950-1955, the average annual growth rate of the population of older
persons in 2010-2015 was 4.1 per cent, but in Côte d’Ivoire, where total fertility at 6.8 children
per woman in 1950-1955 was similar to that in Mexico, the growth rate of the older population in
2010-2015 was only around half that in Mexico, at 2.3 per cent. The difference can be explained
largely by the disparate mortality risks between the two countries: people born in Mexico during

12 Looking at fertility levels some 60-80 or even 90 years prior, would offer a more complete illustration of how past fertility drives the pace of
growth of the older population. However, given that there are no internationally comparable time series of fertility estimates before 1950, the
period 60 years in the past is used as a first approximation for this analysis.
42 World Population Ageing 2015
the mid-twentieth century were twice as likely to survive to old age as those born in Côte
d’Ivoire. More specifically, an estimated 66 per cent of babies born in Mexico in 1950-1955
survived to celebrate their 60th birthdays in 2010-2015, compared to just 33 per cent of their
peers born in Côte d’Ivoire (figure III.2).13 Persons born in Côte d’Ivoire at the mid-century were
twice as likely as their counterparts in Mexico to die before age five and excess mortality
associated with armed conflict and the HIV/AIDS epidemic contributed the lower probabilities
of survival to older ages there as well.
A similar comparison can be made for China and Nigeria. While total fertility rates in both
China and Nigeria were similar at the mid-century at 6.1 and 6.4 children per woman,
respectively, the older population in China in 2010-2015 was growing nearly twice as fast as in
Nigeria (4.6 per cent versus 2.4 per cent per year) owing in part to the greater survival to old age
of people in China. An estimated 66 per cent of the people born in China in 1950-1955 survived
to their 60th birthdays compared to 37 per cent of those born in Nigeria.
Figure III.1.
Average annual percentage change in the population aged 60 years or over in 2010-2015 and total fertility in
1950-1955 *
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.

  • Countries or areas with at least 500,000 residents aged 60 or over in 2015.

13 The probability that members of the 1950-1955 birth cohort survive to age 60 is estimated using cohort life tables constructed of the
quinquennial estimates of age-specific mortality from the 2015 Revision of World Population Prospects.
United Nations Department of Economic and Social Affairs ǀ Population Division 43
Figure III.2.
Average annual percentage change in the population aged 60 years or over in 2010-2015 and probability of
survival to age 60 among the 1950-1955 birth cohort*2
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.

  • Countries or areas with at least 500,000 residents aged 60 or over in 2015.
    Table III.1 lists the current size and growth rate of the population of older persons for the
    world and six regions, as well as the fertility rates around the time that today’s 60-year-olds were
    born and their survival probabilities to age 60.2
    In 2010-2015, the population of older persons
    was growing most rapidly in Asia and Latin America and the Caribbean, at an average 3.8 per
    cent per year. Both of these regions were characterized by high fertility in 1950-1955, at 5.8 and
    5.9 children per woman, respectively. Moreover, a majority of the 1950-1955 birth cohorts
    survived to old age: 59 per cent of those born in Asia during 1950-1955 were still alive at age 60,
    as were 65 per cent of those born in Latin America and the Caribbean.
    The older populations of Northern America and Oceania were also growing rapidly during
    2010-2015, by 3.1 per cent annually in 2010-2015, despite having had much lower fertility
    compared to Latin America and the Caribbean and Asia at the mid-century (3.4 and 3.8 children
    per woman, respectively). In both Northern America and Oceania, growth of the older population
    has been bolstered by high probabilities of survival to older ages: close to 85 per cent of the
    1950-1955 birth cohort in Northern America lived to at least age 60, as did 78 per cent of their
    peers in Oceania.
    The pace of growth of the older population in Africa, at 3.0 per cent per year during 2010-
    2015, was similar to that in Northern America and Oceania, although the probability of survival
    to age 60 years in Africa was much lower, with just 42 per cent of those born in 1950-1955
    44 World Population Ageing 2015
    surviving to their 60th birthdays. In this instance, very high fertility, at 6.6 children per woman in
    1950-1955, has compensated for lower survival to old age to promote rapid growth of the
    population of older persons in Africa.
    While Europe is home to the world’s most aged population in 2015, the pace of growth of the
    older population in Europe was the slowest of the six regions during 2010-2015, at 1.7 per cent
    per year on average, owing to already low fertility in Europe in 1950-1955 at 2.7 children per
    woman, and a lower probability of survival to older ages relative to Northern America, with 76
    per cent of Europe’s 1950-1955 birth cohort alive at age 60 years.
    TABLE III.1. OLDER POPULATION SIZE AND GROWTH RATE, AND PAST FERTILITY AND MORTALITY LEVELS FOR THE WORLD AND
    REGIONS
    Population
    aged 60 years
    or over in 2015
    (thousands)
    Average annual
    rate of change of
    the population
    aged 60 years or
    over in 2010-2015
    (percentage)
    Total
    fertility in
    1950-1955
    (children
    per woman)
    Percentage
    of 1950-1955
    birth cohort
    surviving to
    age 602
    World 900 906 3.3 5.0 61.2
    Africa 64 447 3.0 6.6 42.3
    Asia 507 954 3.8 5.8 59.4
    Europe 176 513 1.7 2.7 75.6
    Latin America and the Caribbean 70 922 3.8 5.9 65.0
    Northern America 74 589 3.1 3.4 84.7
    Oceania 6 481 3.1 3.8 78.3
    Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
    Global trends in the growth rate of the older population reveal the powerful influence of
    major historical events in shaping the age composition of the world’s population.
    Figure III.3 plots the average annual rates of change of the global population aged 60 years
    or over and aged 80 years or over, respectively, by 5-year period, estimated since 1950 and
    projected until 2050. The sharp fluctuations observed in the growth rate of the population of
    older persons point to the historical events that produced significant demographic shocks during
    the early- to mid-twentieth century. For example, the sharp decline in the growth rate of the
    global population aged 80 years or over in the late 1990s marks the period during which the
    cohorts born around World War I and affected by the 1918 influenza pandemic would have
    reached their 80s. Similarly, the decline in the growth rate of the global population aged 60 years
    or over in 2000-2005 marks the period during which the cohorts born during the period of lower
    fertility surrounding World War II would have turned 60 years old; the projected decline in the
    growth rate of the population aged 80 years or over in 2020-2025 marks when they would have
    turned 80 years old.

United Nat
Figure III.3
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Average annual rate of change (percentage)
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3.
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ata source: Unit
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46 World Population Ageing 2015
B. FERTILITY TRENDS
Of the three demographic processes, historically fertility has been the most influential in
shaping trends in the numbers and proportion of older persons in the population over the long
term. Total fertility rates have fallen in each of the world’s regions. That decline, which is
described in the demographic transition, began first in Europe, Northern America and the
developed countries of Oceania as far back as the late nineteenth-century. Since the midtwentieth century, fertility decline has followed in Asia, Latin America and the Caribbean, and
Africa.
Figure III.4 illustrates trends in total fertility for the world and six regions, estimated for
1950 to 2015 and projected to 2050 from the 2015 Revision of World Population Prospects. At
the global level, total fertility in 1950 was just above 5 children per woman and it has fallen to
around 2.5 children per woman in 2015. That global decline reflects reductions in fertility in all
six regions. The steepest declines in fertility since 1950 occurred in Asia and Latin America and
the Caribbean, where total fertility fell from around 6 children per woman in the mid-twentieth
century to around 2.1 children per woman in 2015, which is the level of fertility required to
sustain population size over the long term and is referred to as the replacement rate.
Figure III.4.
Total fertility rate for the world and regions, 1950-2050
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
Total fertility rates in Oceania, Northern America and Europe were comparatively lower in
1950, at around 3.7, 3.1, and 2.6 children per woman, respectively. Following a brief increase in
fertility in the 1950s and early 1960s, fertility decline resumed in these regions. In 2015, total
fertility rates had fallen to close to 2.4 children per woman in Oceania, 1.9 children per woman
in Northern America, and 1.6 children per woman in Europe. Total fertility was highest in
1
2
3
4
5
6
7
1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050
Total fertility rate (children per woman)
Africa
World
Oceania
Northern America
Asia
Latin America
and the
Caribbean
Europe
United Nations Department of Economic and Social Affairs ǀ Population Division 47
Africa in 1950, at 6.6 children per woman on average, and while women in Africa had two fewer
children on average in 2015 than they did in 1950, the region’s total fertility rate of 4.6 children
per woman remained the highest in the world.
Projections of future fertility indicate that rates in Africa will continue to fall towards 3.0
children per woman in 2050. Fertility rates in Oceania, Asia and Latin America are also
projected to decline, although only slightly, from their 2015 levels, while those in Northern
America and Europe are projected to increase, again only slightly from their 2015 levels.
The regional trends in total fertility illustrated in figure III.4 are closely linked to the
observed and projected regional trends in the growth of the population of older persons. Figure
III.5 charts the estimated and projected regional trends in the average annual rate of change of
the population aged 60 years or over from 1980 to 2050 for each of the six regions.
Figure III.5.
Average annual rate of change of the population aged 60 years or over, by region, 1980-2050
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
The influence of the post-World War II baby boom is evident in the spike in the growth rates
of the populations of older persons in the early twenty-first century in Europe, Northern America
and Oceania. From 2015, the growth of the population aged 60 years or over is projected to slow
in Europe, Latin America and the Caribbean, Northern America and Oceania, reflecting the
reductions in fertility that led to slowing in the growth of birth cohorts through the latter half of
the twentieth century. In Asia, the growth rate of the population of older persons is projected to
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
1980-1985
1985-1990
1990-1995
1995-2000
2000-2005
2005-2010
2010-2015
2015-2020
2020-2025
2025-2030
2030-2035
2035-2040
2040-2045
2045-2050
Annual rate of change (percentage)
Africa
Latin America
and the
Caribbean
Asia
Oceania
Northern
America
Europe
48 World Population Ageing 2015
decline precipitously after 2025, reflecting the rapid decline in fertility that began in the mid1960s in that region. In Africa, the pace of growth of the population aged 60 years or over is
projected to increase from just over 3 per cent per year in 2010-2015 reaching nearly 3.9 per cent
per year in 2040-2045, reflecting the higher fertility rates in the region. The pace of growth of
the older population of Africa projected for the 2040s is faster than any region has experienced
since 1950 when the data series begins.
C. TRENDS IN LIFE EXPECTANCIES AND PROBABILITIES OF SURVIVAL TO OLD AGE
As fertility rates fall over time, the size of birth cohorts stabilizes and improvements in
longevity become increasingly important drivers of population ageing. Fertility in Europe has
been well below the replacement level for more than three decades, thus variations across
countries in the rate of growth of the older population are increasingly influenced by disparities
in the likelihood of survival to old age. A similar situation is emerging in Northern America and
is anticipated to occur in Asia and Latin America and the Caribbean where fertility decline began
more recently. This section examines past, present and future mortality risks as summarized in
terms of the life expectancies at birth and at age 60, as well as the cohort probabilities of survival
to older ages.
All regions have experienced substantial increases in life expectancy since 1950.
The life expectancy at birth describes the number of years a person would be expected to live
if he or she were exposed throughout life to the prevailing age-specific mortality risks of a given
period. Figure III.6 shows the life expectancy at birth for the world and six regions estimated for
1950 to 2015 and projected to 2050 from the 2015 Revision of World Population Prospects. In
2010-2015, life expectancy at birth globally was 70.5 years, having risen from 46.8 years in
1950-1955. Across the six regions in 2010-2015, the expectation of life at birth was longest in
Northern America, at 79.2 years, and shortest in Africa, at 59.5 years. All regions have
experienced an increase in life expectancy since 1950, with the fastest increases occurring in
Asia, where life expectancy at birth increased from 42.1 years in 1950-1955 to 71.6 years in
2010-2015, and in Latin America and the Caribbean, where it rose from 51.2 years to 74.5 years
over the same period.
Improvements in the life expectancy at birth can be driven by mortality decline at various
ages. Decomposing the change in life expectancy at birth according to the contribution of
mortality reductions among different age groups offers insight into how the drivers of
improvements in life expectancy vary across populations at different levels of mortality. The
results of this decomposition exercise are shown in figure III.7, which illustrates the contribution
of mortality decline below age 5 years, between ages 5 and 59 years, and at age 60 years or over,
respectively, to the overall increases in life expectancy at birth between 1995-2000 and 2010-
2015 for the world and six regions. At the global level, improved survival between birth and age
5 accounted for close to half of the 4.9-year increase in the life expectancy at birth between
1995-2000 and 2010-2015. Mortality reductions between ages 5 and 59 years and at age 60
years or over each accounted for 25 per cent of the global gain in the life expectancy at birth over
that period.
United Nations Department of Economic and Social Affairs ǀ Population Division 49
Figure III.6.
Life expectancy at birth for the world and regions, 1950-2050
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
Figure III.7.
Contribution of mortality decline at different ages to improvements in the life expectancy at birth between
1995-2000 and 2010-2015, for the world and regions*
*
Calculated using life tables from United Nations (2015). World Population Prospects: The 2015 Revision. The method
applied to decompose the change in life expectancy at birth according to the contribution of improvements in survival at different
age groups is that developed by Arriaga (1984) and described in Preston, Heuveline and Guillot (2001), p. 65.
30
40
50
60
70
80
90
Life expectancy at birth (years)
World
Northern America
Europe
Oceania
Latin America
and the
Caribbean
Asia
Africa
25%
9%
23%
39%
51% 52%
71%
0
1
2
3
4
5
6
7
8
World Africa Asia Latin
America
and the
Caribbean
Europe Oceania Northern
America
Change in life expectancy at birth
(years)
60 years or over
5 to 59 years
0 to 4 years
50 World Population Ageing 2015
Improvements in survival at age 60 or over accounted for more than half of the total
improvement in longevity in Oceania, Europe and Northern America, while reduced
mortality at younger ages was more important in Africa, Asia and Latin America and the
Caribbean.
Africa, the region with the largest gain in life expectancy at birth since 1995-2000 (7.3
years), attributed a majority of that increase (54 per cent) to improved survival among children
under five. Reductions in mortality at age 60 years or over contributed 0.6 years (9 per cent) to
the overall increase in life expectancy at birth in Africa. Across the six regions, the largest
fraction of the total increase in life expectancy at birth due to reduced mortality at older ages
occurred in Northern America, where 71 per cent of the 2.6-year improvement in longevity was
due to reduced mortality above age 60. Mortality reductions at older ages accounted for more
than half of the total increase in the life expectancy at birth in Europe and Oceania as well. In
Latin America and the Caribbean, life expectancy increased by just over four years between
1995-2000 and 2010-2015 and 39 per cent of that gain was due to reductions in mortality risks at
age 60 years or over. Asia added five years to the life expectancy at birth between 1995-2000
and 2010-2015 and while most of that gain was due to mortality reductions among children
under five years, 23 per cent was attributable to reduced mortality at age 60 years or over.
As the life expectancy at birth increases, improvements in survival at older ages account
for a growing proportion of the overall improvement in longevity.
Figure III.8 shows the percentage contribution of increases in the life expectancy at age 60
(both sexes combined) to overall improvements in longevity between 1995-2000 and 2010-2015
versus the life expectancy at birth in 2010-2015 among the 195 countries or areas with at least
90,000 inhabitants in 2015 and for which life expectancy at birth increased over the period.
Among those countries with low life expectancy at birth, below 65 years, most of which are
located in sub-Saharan Africa, changes in survival probabilities above age 60 accounted for only
a small fraction of the change in life expectancy since 1995, at well under 20 per cent in most
cases. Examples include Nigeria, where 3.7 per cent of the total 6.0-year increase in life
expectancy at birth between 1995-2000 and 2010-2015 was attributable to improved survival at
age 60 or over, and Papua New Guinea, where improved survival at older ages accounted for
14.5 per cent of the overall 4.3-year increase in the life expectancy at birth. At the other end of
the spectrum, in countries with life expectancy at birth above 75 years, a majority of the
improvement in overall longevity was due to improvements in survival above age 60. Reduced
mortality at older ages accounted for more than 70 per cent of the net improvement in several
countries, including Canada, Ireland, Japan, Singapore, Sweden, the United Kingdom and the
United States.
Defined similarly to the life expectancy at birth, the life expectancy at age 60 reflects the
number of additional years a 60-year-old person would be expected to live if exposed throughout
the remainder of life to the prevailing age-specific mortality rates of a given period. In 2010-
2015, 60-year-old persons globally could expect to live an additional 20.2 years on average.
Across the six regions, the life expectancy at age 60 was highest in Northern America and
Oceania, at 23.5 years and 23.7 years, respectively, and lowest in Africa, at 16.7 years.
United Nations Department of Economic and Social Affairs ǀ Population Division 51
Figure III.8.
Contribution of increased longevity after age 60 to total improvement in the life expectancy at birth, 1995-
2000 to 2010-2015*
*
Calculated using life tables from United Nations (2015). World Population Prospects: The 2015 Revision. The method
applied to decompose the change in life expectancy at birth according to the contribution of improvements in survival at different
age groups is that developed by Arriaga (1984) and described in Preston, Heuveline and Guillot (2001), p. 65.
195 countries or areas with at least 90,000 inhabitants in 2015 and an improvement in the life expectancy at birth between 1995-
2000 and 2010-2015.
Table III.2 lists the life expectancies at birth and at age 60 for both sexes combined and for
each sex separately for the world and six regions. Women tend to live longer than men, on
average, a phenomenon linked to both biological and behavioural health advantages of women.
At the global level in 2010-2015, women’s life expectancy at birth exceeded that of men by 4.5
years. The female advantage in survival from birth was largest in Europe (7.1 years) and Latin
America and the Caribbean (6.7 years), and lowest in Africa (2.7 years) and Asia (3.8 years).
The female survival advantage persists at older ages. Globally in 2010-2015, 60-year-old
women could expect to outlive 60-year-old men by an average 2.8 years and, as with life
expectancy at birth, the female survival advantage at age 60 was greatest in Europe (4.0 years)
and smallest in Africa (1.5 years).
As with life expectancy at birth, all regions have experienced improvements in the life
expectancy at age 60, and are projected to continue to see improvements in survival at
older ages over the coming decades.
52 World Population Ageing 2015
TABLE III.2. LIFE EXPECTANCY AT BIRTH AND AT AGE 60, BY SEX, FOR THE WORLD AND REGIONS, 2010-2015
Life expectancy at birth
(years)
Life expectancy at age 60
(years)
Both Female Male
Sex
difference
(femalemale) Both Female Male
Sex
difference
(femalemale)
World 70.5 72.7 68.3 4.5 20.2 21.5 18.7 2.8
Africa 59.5 60.9 58.2 2.7 16.7 17.4 15.9 1.5
Asia 71.6 73.6 69.7 3.8 19.4 20.6 18.1 2.5
Latin America and the Caribbean 74.5 77.9 71.2 6.7 21.8 23.3 20.1 3.3
Europe 77.0 80.6 73.4 7.1 21.9 23.8 19.8 4.0
Oceania 77.5 79.7 75.3 4.4 23.7 25.2 22.1 3.1
Northern America 79.2 81.5 76.8 4.7 23.5 24.9 21.9 3.0
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
Figure III.9 shows the life expectancy at age 60 by sex and for both sexes combined for each
of the six regions estimated for the period 1950 to 2015 and projected to 2050. In Africa, the life
expectancy at age 60 for both sexes combined rose from 12.5 years in 1950-1955 to 16.7 years in
2010-2015 and is projected to rise further to 19.3 years in 2045-2050. Women in Africa have
seen greater advances in survival at older ages on average than men: the female advantage in life
expectancy at age 60 widened from 1.0 years in 1950-1955 to 1.5 years in 2010-2015 and is
anticipated to widen further to 2.1 years in 2045-2050.
At the mid-twentieth century, life expectancy at age 60 in Asia was similar to that in Africa,
at 12.1 years for both sexes combined. Yet advances in survival at older ages have outpaced
those in Africa such that by 2010-2015, the expectation of life at age 60 in Asia had grown to
19.4 years. Improvements in survival at older ages have progressed at a similar pace in Latin
America and the Caribbean, where the life expectancy at age 60 for both sexes combined
increased from 15.1 years in 1950-1955 to 21.8 years in 2010-2015. Both in Asia and in Latin
America and the Caribbean, the sex difference in the life expectancy at age 60 widened over
time. From a gender gap of less than two years in the 1970s, the female advantage in life
expectancy at age 60 in 2010-2015 has grown to 2.5 years in Asia and to 3.3 years in Latin
America and the Caribbean.
In Europe, Northern America and Oceania, life expectancy at age 60 ranged from 16 to 17
years in 1950-1955. By 2010-2015, Oceania had added 7.5 years to the life expectancy at age 60;
Europe added 5.7; and Northern America added 4.2 years. After widening between 1950 and
1980, the sex differences in life expectancy at older ages in both Northern America and Oceania
began to decline, tobacco use, which increased later among women than among men, began to
influence similarly their mortality risks (Preston, Glei and Wilmoth, 2010). In Northern America
in particular, the female advantage in survival after age 60 narrowed from close to five years in
1975-1980 to three years in 2010-2015. In Europe, the female advantage in survival after age 60
has remained above four years since 1975-1980, due largely to persistent excess mortality risks
associated with non-communicable diseases and injuries among males in Eastern Europe (Leon,
2011). A recent study from the World Health Organization attributed the increases in life
expectancies at older ages in high-income countries to reductions in tobacco-related mortality
United Nations Department of Economic and Social Affairs ǀ Population Division 53
among men and reductions in cardiovascular-disease mortality among both men and women
(Mathers and others, 2015).
Figure III.9.
Life expectancy at age 60, by sex and region, 1950-2050

Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
Projections indicate that the life expectancy at age 60 will continue to increase in all regions
(figure III.9; table III.3). By 2045-2050 the number of additional years a 60-year-old person can
expect to live, on average, is expected to increase by 2.9 years at the global level for women and
by 3.2 years for men. Men in Latin America and the Caribbean are projected to experience the
largest increase in the life expectancy at age 60 by 2045-2050, with an additional 4.0 years,
10
15
20
25
30
1950 1975 2000 2025 2050
Africa
Female Both sexes Male
10
15
20
25
30
1950 1975 2000 2025 2050
Latin America and the Caribbean
Female Both sexes Male
10
15
20
25
30
1950 1975 2000 2025 2050
Asia
Male Female Both sexes
10
15
20
25
30
1950 1975 2000 2025 2050
Oceania
Male Female Both sexes
10
15
20
25
30
1950 1975 2000 2025 2050
Europe
Male Female Both sexes
10
15
20
25
30
1950 1975 2000 2025 2050
Northern America
Male Female Both sexes
54 World Population Ageing 2015
followed by women in the same region and men in Northern America, each with projected
increases in the life expectancy at age 60 of 3.7 years. While improvements in survival at older
ages are projected to be slower in Africa than in the other regions, still the life expectancy at age
60 is projected to increase by 2.9 years among women and 2.3 years among men between 2010-
2015 and 2045-2050.
TABLE III.3. LIFE EXPECTANCY AT AGE 60, BY SEX, FOR THE WORLD AND REGIONS, 1950-1955, 2010-2015 AND 2045-2050.
Females Males
Life expectancy at age
60 (years)
Life expectancy at age
60 (years)
1950-
1955
2010-
2015
2045-
2050
Change
between
1950-
1955
and
2010-
2015
(years)
Change
between
2010-
2015
and
2045-
2050
(years)
1950-
1955
2010-
2015
2045-
2050
Change
between
1950-
1955
and
2010-
2015
(years)
Change
between
2010-
2015
and
2045-
2050
(years)
World 15.0 21.5 24.4 6.5 2.9 13.0 18.7 21.9 5.7 3.2
Africa 13.0 17.4 20.3 4.4 2.9 12.0 15.9 18.2 4.0 2.3
Asia 12.9 20.6 23.9 7.7 3.3 11.3 18.1 21.6 6.8 3.4
Latin America and the
Caribbean 15.8 23.3 27.0 7.5 3.7 14.4 20.1 24.0 5.7 4.0
Oceania 18.0 25.2 28.1 7.3 2.8 14.8 22.1 25.0 7.3 2.9
Europe 17.8 23.8 27.2 6.0 3.4 15.5 19.8 23.3 4.3 3.6
Northern America 19.0 24.9 27.9 5.9 3.0 15.9 21.9 25.6 6.0 3.7
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
While the life expectancies at birth and at age 60 give a useful summary of the mortality risks
experienced in a population at a single point in time, the probabilities of survival experienced by
different birth cohorts are also instructive on how the mortality risks that people experience over
their lifetimes differ according to the year and location of birth. Figure III.10 shows the
probabilities of survival to ages 60 and 80 estimated for the 1950-1955 birth cohort, whose
survivors were between 60 and 65 years old in 2015, as well as those projected for the 2000-
2005 birth cohort, whose survivors were just 10 to 15 years old in 2015 and will celebrate their
60th birthdays in 2060-2065
A majority of the 1950-1955 birth cohort survived to age 60 in all regions except Africa,
where just 45 per cent of women and 40 per cent of men lived to their 60th birthdays. Of those
born in 1950-1955, women born in Northern America were the most likely to survive to age 60
(89 per cent), followed by women in Europe (82 per cent), women in Oceania and men in
Northern America (81 per cent), men in Oceania (76 per cent), women in Latin America and the
Caribbean (70 per cent), men in Europe (69 per cent), men in Latin America and the Caribbean
and women in Asia (61 per cent), and men in Asia (58 per cent).
Among the 2000-2005 birth cohort, however, projections indicate that more than 8 in 10 men
and women will survive to age 60 in every region but Africa, and the probability of survival to
age 60 will exceed 90 per cent among women in Europe, Latin America and the Caribbean,
Northern America and Oceania, as well as among men in Northern America. Substantial
United Nations Department of Economic and Social Affairs ǀ Population Division 55
increases in survival to age 60 are projected for Africa: of those born in the region in 2000-2005,
71 per cent of females and 66 per cent of males are projected to survive to age 60.
Figure III.10.
Probabilities of survival to ages 60 and 80 years among the 1950-1955 and 2000-2005 birth cohorts, by sex
and region
Data source: Calculated using cohort life tables constructed from United Nations (2015). World Population Prospects:
The 2015 Revision.
40%
45%
58%
61%
76%
81%
61%
70%
69%
82%
81%
89%
58%
64%
66%
71%
82%
86%
87%
90%
86%
91%
89%
95%
92%
94%
80%
84%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Africa Asia Oceania
Latin
America
and the
Caribbean Europe
Northern
America World
Percentage surviving to age 60
Cohort born in 1950-
1955
Cohort born in 2000-
2005
14%
19%
27%
35%
50%
61%
34%
47%
38%
59%
51%
65%
29%
39%
33%
43%
54%
62%
63%
73%
65%
74%
65%
79%
74%
80%
52%
60%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Africa Asia Oceania
Latin
America
and the
Caribbean Europe
Northern
America World
Percentage surviving to age 80
Cohort born in 1950-
1955
Cohort born in 2000-
2005
56 World Population Ageing 2015
Not only are substantially more people projected to reach old age in the future, but more
older people than ever before are projected to survive to age 80 years or over. Among those born
in 1950-1955, majorities of women in Europe, Northern America and Oceania are projected to
survive to age 80, as are slight majorities of men in Northern America and Oceania. In most of
the world, however, survival to age 80 is expected to be comparatively rare among those born at
the mid-century. In Latin America and the Caribbean, 47 per cent of women and 34 per cent of
men born in 1950-1955 are projected to survive to age 80; in Asia, it’s 35 per cent of women and
27 per cent of men; and in Africa it’s 19 per cent of women and 14 per cent of men.

Projected survival to age 80 among the 2000-2005 birth cohort show marked improvements
in all regions compared to the cohorts born 50 years earlier. Among the 2000-2005 birth cohort,
survival to age 80 is expected to be the norm everywhere but in Africa. Around 8 in 10 women
born in Northern America and Europe in 2000-2005 are projected to survive to age 80.
Probabilities of survival to age 80 among the 2000-2005 birth cohort also exceed 70 per cent
among women in Latin America and the Caribbean and Oceania and men in Northern America.
While those born in Africa are least likely to survive to advanced older ages, still 43 per cent of
women and 33 per cent of men born in Africa during 2000-2005 are projected to live to their 80th
birthdays.
The accuracy of projections of life expectancy at older ages will depend on the degree of
progress achieved in preventing or postponing mortality caused by many of the diseases
associated with old age, in particular non-communicable diseases (NCDs) such as cardiovascular
diseases, cancers, diabetes and respiratory diseases. Table III.4 lists the ten leading causes of
death to those aged 60 years or over globally, by sex, for the year 2012.
TABLE III.4. TEN LEADING CAUSES OF DEATH OF THOSE AGED 60 YEARS OR OVER GLOBALLY, BY SEX, 2012
Males Females
Cause of death
Deaths
(thousands) Pct Cause of death
Deaths
(thousands) Pct
1 Ischaemic heart disease 2 985 226 17.8 Stroke 3 102 405 18.6
2 Stroke 2 614 535 15.6 Ischaemic heart disease 3 087 753 18.5
3 COPDi
1 541 208 9.2 COPDi
1 225 348 7.4
4 Lung cancerii 858 088 5.1 Lower respiratory infections 780 539 4.7
5 Lower respiratory infections 746 789 4.5 Diabetes mellitus 656 592 3.9
6 Diabetes mellitus 500 976 3.0 Hypertensive heart disease 571 320 3.4
7 Hypertensive heart disease 399 580 2.4 Alzheimer’s diseaseiii 455 616 2.7
8 Stomach cancer 353 508 2.1 Lung cancerii 389 966 2.3
9 Prostate cancer 309 168 1.8 Breast cancer 286 593 1.7
10 Liver cancer 306 859 1.8 Kidney diseases 279 398 1.7
Data source: World Health Organization (2014). Global Health Estimates 2014 Summary Tables: Deaths by Cause, Age and Sex.
2000-2012. http://www.who.int/healthinfo/global_burden_disease/en/ i
Chronic Obstructive Pulmonary Disease
ii includes trachea and bronchus cancers
iii and other dementias
United Nations Department of Economic and Social Affairs ǀ Population Division 57
Cardiovascular diseases, which include heart diseases and stroke, accounted for the largest
proportion of deaths among older persons worldwide in 2012. Ischaemic heart disease was the
leading cause of death among older men, causing close to 18 per cent of deaths, followed by
stroke, which was responsible for another 16 per cent of deaths to men aged 60 years or over.
Among older women globally, there were slightly more stroke deaths than deaths due to
ischaemic heart disease in 2012; each cause contributed over 18 per cent of deaths to women
aged 60 years or over. Hypertensive heart disease accounted for an additional 2.4 per cent of
deaths to older men and 3.4 per cent of deaths to older women.
Apart from cardiovascular diseases, chronic obstructive pulmonary disease (COPD), lower
respiratory infections, diabetes mellitus and lung cancer (including trachea and bronchus
cancers) rank among the ten leading causes of death to both men and women aged 60 years or
over globally. Cancers of the stomach, prostate and liver are among the ten leading causes of
death to older men, while Alzheimer’s disease, breast cancer and kidney diseases rank among the
ten leading causes of death to older women.
D. FERTILITY AND MORTALITY AS DETERMINANTS OF TRENDS IN THE PERCENTAGE OF OLDER
PERSONS
The contribution of the demographic transition to the increasing share of older persons in a
population can be understood through “population pyramids” that illustrate changes in the size
and age structure of a population over time. Figure III.11 contains the population pyramids for
three countries—Germany, Brazil and the United Republic of Tanzania—corresponding to three
points in time in order to illustrate the implications of the fertility and mortality shifts that
characterize the demographic transition for changes in the age distribution of the population.
Population ageing is an inevitable consequence of the demographic transition.
The demographic transition began first in Europe and Northern America, where fertility
reductions took place over the past two centuries, contributing to their relatively aged population
age structures today. In Germany, the total fertility rate in 1950 was 2.1 children per woman,
and the proportion of the population aged 60 years or over was just under 15 per cent. Fertility
continued to fall in Germany to 1.4 children per woman in 2015, while the proportion of older
persons nearly doubled to 28 per cent. While fertility rates in Germany are expected to increase
somewhat in the coming decades, they are likely to remain below the replacement level of 2.1
children per woman, and, by 2050, the percentage aged 60 years or over is projected to reach 39
per cent.
The demographic transition began later in most of Asia and Latin America and the Caribbean
and thus their populations are youthful compared to Europe and Northern America. In Brazil,
fertility in 1950 was 6.2 children per woman, on average, and just 5 per cent of the population
was aged 60 years or over. But starting around 1960 fertility declined rapidly in Brazil to 1.8
children per woman in 2015, and it is projected to remain below replacement at least through

  1. Fertility decline has occurred much faster in Asia and Latin America and the Caribbean
    than in the more developed regions and thus the populations of Asia and Latin America and the
    58 World Population Ageing 2015
    Caribbean are ageing more rapidly. The share of Brazil’s population aged 60 years or over, for
    example, is projected to increase from 12 per cent in 2015 to 29 per cent in 2050.
    Many countries in Africa remain in the early stages of the demographic transition: some have
    begun to see reductions in fertility only recently, while others have yet to see a significant
    decline in fertility. As a result, while the numbers of older persons have grown, their share of the
    overall population has remained fairly small. In the United Republic of Tanzania, for example,
    total fertility in 2015, at 5.1 children per woman, was still comparatively high, although it had
    fallen from 6.7 children per woman in 1950. Consequently, there has been little change in the
    proportion of older persons in Tanzania: it increased only slightly, from 4 per cent in 1950 to 5
    per cent in 2015. Fertility in Tanzania is projected to continue a relatively slow decline towards
    3.3 children per woman in 2050 and the percentage of the population aged 60 years or over is
    projected to rise gradually to reach 7 per cent by the mid-century.
    The size of the population of older persons over the near term is fairly certain, since: 1) the
    people who will be aged 60 years or over in 2030 are today’s population aged 45 years or over;
    and 2) adult mortality risks tend to change slowly over time. The size of the population of
    children, however, is less certain, since total fertility rates can shift relatively quickly. This
    uncertainty in the future numbers of children shapes the uncertainty associated with projections
    of the proportion of older persons over the medium- to long-term.
    Figure III.12 displays the proportion of the population aged 60 years or over projected in the
    medium variant, as well as two alternative hypothetical fertility scenarios for three countries with
    disparate levels of fertility in 2015. The high-fertility scenario illustrates what the proportion of
    older persons would be if the total fertility rate were 0.5 children per woman higher than in the
    medium variant projection, while the low-fertility scenario illustrates that proportion if the
    fertility rate were 0.5 children per woman lower than in the medium variant projection.
    In Japan where total fertility averaged 1.5 children per woman in 2015, the population has
    aged rapidly over the past 65 years, from 8 per cent aged 60 years or over in 1950 to 33 per cent
    in 2015. According to the medium variant projection, fertility in Japan will remain well below
    the replacement level of 2.1 children per woman and Japan’s population will continue to age,
    reaching 37 per cent aged 60 years or over in 2030 and 42 per cent in 2050. However, if future
    fertility differs from the medium variant, the population ageing process in Japan could be
    accelerated or slowed. If future total fertility is 0.5 children per woman lower than in the
    medium variant projection, the proportion aged 60 years or over in 2050 will be 4 percentage
    points higher, at close to 47 per cent, while if it is 0.5 children per woman higher than in the
    medium variant projection, the proportion of older persons in 2050 will be more than 3
    percentage points lower, at 39 per cent. However, since both the high- and low-fertility
    scenarios fall well outside the 95 per cent prediction interval associated with probabilistic
    projections of total fertility in Japan (data not shown), deviation of this magnitude from the
    medium variant projection of the proportion of older persons is highly unlikely.
    United Nations Department of Economic and Social Affairs ǀ Population Division 59
    Figure III.11.
    Population age structure in Germany, Brazil and the United Republic of Tanzania, 1950, 2015 and 2050
    1950 2015 2050
    Germany
    Brazil
    United Republic of Tanzania

Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
10 8 6 4 2 0 2 4 6 8 10
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-85
85-89
90-94
95-99
100+
Population (millions)
Age
Total
pop =
70
million
10 8 6 4 2 0 2 4 6 8 10
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-85
85-89
90-94
95-99
100+
Population (millions)
Total
pop =
81
million
10 8 6 4 2 0 2 4 6 8 10
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-85
85-89
90-94
95-99
100+
Population (millions)
Total
pop =
75
million
10 8 6 4 2 0 2 4 6 8 10
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-85
85-89
90-94
95-99
100+
Population (millions)
Age
Total
pop =
54
million
10 8 6 4 2 0 2 4 6 8 10
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-85
85-89
90-94
95-99
100+
Population (millions)
Total
pop =
208
million
10 8 6 4 2 0 2 4 6 8 10
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-85
85-89
90-94
95-99
100+
Population (millions)
Total
pop =
238
million
10 8 6 4 2 0 2 4 6 8 10
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-85
85-89
90-94
95-99
100+
Population (millions)
Age
Total
pop = 8
million
10 8 6 4 2 0 2 4 6 8 10
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-85
85-89
90-94
95-99
100+
Population (millions)
Total
pop =
53
million
10 8 6 4 2 0 2 4 6 8 10
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-85
85-89
90-94
95-99
100+
Population (millions)
Total
pop =
137
million
Males Females
60 World Population Ageing 2015
Figure III.12.
Percentage aged 60 years or over under three fertility projection scenarios, and total fertility rate (TFR),
Japan, Pakistan and Nigeria, 1950-2050*
Data source: United Nations (2015). World Population Prospects: The 2015 Revision. *
“Medium” refers to the medium variant projection. “Low” refers to a projected fertility scenario in which total
fertility is 0.5 children per woman lower than the medium variant projection, while “High” refers to a projected fertility scenario
in which total fertility is 0.5 children per woman higher than the medium variant projection.
1
2
3
4
5
6
7
0
10
20
30
40
50
1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050
Total fertility (children per woman)
Percentage aged 60 years or over
Japan
Low
Medium
High
TFR (medium)
1
2
3
4
5
6
7
0
5
10
15
20
1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050
Total fertility (children per woman)
Percentage aged 60 years or over
Pakistan
Low
Medium
High
TFR (medium)
1
2
3
4
5
6
7
0
2
4
6
8
1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050
Total fertility (children per woman)
Percentage aged 60 years or over
Nigeria
Low
Medium
High
TFR (medium)
United Nations Department of Economic and Social Affairs ǀ Population Division 61
In countries where total fertility has been higher than in Japan and the pace of population
ageing has been slower, variations in projected fertility of 0.5 children per woman in either
direction yield smaller changes to the projected proportion of older persons for 2050. In Pakistan
for example, total fertility remained above six children per woman until 1990 when birth rates
began to fall precipitously, reaching 3.4 children per woman in 2015. Reflecting persistently high
historical fertility levels, the proportion aged 60 years or over in Pakistan declined somewhat
between 1950 and 1970, from close to 8 per cent to just under 6 per cent, and has risen only
slightly since then to 6.6 per cent in 2015. Recent fertility declines are projected to yield
accelerated population ageing in Pakistan in the coming decades, however, with the proportion
of older persons expected to increase to 8 per cent in 2030 and to close to 13 per cent in 2050.
Projection scenarios with a trajectory of the total fertility rate 0.5 children per woman lower or
higher than the medium variant produce projected proportions aged 60 years or over in 2050 for
Pakistan that range from 11.6 per cent in the high-fertility scenario to 14.5 per cent in the low
fertility scenario. Unlike for Japan, the high- and low-fertility scenarios for Pakistan fall within
the 95 per cent prediction interval of the probabilistic projections of total fertility, but at the
margins of the 80 per cent prediction interval.
Fertility decline in Nigeria began relatively recently and thus the country has not yet
experienced an increase in the proportion of older persons. In 2015, 4.5 per cent of Nigeria’s
population was aged 60 years or over and that proportion is projected to change only slightly (to
4.8 per cent) through 2030. By 2050, however, the proportion of older persons in Nigeria is
expected to have begun to grow more significantly, reaching 6.3 per cent in the medium variant
projection, 7.0 per cent if total fertility falls to 0.5 children per woman lower than the medium
variant, or 5.8 per cent if total fertility declines less rapidly, to a level that is 0.5 children per
woman higher than in the medium variant. Higher fertility in Nigeria is also associated with
greater uncertainty in projected future fertility. Both the high- and low-fertility scenarios fall
well within the 80 per cent prediction interval associated with the probabilistic projections of
total fertility for Nigeria.
E. INTERNATIONAL MIGRATION AND POPULATION AGEING
While declining fertility and increasing longevity are the key drivers of population ageing
globally, international migration has also contributed to changing population age structures in
some countries and regions. In countries that are experiencing large immigration flows,
international migration can slow the ageing process, at least temporarily, since migrants tend to
be in the young working ages. However, migrants who remain in the country eventually will age
into the older population. Thus, over the long term, only sustained large flows of young
immigrants could slow or reverse population ageing. A 2001 study from the United Nations
concluded that in several European countries, as well as in Japan, the Republic of Korea and the
United States, levels of immigration would need to be much higher than had been observed in
the past in order for international migration to offset population ageing, and thus, replacement
migration alone was unlikely to be an effective policy response to population ageing (United
62 World Population Ageing 2015
Nations, 2001). Other studies also have concluded that the levels of international migration
required to offset population ageing are implausible (see, for example, Bijak and others, 2007).14
Despite these conclusions, there is some evidence that countries are increasingly turning to
international migration as a means to expand the size of the labour force in the context of an
ageing population. The number of countries with policies to increase rates of immigration has
been rising steadily over time from 8 in 1996 to 11 in 2005 and to 22 in 2013. Among those
countries enacting policies to raise the level of immigration, most have identified population
ageing as a “major concern” (figure III.13). In 2013, population ageing was cited as a major
concern by 20 of the 22 countries (91 per cent) with policies to raise immigration levels. By
comparison, 47 per cent of countries that had not enacted policies to promote immigration
identified population ageing as a “major concern” (United Nations, 2014c).
Figure III.13.
Distribution of countries according to the policy on immigration and level of concern about population
ageing, 2005 and 2013
Data source: United Nations (2014c). World Population Policies Database 2013.
Over time, the number of countries seeking to maintain their levels of immigration also has
increased (from 104 in 2005 to 120 in 2013), while the number seeking to lower levels of
immigration has declined (from 43 in 2005 to 30 in 2013). Half of the countries with policies to
maintain levels of immigration in 2013 had identified population ageing as a major concern.

14 This conclusion may soon be challenged by recent experience in Europe, where current evidence suggests that flows of migrants, refugees and
asylum seekers from the Middle East and Africa are reaching historically unprecedented magnitudes (OECD, 2015a,
http://www.oecd.org/migration/Is-this-refugee-crisis-different.pdf).
0
20
40
60
80
100
120
No intervention
Lower
Maintain
Raise
No intervention
Lower
Maintain
Raise
2005 2013
Number of countries
Policy on immigration
Ageing not a major
concern
Ageing a major
concern
United Nations Department of Economic and Social Affairs ǀ Population Division 63
Conversely, the emigration of young workers has accelerated the population ageing process
in some countries, particularly in Eastern Europe where increasing access to European Union
labour markets as well as the economic crisis that began in 2008 have contributed to large
emigration flows. In Lithuania, for example, net emigration over the 2000s was equivalent to 13
per cent of the population, while in Latvia and Estonia it was 9 per cent and 6 per cent,
respectively (OECD, 2013a). Young people aged 20 to 35 accounted for a disproportionate
share of emigrants from these countries (OECD, 2013a), thereby contributing to intensify
population ageing there. Between 2000 and 2015, the share of older persons in Lithuania grew
from 19 per cent to 25 per cent and in both Latvia and Estonia from 21 per cent to 25 per cent.
Looking to the near future, international migration is projected to have only small effects on
the pace of population ageing in most countries. The magnitude of the impact of international
migration on projected trends in population ageing can be understood through a comparison of
the projected proportion of the population aged 60 years or over in 2030 according to the
“medium variant” to the projected proportion aged 60 years or over according to a “zero
migration” scenario. The medium variant reflects median projected future levels of fertility and
mortality rates, as well as future migration levels that take into account levels and trends in
migration observed in the country during the recent past. The zero migration scenario considers
what the future population would be under the median fertility and mortality levels, but in the
absence of any international migration. In 163 out of 201 countries or areas with at least 90,000
inhabitants in 2015, the difference in the percentage aged 60 years or over in 2030 between the
medium variant and zero migration scenarios amounts to less than 1 percentage point.
Net migration is projected to slow population ageing in 24 of the 38 countries or areas where
projected net migration implies a greater than one point difference in the percentage of the
population aged 60 years or over in 2030 (table III.5). In the remaining 14 countries, net
migration is expected to actually accelerate population ageing between 2015 and 2030 (table
III.6). Labour migration to the Gulf States of Bahrain, Kuwait, Qatar and the United Arab
Emirates is projected to counter population ageing trends so that the projected percentage of the
population aged 60 years or over in 2030 is substantially lower than it would be if no migration
were to take place. In Qatar, for example, the medium variant projection indicates that 7.9 per
cent of the population will be aged 60 years or over in 2030, but it would be 11 per cent if no
migration were to take place between 2015 and 2030. In the United Arab Emirates, older
persons are projected to account for 11.3 per cent of the population in 2030 according to the
medium variant, but would account for 14.2 per cent in the absence of migration.
Other populations that receive a large number of migrants in the working ages are also
projected to see slower population ageing as a result, including Luxembourg, Macao, Australia,
Switzerland, Canada, the Channel Islands, Hong Kong, special administrative region of China,
and Norway, where the percentage aged 60 years or over is projected to be more than 2
percentage points lower in 2030 than it would be in the absence of migration. Migration has the
largest impact on the pace of population ageing in Luxembourg: if there were no net migration to
Luxembourg the projected percentage of persons aged 60 years or over in 2030 would be 28.9
per cent instead of the 24.7 per cent projected in the medium variant.
64 World Population Ageing 2015
International migration is anticipated to accelerate population ageing in some countries, due
to projected net emigration of working aged people, net immigration of older people, or both.
Many of the populations that are projected to see ageing accelerated by migration between 2015
and 2030 are located in the Caribbean. In Barbados, for example, the proportion aged 60 years
or over in 2030 is projected to reach 27.7 per cent in the medium variant, compared to 25.4 per
cent with no migration. In Guadeloupe, the population is projected to become 30.5 per cent aged
60 years or over in 2030, compared to 29.3 per cent with no migration. Outside of the Caribbean
region, Lebanon, Samoa, Albania, Tonga, Sri Lanka and Réunion are also projected to see
population ageing accelerated as a result of international migration.
TABLE III.5. COUNTRIES OR AREAS WHERE INTERNATIONAL MIGRATION IS PROJECTED TO SLOW POPULATION AGEING
BY AT LEAST 1 PERCENTAGE POINT BY 2030
Percentage of population aged 60 years or over Difference
between
medium
variant and
zero
migration
Medium
variant
projection
Zero
migration
scenario
2015 2030 2030
Luxembourg 19.1 24.7 28.9 -4.1
Qatar 2.3 7.9 11.0 -3.0
China, Macao SAR 14.8 25.7 28.6 -2.9
United Arab Emirates 2.3 11.3 14.2 -2.9
Bahrain 3.9 10.8 13.7 -2.8
Kuwait 3.4 8.9 11.5 -2.7
Australia 20.4 24.6 27.2 -2.5
Switzerland 23.6 30.6 33.1 -2.4
Canada 22.3 29.4 31.6 -2.3
Channel Islands 23.6 31.0 33.1 -2.1
China, Hong Kong SAR 21.7 33.6 35.6 -2.0
Norway 21.8 26.2 28.2 -2.0
Sweden 25.5 28.6 30.2 -1.6
Singapore 17.9 30.7 32.0 -1.3
Belgium 24.1 29.5 30.7 -1.2
Austria 24.2 32.4 33.5 -1.1
Denmark 24.7 29.4 30.5 -1.1
United Kingdom 23.0 27.8 29.0 -1.1
United States of America 20.7 26.1 27.2 -1.1
New Caledonia 14.5 19.6 20.7 -1.1
Curaçao 21.1 28.4 29.5 -1.1
Germany 27.6 36.1 37.2 -1.1
Cyprus 18.0 23.7 24.8 -1.0
Italy 28.6 36.6 37.6 -1.0
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.

United Nations Department of Economic and Social Affairs ǀ Population Division 65
TABLE III.6. COUNTRIES OR AREAS WHERE INTERNATIONAL MIGRATION IS PROJECTED TO ACCELERATE POPULATION AGEING BY AT
LEAST 1 PERCENTAGE POINT BY 2030
Percentage of population aged 60 years or over Difference
between
medium
variant and
zero
migration
Medium
variant
projection
Zero
migration
scenario
2015 2030 2030
Barbados 19.8 27.7 25.4 2.3
Lebanon 11.5 19.2 17.0 2.2
Samoa 7.9 12.1 10.3 1.8
United States Virgin Islands 24.1 32.2 30.5 1.7
Grenada 10.2 14.3 12.8 1.5
Jamaica 12.8 18.7 17.3 1.5
Guadeloupe 20.2 30.5 29.3 1.2
Albania 17.8 25.5 24.3 1.2
Tonga 8.2 10.5 9.4 1.2
Sri Lanka 13.9 21.0 19.9 1.2
Guyana 8.3 14.9 13.8 1.1
St. Vincent and the Grenadines 10.9 18.3 17.2 1.1
Martinique 26.2 38.5 37.4 1.1
Réunion 15.1 25.5 24.4 1.0
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.

United Nations Department of Economic and Social Affairs ǀ Population Division 67
IV. Population ageing and sustainable development
World population ageing is a consequence, in part, of substantial progress in improving the
health and well-being and reducing mortality risks faced by people around the globe. People are
living longer, and, in many cases, healthier lives than ever before. The benefits of greater
longevity to individuals, families and society are many. Longer lives can afford individuals
opportunities to prolong their working life, embark on second careers, or pursue varied interests
in old age. Families benefit from the contributions of older generations, for example, through
financial support, assistance with household maintenance, or participation in childcare. Societies
benefit from the wisdom and experience of older persons and from their contributions to the
labour force, as well as from their volunteerism, philanthropy and civic engagement.
At the same time, many countries are concerned about population ageing, especially with
respect to its implications for the systems and institutions that aim to protect and preserve
people’s well-being. In many countries, the number of older persons is growing faster than the
number of people in the traditional working ages, giving rise to concerns about the fiscal
sustainability of pension systems that rely upon contributions from current workers to pay
benefits to retirees. Moreover, population ageing and growth in the number of persons at very
advanced ages put pressure on health systems, which must adapt to meet the growing demand for
care, services and technologies to prevent and treat non-communicable diseases and chronic
conditions associated with old age.
This chapter explores the implications of recent and projected trends in population ageing for
efforts towards progress in achieving the 2030 Agenda for Sustainable Development. In
particular, the three sections of this chapter address the challenges posed by the growth in the
number and share of older persons in the population for efforts to eradicate poverty and promote
economic growth, to ensure the sustainability of pension systems and to promote health and
well-being at all ages.

A. AGEING, POVERTY AND ECONOMIC GROWTH
This section draws upon the latest empirical evidence and economic literature in order to: 1)
describe the poverty status of older persons relative to the population overall; 2) analyse older
persons’ levels of consumption compared to other age groups and across countries at different
levels of national income; and 3) assess the macroeconomic implications of population ageing on
economic growth.
Poverty rates among older persons relative to the general population vary, largely due to
the coverage and adequacy of old-age social protection systems.
Describing the poverty rates of people in different age groups is challenging for a number of
reasons. First, surveys generally measure income and consumption at the household level rather
than for individuals at different ages. Household welfare does not necessarily reflect accurately
the welfare of all individuals in the household because the household resources could be
distributed unequally across its members. Second, different definitions and approaches to
68 World Population Ageing, 2015
measuring poverty present difficulties for comparisons across studies and populations. The
national poverty lines defined by countries often differ from the World Bank’s poverty threshold
of US$1.90 a day15 or from the (relative) measure of half the median national income used by the
Organization for Economic Cooperation and Development (OECD). Third, discussions of age
patterns of poverty in international comparative perspective are further challenged by the
absence of an international harmonized database of poverty rates disaggregated by age. The
World Bank’s comprehensive poverty database covering all countries (PovcalNet) is not age
disaggregated. Thus, evidence on poverty rates among older persons and for other age groups is
limited to selected country-level or regional-level studies.
Nevertheless, available data on the prevalence of poverty by age offer some useful insights
into how well older persons are faring relative to people in other age groups. The following
section reviews the existing evidence on poverty rates among older persons in relation to the
poverty rates of the population as a whole, acknowledging the differences in concepts and
measures across studies and regions.
Older persons tend to be poorer than the general population in African countries and are
more often less poor than the overall population in Latin America and Europe.
Figure IV.1 plots, by region, the poverty rate for older persons against the poverty rate for the
total population for countries with available data. Estimates for countries in Africa, depicted in
the upper-left chart of the figure, are from a 2005 study that assessed poverty among older
persons using the national definition of the poverty line between 1998 and 2001 (Kakwani and
Subbarao, 2005). For the 18 Latin American countries depicted in the upper-right chart of the
figure, poverty estimates are from a 2011 study of the Socioeconomic Database for Latin
America and the Caribbean (SEDLAC) (Cotlear and Tornarolli, 2011), and the poverty threshold
is defined as US$2.5 per day. Estimates for countries located in Eastern and Southern Europe,
plotted in the lower-left chart, are from a World Bank study (Bussolo and others, 2015) that
defined the poverty line at US$5 per day. Estimates for selected OECD countries, depicted in the
lower-right chart of the figure, are as reported by the OECD (2015b) using the relative poverty
line definition of half the median disposable income in the country.
The 45-degree line in each chart represents the points at which the poverty rates among older
persons are equivalent to the poverty rates for the population overall. Points that fall above the
45-degree line indicate that poverty rates among older persons exceed those of the total
population, while the points that fall below the 45-degree line indicate that poverty rates among
older persons are lower than among the total population.
Older persons in most sub-Saharan African countries are most commonly poorer than
other age groups.
While most African countries are not far from the 45-degree line, indicating that poverty
rates among older persons were similar to those of the total population, disparities were evident
in some countries. In Zambia, for example, 80 per cent of people aged 60 years or over were

15 In October 2015 the World Bank revised its definition of “extreme poverty” to living on less than $1.90 per day from $1.25 per day, reflecting
the latest updates in purchasing power parities. (http://www.worldbank.org/en/publication/global-monitoring-report/poverty-forecasts-2015).
United Nations Department of Economic and Social Affairs ǀ Population Division 69
under the national poverty line, compared to around 67 per cent of the general population
overall. By comparison, in some countries in Africa, including Burundi, Madagascar,
Mozambique and Nigeria, older persons were somewhat less poor, on average, than the total
population.
Figure IV.1.
Poverty rate for older persons versus the poverty rate for the total population, recent estimates for selected
countries
Data sources: a) Data for Africa are from Kakwani and Subbarao (2005), refer to a year between 1998 and 2001, and
the poverty line is defined according to the national poverty definition. b) Data for Latin America are from Cotlear and
Tornarolli (2011), refer to the period between 2005 and 2007, and the poverty line is defined as US$2.5 per day. c) Data for
Eastern and Southern Europe are from Bussolo and others (2015), Golden Ageing, Table 5.2, refer to the year 2012 and the
poverty line is defined as US$5 per day. d) Data for OECD countries are from OECD (2015b), Table 1.A1.1, refer to the 2013 or
the latest available year, and the poverty line is defined as 50 per cent of the median disposable income.
70 World Population Ageing, 2015
In assessing poverty rates among older persons in Africa, Kakwani and Subbarao (2005) also
found some significant rural-urban differences with a much higher proportion of single older
persons living in poverty in rural areas compared to urban areas. In addition, poverty rates were
higher for older persons in countries with high prevalence of HIV. Excess mortality among
young adults in these countries meant that many older persons lost the support that they would
have received from their adult children and they also have assumed greater responsibility for
generating income and caring for children in their extended families. Deaton and Paxson (1997)
found that the poverty rate for older persons was higher than that for younger adults in South
Africa in 1996. Some significant differences were found by gender, wherein households headed
by older women were more prone to poverty than households headed by older men, especially in
parts of sub-Saharan Africa that are patriarchal (Kakwani and Subbarao, 2005). In societies
where women lack certain rights to own or inherit property, widows face a significant risk of
poverty following the dispossession of their house and land by the deceased husband’s kin
(Toulmin, 2006).
In Latin America, poverty rates among older persons tend to be lower than for the
population as a whole.
For the Latin American region as a whole, an estimated 19 per cent of people aged 60 years
or over were poor in the mid-2000s, with the poverty line defined as US$2.5 per day. By
comparison, 30 per cent of children under age 15, 20 per cent of young adults aged 15-24 years,
and 23 per cent of the population overall were poor (Cotlear and Tornarolli, 2011). In several
countries, such as Argentina, Brazil, Chile and Uruguay, where pension systems include
minimum levels of support for both contributors and non-contributors (for example, persons who
are unable to contribute due to poverty or disability), older persons were substantially better off,
on average, compared to the population as a whole. In Argentina, just 4 per cent of older persons
were poor, compared to 11 per cent of the overall population. The national poverty rate was
higher in Brazil, at close to 18 per cent, but there, too, just 4 per cent of older persons were poor.
Pensions are generous in some countries in Latin America compared to other developing
countries, and public spending was highly skewed towards older persons. As a result, older
persons usually had higher average levels of welfare relative to children. Examples of countries
where the poverty rate among children exceeded that of older persons include Brazil, Chile and
Uruguay (Bravo and Holz, 2011; Turra and others, 2011). By contrast, social pension benefits
were lower in Colombia, Costa Rica and Mexico, where older persons were slightly poorer, on
average, than the total population. In addition, the incidence of poverty in these three countries
was higher for older persons living in rural areas and for the oldest-old (aged 80 years or over)
(Cotlear and Tornarolli, 2011).
As noted earlier, conclusions about the relative poverty of older persons are sensitive to the
choice of the poverty definition (Deaton and Paxson, 1997). Indeed, another study of Latin
American countries that used the relative poverty measure of 50 per cent of the national median
income arrived at a slightly different conclusion. Using the same SEDLAC database as Cotlear
and Tornarolli (2011), Dethier and others (2010) concluded that poverty rates were consistently
lower for older persons relative to the total population only in Argentina, Brazil, Chile and
Uruguay. Using the half the median income definition of poverty, poverty rates among older
United Nations Department of Economic and Social Affairs ǀ Population Division 71
persons in Bolivia, Colombia, Costa Rica, Honduras and Mexico were found to be higher than
for the population overall.
In Eastern and Southern Europe, older persons tend to be less poor than average.
A 2015 World Bank study of selected countries in Eastern and Southern Europe assessed the
poverty rates among older persons using a poverty definition of US$5 per day purchasing power
parity (Bussolo and others, 2015). Among the 21 countries plotted in the lower-left chart of
figure IV.1, only the Republic of Moldova lies above the 45-degree line, indicating that older
persons were, on average, somewhat poorer than the total population in that country. For all the
21 countries in Eastern and Southern Europe, the poverty rate among the older population (aged
65 years or over) was 10.7 per cent on average, compared to an average 14.5 per cent for the
total population. As many of these countries transitioned away from socialist economies, older
people were able to build up some assets while still receiving relatively generous pensions, and
thus became wealthier than other age groups (Bloom and others, 2011).
In most countries in Northern and Western Europe, poverty rates among older persons are
lower than for the overall population.
Estimates from the OECD, shown in the lower-right chart of figure IV.1, summarize poverty
rates according to the measure of 50 per cent of median disposable income (OECD, 2015b). The
prevalence of poverty was lower for older persons (aged 65 years or over) than for the total
population in numerous countries, including Denmark, Iceland, Ireland, Luxembourg, the
Netherlands and Portugal, among others. This is explained by the current generation of older
persons having benefitted from long and significant contributions to private or public social
security systems, as well as their private asset accumulation. However, the incidence of poverty
was higher, on average, for older persons relative to the general population in Australia, Austria,
Switzerland, the United Kingdom and the United States of America. Some factors contributing to
the higher relative poverty rates among older persons in these countries included the high costs
of health care, modest public pensions and relatively high earnings among younger working-age
adults.
In Asian countries, poverty rates among older persons are often similar to or slightly
higher than those for other age groups.
Data on poverty rates by age group are more limited in Asia than in other developing regions.
Evidence from China and Indonesia suggests that poverty rates are somewhat higher for older
persons than for others. In China, home to nearly a quarter of the world’s older population, a
World Bank report (2009) showed that nearly 13 per cent of Chinese older persons had incomes
below the US$1 per day per capita consumption poverty line in 2003, compared to 12 per cent of
the working-age population (defined in this study as ages 16-60 years) and 17 per cent of
children (younger than 16 years). The welfare of older persons in China varied considerably
according to living arrangement, health status and location. Older persons who lived alone, in
rural areas, with poor health status, without pensions, or who were illiterate, were more likely to
be poor (Park and others, 2012). However, a separate study that assessed poverty by measuring
consumption at the individual level rather than at the household level found that Chinese older
72 World Population Ageing, 2015
persons who lived with grandchildren, without adult children or who lived in multi-generational
households with young children fared worse than those who lived alone (Tung and Lai, 2011).
Older persons living in these households tended to have lower levels of consumption as some of
the family resources, either from the working-age adults or the older persons themselves, were
diverted to the young dependents. Population ageing is occurring rapidly in China due to the
precipitous decline in fertility that began in the 1970’s. In response to population ageing and a
growing concern that the future older population in China will have few children on whom to
rely for support, the Chinese government has recently lifted its one-child policy (Zhao, 2015).
In Indonesia, older persons were also found to be slightly poorer, on average, than younger
people in 2012 (Priebe and Howell, 2014). Measured by the national consumption poverty line,
an estimated 13 per cent of older persons in Indonesia were considered to be poor, compared to
12 per cent of people in other age groups. An estimated 2.5 million older persons lived in
poverty in Indonesia, where the formal pension system covered only a minority of older persons.
Conversely, evidence for India indicates that the poverty rate of older persons is lower than
that of other age groups. In India, home to 13 per cent of the world’s older population,
households with older persons were not found to be poorer than households without an older
person (Pal and Palacios, 2008; Srivastava and Mohanty, 2012). An estimated 18 million older
persons (approximately one in five older persons) lived below the national consumption poverty
line in 2004 in India (Srivastava and Mohanty, 2012).
Data on age patterns of consumption document the relative welfare of older persons in the
population.
Although the level of consumption is not equivalent to welfare, consumption is a major
determinant of welfare and therefore garners attention from both researchers and policymakers.
In particular, the “lifecycle hypothesis” of consumption and saving proposes that individuals
tend to smooth their consumption over time in order to maximize their lifetime welfare. To
accomplish that, people may borrow against their future earnings when young, save during their
working years and consume accumulated assets during retirement. Because data typically are
collected at the household level, empirical research on the consumption of individuals at
different ages is not straightforward. The National Transfer Accounts (NTA) project has
addressed this issue by developing a consistent conceptual and accounting framework, as well as
standardized estimation methods that have yielded a harmonized database of production,
consumption and inter-age reallocations for 36 countries, representing all regions of the world.16
NTA methods allocate household consumption to individuals using a combination of regression
methods for age-specific consumption on education and health care expenditures, as well as
weights for other types of consumption. Both private and public consumption are taken into
account. Details of the methodology can be found in the National Transfer Accounts Manual
(United Nations, 2013). Selected findings on the levels of consumption among older persons are
highlighted below.

16 United Nations (2013) National Transfer Accounts Manual: Understanding and Measuring the Generational Economy.
United Nations Department of Economic and Social Affairs ǀ Population Division 73
Older persons in middle-income countries often consume less than working-age adults,
whereas in high-income countries, older persons tend to consume more than working-age
adults, on average.
Figure IV.2 shows the average consumption age profiles for countries of three broad income
groups. To facilitate comparisons, the average level of consumption at each age is compared to
the average level of consumption of persons aged 30-49 years, which are often considered the
prime working ages. In all income groups, consumption increases steadily from childhood to
adulthood. Relative consumption patterns at older ages display two distinctive patterns. The first
is characterized by levels of consumption that decline gradually or stay constant with age relative
to the consumption of other adults, as, for example, in some middle-income countries such as
India, the Philippines and Thailand. Other middle-income countries like Indonesia and Mexico
experienced a slight decline in the level of consumption at older ages; that is to say, older
persons consume slightly less than other adults in these countries. A second general age pattern
is that of consumption levels that increase at the older ages. This pattern is observed mainly in
high-income countries such as Germany, Japan, Sweden and the United States. In some highincome countries, the consumption of older people exceeds that of younger adults by 30 per cent
or more.
Figure IV.2.
Levels of consumption per capita among older persons (aged 60 years or over) relative to the levels of
consumption among those aged 30-49 years

Data source: National Transfer Accounts database (http://www.ntaccounts.org/), accessed on 1 September 2015.
Notes: High-income countries in the NTA database include Argentina, Australia, Austria, Canada, Chile, Finland,
France, Germany, Hungary, Italy, Japan, Slovenia, the Republic of Korea, Spain, Sweden, the United Kingdom, Uruguay and the
United States of America. Upper-middle income countries include Brazil, China, Colombia, Costa Rica, Ecuador, Jamaica,
Mexico, Peru, South Africa and Thailand. Lower-middle income countries include India, Indonesia, Kenya, Nigeria, Philippines,
Senegal and Viet Nam.
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
0 10 20 30 40 50 60 70 80 90
High-income
countries
Upper-middleincome countries
Lower-middleincome countries
Age
Ratio of average level of consumption
relative to consumption of persons aged 30-
49 years
74 World Population Ageing, 2015
Public spending, especially on health, plays an important redistributive role and provides
significant support to consumption in old-age, especially in high-income countries.
Figure IV.3 shows the public and private sector components of older persons’ consumption
in countries grouped according to the level of national income. Two major differences are found
between countries of different income groups. First, the health component of older persons’
consumption increases with the level of national income. High-income countries spent a quarter
of older persons’ total consumption on health, while health consumption represents only around
10 per cent of older persons’ consumption in lower-middle-income countries and low-income
countries. Second, the role of the public sector in financing older persons’ consumption increases
with the level of national income. In high-income countries, the public sector finances a large
majority of older persons’ health consumption, while in low-income and lower-middle-income
countries, public spending on health for older people is marginal; the lion’s share of health
consumption is paid as out-of-pocket expenditures.
Figure IV.3.
Components of older persons’ (aged 60 years or over) consumption, by income group
Data source: National Transfer Accounts database (http://www.ntaccounts.org/), accessed on 1 September 2015.
Notes: High-income countries in the NTA database include Argentina, Australia, Austria, Canada, Chile, Finland,
France, Germany, Hungary, Italy, Japan, Slovenia, the Republic of Korea, Spain, Sweden, the United Kingdom, Uruguay and the
United States of America. Upper-middle-income countries include Brazil, China, Colombia, Costa Rica, Ecuador, Jamaica,
Mexico, Peru, South Africa and Thailand. Lower-middle-income countries include India, Indonesia, Kenya, Nigeria, Philippines,
Senegal and Viet Nam. Low-income countries include Cambodia and Mozambique.
Figure IV.4 shows a positive correlation between older persons’ consumption (relative to that
of adults aged 30-49 years) and the share of older persons’ consumption that is financed by the
public sector. Older persons tend to fare less well in countries where the public sector finances a
small share of their consumption. In many low-income and lower-middle-income countries, less
than 15 per cent of older persons’ consumption is supported by the public sector, and their
consumption tends to be lower than that of adults aged 30-49 years. Examples include Indonesia,
Mozambique, Nigeria, Senegal and Viet Nam. The welfare of older persons is relatively higher
61
71
80 83
13
11
9 7
6
9
9 8
20
9 2 2
0
20
40
60
80
100
High income Upper-middle
income
Lower-middle
income
Low income
Public health
Private health
Public other
Private other
Percetage of total consumption
United Nations Department of Economic and Social Affairs ǀ Population Division 75
in countries where public transfers finance a larger share of old-age consumption, as in Germany,
Japan, Slovenia, Sweden, the United Kingdom and the United States of America. The association
between public financing and older persons’ welfare underscores the need for improved social
protection for older persons, especially for health-care services in low-income and lower-middleincome countries.
Figure IV.4.
Ratio of older persons’ (aged 60 years or over) consumption to that of persons aged 30-49 years and public
transfers as a share of total consumption
Data source: National Transfer Accounts database (http://www.ntaccounts.org/), accessed on 1 September 2015.
Population ageing need not impede economic growth.
Demographic and macroeconomic trends in Eastern Asia during the second half of the
twentieth century demonstrated the powerful potential of changing age structures for accelerating
economic growth. Sustained fertility declines in many countries in the region led to: 1) an
increasing share of the working-age population, which helped to boost economic production; and
2) a sharp decline share of dependent children, which freed up resources for investment in
economic development and family welfare. In the language of the economic support ratio
discussed in section II.D, each equivalent consumer was supported by more equivalent workers
in Eastern Asia, which led to higher per capita income and faster economic growth. This
accelerated economic growth, directly associated with the changing age structure brought on by a
sustained drop in the fertility level, is known as the “first demographic dividend.”
76 World Population Ageing, 2015
As the large working-age cohorts that produced the demographic dividend in past decades
grow older, and as continued low fertility puts downward pressure on the future growth of the
labour force, the effect on per capita income growth will be reduced and could eventually turn
negative.
Figure IV.5 illustrates how China’s economic support ratio,17 the effective number of
workers divided by the effective number of consumers in the population, has changed since
1950, producing the first demographic dividend in the country since the 1970s. Although China’s
fertility decline began in the 1950s, it accelerated in the 1970s when the labour force increased as
a share of the total population and the economic support ratio started to pick up, yielding a boost
in economic growth of nearly 0.7 per cent per year during 1970-2015. As the population of
China continues to age, the economic support ratio is expected to decline from its current peak,
and the effect of changing age structures is expected to turn slightly negative in the coming
decades.
Figure IV.5.
Economic support ratio and demographic dividends in China, 1950-2050
Source: United Nations (2013). National Transfer Accounts Manual.
A second demographic dividend could fuel economic growth as populations age if societies
encourage savings and invest in human and physical capital early on.
Although population ageing poses these and other economic challenges, two recent studies
concluded that ageing need not impede economic growth, and, in fact, could support continued
economic growth under certain conditions. Lee and Mason (2010) proposed that an additional
contribution to economic growth beyond the period of the first dividend, termed the “second
demographic dividend,” could be generated when low fertility and rising longevity lead to an
increase in human capital and physical investment, which in turn raises labour productivity and

17 Please refer to Chapter II for additional discussion of the economic support ratio.
0.3
0.4
0.5
0.6
1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050
Economic support ratio
(effective worker/effective consumer)
First demographic dividend
Second demographic dividend
United Nations Department of Economic and Social Affairs ǀ Population Division 77
income per capita. Based on an analysis of cross-country data, the authors present evidence that
lower fertility is strongly associated with rising rates of investment in human capital per child,18
which raises labour productivity and economic growth. Their analysis is also consistent with the
notion that individuals, as they anticipate increasing longevity, are motivated to accumulate
assets for their old age (Tobin, 1973).19 The second demographic dividend can persist over a
much longer period of time than the first dividend, and is more likely to be more significant in
societies that rely not only on public or familial transfers to finance older persons’ consumption,
but that also promote personal savings for retirement and old age.
A second study postulates that societies will initiate behavioural changes and policy
responses to countervail the negative economic effects of population ageing (Bloom and others,
2014). For example, the increasing share of older dependents could be offset, partially or
completely, in some cases, by a decrease in dependent children due to fertility decline. The
eventual contraction of the share of working-age population could be mitigated by rising female
labour force participation and delayed retirement ages. Furthermore, the labour market could
adjust by enabling more labour-saving technology that can increase productivity per worker. As
noted earlier, as people expect to live longer, many may increase their savings in anticipation of
long periods of retirement. Finally, the coming cohorts of older persons have benefitted from
higher levels of education, income and wealth relative to today’s older population, and are
therefore more likely to be able to support themselves during old age.
B. POPULATION AGEING AND SOCIAL PROTECTION
Older persons vary greatly in regard to their independence and economic self-sufficiency.
Many older persons live independently and support themselves with their own income and
savings while helping others, including some that remain active in the labour force. But for large
segments of the population, old age is associated with increasing dependency and vulnerability
associated with declining income or health and a growing need for care and support. Older
people’s vulnerability is greater where there is no reliable source of income support, such as
through social protection mechanisms, which may take the form of pensions, disability insurance
or health care benefits for older persons.
Retirement pensions or similar schemes involving income support at older ages are critical to
older persons’ social protection. The right to income security in old age is grounded in the
Universal Declaration of Human Rights (1948) and in the International Covenant on Economic,
Social and Cultural Rights (1966). More recently, social protection, including the need to ensure
social protection floors that establish a minimum standard of living, was reflected in the 2030
Agenda for Sustainable Development. In recent decades, many low-income and middle-income
countries have expanded the coverage of contributory pension schemes and established noncontributory social pensions. Many high-income countries have undertaken fiscal consolidation,
reforming their pension systems by raising the statutory pensionable age, reducing benefits or
increasing contribution rates to ensure the system’s long-term sustainability.

18 In accordance with the quantity-quality trade off model proposed by Becker and Lewis (1973). 19 If these assets are invested domestically, then physical capital per worker and aggregate production will grow. If invested abroad, then net
foreign income will increase and so will national income.
78 World Population Ageing, 2015
This section describes the global situation with respect to the social protection of older
persons by examining the interrelated domains of the labour force participation of older persons
and the statutory retirement ages for older men and women, which influence older persons’
levels of income, and, in turn, their need for social protection. Next, this section discusses the
pension coverage and pension replacement rates that describe older persons’ access to social
protection, as well as the adequacy of existing schemes.
Box 1.
Types of old-age pension schemes
In 2015, more than 30 per cent of older men and more than 14 per cent of older women
were active in the labour force. Older people in developing regions were more likely to be
economically active than their peers in the developed regions.
The labour force participation rate is defined as the share of the working-age population that
is active in the labour market, either employed or seeking employment. According to estimates
from the International Labour Organization (ILO), the labour force participation rate of persons
aged 65 years or over globally was 30.3 per cent for men and 14.5 per cent for women in 2015.
In the more developed regions, 16.8 per cent of older men and 9.4 per cent of older women were
in the labour force compared to 37.3 per cent of older men and 17.5 per cent of older women in
the less developed regions. In the least developed countries, 59.1 per cent of older men and 34.5
per cent of older women participated in the labour force in 2015.
Contributory pension schemes protect persons who have made contributions during a qualifying period.
Contributory schemes cover mostly workers on formal wage-employment and, in some countries, the selfemployed.
Non-contributory pension schemes do not require specific contribution from beneficiaries or their
employers. These schemes are usually financed through general taxes or other state revenues. Noncontributory benefits play a key role in providing at least a minimum level of income security for older people,
especially for those who, for any reason, do not contribute to social insurance for long enough to be eligible
for benefits. Non-contributory schemes can be:
(a) Universal, providing benefits to all people above the age of eligibility who meet
criteria of residency and/or citizenship;
(b) Means-tested schemes, provide benefits upon proof of need and target older persons
whose total income (including contributory pensions, if any) fall below a certain
threshold.
United Nations Department of Economic and Social Affairs ǀ Population Division 79
Figure IV.6.
Labour force participation of persons aged 65 years or over, by sex, 2015
Males
Females
Data source: ILOSTAT Database. Available from http://www.ilo.org/ilostat/faces/home/statisticaldata/bulkdownload?_adf.ctrl-state=15f9flr0r2_9&clean=true&_afrLoop=43258501143783). Accessed September 2015.
Note: The boundaries and names shown and the designations used on this map do not imply official endorsement or
acceptance by the United Nations. Dotted line represents approximately the Line of Control in Jammu and Kashmir, agreed upon
by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by the parties. Final boundary
between the Republic of Sudan and the Republic of South Sudan has not yet been determined.
Labour force participation among older men was highest in Africa (52.2 per cent), followed
by Latin America and the Caribbean (38.1 per cent), Asia (34.8 per cent), Northern America
(23.5 per cent), Oceania (21.4 per cent) and Europe (10.2 per cent). The labour force
participation of older women was lower than that of older men in all regions, but followed a
similar pattern across regions, with Africa having the highest participation rate (32.6 per cent of
80 World Population Ageing, 2015
women aged 65 years or over were active in the labour force), followed by Latin America and
the Caribbean (16.8 per cent), Asia (15.6 per cent), Northern America (14.5 per cent), Oceania
(11.8 per cent) and Europe (6.2 per cent).
Figure IV.6 maps the labour force participation rate of older men and women by country in

  1. In 52 countries, more than 50 per cent of older men aged 65 years or over were active in
    the labour market. Most of these countries were located in Africa, Latin America and the
    Caribbean or Asia. A number of countries in Africa had the highest levels of labour force
    participation of older men in the world. Labour force participation was highest for older men in
    Malawi (94 per cent), followed by Mozambique (85.4 per cent) and Gambia (84.2 per cent). In
    Latin America and the Caribbean, Bolivia, Haiti, Honduras, Peru and Ecuador each had more
    than 50 per cent of older men active in the labour force. Despite the existence of a universal
    pension system in Bolivia, almost two thirds of older men participated in the labour force there.
    Older men’s labour force participation was below 10 per cent in 28 countries, most of which
    were located in Europe.
    Older women’s labour force participation exceeded 50 per cent in only 15 countries, mostly
    located in Africa. As for older men, Malawi had the highest labour force participation rate for
    older women (86.1 per cent). Malawi was followed by Mozambique (76.1 per cent) and Zambia
    (68 per cent). Older women’s labour force participation was below 10 per cent in 87 countries.
    All countries in Europe except Iceland, Estonia, Romania and Ukraine were among those where
    fewer than 10 per cent of women aged 65 years or over were active in the labour force in 2015.
    In Europe, Oceania and Northern America, the labour force participation of older men has
    increased gradually since 1990. In contrast, the labour force participation of older men has
    declined steadily in Asia, Latin America and the Caribbean and Africa. Labour force
    participation of older women has increased since 1990 in all regions.
    Figure IV.7 shows the changes over time in older men’s and women’s labour force
    participation, by region. The labour force participation of men aged 65 years or over gradually
    increased from 1990 to 2015. In contrast, the labour force participation of older men is declining
    steadily in Asia, Latin America and the Caribbean and Africa. Older women’s labour force
    participation increased in all regions between 1990 and 2015. These trends for older women are
    driven primarily by the overall increases in female labour force participation, with each
    successive cohort of women reaching age 65 tending to have higher rates of attachment to the
    labour market relative to earlier cohorts.
    The availability of pensions is an important factor associated with the labour force
    participation of older persons. After a period of steady decline, the labour force participation of
    men has increased recently in most high-income OECD countries, mostly due to policies that
    have increased the statutory retirement ages, restricted access to early retirement options or made
    early retirement less attractive financially. Labour force participation rates of older women in
    OECD countries have increased steadily over the past twenty-five years, reflecting both broader
    societal trends in women’s labour force participation, as well as pension system reforms that
    encourage them to continue working until older ages (European Commission, 2014; Leonesio
    and others, 2012). In contrast, the very high participation rates of older people in most low-
    United Nations Department of Economic and Social Affairs ǀ Population Division 81
    income and middle-income countries are an expression of need, given the low pension coverage
    and modest benefits for those who are covered.
    Figure IV.7.
    Labour force participation of persons aged 65 years or over, by sex and region, 1990, 2000, 2015 and 2030
    Males
    Females
    Data source: ILOSTAT Database. Available from http://www.ilo.org/ilostat/faces/home/statisticaldata/bulkdownload?_adf.ctrl-state=15f9flr0r2_9&clean=true&_afrLoop=43258501143783). Accessed September 2015.
    30
    52
    38
    23
    35
    21
    10
    31
    54
    40
    17
    39
    13
    9
    32
    57
    41
    16
    41
    12
    9
    0 10 20 30 40 50 60
    World
    Africa
    Latin America and the Caribbean
    Northern America
    Asia
    Oceania
    Europe
    1990
    2000
    2015
    15
    33
    17
    14
    16
    12
    6
    13
    31
    14
    9
    16
    6
    4
    10
    31
    10
    8
    12
    5
    4
    0 10 20 30 40 50 60
    World
    Africa
    Latin America and the Caribbean
    Northern America
    Asia
    Oceania
    Europe
    1990
    2000
    2015
    82 World Population Ageing, 2015
    Since most older persons in low-income and many middle-income countries have worked in
    the informal economy or in rural areas, they generally have not contributed to pension schemes
    during their working life and are thus not eligible to receive benefits from contributory pension
    systems. Non-contributory social assistance or universal pensions are not available in all
    countries, leaving many adults little choice but to continue working into their old-age.
    Statutory retirement ages are increasing in most countries in the world.
    Typically, pension benefits become payable between the ages of 60 and 65 years, although in
    some countries, workers become eligible for length-of-service benefits payable after they
    complete 30 to 40 years of work or contributions. Another type of eligibility requirement for
    retirement pensions is total or substantial withdrawal from the labour force. Many programmes
    offer optional settlements or early retirement benefits before the statutory retirement age is
    reached. A reduced (early) pension, in many instances, may be claimed up to five years before
    the statutory retirement age. Some countries also allow for lower retirement ages for some
    specific occupations considered unhealthy or hazardous, such as underground mining (United
    States Social Security Administration, 2014).
    Europe is the world’s major region with the most aged population, yet the average statutory
    retirement age for men in Europe was lower than for men in Northern America, which has a
    younger population. Information available for 41 European countries in 2014 indicate that the
    statutory retirement age for males exceeded 65 years only in Iceland, Norway and Italy. It was
    exactly 65 years in 22 countries, and it was between 60 and 64 years in 16 countries. The
    statutory retirement age for men was 65 years or more in Canada and the United States of
    America. From 2006 to 2014, many countries in Europe and in Northern America increased
    gradually the statutory age of retirement (figure IV.8). For example, in the United States of
    America, the age of retirement with full benefits increased from 65 years to 66 years for people
    born in 1943-1954, and policies indicated that it would rise to 67 years for those born in 1960 or
    later.
    The statutory retirement ages for men in Latin America and the Caribbean were generally
    higher than those for men in Africa, Asia and Oceania. The statutory retirement age for men was
    lowest in Oceania on average, where it was equal to or lower than 55 years in more than half of
    the 11 countries. Between 2006 and 2014, Micronesia raised the age of retirement from 60 to 65
    years, while Australia had plans to raise it gradually beginning in 2017 to reach 67 years in 2023.
    In Latin America and the Caribbean, the retirement age for men was between 60 and 64 years
    in a majority (53 per cent) of the 31 countries with available data in 2014. In the remaining
    countries, the retirement age was 65 years, with the exceptions of Bolivia and Haiti, where the
    retirement age was 58 years. Between 2006 and 2014, while some countries such as Cuba and
    Dominica raised the age of retirement from 60 years to 65 years,20 Bolivia lowered the age of
    retirement from 65 years to 58 years in 2010.

20 Cuba gradually raised the age of retirement to 65 years by 2015. Dominica planned to increase the statutory retirement age incrementally—by
six months every year—until the year 2021, when the pensionable age would be set at age 65.
United Nations Department of Economic and Social Affairs ǀ Population Division 83
Figure IV.8.
Distribution of countries according to the statutory retirement age, by sex and region, 2006 and 2015
Males
Females
Data sources: United States Social Security Administration (2013 and 2014). Social security programmes throughout
the world (International updates, 2005; Europe, 2004; Asia and the Pacific, 2004; Africa, 2005; the Americas 2005), and ILO,
2014.
40
23 28
18
6 6
55 55
49
67 58
68
44 39
56
50
27
18
12 9
15 13
49 54
38
44
100
50
18
27
3 7 7
50
0
10
20
30
40
50
60
70
80
90
100
2006 2014 2006 2014 2006 2014 2006 2014 2006 2014 2006 2014
(42) (40) (41) (31) (2) (11)
Africa Asia Europe Latin America
and the
Carribbean
Northern
America
Oceania
Percentage
Higher than 65 years
65 years
60 to 64 years
Lower than 60 years
49
37
71 66
32
15
25
19
55 55
49
60
21 26
34
49
53 66
27 27
2 2
8 8
29 32
22
16
100
50
18 18
5 5
50
0
10
20
30
40
50
60
70
80
90
100
2006 2014 2006 2014 2006 2014 2006 2014 2006 2014 2006 2014
(42) (40) (41) (31) (2) (11)
Africa Asia Europe Latin America
and the
Carribbean
Northern
America
Oceania
Percentage
Higher than 65 years
65 years
60 to 64 years
Lower than 60 years
84 World Population Ageing, 2015
In Africa and Asia, the retirement age for men was between 60 and 64 years in a majority of
the countries. However, about 23 per cent of the countries in Africa had a retirement age for men
lower than 60 years in 2014. Between 2006 and 2014, 7 countries in Africa increased the
retirement age from 55 to 60 years (Benin, Chad, Congo, Côte d’Ivoire, Mozambique, Togo and
the United Republic of Tanzania), and one country in Africa (Mauritius) raised the retirement
age from 60 to 62.5 years. In contrast, South Africa reduced the retirement age for men from 65
years to 60 years.
In general, the statutory age of retirement for women was the same as or lower (often by five
years) than the retirement age for men. In 2014, the age of retirement for women was lower than
that for men in 61 out of 167 countries with data available. Among developing countries,
younger retirement ages for women were most prevalent in Asia (the retirement age for women
was below 60 years in 66 per cent of countries), followed by Oceania (55 per cent of countries),
and Africa (37 per cent of countries) (figure IV.8). Statutory retirement ages for women in Latin
America and the Caribbean were often higher than those in other developing regions: roughly 88
per cent of countries in the Latin American and Caribbean region had female retirement ages
between 60 and 64 years. In Europe, the female retirement age was between 60 and 64 years in
20 countries, it was exactly 65 years in 13 countries, and it was above 65 years only in Iceland
and Norway. The statutory retirement age for women was 65 years or more in Canada and the
United States of America. Between 2006 and 2014, many countries increased the age of
retirement for women in efforts to prolong their labour force participation and improve the
financial sustainability of pension systems.
At the global level, nearly half of all people over pensionable age do not receive a pension.21
Most developed countries have set up mandatory pension plans, either public or private, that
together achieve quasi-universal coverage. According to ILO (2014) estimates, pension coverage
ratios in Europe and in North America were higher than 90 per cent in 2013-2014. In the less
developed regions, however, old-age pensions covered only a fraction of older persons. In
Africa, nearly 22 per cent of older persons received a pension. Pension coverage for older
persons was almost 30 per cent in the Middle East, nearly 37 per cent in North Africa, 47 per
cent in Asia and the Pacific, and 56 per cent in Latin America and the Caribbean (ILO, 2014).
Many developing countries face severe limitations to providing income security for older
persons due to the low coverage of formal pension systems. In the last decade, many low-income
and middle-income countries have extended coverage through non-contributory pension
schemes, while others have expanded contributory schemes to previously uncovered groups of
the population. Non-contributory schemes can be either universal (providing benefits to
everyone) or targeted (providing benefits to those in a particular situation of need). For instance,
China has achieved nearly universal pension coverage by complementing social insurance with
social pensions in rural areas. Other countries like Bolivia provided tax-financed universal
benefits to all older persons. Chile introduced a new programme that provided means-tested
benefits to older persons who received a low pension or no benefit at all. Most Latin American
countries, with exceptions of Haiti, Honduras and Nicaragua, have expanded their pension

21 The ILO estimates the extent of legal coverage for old-age as percentage of the older persons above statutory pensionable age who receive
periodic cash benefits (old-age pension). Pension coverage is the total coverage, including contributory mandatory, contributory voluntary and
non-contributory pension coverage.
United Nations Department of Economic and Social Affairs ǀ Population Division 85
systems or established non-contributory pensions or cash transfer programmes targeted to older
persons.
Pension coverage is typically less extensive among women than among men owing to their
lower rates of participation in the labour market, their over-representation in the informal sector,
in self-employed or unpaid family work. (ILO, 2014a; ILO, 2014b). In many countries, the
survivor’s benefits paid through a husband’s contributory pension benefits are the sole source of
income for older women.
Figure IV.9 illustrates the ratio of the projected population aged 60 years or over in 2030 to
the estimated population aged 60 years or over in 2015 by the level of pension coverage in 2010.
Many of the countries that are projected to see substantial growth in the size of the older
population also had low rates of pension coverage among older persons. In Iran, for example, the
number of people aged 60 years or over is expected to double between 2015 and 2030, and less
than 30 per cent of those of statutory age were receiving a pension in 2010. The population of
older persons is projected to increase by 84 per cent in Indonesia, while less than 10 per cent of
those of statutory age received a pension.
Figure IV.9.
Ratio of projected population aged 60 years or over in 2030 to estimated population aged 60 years or over in
2015 by the level of pension coverage in 2010
Data sources: United Nations (2015). World Population Prospects: The 2015 Revision and ILO (2014). World Social
Protection Report 2014/15: Building economic recovery, inclusive development and social justice.
Notably, there is a great deal of heterogeneity in the projected increases in the size of the
older population at all levels of pension coverage (United Nations, 2015b). For example, the
projected increase in the number of older persons in Brazil, at 76 per cent, is nearly three times
86 World Population Ageing, 2015
that in Italy, at 26 per cent, both countries where more than 80 per cent of persons of statutory
age were covered by pensions. At middle levels of pension coverage, between 40 and 50 per
cent, growth rates of the older population are similarly diverse. In Serbia, for example, the
population aged 60 years or over is projected to increase by 4 per cent over the next 15 years,
compared to a near doubling of the numbers of older persons in Jordan and in Libya. Despite the
heterogeneity observed across countries, an overwhelming majority (78 per cent) of the countries
with pension coverage of less than 80 per cent are anticipating substantial growth of the older
population, with increases of more than 50 per cent projected between 2015 and 2030. Examples
include Mexico and Colombia, where 25 and 23 per cent, respectively, of those of statutory age
received a pension in 2010. The numbers of older persons in both countries is projected to grow
by more than 80 per cent by 2030. In both Papua New Guinea and Pakistan, less than 5 per cent
received a pension in 2010 and the population aged 60 years or over is projected to grow by 73
per cent and 66 per cent, respectively.
As a result of continued reductions in fertility and improvements in life expectancy,
population ageing brings challenges for pension systems; affecting both pay-as-you-go (PAYG)
financed public pensions and funded pensions. Pay-as-you-go pension schemes face problems of
financial sustainability as the proportion of people in the working-ages shrinks and the
proportion of people reaching retirement age increase, while the number of years spent in
retirement is also on the rise. Trends in the potential support ratio, defined as the number of
people in the working ages (20-64 years) per person aged 65 years or over, illustrate the
demographic pressure faced by PAYG pension schemes, in particular. Figure IV.10 shows the
potential support ratios in 2015 and projected for 2030 and 2050, by region. In 2015, there were
7 working-aged people for each older person in the world. By 2050, the global potential support
ratio is projected to fall to 3.5 and all regions except Africa are expected to have potential
support ratios of 3.2 or lower. In 2050, projections indicate that there will be 2.4 working-aged
people for every older person aged 65 years or over in Northern America, 1.9 in Europe, and that
the potential support ratio will fall below 2 working-aged people for every older person aged 65
years or over in 46 countries or areas, such as Japan (1.3), Portugal (1.4), Cuba (1.5) and Austria
(1.7).
Pension replacement rates, together with ageing and population coverage rates, affect
aggregate spending in pensions.
The gross pension replacement rate is an indicator of how effectively a pension system
provides a retirement income to replace labour earnings, the main source of income before
retirement for most people (OECD, 2015).22 The average gross replacement rate among OECD
countries was 53 per cent, with substantial cross-country variation ranging from nearly 30 per
cent in the United Kingdom to approximately 90 per cent in the Netherlands. Among the OECD
countries, workers with average earnings in Canada, Ireland, Japan, the United Kingdom, the
United States of America and the Republic of Korea had gross replacement rates of less than 40
per cent. Among Latin American and Caribbean countries, the Dominican Republic, Haiti and

22 The gross replacement rate is defined as gross pension entitlement divided by gross pre-retirement earnings. For more details, see OECD
(2016).
United Nations Department of Economic and Social Affairs ǀ Population Division 87
Mexico had gross replacement rates below 30 per cent, while Ecuador, Nicaragua, Paraguay and
Venezuela had replacement rates of more than 90 per cent.23
Figure IV.10.
Potential support ratio (persons aged 20-64 years per person aged 65 years or over), by region, 2015, 2030
and 2050
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.
In general, the variation in current public pension spending across countries reflected mainly
differences in: 1) potential support ratios; and 2) the generosity of benefits and coverage rates
(IMF, 2011). Figure IV.11 illustrates the variation in public pension expenditures as a percentage
of gross domestic product (GDP) according to the potential support ratio and the replacement
rate for selected countries. Marker (“bubble”) sizes are proportional to the pension replacement
rate. Among countries in Europe, there was substantial variation in public spending on pensions,
ranging from less than 5 per cent of GDP in Iceland and Ireland to more than 12 per cent of GDP
in Austria, France, Greece, Italy and Portugal. Japan had the lowest potential support ratio in the
world in 2015, with 2.1 working-age people per person aged 65 years or over, but the level of
public pension expenditure in Japan was lower than in Italy (10.2 per cent versus 15.8 per cent),
due primarily to the lower pension replacement rate in Japan than in Italy (35.1 per cent versus
69.5 per cent, respectively).
Among the Latin American and Caribbean countries, pension spending varied among
countries ranging from less than 1 per cent of GDP in Guatemala, Haiti, Jamaica and Guyana to
7.9 per cent in Argentina and 8.2 per cent in Uruguay. The relatively low spending in Latin
American and Caribbean countries reflected a combination of relatively low pension coverage
(generally limited to those in the formal sector) and relatively younger populations. The average
gross replacement ratio in the 26 countries of Latin America and the Caribbean was 62 per cent,
with significant cross-country variation (OECD, 2014). Paraguay provided pension earnings that

23 Data are available for OECD countries, as well as for countries in Latin America and the Caribbean region, and for China, India, South Africa
and the Russian Federation. Other countries lack the comparable earnings statistics or the household surveys needed to estimate the pension
replacement rate (ILO, 2014).
3.5
1.9
2.4
3.0
2.9
3.2
8.9
4.9
2.4
2.6
3.5
5.0
5.1
11.7
7.0
3.5
4.0
4.8
7.6
8.0
12.9
0 2 4 6 8 10 12 14
World
Europe
Northern America
Oceania
Latin America and the Caribbean
Asia
Africa
Persons aged 20-64 years per person aged 65 years or over
2015
2030
2050
88 World Population Ageing, 2015
exceeded working earnings (104 per cent), but just 38 per cent were receiving a pension. By
comparison, the Dominican Republic and Mexico had replacement rates of 23 per cent and 30
per cent, respectively. In some Latin American and Caribbean countries, gross replacement rates
for women were lower than those for men, due to fewer years of contribution and lower pension
eligibility ages for women. In Chile, the gross pension replacement rate for women was 10 to 13
percentage points lower than for men. Other countries like Argentina, Brazil, Colombia, El
Salvador, Honduras, Panama and Venezuela also had lower replacement rates for women than
for men, but the gender gaps were narrower than in Chile (OECD, IDB and World Bank, 2014).
Figure IV.11.
Pension expenditure (percentage of GDP) and potential support ratio by the size of the pension replacement
rate for selected countries, 2015
Data sources: OECD (2015), Pensions at a Glance 2015: OECD and G20 indicators; OECD (2014). Pensions at a
Glance: Latin America and the Caribbean; and United Nations (2015) World Population Prospects: The 2015 Revision.
Note: The size of the bubble is proportional to the gross pension replacement rate in each country.
In general, countries with relatively low pension coverage rates had higher labour force
participation rates among people aged 65 years and over. In Mozambique, for example, the
pension coverage rate was only 3.7 per cent and 75 per cent of those aged 65 years or over were
economically active. In Madagascar, pension coverage was 11.4 per cent and 72 per cent of older
persons were active in 2015. Furthermore, some countries with low pension replacement rates
had higher labour force participation rates among older people, despite having high coverage
rates. In Japan, for example, despite a 100 per cent pension coverage rate, the labour force
participation rate for men aged 65 years or over was considerably higher (29.4 per cent) than in
other OECD countries, partly due to the low pension replacement rate.
United Nations Department of Economic and Social Affairs ǀ Population Division 89
Recognizing the challenges posed by population ageing, many countries are pursuing
pension system reforms.
In recent years, many governments have addressed concerns about the adequacy or
sustainability of their pension systems by modifying the parameters of those programmes. These
measures included: increases in statutory retirement ages; increases in contribution rates for
defined benefit schemes, taxes or social security contributions on pension income, as well as
minimum contributory periods; elimination of incentives for early retirement; and the
introduction of automatic adjustment mechanisms such as by linking the age at which retirement
benefits can begin to changes in life expectancy. Governments also have introduced reforms to
strengthen funded private pensions and improve their complementary role in ensuring the
adequacy of retirement income.
More than half of governments instituted retirement or pension system reforms between
2008 and 2013.
Information about changes in statutory retirement ages and major reforms to pension systems
over the period 2008-2013 was available for 189 countries (United Nations, 2013). Of these, the
governments of 61 countries (32 per cent) changed their statutory retirement age between 2008
and 2013 and governments of 89 countries (47 per cent) reformed their pension system during
that period. Forty-seven of the 189 governments (25 per cent) changed both the retirement age
and reformed their pension systems during this time. A little less than half (46 per cent) of the
governments neither changed their statutory retirement ages nor reformed their pension system
over 2008-2013.
Most of the OECD countries passed legislation that raised the statutory retirement age or
equalized the statutory retirement age for women and men. For example, Slovenia enacted a
reform in January 2013 that gradually increased women’s statutory retirement age to 65 years by
2016, when it will be the same as men’s. Australian women’s statutory retirement age rose to 65
years in July 2013 and the policy indicated that it would again rise—to 67 years—for both men
and women by 2023. Poland increased the statutory retirement age to 67 years for both sexes,
although on different timelines: retirement at 67 years would be effective for men in 2020, but
only by 2040 for women. In a number of countries, the age of retirement would increase
gradually, to 67 years or higher. In Canada, for instance, the normal retirement age to be eligible
for the basic pension (Old-age security) benefit would increase gradually from 65 to 67 years
between 2023 and 2029. In Ireland, the pension age increased from 65 to 66 years in 2014 and
would increase further to 67 years by 2021 and 68 years after 2028. In the Netherlands, the
retirement age would reach 66 years by 2019 and 67 years by 2023 (OECD, 2014).
Some countries introduced policies to increase minimum contribution periods while others
restricted access to early retirement. In France, the minimum contributory periods would increase
from 41.5 years to 43 years in 2030. In Austria, the required insurance period for individuals to
be eligible for early retirement (Korridorpension) would increase from 38 years in 2013 to 40
years in 2017. In Belgium, the age for early retirement benefit eligibility increased to 60.5 years
in 2013, and the contribution period to 38 years. These parameters would increase further in
Belgium to age 62 and 40 years of contributions in 2016 (OECD, 2014).
90 World Population Ageing, 2015
Although measures to increase statutory retirement ages as well as other reforms to pension
systems could improve the sustainability of pension programmes, it is important to also keep in
mind the potential impact of such broad reforms on poverty and inequality among older persons.
Both the prevalence of disability and the physical demands associated with employment can vary
considerably across socioeconomic groups, with disparate implications of continued labour force
participation at older ages. Moreover, there are significant differences in life expectancy by
socioeconomic status. Raising the statutory ages by a fixed amount is disadvantageous for groups
whose shorter average lifespans imply fewer years to collect pension benefits.
C. POPULATION AGEING AND HEALTH
Across studies of population health, age nearly always stands out as the single most powerful
predictor of the state of people’s health and the prevailing risks of morbidity and mortality they
face. The specific mechanisms that link age to health status are many and complex (WHO,
2015). At the biological level, ageing is associated with accumulated damage to cells that, over
time, weakens the immune system, diminishes the body’s capacity to repair itself and increases
the risk of developing a host of different diseases (Steves and others, 2012; Vasto and others,
2010; Beard and Bloom, 2015). A person’s age also reflects the amount of time he or she may
have been exposed to various external health risks whose effects accumulate over time, such as
tobacco use or unhealthy diet. Moreover, the social changes that often take place as people enter
advanced ages, such as shifts in social roles and the loss of close relationships, may pose
additional threats to older persons’ health and well-being (WHO, 2015).
However, while age is an important predictor of the average health risks people face, there is
a huge degree of diversity in the health status of people at any given age, reflecting random
variation across individuals, as well as differences in the life course, environment and behaviours
that shape health risks. This is especially true at older ages when the risks of specific morbidities
and mortality vary widely across individuals of the same age. That variability is associated with
numerous other predictors of health status, including, inter alia, genetic factors, which are
estimated to account for roughly a quarter of the differences in health and function observed at
older ages (Brooks-Wilson, 2013), as well as individual characteristics such as occupation, level
of income or educational attainment; environmental factors such as pollution or accessible
infrastructure; and behaviours that pose risks to health, such as tobacco use, physical inactivity or
excessive consumption of alcohol. Thus, while one 70-year-old person may enjoy good health
that enables them to remain active in the labour force and to live without much health care
support or intervention, a peer of the same age may face multiple chronic morbidities that cause
significant disability and require frequent medical interventions or health care support resources.
While all older persons will eventually face declining health and functioning, their specific
health trajectories may vary widely. Some older persons will experience a sudden and rapid
decline from good health to death, while for others the decline in functioning will occur
gradually over many years, and others still will experience periods of illness and disability
interspersed by periods of partial or full recovery (WHO, 2015). The substantial heterogeneity in
the health status of older persons underscores the need for health systems that are responsive to
the diversity of their experience. In addition to health systems, other sectors must respond by
United Nations Department of Economic and Social Affairs ǀ Population Division 91
creating the infrastructure and environments that support older persons with varying functional
capacities. This includes, for example, housing and transportation infrastructure that is accessible
and safe for older persons.
A recent assessment by the World Health Organization (WHO) (2015) warns that health
systems around the world are falling short with respect to meeting the needs of older persons.
The report summarises the present situation:
Current public-health approaches to population ageing have clearly been ineffective.
The health of older people is not keeping up with increasing longevity; marked
health inequities are apparent in the health status of older people; current health
systems are poorly aligned to the care that older populations require even in highincome countries; long-term care models are both inadequate and unsustainable; and
physical and social environments present multiple barriers and disincentives to both
health and participation (p. 18).
Thus changes are needed around the globe to continue to adapt health systems to serve a
growing number and proportion of older persons and to maximize health and well-being at all
ages. Importantly, WHO emphasizes that the changes needed to ensure that older persons receive
the health care they require need not imply exorbitant increases in national health budgets, even
in countries with rapidly ageing populations. The following sections describe some of the key
trends identified as central to the health care needs of older persons and their associations with
population ageing, including: 1) healthy life in the context of increasing life expectancy; 2)
population ageing and the overall burden of disability experienced in a population; and 3) the
implications of population ageing for national health care expenditures.
People lost an average nine years of healthy life due to disability in 2013.
The health of a population at a given time is often summarized with the “healthy life
expectancy” metric, which is similar conceptually to life expectancy at birth. While life
expectancy at birth summarizes the average number of years a person would be expected to live
if exposed throughout their lives to the age-specific mortality rates of a given period, healthy life
expectancy summarizes how many of those years are expected to be lived in good health, free of
disease and disability. The World Health Organization relies upon a combination of countrylevel information about the incidence and prevalence of diseases, the duration and severity of the
disabilities they cause, as well as models and assumptions, in order to estimate the average
number of years spent in good health (WHO, 2014). In 2013, the most recent year for which
WHO estimates are available, life expectancy at birth was 71 years globally and the
corresponding value of healthy life expectancy was 62 years (figure IV.12). Across the six
regions defined by the WHO for statistical reporting purposes, healthy life expectancy was
longest in the Western Pacific at 68 years, followed by Europe and the Americas both at 67
years. Healthy life expectancy was shortest in Africa at 50 years, as was life expectancy at birth
at 58 years.
A complementary metric describes the number of potentially healthy years of life lost due to
morbidity or disability. It is calculated as the difference between healthy life expectancy and life
expectancy at birth. Thus, for the world as a whole in 2013, the life expectancy of 71 years and
92 World Population Ageing, 2015
healthy life expectancy of 62 years imply that, on average, approximately nine years of healthy
life were lost due to disability. Across the regions, as shown in figure IV.12, the average
numbers of healthy years of life lost due to disability range from 8 years in Africa and in the
Western Pacific to 10 years in the Americas.
Figure IV.12.
Life expectancy at birth and healthy life expectancy at birth, by WHO region, 2013
Data source: World Health Organizaiton. Global Health Observatory Data Repository. Available from http://apps.
who.int/gho/data/view.main.690?lang=en. (Accessed 1 October 2015).
On average, people in longer-lived populations tend to spend more years living with
disability than people in populations where the average lifespan is shorter.
In general, the number of healthy life years lost due to disability tends to be greater in
countries with a higher life expectancy at birth compared to countries with shorter average
lifespans. The top two charts in figure IV.13 plot WHO’s estimates of the number of healthy
years of life lost against the life expectancy at birth in 2013 for females and males in 194
countries or areas. For both sexes in 2013, a comparison across countries reveals an upward
sloping relationship between the two indicators. People who lived in countries with longer
lifespans lost more healthy years of life, on average, than those living in countries with shorter
lifespans. Among women in Spain, for example, who had one of the highest life expectancies in
the world at nearly 86 years, an average of 10.4 years of healthy life were lost due to disability in

  1. Women in Somalia, who had among the world’s shortest avearge lifespans at around 56
    years, lost about 8.9 years of healthy life due to disability.
    However, when one considers instead the number of healthy years lost due to disability as a
    percentage of the average lifespan, an inverse association is revealed across countries: on
    average, people living in countries with longer life expectancies at birth tend to spend a smaller
    proportion of their lives with disability or ill-health relative to people living in countries with
    shorter life expectancies overall. Thus while the average woman in Spain is expected live 12 per
    71
    58
    68 68
    76 76 77
    62
    50
    59 59
    67 68 67
    30
    35
    40
    45
    50
    55
    60
    65
    70
    75
    80
    Years of life
    Life expectancy at birth
    Healthy life expetancy
    United Nations Department of Economic and Social Affairs ǀ Population Division 93
    cent of her life span with disability, the average 8.9 years of disability for the average woman in
    Somalia accounts for 16 per cent of her life span.
    Associations observed in cross section among countries do not necessarily persist in
    assessments of changes over time within a given population. That is, just because the years of
    healthy life lost tends to be greater among countries with higher life expectancies at birth does
    not guarantee that the number of healthy life years lost will increase as longevity improves in a
    Figure IV.13.
    Healthy years of life lost and life expectancy at birth, by country and sex, 2013
    Data source: World Health Organization. Global Health Observatory Data Repository. Available from
    http://apps.who.int/ gho/data/view.wrapper.MGHEHALEv?lang=en&menu=hide. (Accessed 1 October 2015).
    94 World Population Ageing, 2015
    given country. In fact, to date, there is very limited evidence to indicate whether, as life
    expectancy increases, people are living those additional years in good health, or are instead
    experiencing extended periods of disability and illness (Crimmins and others, 2011; Beard and
    Bloom, 2015). One study in the United States of America found an increased prevalence of
    disabilities affecting basic activities of daily living, instrumental activities and mobility among
    recent cohorts of older persons aged 60 to 69 years compared to cohorts a decade earlier
    (Seeman and others, 2010). The same study also detected a lower prevalence of functional
    limitations among recent cohorts of persons aged 80 years or over relative to oldest-old persons a
    decade earlier. Another study in Austria concluded that the healthy life expectancy for older
    persons had increased between 1978 and 1998, and that the proportion of healthy life years lost
    due to disability had declined over the same period, indicating that ill health was increasingly
    compressed into the last years of life in that country (Doblhammer and Kytir, 2001). A WHO
    study found evidence of reductions in the amount of time spent in poor health in many contexts,
    but noted that conflicting conclusions could be drawn from analyses with different study designs
    (Chatterji and others, 2015).
    So far, these empirical studies of the association betweeen life expectancy and the average
    length of healthy life have been almost exclusively limited to high-income countries. As a result,
    any meaningful understanding of how trends in healthy life expectancy relate to improvements in
    longevity in most of the world is currently lacking.
    Whether the growing numbers of older persons are enjoying their added years of life in good
    health is a crucial consideration for policy development (WHO, 2015). If the added years of life
    expectancy are years spent in disability or ill-health, then the coming trends in population ageing
    could portend substantially increased demand for health care, while also preventing families,
    communities and societies from benefitting from the contributions that older persons would
    otherwise be able to make if they remained in good health. In contrast, if the onset or severity of
    ill-health is increasingly postponed as life expectancy increases—a phenomenon termed a
    “compression of morbidity”—then the health system pressures exerted by population ageing may
    be attenuated.
    Growing numbers of older persons lead to greater demands for the prevention and
    treatment of the non-communicable diseases associated with old age.
    Irrespective of any association between population ageing and the length of healthy life, one
    thing is clear: population growth equates to an increasing number of people who require access
    to health care. The prevalence of chronic illness and the disabilities they cause are strongly
    associated with age. For this reason, the very rapid current and future growth in the number of
    older persons foretells a surge in the demand for care aimed at the prevention and treatment of
    the health conditions they face. Indeed, WHO estimates of the burdens of disability caused by
    non-communicable diseases (NCDs) indicate a powerful association with the pace of growth of
    the older population.
    Figure IV.14 depicts the percentage change of the population aged 60 years or over between
    2000 and 2012 against the percentage change of NCD-related disability over the same period, as
    United Nations Department of Economic and Social Affairs ǀ Population Division 95
    estimated in the WHO’s 2014 update of Global Health Estimates.24 Some of the countries that
    saw the largest increases in NCD-related disability between 2000 and 2012 are those that
    experienced the greatest proportional growth in the population of older persons. In Lebanon, for
    example, the number of people aged 60 years or over grew by 71 per cent between 2000 and
    2012, while the burden of NCD-related disability increased by 54 per cent. In Kuwait, the
    increases in the number of older persons (78 per cent) and overall burden of NCD-related
    disability (74 per cent) were similarly rapid. In South Africa, the population aged 60 years or
    over grew by 41 per cent at the same that time the burden of NCD-related disability rose by 22
    per cent. The number of older persons grew more slowly in the United Kingdom between 2000
    and 2012, increasing by 18 per cent, and the change in the total burden of NCD-related
    disability, at 7 per cent, was comparatively small as well. In the Ukraine, the population aged 60
    years or over in 2012 was 5 per cent smaller than in 2000, and the country experienced a
    concomitant reduction in the burden of NCD-related disability of approximately 7 per cent.
    Figure IV.14.
    Changes in population aged 60 years or over and NCD-related disability (YLDs) between 2000 and 2012
    Data sources: United Nations (2015). World Population Prospects: The 2015 Revision and WHO (2014). Global
    Health Estimates.
    Despite the strong positive association observed in figure IV.14, it is evident that factors
    other than the growth in the number of older persons also influence the pace of change in NCDrelated disability. Most countries fall above the 45-degree dotted line in the chart, indicating that
    the older population grew faster than the burden of NCD-related disability between 2000 and
  2. In some cases, the differences were substantial. In China, for example, the population aged

24 The burden of NCD-related disability is represented by the total years of life lost due to disability (YLDs) in a population as a result of the
group of causes classified by the WHO as non-communicable diseases.
96 World Population Ageing, 2015
60 years or over grew more than twice as fast as the burden of NCD-related disability (46 per
cent versus 17 per cent). In Brazil, there were 59 per cent more older persons in 2012 than in
2000, but the burden of NCD-related disability had increased by only 22 per cent.
While growing numbers of older persons almost certainly portends growing demand for the
prevention and care of NCDs, any association between the proportion of older persons in the
population and the burden of disability or demand for care is less direct. The WHO’s global
health estimates suggest that the share of older persons is, in fact, a poor predictor of the overall
burden of disability in a population. Figure IV.15 plots the average number of years of life lost
per capita due to disability, including all ages and all causes, against the percentage of the
population aged 60 years or over. By this measure, Hungary, Cuba and Haiti experienced the
heaviest burdens of disability. In each of these three countries, disability contributed to the loss
of approximately 0.14 years of healthy life per person, on average, in 2012. Yet, Hungary, Cuba
and Haiti are at very different stages of the population ageing process: in Hungary nearly one in
four people was aged 60 years or over in 2012, versus around one in five people in Cuba and one
in fifteen people in Haiti. Germany and South Africa were similar to each other with respect to
the overall level of disability, with approximately 0.12 years of health life lost per captia due to
disability in 2012. However, Germany, with 26 per cent of the population in 2012 aged 60 years
or over was substantially more aged than South Africa, where older persons accounted for just 7
per cent of the population. Similarly, in Japan and Bangladesh, people lost on average about
0.11 years of healthy life due to disability, despite the fact that the two countries were at very
different stages of the ageing process.
Figure IV.15.
Years of life lost per capita due to disability and percentage of population aged 60 years or over in 2012
Data sources: United Nations (2015). World Population Prospects: The 2015 Revision and WHO (2014). Global
Health Estimates.
United Nations Department of Economic and Social Affairs ǀ Population Division 97
Population ageing will not necessarily imply growing burdens of disability.
There are several plausible explanations for why ageing may not lead to greater levels of
disability in a population overall. First, countries that are more advanced in the ageing process
tend to be those with higher levels of economic development, which is associated with
improvements in health and well-being. Second, the more aged and more developed countries
are often better able to treat illnesses or to accommodate the disabilities that commonly occur in
older persons, thereby lessening the degree of functional limitations they cause. Thus while
vision impairments associated with cataracts, for example, may cause minimal limitation in a
country that offers corrective surgery or adaptations that preserve the functional capacities of
persons with poor sight, the same health condition could be profoundly disabling in contexts
where such treatments or adaptations are unavailable. Surveys of older persons’ health in subSaharan Africa indicate high rates of hypertension, musculoskeletal disease, visual impairment,
functional limitations and depression, many cases of which go undiagnosed or untreated
(Aboderin and Beard, 2015). Finally, some of the health conditions that commonly afflict young
people in the comparatively youthful developing regions cause chronic disability, adding
substantially to the overall level of disability in the population. Parasitic diseases, such as
intestinal worms, are an example. They afflict hundreds of millions of mostly poor people in the
developing regions and are among the leading causes of disability worldwide (Hotez, 2008).
Given the growth of the older population, which will occur in virtually every country in the
world over the coming decades, health systems should prepare now to address the specific health
concerns of older persons. Table IV.1 lists the 10 leading causes of disability globally among
women and men aged 60 years or over, according to WHO estimates for 2012. Topping the list
for older women were unipolar depressive disorders, followed by hearing loss, back and neck
pain, Alzheimer’s disease and other dementias, and osteoarthritis. Among older men, hearing
loss was the leading cause of disability in 2012, followed by back and neck pain, falls, chronic
obstructive pulmonary disease and diabetes mellitus. Vision loss, caused by refractive errors or
cataracts, is also an important cause of disability among older persons globally.
TABLE IV.1. TEN LEADING CAUSES OF DISABILITY GLOBALLY AMONG PERSONS AGED 60 YEARS OR OVER, BY SEX, 2012
Females
YLDs*
per
100,000
people Males
YLDs*
per
100,000
people
1 Unipolar depressive disorders 1 465 Other hearing loss 1 870
2 Other hearing loss 1 427 Back and neck pain 1 530
3 Back and neck pain 1 413 Falls 1 347
4 Alzheimer’s disease and other dementias 1 295 Chronic obstructive pulmonary disease 1 276
5 Osteoarthritis 1 201 Diabetes mellitus 1 121
6 Chronic obstructive pulmonary disease 1 200 Refractive errors 902
7 Diabetes mellitus 1 143 Unipolar depressive disorders 883
8 Refractive errors 1 066 Alzheimer’s disease and other dementias 850
9 Falls 998 Hyperplasia of prostate 840
10 Cataracts 756 Osteoarthritis 739
Data source: WHO (2014). Global Health Estimates.
*YLDs = Years of life lost due to disability.
98 World Population Ageing, 2015
Addressing disability among older persons entails not only treating health conditions as they
arise, but also: 1) providing the necessary accomodations, such as eyeglasses, hearing aids and
accessible housing and transportation, to reduce the degree of functional limitations they cause;
and 2) preventing or postponing the incidence of disability-causing conditions in the first place.
A growing body of research supports the notion that much of the disability-causing chronic
disease that arises in old age is linked to exposures to risk factors early in life, or even prior to
birth. Factors like low birthweight, childhood obesity, poverty, and experiences of stress during
childhood have all been linked to the onset of chronic diseases, such as heart diseases and
diabetes in adulthood (for example, see Barker, 2004; Haas, 2008; Hayward and Gorman, 2004;
Winning and others, 2005). Taken as a whole, the literature underscores the importance of
fostering good health and habits early in life to prevent or postpone the onset of morbidity at
older ages.
Population ageing need not imply exorbitant increases in national health budgets.
The growing number and proportion of older persons in the population understandably raises
concerns about the potential pressures the health systems will face to meet their needs. What
popualtion ageing will mean for national health care expenditures is not immediately clear
(WHO, 2015). Despite the impending increased need for care, several studies have found that
older persons use health services significantly less often than younger adults. Often, the lower
rates of health care utilization among older persons reflect inadequacies in the availability or
delivery of care, or structural barriers that prevent older persons from utilizing the care they
need, which occurs in both developed and developing countries (WHO, 2015). Some evidence
from high-income countries indicates that health expenditures per person actually fall
significantly starting around age 70 (Kingsley, 2015).
Over the recent past, there has been a great deal of variability in the observed increases of
health care expenditures across countries with a similar pace of population ageing. Figure IV.16
plots the percentage point change in the proportion of the population aged 60 years or over
between 2000 and 2013 against the percentage increase in a country’s per capita health care
expenditures over the same period.
If population ageing were the major driver of increases in health costs, then the largest
increases in per capita health expenditures would be observed in the countries that were ageing
the fastest. By and large, this is not the case. Instead, most of the countries that experienced
extremely rapid rises in health care expenditures since 2000, were ageing relatively slowly. Both
Mongolia and the Russian Federation, for example, experienced a more than a tenfold increase in
per capita health expenditures between 2000 and 2013, even as the share of older persons
changed by only around ½ percentage point. Conversely, per capita health care expenditures
changed relatively little among many of the countries that were ageing the fastest. In Japan, the
proportion aged 60 years or over increased by 9 percentage points between 2000 and 2013, while
per capita health expenditures grew by only 38 per cent. Health expenditures in Finland more
than doubled between 2000 and 2013, which is a comparatively small increase compared to
numerous other countries, but the pace of population ageing was one of the fastest in the world,
with the share of older persons increasing by more than 6 percentage points during that period.
United Nations Department of Economic and Social Affairs ǀ Population Division 99
Given the loose and variable relationship between population ageing and health expenditures,
WHO cautions that to predict increases in health-care costs on the basis of population ageing is
simplistic and unlikely to lead to good policy decisions (WHO, 2015). Instead, a host of other
factors should be taken into account when evaluating short- and long-term trends in health-care
costs, such as technology-related changes, growth in personal income, and cultural norms and
attitudes surrounding end-of-life care.
Figure IV.16.
Change in percentage of older persons over time versus changes in health care expenditures per capita,
2000-2013
Data sources: United Nations (2015). World Population Prospects: The 2015 Revision and World Bank (2015). World
Development Indicators database.
D. CONCLUSIONS
Preparing for an ageing population is integral to the achievement of many of the
sustainable development goals.
Population ageing is especially relevant for development goals related to poverty eradication,
ensuring healthy lives and promoting social protection and well-being at all ages, gender
equality, and full and productive employment and decent work for all, reducing inequalities
between and within countries, and making cities and human settlements inclusive, safe, resilient
and sustainable. As populations grow increasingly aged, it is more important than ever that
governments design innovative policies and public services specifically targeted to older persons,
including those addressing, inter alia, housing, employment, health care, infrastructure and
100 World Population Ageing, 2015
social protection. Such policies will be essential to the success of efforts to achieve the goals laid
out in the 2030 Agenda for Sustainable Development.
Planning for growing numbers and proportions of older persons is essential to ensure the
sustainability of pension systems.
In some countries, large majorities of older people are covered by existing pay-as-you go or
unfunded pension programmes, but declining old-age support ratios imply that such programmes
may struggle to maintain adequate income support into the future. In response, some countries
are pursuing pension system reforms, such as increasing the statutory ages at retirement and
encouraging private savings. In many developing countries, existing pension systems cover only
a minority of older persons. There, governments should prioritize enhancing system coverage
and taking other measures to properly finance pensions for the ever-expanding population of
retirees. Countries, where appropriate, should expand their pension systems to guarantee basic
income security in old age for all, at the same time ensuring the sustainability and solvency of
pension schemes.
Health care systems must adapt to meet the needs of growing numbers of older persons.
In countries where health systems are already well-equipped to diagnose and treat conditions
associated with old age, public policies are needed to mitigate the upward pressure on national
health care budgets exerted by the rising costs of health care services, and the longer lifespans
and increasing numbers of older persons. In places where existing health systems are weak or illequipped to address the needs of an ageing population, countries should work to expand and
evolve those systems in preparation for a growing burden of non-communicable diseases. As life
expectancies increase, it is more important than ever to enact policies that promote lifelong
health and emphasize preventive care—such as those that support good nutrition and physical
activity, and discourage tobacco use and the harmful use of alcohol and drugs—to prevent or
postpone the onset of age-related disability. In addition, countries should prepare for a growing
need for long-term care, both home-based and facility-based, to ensure the well-being of those at
advanced ages.
Population ageing underscores the urgency of eliminating age-related discrimination,
promoting and protecting the rights and dignity of older persons and facilitating their full
participation in society.
Ensuring that older persons who want to work have access to employment opportunities is a
key policy priority. Policies are needed to eliminate age barriers in the formal labour market and
promote the recruitment of and flexible employment opportunities for older workers, as well as
facilitate access to microcredit and, where applicable, provide subsidies and other incentives for
self-employment. In addition, countries should ensure that older persons are included in public
policy and decision-making processes, including by utilising information and communications
technologies to facilitate their engagement in public governance processes.
United Nations Department of Economic and Social Affairs ǀ Population Division 101
Governments should act to improve older persons’ access to public services in both urban
and rural settings.
Governments should ensure that infrastructure and services are accessible to persons with
limited mobility, or visual, hearing and other impairments, the prevalence of which tends to
increase with age. The proliferation of technologies, such as mobile devices, offers a variety of
new channels for reaching older persons, for example, by delivering messages related to health,
security or environmental hazards via short message service (SMS). Governments should help to
bridge the digital divide by addressing differences in educational background and information
and communications technology (ICT) skills of older persons through technology training
courses, programmes and learning hubs tailored to their needs.
Recent population trends indicate that virtually every country should anticipate significant
growth in the number of older persons over the coming decades, necessitating multisectoral
policies to ensure that older persons are able to participate actively in the economic, social,
cultural and political life of their societies.
By understanding their specific population trends, governments can assess present needs and
anticipate future needs with respect to their older population. In doing so, they can proactively
implement the policies and programmes that ensure the well-being and full socio-economic
integration of older persons while maintaining the fiscal solvency of pension and health care
systems and promoting economic growth.

United Nation Department of Economic and Social Affairs ǀ Population Division 103
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Annexes

United Nations Department of Economic and Social Affairs ǀ Population Division 111
Annex I
Glossary of terms
DISABILITY-ADJUSTED LIFE YEAR (DALY)
The Disability-Adjusted Life Years (DALYs) is a measurement of the gap between
current health status and an ideal health situation where the entire population lives to an
advanced age, free of disease and disability. One DALY can be thought of as one lost year of
“healthy” life. It is calculated as the sum of the Years of Life Lost (YLL) due to premature
mortality in the population and the Years Lost due to Disability (YLD) for people living with the
health condition or its consequences.
DEPENDENCY RATIO
The total dependency ratio is the number of persons under age 20 years plus persons aged
65 years or over per one hundred persons aged 20 to 64 years. It is the sum of the child
dependency ratio and the old-age dependency ratio.
The child dependency ratio is the number of persons 0 to 19 years per one hundred
persons aged 20 to 64 years
The old-age dependency ratio is the number of persons aged 65 years or over per one
hundred persons aged 20 to 64 years.
GROWTH RATE
A population’s growth rate is the increase (or decrease) in the number of persons in the
population during a certain period of time, expressed as a percentage of the population at the
beginning of the time period. The average annual growth rates for all ages as well as for
particular age groups are calculated on the assumption that growth is continuous.
LABOUR FORCE PARTICIPATION
The labour force participation rate consists of the economically active population in a
particular age group as a percentage of the total population of that same age group. The active
population (or labour force) includes persons in paid or unpaid employment, members of the
armed forces (including temporary members) and the unemployed (including first-time jobseekers.). This definition is the one adopted by the Thirteenth International Conference of
Labour Statisticians (Geneva, 1982). National definitions may differ in some cases. For
information on the differences in scope, definitions and methods of calculation used for the
various national series, see International Labour Organization, Sources and Methods: Labour
Statistics (formerly Statistical Sources and Methods), Volume 5: Total and Economically Active
Population, Employment and Unemployment (Population Censuses), available from
http://laborsta.ilo.org/applv8/data/SSM5/E/ssm5.html#E.
112 World Population Ageing 2015
ECONOMIC SUPPORT RATIO
The economic support ratio is the number of equivalent producers or workers divided by
the number of equivalent consumers in a given population.
HEALTHY LIFE EXPECTANCY AT BIRTH
The health life expectancy at a specific age is average number of years of life spent in
good health, free of illness or disability.
HEALTHY YEARS OF LIFE LOST
The equivalent healthy years of life lost is the average number of years spent living with
disability in a population. It is equal to the life expectancy at birth minus the healthy life
expectancy at birth.
LIFE EXPECTANCY
Life expectancy at a specific age is the average number of additional years a person of that
age could expect to live if current mortality levels observed for ages above that age were to
continue for the rest of that person’s life. In particular, life expectancy at birth is the average
number of years a newborn would live if current age-specific mortality rates were to continue.
The life expectancy at age 60 is the average number of years a 60-year-old person would life if
current age-specific mortality rates were to continue.
MEDIAN AGE
The median age of a population is the age that divides a population into two groups of the
same size, such that half the total population is younger than this age, and the other half older.
PENSION COVERAGE
The potential coverage reflects the percentage of persons over the statutory pensionable
age that is receiving a pension.
POTENTIAL SUPPORT RATIO
The potential support ratio is the number of persons aged 20 to 64 years per every person
aged 65 years or over.
SEX RATIO
The sex ratio is calculated as the number of males per one hundred females in a
population. The sex ratio may be calculated for a total population or for a specific age group.
United Nations Department of Economic and Social Affairs ǀ Population Division 113
STATUTORY PENSIONABLE AGE
The statutory pensionable age (or statutory retirement age) is the age at which eligible
individuals qualify to receive old-age benefits in accordance to national laws and regulations. In
addition to attainment of a specified age, receiving old-age benefits can also be conditional on
the completion of a specified period of contributions or covered employment.
TOTAL FERTILITY RATE
The total fertility rate is the average number of children a woman would bear over the
course of her lifetime if current age-specific fertility rates remained constant throughout her
childbearing years (normally between the ages of 15 and 49 years). The current total fertility
rate is an indicator of the level of fertility at a given time.

United Nations Department of Economic and Social Affairs ǀ Population Division 115
Annex II
Classification of regions, least developed countries and
income groups
Africa

Eastern Africa Middle Africa Northern Africa Western Africa
Burundi Angola Algeria Benin
Comoros Cameroon Egypt Burkina Faso
Djibouti Central African Republic Libya Cape Verde
Eritrea Chad Morocco Côte d’Ivoire
Ethiopia Congo Sudan Gambia
Kenya Democratic Republic of Tunisia Ghana
Madagascar the Congo Western Sahara Guinea
Malawi Equatorial Guinea Guinea-Bissau
Mauritius Gabon Liberia
Mayotte São Tomé and Príncipe Mali
Mozambique Southern Africa Mauritania
Réunion Niger
Rwanda Botswana Nigeria
Seychelles Lesotho St. Helena
Somalia Namibia Senegal
South Sudan South Africa Sierra Leone
Uganda Swaziland Togo
United Republic of
Tanzania
Zambia
Zimbabwe
Asia

Eastern Asia Central Asia South-Eastern Asia Western Asia
China Kazakhstan Brunei Darussalam Armenia
China, Hong Kong SAR Kyrgyzstan Cambodia Azerbaijan
China, Macao SAR Tajikistan Indonesia Bahrain
Democratic People’s Turkmenistan Lao People’s Democratic Cyprus
Republic of Korea Uzbekistan Republic Georgia
Japan Malaysia Iraq
Mongolia Southern Asia Myanmar Israel
Republic of Korea Philippines Jordan
Afghanistan Singapore Kuwait
Bangladesh Thailand Lebanon
Bhutan Timor-Leste Oman
India Viet Nam Qatar
Iran (Islamic Republic of) Saudi Arabia
Maldives State of Palestine
Nepal Syrian Arab Republic
Pakistan Turkey
Sri Lanka United Arab Emirates
Yemen
116 World Population Ageing, 2015
Europe

Eastern Europe Northern Europe Southern Europe Western Europe
Belarus Channel Islands Albania Austria
Bulgaria Denmark Andorra Belgium
Czech Republic Estonia Bosnia and Herzegovina France
Hungary Faeroe Islands Croatia Germany
Poland Finland Gibraltar Liechtenstein
Republic of Moldova Iceland Greece Luxembourg
Romania Ireland Holy See Monaco
Russian Federation Isle of Man Italy Netherlands
Slovakia Latvia Malta Switzerland
Ukraine Lithuania Montenegro
Norway Portugal
Sweden San Marino
United Kingdom of Great Serbia
Britain and Slovenia
Northern Ireland Spain
The former Yugoslav
Republic of Macedonia

Latin America and the Caribbean

Caribbean Central America South America
Anguilla Belize Argentina
Antigua and Barbuda Costa Rica Bolivia (Plurinational State of)
Aruba El Salvador Brazil
Bahamas Guatemala Chile
Barbados Honduras Colombia
British Virgin Islands Mexico Ecuador
Caribbean Netherlands Nicaragua Falkland Islands (Malvinas)
Cayman Islands Panama French Guiana
Cuba Guyana
Curaçao Paraguay
Dominica Peru
Dominican Republic Suriname
Grenada Uruguay
Guadeloupe Venezuela (Bolivarian Republic of)
Haiti
Jamaica
Martinique
Montserrat
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the
Grenadines
Sint Maarten
Trinidad and Tobago
Turks and Caicos Islands
United States Virgin Islands

United Nations Department of Economic and Social Affairs ǀ Population Division 117
Northern America
Bermuda
Canada
Greenland
St. Pierre and Miquelon
United States of America

Oceania

Australia/New Zealand Melanesia Micronesia Polynesia
Australia Fiji Guam American Samoa
New Zealand New Caledonia Kiribati Cook Islands
Papua New Guinea Marshall Islands French Polynesia
Solomon Islands Micronesia Niue
Vanuatu (Federated States of) Samoa
Nauru Tokelau
Northern Mariana Islands Tonga
Palau Tuvalu
Wallis and Futuna Islands
Least developed countries

Afghanistan Djibouti Madagascar Somalia
Angola Equatorial Guinea Malawi South Sudan
Bangladesh Eritrea Mali Sudan
Benin Ethiopia Mauritania Timor-Leste
Bhutan Gambia Mozambique Togo
Burkina Faso Guinea Myanmar Tuvalu
Burundi Guinea-Bissau Nepal Uganda
Cambodia Haiti Niger United Republic of
Central African Republic Kiribati Rwanda Tanzania
Chad Lao People’s Democratic São Tomé and Príncipe Vanuatu
Comoros Republic Senegal Yemen
Democratic Republic of Lesotho Sierra Leone Zambia
the Congo Liberia Solomon Islands

118 World Population Ageing, 2015
Low-income economies(GNI per capita $1,045 or less)
Afghanistan Dem. Republic of the Congo Liberia Sierra Leone
Benin Eritrea Madagascar Somalia
Burkina Faso Ethiopia Malawi South Sudan
Burundi Gambia Mali Togo
Cambodia Guinea Mozambique Uganda
Central African Republic Guinea-Bissau Nepal United Republic of Tanzania
Chad Haiti Niger Zimbabwe
Comoros Dem. Republic of Korea Rwanda

Lower-middle-income economies (GNI per capita $1,046 to $4,125)
Armenia Guatemala Moldova State of Palestine
Bangladesh Guyana Morocco Sudan
Bhutan Honduras Myanmar Swaziland
Bolivia (Plurinational State of) India Nicaragua Syrian Arab Republic
Cabo Verde Indonesia Nigeria Tajikistan
Cameroon Kenya Pakistan Timor-Leste
Congo Kiribati Papua New Guinea Ukraine
Cote d’Ivoire Kosovo Philippines Uzbekistan
Djibouti Kyrgyz Republic Samoa Vanuatu
Egypt Lao People’s Dem. Republic Sao Tome and Principe Viet Nam
El Salvador Lesotho Senegal Yemen
Georgia Mauritania Solomon Islands Zambia
Ghana Micronesia, Fed. Sts of Sri Lanka

Upper-middle-income economies (GNI per capita $4,126 – $12,735)
Albania Cuba Malaysia South Africa
Algeria Dominica Maldives St. Lucia
American Samoa Dominican Republic Marshall Islands St. Vincent and the Grenadines
Angola Ecuador Mauritius Suriname
Azerbaijan Fiji Mexico Thailand
Belarus Gabon Mongolia TFYR Macedonia
Belize Grenada Montenegro Tonga
Bosnia and Herzegovina Iran (Islamic Rep. of) Namibia Tunisia
Botswana Iraq Palau Turkey
Brazil Jamaica Panama Turkmenistan
Bulgaria Jordan Paraguay Tuvalu
China Kazakhstan Peru
Colombia Lebanon Romania
Costa Rica Libya Serbia

United Nations Department of Economic and Social Affairs ǀ Population Division 119
High-income economies (GNI per capita $12,736 or more)
Andorra Denmark Kuwait Saudi Arabia
Antigua and Barbuda Estonia Latvia Seychelles
Argentina Equatorial Guinea Liechtenstein Singapore
Aruba Faeroe Islands Lithuania Sint Maarten (Dutch part)
Australia Finland Luxembourg Slovak Republic
Austria France Macao SAR, China Slovenia
Bahamas French Polynesia Malta Spain
Bahrain Germany Monaco St. Kitts and Nevis
Barbados Greece Netherlands St. martin (French part)
Belgium Greenland New Caledonia Sweden
Bermuda Guam New Zealand Switzerland
Brunei Darussalam Hong Kong, SAR China Northern Mariana Islands Taiwan, Province of China
Canada Hungary Norway Trinidad and Tobago
Cayman Islands Iceland Oman Turks and Caicos Islands
Channel Islands Ireland Poland United Arab Emirates
Chile Isle of Man Portugal United Kingdom
Croatia Israel Puerto Rico United States of America
Curacao Italy Qatar Uruguay
Cyprus Japan Russian Federation Venezuela (Bolivarian Rep. of)
Czech Republic Republic of Korea San Marino United States Virgin Islands

Annex III
Summary tables
122 World Population Ageing 2015
Table A.III.1. Population aged 60 years or over, percentage of population aged 60
years or over and median age, 2015, 2030 and 2050
Country or area Population aged 60 or over
(thousands)
Percentage aged 60 or
over
Median age
(years)
2015 2030 2050 2015 2030 2050 2015 2030 2050
World 900 906 1 402 405 2 091 966 12.3 16.5 21.5 29.6 33.1 36.1
More developed regions 298 783 375 219 421 449 23.9 29.2 32.8 41.2 44.1 45.1
Less developed regions 602 123 1 027 187 1 670 517 9.9 14.2 19.8 27.8 31.3 34.9
Least developed countries 52 066 88 531 185 600 5.5 6.7 9.8 19.7 22.3 26.1
Other less developed countries 550 057 938 655 1 484 917 10.7 15.9 22.7 29.3 33.8 37.8
Less developed regions, excluding China 386 862 658 943 1 166 149 8.2 11.4 16.5 25.2 28.5 32.6
High-income countries 309 662 408 853 483 125 22.1 27.7 31.9 39.7 42.9 44.7
Middle-income countries 557 662 938 759 1 493 047 10.5 15.4 21.9 28.9 33.2 37.1
Upper-middle-income countries 320 158 544 856 800 567 13.4 21.2 30.5 33.5 39.7 44.1
Lower-middle-income countries 237 504 393 903 692 480 8.1 11.2 16.5 25.3 28.8 33.4
Low-income countries 33 161 54 040 114 777 5.2 5.8 8.3 18.5 20.7 24.6
Sub-Saharan Africa 46 455 74 504 161 077 4.8 5.3 7.6 18.3 20.1 23.7
Africa 64 447 105 387 220 341 5.4 6.3 8.9 19.4 21.2 24.8
Eastern Africa 18 868 30 818 72 436 4.8 5.3 8.2 18.0 20.4 24.6
Burundi 468 844 1 944 4.2 4.9 6.8 17.6 18.5 21.8
Comoros 36 65 139 4.6 6.0 9.2 19.7 22.1 26.3
Djibouti 56 97 183 6.3 9.2 15.5 23.6 27.7 33.4
Eritrea 218 339 959 4.2 4.6 9.2 18.6 21.7 26.7
Ethiopia 5 205 8 464 19 525 5.2 6.1 10.4 18.6 22.9 29.2
Kenya 2 090 3 628 9 163 4.5 5.5 9.6 18.9 21.6 25.7
Madagascar 1 128 2 091 4 551 4.7 5.8 8.2 18.7 20.9 24.5
Malawi 849 1 218 3 276 4.9 4.6 7.6 17.2 19.3 23.5
Mauritius 188 305 383 14.7 23.3 30.6 35.2 40.4 47.1
Mayotte 13 28 66 5.6 8.0 13.3 19.0 23.2 29.3
Mozambique 1 432 2 138 4 075 5.1 5.2 6.2 17.1 18.9 22.4
Réunion 130 241 305 15.1 25.5 30.9 34.3 38.7 44.4
Rwanda 527 989 2 551 4.5 6.3 12.0 19.2 23.2 29.7
Seychelles 11 19 27 10.9 19.1 27.4 32.6 37.2 39.7
Somalia 482 736 1 401 4.5 4.5 5.2 16.5 17.7 20.8
South Sudan 634 1 007 1 943 5.1 5.7 7.5 18.6 20.6 24.6
Uganda 1 474 2 297 6 160 3.8 3.7 6.0 15.9 18.1 21.9
United Republic of Tanzania 2 552 4 292 9 942 4.8 5.2 7.2 17.3 18.8 22.2
Zambia 690 1 047 2 829 4.3 4.1 6.6 16.9 18.5 21.4
Zimbabwe 686 973 3 014 4.4 4.6 10.2 18.9 21.6 27.5
Middle Africa 6 901 11 267 24 411 4.5 4.9 6.6 17.1 18.9 22.5
Angola 959 1 652 3 609 3.8 4.2 5.5 16.1 17.7 21.0
Cameroon 1 131 1 728 3 930 4.8 5.2 8.1 18.5 20.8 24.9
Central African Republic 287 404 880 5.9 6.2 10.0 20.0 22.9 27.7
Chad 555 867 1 886 4.0 4.0 5.4 16.0 17.9 21.7
Congo 255 414 888 5.5 6.1 8.3 18.7 20.1 23.3
Dem. Republic of the Congo 3 537 5 900 12 642 4.6 4.9 6.5 16.9 18.6 22.3
Equatorial Guinea 43 105 167 5.1 8.5 9.2 20.5 22.3 26.5
Gabon 125 182 375 7.3 7.8 11.8 21.4 24.0 29.0
Sao Tome and Principe 8 15 34 4.4 5.8 9.6 18.5 21.2 25.5
Northern Africa 17 992 30 883 59 264 8.0 10.9 16.7 25.1 27.7 32.2
Algeria 3 573 6 413 12 988 9.0 13.3 23.0 27.6 31.9 37.1
Egypt 7 238 11 593 23 045 7.9 9.9 15.3 24.7 26.5 31.0
Libya 439 894 1 823 7.0 12.0 21.8 27.5 31.8 38.4
Morocco 3 317 6 012 10 239 9.6 15.1 23.4 28.0 33.1 38.6
Sudan 2 081 3 633 7 406 5.2 6.4 9.2 19.4 22.3 26.2
Tunisia 1 314 2 247 3 565 11.7 17.7 26.5 31.2 36.5 40.4
United Nations Department of Economic and Social Affairs ǀ Population Division 123
Country or area Population aged 60 or over
(thousands)
Percentage aged 60 or
over
Median age
(years)
2015 2030 2050 2015 2030 2050 2015 2030 2050
Western Sahara 31 91 198 5.5 12.4 22.0 29.4 34.9 39.8
Southern Africa 4 680 6 958 11 477 7.5 9.9 14.7 25.2 28.6 33.2
Botswana 133 224 531 5.9 8.0 15.7 24.2 28.0 33.6
Lesotho 133 132 270 6.2 5.3 9.0 21.0 23.1 28.0
Namibia 134 233 477 5.5 7.1 11.0 21.2 23.9 28.8
South Africa 4 209 6 283 10 061 7.7 10.5 15.4 25.7 29.3 33.9
Swaziland 71 86 138 5.5 5.7 7.7 20.5 22.6 27.5
Western Africa 16 006 25 462 52 752 4.5 4.9 6.6 18.0 19.4 22.6
Benin 501 873 1 789 4.6 5.6 7.9 18.6 21.1 25.1
Burkina Faso 692 1 201 2 736 3.8 4.4 6.4 17.0 19.1 22.7
Cabo Verde 35 64 145 6.7 10.4 20.5 24.5 30.8 38.4
Côte d’Ivoire 1 100 1 642 3 193 4.8 5.1 6.5 18.4 19.8 22.8
Gambia 74 136 293 3.7 4.4 5.9 16.8 18.3 22.1
Ghana 1 444 2 413 4 833 5.3 6.5 9.7 20.6 22.7 26.8
Guinea 643 1 015 2 083 5.1 5.6 7.6 18.5 20.5 24.5
Guinea-Bissau 98 146 295 5.3 5.7 8.3 19.4 21.4 25.4
Liberia 217 361 756 4.8 5.6 8.0 18.6 21.1 24.7
Mali 706 1 100 2 618 4.0 4.0 5.8 16.2 17.9 21.4
Mauritania 207 371 724 5.1 6.5 9.0 19.8 22.1 25.5
Niger 837 1 502 2 944 4.2 4.2 4.1 14.8 15.2 17.8
Nigeria 8 158 12 525 25 262 4.5 4.8 6.3 17.9 19.3 22.5
Senegal 684 1 154 2 931 4.5 5.1 8.1 18.0 19.6 23.5
Sierra Leone 284 413 872 4.4 4.8 7.7 18.5 21.3 26.4
Togo 325 545 1 277 4.5 5.2 8.1 18.7 21.0 24.6
Asia 507 954 844 487 1 293 710 11.6 17.2 24.6 30.3 35.4 39.9
Eastern Asia 269 797 435 155 578 413 16.7 26.4 36.9 37.9 43.7 49.9
China 209 240 358 146 491 533 15.2 25.3 36.5 37.0 43.2 49.6
China, Hong Kong SAR 1 581 2 670 3 334 21.7 33.6 40.9 43.2 48.6 52.7
China, Macao SAR 87 185 289 14.8 25.7 34.5 37.9 43.7 47.0
China, Taiwan Province of China 4 354 7 243 9 212 18.6 31.3 44.3 39.7 48.1 56.2
Dem. People’s Rep. of Korea 3 149 5 181 6 557 12.5 19.4 24.4 33.9 37.3 41.0
Japan 41 873 44 808 45 637 33.1 37.3 42.5 46.5 51.5 53.3
Mongolia 189 420 849 6.4 11.9 21.1 27.3 31.2 35.4
Republic of Korea 9 325 16 501 21 002 18.5 31.4 41.5 40.6 47.5 53.9
Central Asia 5 313 9 402 15 677 7.9 11.9 17.7 26.5 30.2 34.4
Kazakhstan 1 882 2 889 4 182 10.7 14.4 18.6 29.3 31.9 34.3
Kyrgyzstan 420 799 1 327 7.1 11.3 16.1 25.1 27.5 32.1
Tajikistan 425 958 1 886 5.0 8.6 13.2 22.5 24.8 29.6
Turkmenistan 369 700 1 196 6.9 11.4 18.2 26.4 31.5 36.7
Uzbekistan 2 218 4 055 7 086 7.4 11.8 19.1 26.3 31.4 36.4
Southern Asia 153 490 256 153 460 096 8.4 11.9 19.0 26.1 30.6 36.7
Afghanistan 1 300 2 232 5 038 4.0 5.1 9.0 17.5 22.5 29.8
Bangladesh 11 235 21 526 43 491 7.0 11.5 21.5 25.6 31.5 39.6
Bhutan 57 102 233 7.4 11.6 24.5 26.7 33.7 41.9
India 116 553 190 730 330 043 8.9 12.5 19.4 26.6 31.2 37.3
Iran (Islamic Republic of) 6 502 12 745 28 754 8.2 14.4 31.2 29.5 38.3 44.7
Maldives 25 51 125 6.8 11.7 25.3 26.4 33.9 41.4
Nepal 2 456 3 572 6 491 8.6 10.8 17.9 23.1 29.3 38.9
Pakistan 12 476 20 671 39 970 6.6 8.4 12.9 22.5 25.5 30.9
Sri Lanka 2 887 4 524 5 951 13.9 21.0 28.6 32.3 37.0 42.5
South-Eastern Asia 59 008 106 415 167 320 9.3 14.7 21.1 28.8 33.1 37.6
Brunei Darussalam 32 85 169 7.6 17.1 30.9 30.6 37.8 45.4
Cambodia 1 053 1 972 3 969 6.8 10.4 17.6 23.9 28.6 34.5
Indonesia 21 194 38 957 61 896 8.2 13.2 19.2 28.4 31.9 36.5
124 World Population Ageing 2015
Country or area Population aged 60 or over
(thousands)
Percentage aged 60 or
over
Median age
(years)
2015 2030 2050 2015 2030 2050 2015 2030 2050
Lao People’s Dem. Republic 407 685 1 491 6.0 8.1 14.7 21.9 26.4 33.7
Malaysia 2 785 5 196 9 593 9.2 14.4 23.6 28.5 34.5 40.5
Myanmar 4 786 7 982 11 965 8.9 13.2 18.8 27.9 32.4 38.0
Philippines 7 321 12 682 20 779 7.3 10.3 14.0 24.2 27.7 32.0
Singapore 1 001 1 969 2 700 17.9 30.7 40.4 40.0 47.0 53.0
Thailand 10 731 18 355 23 153 15.8 26.9 37.1 38.0 44.8 50.6
Timor-Leste 85 108 174 7.2 6.8 8.1 18.5 19.2 24.3
Viet Nam 9 613 18 425 31 431 10.3 17.5 27.9 30.4 37.0 41.9
Western Asia 20 346 37 363 72 204 7.9 11.6 18.3 26.3 29.9 34.3
Armenia 493 712 902 16.3 23.8 33.1 34.6 41.4 46.9
Azerbaijan 980 1 885 2 675 10.0 17.6 24.4 30.9 37.1 38.6
Bahrain 53 178 432 3.9 10.8 23.7 30.3 35.6 42.2
Cyprus 209 309 465 18.0 23.7 33.2 35.9 41.9 47.5
Georgia 770 969 1 151 19.3 25.1 33.0 37.5 42.0 45.0
Iraq 1 817 3 162 7 402 5.0 5.8 8.8 19.3 21.1 24.3
Israel 1 278 1 808 2 758 15.8 18.1 21.9 30.3 31.8 35.2
Jordan 414 782 1 853 5.4 8.6 15.8 22.5 26.3 32.4
Kuwait 133 442 1 188 3.4 8.9 20.1 31.0 33.9 37.8
Lebanon 670 1 014 1 726 11.5 19.2 30.8 28.5 37.6 46.8
Oman 196 494 1 434 4.4 9.4 24.5 29.0 34.2 40.1
Qatar 51 221 633 2.3 7.9 19.8 30.7 34.0 41.0
Saudi Arabia 1 582 4 324 9 610 5.0 11.1 20.9 28.3 32.3 38.2
State of Palestine 211 421 1 014 4.5 6.2 10.4 19.3 22.3 27.4
Syrian Arab Republic 1 191 2 556 5 740 6.4 8.9 16.4 20.8 27.2 33.7
Turkey 8 828 14 911 25 530 11.2 17.0 26.6 29.8 35.2 41.8
United Arab Emirates 215 1 238 3 004 2.3 11.3 23.5 33.3 36.6 43.4
Yemen 1 254 1 939 4 688 4.7 5.3 9.9 19.3 23.0 29.6
Europe 176 513 217 220 242 001 23.9 29.6 34.2 41.7 45.1 46.2
Eastern Europe 63 091 71 662 80 314 21.5 25.7 31.9 39.6 43.8 43.9
Belarus 1 927 2 260 2 410 20.3 25.2 29.7 39.6 42.8 42.2
Bulgaria 1 926 1 898 1 877 26.9 30.1 36.4 43.5 47.1 47.8
Czech Republic 2 630 3 027 3 683 24.9 28.9 37.0 41.5 46.9 48.1
Hungary 2 455 2 559 2 876 24.9 27.6 34.6 41.3 45.7 47.8
Poland 8 753 10 657 13 038 22.7 28.6 39.3 39.6 46.1 51.8
Republic of Moldova 674 858 1 090 16.6 22.4 33.6 35.6 42.6 49.3
Romania 4 763 5 258 5 531 24.4 29.8 36.4 42.1 47.0 48.1
Russian Federation 28 730 33 233 36 990 20.0 24.0 28.8 38.7 42.4 40.8
Slovakia 1 114 1 411 1 773 20.5 26.4 36.2 39.1 45.2 49.0
Ukraine 10 118 10 501 11 046 22.6 25.7 31.5 40.3 44.1 43.7
Northern Europe 23 968 30 820 36 041 23.4 28.0 30.7 40.3 42.1 43.3
Channel Islands 39 54 63 23.6 31.0 34.9 42.6 46.1 48.0
Denmark 1 401 1 764 1 885 24.7 29.4 29.9 41.6 42.3 44.1
Estonia 331 361 396 25.2 29.1 35.1 41.7 44.9 45.9
Finland 1 496 1 797 1 863 27.2 31.5 32.4 42.5 44.4 45.1
Iceland 63 94 120 19.2 25.8 30.9 36.0 40.1 44.3
Ireland 861 1 267 1 792 18.4 24.4 31.0 36.9 41.3 42.6
Latvia 506 524 528 25.7 29.0 33.1 42.9 44.7 45.3
Lithuania 719 761 711 25.0 28.7 29.9 43.1 43.3 44.3
Norway 1 134 1 559 1 963 21.8 26.2 29.5 39.1 40.9 42.8
Sweden 2 497 3 074 3 513 25.5 28.6 29.6 41.0 41.8 42.0
United Kingdom 14 889 19 521 23 159 23.0 27.8 30.7 40.0 41.9 43.3
Southern Europe 39 914 50 712 56 844 26.2 33.9 40.0 43.9 49.3 51.3
Albania 515 752 838 17.8 25.5 30.9 34.3 39.0 47.6
Bosnia and Herzegovina 853 1 097 1 244 22.4 30.6 40.5 41.5 47.2 53.2
United Nations Department of Economic and Social Affairs ǀ Population Division 125
Country or area Population aged 60 or over
(thousands)
Percentage aged 60 or
over
Median age
(years)
2015 2030 2050 2015 2030 2050 2015 2030 2050
Croatia 1 100 1 233 1 309 25.9 31.0 36.8 42.8 46.5 49.6
Greece 2 961 3 480 3 958 27.0 33.2 40.8 43.6 48.9 52.3
Italy 17 108 21 605 23 016 28.6 36.6 40.7 45.9 50.8 51.7
Malta 107 130 149 25.6 30.4 36.2 41.5 45.8 50.2
Montenegro 127 156 175 20.3 25.2 30.5 37.6 41.6 45.5
Portugal 2 801 3 413 3 793 27.1 34.7 41.2 44.0 50.2 52.5
Serbia 2 163 2 254 2 368 24.4 27.2 32.3 40.6 43.5 46.8
Slovenia 521 672 757 25.2 32.7 39.0 43.1 48.1 49.3
Spain 11 246 15 361 18 546 24.4 33.5 41.4 43.2 50.1 51.8
TFYR Macedonia 385 515 635 18.5 24.8 32.8 37.5 42.6 47.2
Western Europe 49 540 64 026 68 802 26.0 32.7 35.2 43.7 45.8 47.4
Austria 2 064 2 864 3 282 24.2 32.4 37.1 43.2 46.5 49.7
Belgium 2 725 3 544 4 079 24.1 29.5 32.6 41.5 43.6 44.6
France 16 249 20 321 22 592 25.2 29.9 31.8 41.2 43.0 43.9
Germany 22 269 28 644 29 275 27.6 36.1 39.3 46.2 48.6 51.4
Luxembourg 108 168 233 19.1 24.7 29.0 39.2 41.0 42.7
Netherlands 4 148 5 633 5 852 24.5 32.0 33.2 42.7 44.7 46.2
Switzerland 1 955 2 825 3 461 23.6 30.6 34.5 42.3 45.1 46.9
Latin America and the Caribbean 70 922 120 959 200 031 11.2 16.8 25.5 29.2 34.5 41.2
Caribbean 5 745 8 946 12 214 13.3 19.2 25.4 30.2 34.9 40.2
Antigua and Barbuda 10 21 28 10.8 19.7 24.9 30.9 35.3 40.6
Aruba 19 30 29 18.5 28.4 28.8 40.2 42.0 45.6
Bahamas 49 90 133 12.5 20.1 27.1 32.4 37.6 42.0
Barbados 56 81 88 19.8 27.7 31.1 38.5 41.9 43.4
Cuba 2 215 3 552 4 106 19.4 31.6 39.7 41.2 46.4 51.9
Curaçao 33 50 54 21.1 28.4 28.7 40.5 41.0 42.9
Dominican Republic 1 023 1 722 2 788 9.7 14.2 21.1 26.1 30.6 37.1
Grenada 11 16 28 10.2 14.3 25.1 27.2 33.4 40.0
Guadeloupe 95 150 169 20.2 30.5 34.0 39.4 43.0 45.5
Haiti 755 1 168 2 172 7.1 9.3 15.3 23.0 27.2 33.1
Jamaica 357 537 760 12.8 18.7 28.0 29.1 35.6 43.8
Martinique 104 151 129 26.2 38.5 35.9 46.1 47.0 48.0
Puerto Rico 723 927 1 137 19.6 25.5 33.8 36.3 41.4 48.3
Saint Lucia 23 39 57 12.5 19.1 27.3 31.2 36.8 43.9
St. Vincent and the Grenadines 12 21 28 10.9 18.3 25.6 29.8 35.7 42.1
Trinidad and Tobago 193 277 364 14.2 20.2 28.2 33.8 40.2 42.6
United States Virgin Islands 26 34 31 24.1 32.2 32.1 41.0 42.4 44.6
Central America 16 144 28 786 53 062 9.3 14.2 23.2 26.6 32.1 39.5
Belize 21 42 86 5.9 8.9 14.7 23.5 28.4 34.0
Costa Rica 613 1 111 1 749 12.8 20.5 30.4 31.4 38.0 45.3
El Salvador 703 1 010 1 540 11.5 15.8 24.1 26.7 33.1 41.8
Guatemala 1 145 1 834 3 954 7.0 8.6 14.2 21.2 25.5 31.5
Honduras 581 1 044 2 187 7.2 10.7 19.5 23.4 29.9 38.2
Mexico 12 177 22 094 40 391 9.6 14.9 24.7 27.4 33.1 40.9
Nicaragua 473 878 1 838 7.8 12.5 23.4 25.2 31.7 40.1
Panama 430 773 1 318 10.9 16.2 23.5 28.7 33.0 38.5
South America 49 033 83 227 134 756 11.7 17.7 26.6 30.2 35.5 42.0
Argentina 6 559 8 634 13 084 15.1 17.5 23.6 30.8 34.1 38.6
Bolivia (Plurinational State of) 988 1 499 2 714 9.2 11.4 17.0 24.1 28.2 33.6
Brazil 24 392 42 879 69 882 11.7 18.8 29.3 31.3 37.4 44.8
Chile 2 818 4 800 7 100 15.7 23.7 32.9 34.4 40.1 46.9
Colombia 5 226 9 721 15 169 10.8 18.3 27.6 30.0 36.4 43.4
Ecuador 1 602 2 840 5 025 9.9 14.5 21.8 26.6 31.2 37.4
French Guiana 21 48 93 7.8 12.7 17.0 24.5 27.6 32.0
126 World Population Ageing 2015
Country or area Population aged 60 or over
(thousands)
Percentage aged 60 or
over
Median age
(years)
2015 2030 2050 2015 2030 2050 2015 2030 2050
Guyana 64 122 111 8.3 14.9 13.8 24.7 29.9 34.0
Paraguay 598 942 1 629 9.0 12.0 18.3 24.9 29.8 35.5
Peru 3 127 5 409 9 708 10.0 14.7 23.2 27.5 32.4 38.7
Suriname 56 94 133 10.2 15.7 21.4 29.0 32.7 37.9
Uruguay 657 796 1 009 19.1 22.1 27.5 34.9 37.8 42.5
Venezuela (Bolivarian Republic of) 2 925 5 442 9 097 9.4 14.8 21.9 27.4 32.1 38.0
Northern America 74 589 104 799 122 679 20.8 26.4 28.3 38.3 40.4 42.1
Canada 8 021 11 858 14 320 22.3 29.4 32.4 40.6 43.5 45.5
United States of America 66 545 92 906 108 326 20.7 26.1 27.9 38.0 40.0 41.7
Oceania 6 481 9 553 13 204 16.5 20.2 23.3 32.9 35.1 37.4
Australia/New Zealand 5 808 8 391 11 133 20.4 25.0 28.5 37.6 39.9 41.6
Australia 4 887 7 014 9 483 20.4 24.6 28.3 37.5 39.8 41.4
New Zealand 921 1 378 1 650 20.3 27.0 29.4 38.0 40.0 43.0
Melanesia 555 950 1 771 5.8 7.7 11.1 22.0 24.8 28.9
Fiji 83 134 184 9.3 14.3 19.9 27.6 30.5 35.4
New Caledonia 38 61 91 14.5 19.6 24.9 33.1 36.5 40.8
Papua New Guinea 387 671 1 322 5.1 6.7 10.0 21.2 24.3 28.2
Solomon Islands 30 52 107 5.2 6.9 10.8 19.9 23.2 27.9
Vanuatu 17 32 68 6.5 9.1 14.2 22.2 25.2 30.2
Micronesia 51 95 133 9.7 15.6 19.3 26.3 30.3 34.9
Guam 22 40 57 13.0 19.9 24.9 30.1 34.3 39.9
Kiribati 7 13 21 6.1 9.3 12.0 22.4 24.2 28.4
Micronesia (Fed. States of) 8 11 16 7.5 9.1 12.2 21.5 25.6 30.9
Polynesia 67 117 167 9.8 15.6 20.4 26.2 30.2 35.1
French Polynesia 33 62 94 11.6 19.7 28.4 31.5 37.3 43.2
Samoa 15 25 34 7.9 12.1 14.1 21.2 24.0 28.5
Tonga 9 13 18 8.2 10.5 12.9 21.3 24.6 28.4
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.

United Nations Department of Economic and Social Affairs ǀ Population Division 127
Table A.III.2. Fertility, life expectancy at birth and at age 60, and healthy life
expectancy
Country or area
Total
fertility
(children
per woman)
Life expectancy at
birth
(years)
Life expectancy at
age 60
(years)
Healthy life
expectancy
(years)
2010-2015
2010-2015 2010-2015 2013
Males Females Males Females Males Females
World 2.5 68.3 72.7 18.7 21.5 60 64
More developed regions 1.7 75.1 81.5 20.8 24.6 .. ..
Less developed regions 2.6 66.9 70.7 17.8 20.0 .. ..
Least developed countries 4.3 60.7 63.6 16.7 17.8 .. ..
Other less developed countries 2.4 68.3 72.1 17.9 20.2 .. ..
Less developed regions, excluding China 3.0 65.1 69.1 17.4 19.6 .. ..
High-income countries 1.7 75.7 81.9 21.2 25.0 67 72
Middle-income countries 2.4 67.7 71.5 17.7 19.9 .. ..
Upper-middle-income countries 1.9 71.8 76.0 18.5 21.1 64 68
Lower-middle-income countries 2.9 64.6 68.1 16.7 18.6 56 59
Low-income countries 4.9 58.7 61.9 16.0 17.7 52 54
Sub-Saharan Africa 5.1 55.9 58.4 15.4 16.8 .. ..
Africa 4.7 58.2 60.9 15.9 17.4 .. ..
Eastern Africa 4.9 58.9 62.2 16.9 18.3 .. ..
Burundi 6.1 54.2 58.0 15.8 17.1 47 49
Comoros 4.6 61.2 64.5 15.3 17.0 53 55
Djibouti 3.3 60.0 63.2 16.9 18.1 52 54
Eritrea 4.4 60.9 65.2 13.7 16.9 53 56
Ethiopia 4.6 61.3 65.0 17.1 18.4 54 57
Kenya 4.4 59.1 62.2 17.1 18.4 52 54
Madagascar 4.5 63.0 66.0 16.2 17.5 54 56
Malawi 5.3 59.9 62.0 17.6 19.9 50 52
Mauritius 1.5 70.7 77.7 18.0 22.1 62 68
Mayotte 4.1 76.0 82.9 21.4 25.4 .. ..
Mozambique 5.5 52.9 56.2 16.2 17.6 46 47
Réunion 2.2 76.0 82.9 21.4 25.4 .. ..
Rwanda 4.1 59.7 66.3 17.1 18.5 55 57
Seychelles 2.3 68.7 77.9 16.9 21.9 63 71
Somalia 6.6 53.3 56.5 15.5 16.6 45 47
South Sudan 5.2 54.1 56.0 15.9 16.9 48 49
Uganda 5.9 55.7 58.8 16.6 17.9 49 52
United Republic of Tanzania 5.2 62.6 65.6 17.8 19.1 52 55
Zambia 5.5 57.2 60.3 17.0 18.4 49 51
Zimbabwe 4.0 53.6 56.0 16.8 18.2 48 52
Middle Africa 5.8 54.3 57.0 15.8 17.0 .. ..
Angola 6.2 50.2 53.2 15.1 16.3 43 46
Cameroon 4.8 53.7 56.0 15.8 17.0 48 49
Central African Republic 4.4 47.8 51.3 15.0 16.5 43 44
Chad 6.3 50.1 52.2 15.2 16.2 44 45
Congo 5.0 60.0 62.9 17.2 18.5 50 51
Dem. Republic of the Congo 6.2 56.7 59.5 16.0 17.1 43 46
Equatorial Guinea 5.0 55.9 58.6 16.3 17.5 47 48
Gabon 4.0 63.2 64.1 17.7 18.9 53 55
Sao Tome and Principe 4.7 64.2 68.2 17.5 18.8 56 59
Northern Africa 3.3 68.6 72.4 17.6 19.5 .. ..
Algeria 2.9 72.1 76.8 20.9 22.3 62 63
Egypt 3.4 68.7 73.1 16.0 18.4 61 63
Libya 2.5 68.8 74.4 16.8 19.6 64 65
128 World Population Ageing 2015
Country or area
Total
fertility
(children
per woman)
Life expectancy at
birth
(years)
Life expectancy at
age 60
(years)
Healthy life
expectancy
(years)
2010-2015
2010-2015 2010-2015 2013
Males Females Males Females Males Females
Morocco 2.6 72.6 74.6 18.5 19.7 60 62
Sudan 4.5 61.6 64.6 17.2 18.3 52 54
Tunisia 2.2 72.3 77.0 17.7 21.2 65 68
Western Sahara 2.2 65.9 69.8 16.1 18.0 .. ..
Southern Africa 2.5 55.0 59.0 13.7 18.0 .. ..
Botswana 2.9 61.8 66.5 15.9 18.1 53 55
Lesotho 3.3 49.2 49.6 14.5 16.2 41 44
Namibia 3.6 61.6 67.0 15.9 18.4 56 60
South Africa 2.4 54.9 59.1 13.5 18.1 49 54
Swaziland 3.4 49.7 48.5 15.3 17.2 45 45
Western Africa 5.5 54.4 55.6 14.1 14.7 .. ..
Benin 4.9 57.8 60.6 15.0 16.1 50 51
Burkina Faso 5.6 56.7 59.3 14.7 15.4 50 51
Cabo Verde 2.4 71.1 74.7 17.3 19.7 61 66
Côte d’Ivoire 5.1 50.2 51.9 13.8 14.4 45 46
Gambia 5.8 58.5 61.2 14.7 15.9 52 54
Ghana 4.2 60.1 62.0 15.0 16.0 53 55
Guinea 5.1 57.6 58.5 14.7 15.3 49 50
Guinea-Bissau 5.0 53.0 56.5 14.5 15.5 45 47
Liberia 4.8 59.3 61.2 14.8 15.8 52 53
Mali 6.4 57.4 57.0 15.1 15.3 50 48
Mauritania 4.7 61.3 64.3 15.8 17.0 53 55
Niger 7.6 59.9 61.6 15.5 16.5 51 51
Nigeria 5.7 52.0 52.6 13.4 13.9 47 47
Senegal 5.2 63.9 67.6 15.7 17.4 55 56
Sierra Leone 4.8 49.7 50.7 13.0 13.1 39 40
Togo 4.7 58.3 59.7 14.7 15.4 49 51
Asia 2.2 69.7 73.6 18.1 20.6 .. ..
Eastern Asia 1.6 74.7 78.6 19.1 22.1 .. ..
China 1.6 74.0 77.0 18.3 20.6 67 69
China, Hong Kong SAR 1.2 80.9 86.6 23.4 28.2 .. ..
China, Macao SAR 1.2 78.1 82.5 21.3 24.4 .. ..
China, Taiwan Province of China 1.1 76.4 82.3 21.7 24.9 .. ..
Dem. People’s Rep. of Korea 2.0 66.3 73.3 13.7 19.3 60 65
Japan 1.4 80.0 86.5 23.0 28.4 72 78
Mongolia 2.7 64.8 73.3 16.0 19.8 57 64
Republic of Korea 1.3 78.0 84.6 21.5 26.5 70 75
Central Asia 2.7 64.5 72.3 15.6 19.6 .. ..
Kazakhstan 2.6 64.3 73.9 14.4 19.2 56 64
Kyrgyzstan 3.1 66.4 74.3 15.5 19.6 58 64
Tajikistan 3.6 65.9 72.8 16.2 20.8 60 61
Turkmenistan 2.3 61.3 69.7 15.0 18.8 53 59
Uzbekistan 2.5 64.9 71.6 16.6 19.8 59 62
Southern Asia 2.6 66.4 69.2 17.2 18.5 .. ..
Afghanistan 5.1 58.7 61.1 14.9 16.5 50 50
Bangladesh 2.2 69.9 72.3 18.2 19.1 60 62
Bhutan 2.1 68.6 69.1 20.2 20.1 59 60
India 2.5 66.1 68.9 17.0 18.4 56 59
Iran (Islamic Republic of) 1.7 74.0 76.2 19.1 19.7 63 65
Maldives 2.2 75.4 77.4 19.0 20.1 67 68
Nepal 2.3 67.6 70.5 16.4 18.1 58 60
United Nations Department of Economic and Social Affairs ǀ Population Division 129
Country or area
Total
fertility
(children
per woman)
Life expectancy at
birth
(years)
Life expectancy at
age 60
(years)
Healthy life
expectancy
(years)
2010-2015
2010-2015 2010-2015 2013
Males Females Males Females Males Females
Pakistan 3.7 65.0 66.8 17.5 18.0 56 57
Sri Lanka 2.1 71.2 78.0 19.1 21.6 63 68
South-Eastern Asia 2.4 67.5 73.2 16.8 19.9 .. ..
Brunei Darussalam 1.9 76.6 80.4 20.1 22.7 68 69
Cambodia 2.7 65.5 69.6 16.3 17.7 60 64
Indonesia 2.5 66.6 70.7 15.2 17.8 61 64
Lao People’s Dem. Republic 3.1 64.1 66.8 15.8 17.4 56 58
Malaysia 2.0 72.2 76.9 18.4 20.1 63 66
Myanmar 2.3 63.6 67.7 15.7 17.5 56 59
Philippines 3.0 64.7 71.6 15.1 18.3 57 63
Singapore 1.2 79.6 85.6 22.5 27.5 75 78
Thailand 1.5 70.8 77.6 20.0 22.6 63 69
Timor-Leste 5.9 66.1 69.5 16.1 17.7 56 59
Viet Nam 2.0 70.7 80.3 19.3 24.8 62 70
Western Asia 2.9 70.0 75.6 18.0 21.5 .. ..
Armenia 1.6 70.7 78.4 17.0 21.9 59 66
Azerbaijan 2.3 67.5 73.8 16.4 19.9 61 65
Bahrain 2.1 75.6 77.4 18.9 20.0 66 66
Cyprus 1.5 77.7 82.2 20.4 23.8 73 76
Georgia 1.8 70.9 78.1 17.5 21.6 62 68
Iraq 4.6 67.0 71.4 16.2 18.6 59 64
Israel 3.1 80.2 83.8 23.2 25.7 71 74
Jordan 3.5 72.2 75.5 17.8 20.2 64 65
Kuwait 2.2 73.3 75.6 17.4 18.1 68 67
Lebanon 1.7 77.1 80.9 20.4 23.8 69 71
Oman 2.9 74.7 78.9 19.3 22.0 65 67
Qatar 2.1 77.1 79.7 20.5 21.9 68 67
Saudi Arabia 2.9 72.8 75.5 17.4 19.7 65 66
State of Palestine 4.3 70.7 74.7 17.2 19.7 .. ..
Syrian Arab Republic 3.0 64.0 76.3 16.8 20.9 65 67
Turkey 2.1 71.5 78.1 18.6 22.7 63 67
United Arab Emirates 1.8 76.0 78.2 19.5 20.6 67 67
Yemen 4.4 62.2 64.9 15.4 17.1 54 55
Europe 1.6 73.4 80.6 19.8 23.8 .. ..
Eastern Europe 1.6 66.9 76.8 16.2 21.2 .. ..
Belarus 1.6 65.3 77.0 14.5 20.9 57 68
Bulgaria 1.5 70.6 77.6 17.0 21.2 62 68
Czech Republic 1.5 75.4 81.3 19.3 23.4 66 71
Hungary 1.3 71.2 78.5 17.5 22.1 61 68
Poland 1.4 73.1 81.1 18.7 23.9 63 71
Republic of Moldova 1.3 67.2 75.4 14.8 19.5 59 66
Romania 1.5 70.9 78.1 17.6 21.6 63 69
Russian Federation 1.7 64.2 75.6 15.2 20.7 55 66
Slovakia 1.4 72.2 79.7 17.7 22.4 63 70
Ukraine 1.5 65.7 75.7 15.2 20.2 59 67
Northern Europe 1.9 77.8 82.3 21.7 24.8 .. ..
Channel Islands 1.5 78.5 82.4 21.3 24.9 .. ..
Denmark 1.7 78.0 81.9 21.3 24.2 69 71
Estonia 1.6 71.6 81.1 17.9 23.9 63 71
Finland 1.7 77.6 83.4 21.6 25.6 68 73
Iceland 2.0 80.7 83.8 23.4 25.5 71 73
130 World Population Ageing 2015
Country or area
Total
fertility
(children
per woman)
Life expectancy at
birth
(years)
Life expectancy at
age 60
(years)
Healthy life
expectancy
(years)
2010-2015
2010-2015 2010-2015 2013
Males Females Males Females Males Females
Ireland 2.0 78.4 82.7 21.7 24.9 69 73
Latvia 1.5 68.9 78.7 16.4 22.2 61 69
Lithuania 1.6 67.4 78.8 15.4 22.3 60 70
Norway 1.8 79.2 83.4 22.2 25.4 69 72
Sweden 1.9 80.1 83.7 22.8 25.6 70 73
United Kingdom 1.9 78.5 82.4 22.1 24.9 69 72
Southern Europe 1.4 78.4 83.9 21.8 25.9 .. ..
Albania 1.8 75.0 80.2 19.2 23.3 64 66
Bosnia and Herzegovina 1.3 73.7 78.8 18.5 21.8 66 70
Croatia 1.5 73.6 80.4 18.2 22.7 65 70
Greece 1.3 77.6 83.6 21.5 25.6 69 73
Italy 1.4 80.3 85.2 23.0 27.0 71 74
Malta 1.4 78.6 82.0 21.5 23.9 70 72
Montenegro 1.7 73.8 78.2 18.4 21.1 64 67
Portugal 1.3 77.4 83.5 21.5 25.6 68 73
Serbia 1.6 71.8 77.5 17.3 20.8 63 67
Slovenia 1.6 76.9 83.1 20.6 25.2 66 72
Spain 1.3 79.4 85.1 22.5 26.9 71 75
TFYR Macedonia 1.5 72.9 77.5 17.7 20.4 64 68
Western Europe 1.7 78.5 83.7 22.1 25.9 .. ..
Austria 1.5 78.5 83.6 21.8 25.6 68 73
Belgium 1.8 78.0 83.0 21.7 25.4 69 72
France 2.0 78.8 84.9 22.9 27.2 69 74
Germany 1.4 78.2 83.1 21.6 25.2 69 73
Luxembourg 1.6 78.9 83.7 21.9 25.6 70 73
Netherlands 1.8 79.4 83.1 22.0 25.4 70 72
Switzerland 1.5 80.4 84.7 23.2 26.6 71 74
Latin America and the Caribbean 2.2 71.2 77.9 20.1 23.3 .. ..
Caribbean 2.3 69.7 75.2 20.3 23.3 .. ..
Antigua and Barbuda 2.1 73.3 78.2 20.0 22.8 63 66
Aruba 1.7 72.9 77.8 18.0 21.6 .. ..
Bahamas 1.9 72.0 78.1 20.4 23.8 62 67
Barbados 1.8 72.9 77.7 17.8 21.1 64 68
Cuba 1.6 77.1 81.3 21.7 24.5 65 68
Curaçao 2.1 74.5 80.7 20.9 24.0 .. ..
Dominican Republic 2.5 70.2 76.5 20.4 23.1 62 64
Grenada 2.2 70.8 75.6 17.5 19.9 60 66
Guadeloupe 2.2 76.8 84.0 22.2 26.6 .. ..
Haiti 3.1 60.2 64.4 16.9 18.7 50 53
Jamaica 2.1 73.1 77.9 21.0 23.4 61 66
Martinique 2.0 77.8 84.4 22.4 26.8 .. ..
Puerto Rico 1.6 75.2 83.2 21.1 25.9 .. ..
Saint Lucia 1.9 72.2 77.6 19.2 22.9 60 66
St. Vincent and the Grenadines 2.0 70.7 74.9 18.9 20.8 61 65
Trinidad and Tobago 1.8 66.9 73.8 16.1 20.2 58 63
United States Virgin Islands 2.3 77.2 82.9 20.4 25.9 .. ..
Central America 2.4 73.1 78.4 21.5 23.6 .. ..
Belize 2.6 67.2 72.7 15.8 18.4 61 66
Costa Rica 1.9 76.7 81.7 22.2 25.0 68 71
El Salvador 2.0 67.9 77.1 20.1 22.6 60 66
Guatemala 3.3 67.9 75.0 20.3 22.3 60 65
United Nations Department of Economic and Social Affairs ǀ Population Division 131
Country or area
Total
fertility
(children
per woman)
Life expectancy at
birth
(years)
Life expectancy at
age 60
(years)
Healthy life
expectancy
(years)
2010-2015
2010-2015 2010-2015 2013
Males Females Males Females Males Females
Honduras 2.5 70.4 75.4 20.7 23.4 62 65
Mexico 2.3 74.0 78.9 21.6 23.7 65 69
Nicaragua 2.3 71.4 77.5 21.0 23.4 62 66
Panama 2.5 74.3 80.5 22.5 25.3 65 70
South America 2.0 70.7 78.0 19.6 23.2 .. ..
Argentina 2.3 72.2 79.8 18.6 23.8 64 69
Bolivia (Plurinational State of) 3.0 65.3 70.2 20.0 22.2 57 61
Brazil 1.8 70.3 77.9 19.4 23.0 63 68
Chile 1.8 78.1 84.1 23.1 26.9 68 72
Colombia 1.9 70.2 77.4 20.1 22.5 65 69
Ecuador 2.6 72.8 78.4 21.7 23.9 64 68
French Guiana 3.5 75.8 82.6 19.5 25.0 .. ..
Guyana 2.6 64.0 68.6 15.4 16.6 52 57
Paraguay 2.6 70.7 74.9 20.0 22.2 63 67
Peru 2.5 71.5 76.8 19.8 22.7 66 68
Suriname 2.4 67.8 74.2 16.7 20.1 63 68
Uruguay 2.0 73.3 80.4 19.0 24.5 65 70
Venezuela (Bolivarian Republic of) 2.4 69.9 78.2 18.6 22.6 63 69
Northern America 1.9 76.8 81.5 21.9 24.9 .. ..
Canada 1.6 79.7 83.8 23.1 26.2 71 73
United States of America 1.9 76.5 81.3 21.8 24.7 68 71
Oceania 2.4 75.3 79.7 22.1 25.2 .. ..
Australia/New Zealand 1.9 79.9 84.1 23.3 26.4 .. ..
Australia 1.9 79.9 84.3 23.3 26.5 71 74
New Zealand 2.1 79.7 83.4 23.2 25.8 71 73
Melanesia 3.7 61.9 66.3 14.1 17.3 .. ..
Fiji 2.6 66.9 72.9 15.3 18.8 58 63
New Caledonia 2.1 73.6 79.3 18.3 22.7 .. ..
Papua New Guinea 3.8 60.3 64.5 13.3 16.5 52 55
Solomon Islands 4.1 66.2 69.0 16.1 17.8 59 61
Vanuatu 3.4 69.6 73.6 16.9 19.2 61 64
Micronesia 2.8 70.5 75.3 18.2 21.3 .. ..
Guam 2.4 76.1 81.5 19.8 24.2 .. ..
Kiribati 3.8 62.6 68.9 15.5 17.8 56 60
Micronesia (Fed. States of) 3.3 68.0 69.9 16.5 18.0 59 61
Polynesia 3.0 71.7 77.1 17.6 21.5 .. ..
French Polynesia 2.1 74.0 78.6 18.9 21.7 .. ..
Samoa 4.2 70.0 76.4 16.4 21.4 62 67
Tonga 3.8 69.7 75.6 16.2 21.0 64 61
Data sources: Estimates of total fertility, life expectancy at birth and life expectancy at age 60 are from United Nations (2015). World
Population Prospects: The 2015 Revision. Estimates of healthy life expectancy are from WHO (2014). Global Health Estimates. Available via
the WHO Global Health Observatory data repository at http://www.who.int/gho/mortality_burden_disease/life_tables/hale/en/ Accessed 2
December 2015.

132 World Population Ageing 2015
Table A.III.3. Dependency and support ratios, pension coverage, labour force
participation and statutory retirement ages
Country or area
Total
dependency
ratio (persons
aged 0-19 and
aged 65 or
over per 100
persons aged
20-64)
Potential
support ratio
(persons aged
20-64 per
person aged 65
or over)
Pension
coverage
(per cent of
persons of
statutory
pensionable
age)
Labour force
participation of
persons aged 65
years or over
(percentage)
Statutory
retirement age
(years)
2015 2030 2015 2030 2010
2015 latest available
Males Females Males Females
World 73.5 75.7 7.0 4.9 .. 30.2 14.4 .. ..
More developed regions 65.1 80.1 3.4 2.4 .. 16.8 9.4 .. ..
Less developed regions 75.4 75.0 9.0 5.9 .. 37.3 17.5 .. ..
Least developed countries 118.5 100.4 12.8 11.5 .. 59.1 34.5 .. ..
Other less developed countries 69.2 70.1 8.6 5.4 .. .. .. .. ..
Less developed regions, excluding China 85.6 78.9 10.0 7.2 .. .. .. .. ..
High-income countries 64.8 78.0 3.7 2.6 .. 18.2 9.5 .. ..
Middle-income countries 70.8 71.0 8.7 5.6 .. 35.3 15.9 .. ..
Upper-middle-income countries 56.8 64.6 7.4 4.2 .. 67.2 45.2 .. ..
Lower-middle-income countries 84.2 75.9 10.4 7.6 .. .. .. .. ..
Low-income countries 131.1 110.5 12.7 12.5 .. .. .. .. ..
Sub-Saharan Africa 131.3 113.9 14.0 13.6 .. .. .. .. ..
Africa 121.0 108.2 12.9 11.7 .. 52.2 32.6 .. ..
Eastern Africa 135.5 111.5 13.6 13.4 .. 70.9 52.3 .. ..
Burundi 133.6 130.0 17.3 13.6 4.0 61.0 59.4 60 60
Comoros 115.1 99.5 16.6 13.2 .. 70.9 22.7 .. ..
Djibouti 88.3 75.6 12.7 9.5 12.0 19.0 4.6 60 60
Eritrea 124.4 98.2 16.9 16.9 .. 64.7 34.7 .. ..
Ethiopia 131.2 94.4 12.4 12.7 9.0 73.1 37.2 60 60
Kenya 122.3 102.7 16.1 13.4 7.9 61.1 49.6 65 65
Madagascar 125.7 109.0 15.6 12.9 4.6 73.1 57.1 60 55
Malawi 147.9 120.8 11.7 14.4 4.1 93.9 86.1 60 60
Mauritius 57.7 62.1 6.6 3.6 100.0 16.2 5.7 60 60
Mayotte 126.4 95.8 11.8 9.4 .. .. .. .. ..
Mozambique 147.8 127.5 12.1 12.5 17.3 85.4 76.1 60 55
Réunion 71.2 79.3 5.7 3.0 .. 4.6 2.6 .. ..
Rwanda 119.4 91.6 16.3 12.0 4.7 60.9 49.0 55 55
Seychelles 59.2 71.4 9.1 4.4 100.0 .. .. 63 63
Somalia 154.3 137.3 13.9 14.8 .. 37.0 11.6 .. ..
South Sudan 130.0 110.0 12.5 13.2 .. .. .. .. ..
Uganda 161.0 130.9 15.4 18.4 6.6 71.4 59.6 55 55
United Republic of Tanzania 142.5 127.3 12.9 12.8 3.2 72.7 60.3 60 60
Zambia 147.9 126.4 13.9 16.6 7.7 77.2 68.0 55 55
Zimbabwe 123.5 100.2 15.1 16.3 6.2 74.9 65.3 60 60
Middle Africa 144.1 125.1 14.0 14.2 .. 66.7 50.9 .. ..
Angola 154.4 136.4 17.0 15.8 14.5 54.6 39.4 60 60
Cameroon 129.8 108.1 13.6 14.1 12.5 71.4 38.2 60 60
Central African Republic 116.6 95.8 12.0 12.3 .. 76.6 66.2 60 60
Chad 158.4 134.3 15.8 16.8 1.6 79.0 52.1 60 60
Congo 129.2 116.3 11.9 11.5 22.1 53.7 47.4 60 60
Dem. Republic of the Congo 147.3 128.4 13.6 13.9 15.0 67.6 57.2 .. ..
Equatorial Guinea 108.6 106.0 16.6 8.8 .. 54.4 51.0 60 60
Gabon 110.3 92.8 9.3 9.9 38.8 42.0 41.8 55 55
Sao Tome and Principe 129.0 105.2 14.2 13.3 41.8 35.1 9.2 62 57
Northern Africa 85.6 83.8 10.3 7.3 .. 25.3 7.3 .. ..
United Nations Department of Economic and Social Affairs ǀ Population Division 133
Country or area
Total
dependency
ratio (persons
aged 0-19 and
aged 65 or
over per 100
persons aged
20-64)
Potential
support ratio
(persons aged
20-64 per
person aged 65
or over)
Pension
coverage
(per cent of
persons of
statutory
pensionable
age)
Labour force
participation of
persons aged 65
years or over
(percentage)
Statutory
retirement age
(years)
2015 2030 2015 2030 2010
2015 latest available
Males Females Males Females
Algeria 72.6 76.2 9.8 6.1 63.6 10.9 2.1 60 55
Egypt 88.6 87.3 10.2 8.0 32.7 19.1 3.7 60 60
Libya 74.1 62.4 12.6 8.4 43.3 29.7 6.0 65 60
Morocco 72.5 73.6 9.4 5.4 39.8 28.4 20.3 60 60
Sudan 119.9 99.5 13.7 12.2 4.6 67.6 10.3 60 60
Tunisia 62.1 69.6 8.1 4.8 68.8 21.9 5.4 60 60
Western Sahara 57.1 54.4 21.8 8.7 .. 32.9 11.8 .. ..
Southern Africa 80.9 72.4 11.4 8.6 .. 14.2 5.6 .. ..
Botswana 82.9 72.8 15.2 11.1 100.0 54.9 27.8 65 65
Lesotho 108.0 92.0 11.6 13.5 100.0 51.7 42.6 70 70
Namibia 104.2 91.4 13.9 11.3 98.4 41.6 29.2 60 60
South Africa 78.4 70.2 11.1 8.3 92.6 9.4 3.1 60 60
Swaziland 110.0 95.5 13.3 12.4 86.0 47.4 21.0 60 60
Western Africa 133.0 119.1 15.3 15.0 .. 63.7 40.7 .. ..
Benin 126.4 105.4 15.3 14.2 9.7 71.3 46.9 60 60
Burkina Faso 142.9 120.6 17.2 17.0 3.2 68.3 32.6 56 56
Cabo Verde 80.7 66.2 12.1 8.7 55.7 40.5 10.0 60 60
Côte d’Ivoire 130.2 115.3 14.4 14.6 7.7 71.3 37.8 60 60
Gambia 144.8 129.2 17.7 16.3 10.8 84.2 58.0 60 60
Ghana 109.7 96.3 14.0 12.7 7.6 59.4 42.5 60 60
Guinea 128.8 111.4 14.3 13.3 8.8 55.3 40.1 55-56 55-56
Guinea-Bissau 119.4 104.3 14.4 13.4 6.2 55.4 42.0 60 60
Liberia 126.8 106.0 14.6 13.9 .. 60.4 37.7 60 60
Mali 153.9 133.8 15.6 17.4 5.7 69.4 32.4 58 58
Mauritania 115.9 100.7 14.4 12.2 9.3 55.6 18.0 60 55
Niger 172.3 171.4 14.2 13.3 6.1 64.3 30.2 60 60
Nigeria 132.9 119.5 15.7 15.7 .. 64.1 43.5 50 50
Senegal 133.4 117.6 14.6 14.3 23.5 57.3 44.3 55 55
Sierra Leone 126.5 101.0 16.5 17.2 0.9 49.2 22.9 60 60
Togo 124.1 105.7 16.1 15.2 10.9 60.0 50.6 60 60
Asia 66.5 67.2 8.0 5.1 .. 34.8 15.6 .. ..
Eastern Asia 50.5 63.1 6.0 3.3 .. 29.1 16.3 .. ..
China 48.2 60.9 7.1 3.6 74.4 28.2 16.1 60 55
China, Hong Kong SAR 47.0 80.9 4.5 2.1 72.9 11.4 3.4 65 65
China, Macao SAR 37.3 67.7 8.1 3.1 .. 20.9 6.0 .. ..
China, Taiwan Province of China 47.6 64.6 5.6 2.5 .. .. .. .. ..
Dem. People’s Rep. of Korea 62.5 61.8 6.5 5.1 .. .. .. .. ..
Japan 78.3 88.9 2.1 1.7 80.3 29.7 14.5 65 65
Mongolia 66.7 74.6 14.8 7.3 100.0 18.1 10.0 60 55
Republic of Korea 50.6 70.4 5.1 2.5 77.6 42.2 23.4 60 60
Central Asia 73.5 76.6 11.7 6.9 .. 18.4 8.1 .. ..
Kazakhstan 66.3 80.0 8.9 5.4 95.9 13.4 8.4 63 58
Kyrgyzstan 79.8 88.0 13.2 6.9 100.0 21.2 8.6 63 58
Tajikistan 92.6 92.0 17.3 9.2 80.2 21.6 8.8 63 58
Turkmenistan 69.8 65.8 14.2 8.0 .. 20.6 7.7 62 57
Uzbekistan 72.6 70.1 12.4 7.3 98.1 20.6 7.6 60 55
Southern Asia 80.0 68.8 10.3 7.4 .. 43.2 11.7 .. ..
Afghanistan 139.8 92.0 16.9 16.4 10.7 43.5 7.5 60 55
134 World Population Ageing 2015
Country or area
Total
dependency
ratio (persons
aged 0-19 and
aged 65 or
over per 100
persons aged
20-64)
Potential
support ratio
(persons aged
20-64 per
person aged 65
or over)
Pension
coverage
(per cent of
persons of
statutory
pensionable
age)
Labour force
participation of
persons aged 65
years or over
(percentage)
Statutory
retirement age
(years)
2015 2030 2015 2030 2010
2015 latest available
Males Females Males Females
Bangladesh 80.0 62.4 11.2 8.3 39.5 49.4 15.9 65 62
Bhutan 70.8 56.2 11.6 8.3 3.2 46.4 30.6 60 60
India 78.0 67.5 10.0 7.0 24.1 43.2 11.4 55 55
Iran (Islamic Republic of) 55.3 54.6 12.7 6.7 26.4 30.8 3.9 60 55
Maldives 69.7 61.6 12.5 8.0 99.7 50.6 24.9 65 65
Nepal 98.5 67.3 9.1 8.1 62.5 67.6 41.6 58 58
Pakistan 98.9 85.1 11.2 9.8 2.3 40.6 9.9 60 55
Sri Lanka 71.0 73.4 6.3 3.7 17.1 35.0 8.2 55 50
South-Eastern Asia 70.0 68.3 9.9 6.0 .. 44.9 24.6 .. ..
Brunei Darussalam 56.1 58.2 14.5 5.6 81.7 14.4 3.8 60 60
Cambodia 84.6 76.3 13.2 8.3 5.0 64.8 44.3 55 55
Indonesia 71.7 67.3 11.3 7.1 8.1 54.3 27.9 55 55
Lao People’s Dem. Republic 98.6 78.6 13.2 10.6 5.6 .. .. .. ..
Malaysia 65.3 62.6 10.3 6.2 19.8 31.7 10.3 55 55
Myanmar 72.9 61.7 10.8 7.1 .. 41.5 26.2 .. ..
Philippines 87.2 78.5 11.7 8.4 28.5 47.4 28.1 60 60
Singapore 50.6 69.0 5.7 2.5 0.0 36.0 16.5 55 55
Thailand 53.0 63.4 6.2 3.1 81.7 38.4 19.7 55 55
Timor-Leste 142.3 130.2 7.4 9.6 100.0 36.2 16.2 60 60
Viet Nam 59.5 66.1 9.3 4.9 34.5 33.9 22.8 60 55
Western Asia 78.9 73.9 10.9 7.3 .. 23.1 7.7 .. ..
Armenia 54.2 71.5 6.0 3.1 80.0 40.6 26.8 63 63
Azerbaijan 53.3 71.9 11.6 4.7 81.7 11.4 5.1 63 59
Bahrain 43.6 41.6 28.9 10.5 40.1 24.2 3.4 60 55
Cyprus 56.1 62.2 5.0 3.4 85.2 16.2 5.5 65 65
Georgia 59.9 76.1 4.5 3.0 89.8 53.1 39.8 65 60
Iraq 119.8 106.6 14.9 13.8 56.0 20.8 2.5 60 55
Israel 88.0 89.7 4.7 3.8 73.6 24.8 11.2 70 67
Jordan 97.1 79.7 13.4 10.6 42.2 11.0 0.4 60 55
Kuwait 42.9 48.8 35.5 13.4 27.3 17.5 3.4 50 50
Lebanon 71.4 64.9 7.2 4.3 0.0 26.8 2.2 64 64
Oman 40.0 51.2 27.7 11.5 24.7 19.9 2.2 60 55
Qatar 27.6 30.7 66.2 18.5 7.9 48.6 5.5 60 55
Saudi Arabia 65.2 59.7 21.1 9.3 .. 25.0 1.1 60 55
State of Palestine 120.0 99.3 15.4 12.8 8.0 .. .. 65 65
Syrian Arab Republic 111.5 78.2 11.6 9.5 16.7 21.9 2.0 60 55
Turkey 71.6 66.4 7.7 5.0 88.1 20.6 6.8 60 58
United Arab Emirates 24.6 30.1 70.5 12.3 .. 24.0 1.7 .. ..
Yemen 118.8 91.3 16.4 14.7 8.5 27.7 6.0 60 55
Europe 62.3 78.0 3.5 2.4 .. 10.2 6.2 .. ..
Eastern Europe 54.4 72.5 4.4 2.9 .. 13.4 9.3 .. ..
Belarus 53.0 73.8 4.7 3.0 93.6 7.2 3.5 60 55
Bulgaria 62.9 74.2 3.1 2.5 96.9 5.1 2.4 63 60
Czech Republic 59.8 73.1 3.5 2.5 100.0 8.1 4.0 62 61
Hungary 59.8 67.9 3.5 2.8 91.4 4.8 2.2 63 63
Poland 55.3 71.3 4.1 2.5 96.5 8.9 3.8 65 60
Republic of Moldova 46.3 57.8 6.9 3.7 72.8 10.8 5.7 62 57
Romania 61.9 68.2 3.6 2.7 98.0 21.6 17.7 64 59
United Nations Department of Economic and Social Affairs ǀ Population Division 135
Country or area
Total
dependency
ratio (persons
aged 0-19 and
aged 65 or
over per 100
persons aged
20-64)
Potential
support ratio
(persons aged
20-64 per
person aged 65
or over)
Pension
coverage
(per cent of
persons of
statutory
pensionable
age)
Labour force
participation of
persons aged 65
years or over
(percentage)
Statutory
retirement age
(years)
2015 2030 2015 2030 2010
2015 latest available
Males Females Males Females
Russian Federation 52.7 74.7 4.9 3.0 100.0 13.2 8.4 60 55
Slovakia 52.0 67.9 4.8 2.9 100.0 3.1 1.4 62 60
Ukraine 53.7 70.5 4.2 2.9 95.0 22.7 19.3 60 56
Northern Europe 70.5 81.2 3.3 2.6 .. 13.8 7.3 .. ..
Channel Islands 59.5 73.6 3.6 2.4 .. 9.9 5.0 .. ..
Denmark 72.9 79.4 3.1 2.5 100.0 12.0 5.9 65 65
Estonia 64.1 79.8 3.2 2.4 98.0 15.7 12.5 63 61
Finland 73.4 88.2 2.8 2.1 100.0 10.1 4.2 65 65
Iceland 68.7 79.6 4.3 2.8 100.0 26.0 14.7 67 67
Ireland 68.5 75.4 4.5 3.1 90.5 14.6 4.9 65 65
Latvia 62.2 76.1 3.2 2.5 100.0 12.6 6.9 62 62
Lithuania 63.7 79.1 3.2 2.5 100.0 8.9 5.0 63 60
Norway 68.3 77.6 3.6 2.8 100.0 15.9 8.7 67 67
Sweden 73.6 85.1 2.9 2.4 100.0 13.8 7.0 65 65
United Kingdom 70.6 81.3 3.3 2.6 99.5 14.3 7.8 65 61
Southern Europe 65.4 77.9 3.0 2.1 .. 7.8 3.6 .. ..
Albania 66.2 79.6 4.9 2.8 77.0 8.4 4.0 65 60
Bosnia and Herzegovina 53.2 68.7 4.2 2.5 29.6 7.9 3.9 65 65
Croatia 65.3 76.6 3.2 2.3 57.6 6.9 4.0 65 60
Greece 68.5 74.6 2.8 2.2 77.4 5.8 2.6 65 65
Italy 68.9 83.8 2.6 1.9 81.1 7.5 2.7 66 62
Malta 66.5 76.0 3.1 2.3 60.5 8.3 1.6 61 60
Montenegro 64.2 70.5 4.5 3.0 52.3 4.0 1.9 65 60
Portugal 67.0 76.2 2.9 2.1 100.0 22.6 10.9 65 65
Serbia 65.7 71.4 3.5 2.8 46.1 12.8 7.1 65 60
Slovenia 59.4 82.7 3.5 2.1 95.1 8.1 4.3 63 61
Spain 61.8 74.4 3.3 2.2 68.2 4.6 2.6 65 65
TFYR Macedonia 55.9 65.8 5.2 3.3 52.2 4.9 2.4 64 62
Western Europe 68.7 84.6 3.0 2.1 .. 7.3 3.6 .. ..
Austria 62.2 78.0 3.3 2.3 100.0 9.6 5.0 65 60
Belgium 68.5 83.0 3.3 2.4 84.6 4.8 1.9 65 65
France 77.0 88.1 3.0 2.2 100.0 3.8 2.2 60 60
Germany 64.2 83.8 2.9 1.9 100.0 8.4 4.3 65 65
Luxembourg 57.2 68.9 4.5 3.2 90.0 6.1 2.4 65 65
Netherlands 68.4 84.1 3.3 2.2 100.0 11.2 4.0 65 65
Switzerland 61.4 77.6 3.4 2.4 100.0 15.5 6.8 65 64
Latin America and the Caribbean 72.8 67.9 7.6 5.0 .. 38.1 16.8 .. ..
Caribbean 74.8 74.5 6.1 4.1 .. 24.6 9.9 .. ..
Antigua and Barbuda 66.6 68.3 8.4 4.7 69.7 .. .. 60 60
Aruba 60.8 71.8 5.1 2.7 79.3 .. .. 60 60
Bahamas 58.9 68.7 7.6 4.0 84.2 27.4 12.3 65 65
Barbados 66.7 83.5 4.2 2.5 68.3 13.1 7.1 66 66
Cuba 57.1 71.2 4.6 2.5 .. 14.4 3.9 65 60
Curaçao 67.3 87.9 4.0 2.4 .. .. .. .. ..
Dominican Republic 84.7 76.6 8.1 5.6 11.1 35.2 9.1 65 60
Grenada 74.7 71.9 8.0 5.4 34.0 .. .. 60 60
Guadeloupe 76.7 89.4 3.9 2.3 .. 4.5 1.6 .. ..
Haiti 95.4 77.8 11.0 9.0 1.0 58.2 35.4 55 55
136 World Population Ageing 2015
Country or area
Total
dependency
ratio (persons
aged 0-19 and
aged 65 or
over per 100
persons aged
20-64)
Potential
support ratio
(persons aged
20-64 per
person aged 65
or over)
Pension
coverage
(per cent of
persons of
statutory
pensionable
age)
Labour force
participation of
persons aged 65
years or over
(percentage)
Statutory
retirement age
(years)
2015 2030 2015 2030 2010
2015 latest available
Males Females Males Females
Jamaica 73.9 71.2 6.3 4.3 55.5 40.8 15.2 65 60
Martinique 73.6 105.7 3.0 1.6 .. 4.0 1.5 .. ..
Puerto Rico 69.0 70.5 4.1 3.0 .. 9.8 4.5 .. ..
Saint Lucia 68.8 64.7 6.6 4.5 26.5 35.6 20.4 63 63
St. Vincent and the Grenadines 68.9 67.3 8.1 4.5 76.6 .. .. .. ..
Trinidad and Tobago 57.6 63.8 6.7 4.1 98.7 13.7 7.4 60 60
United States Virgin Islands 80.2 100.3 3.2 1.9 .. 34.8 15.9 .. ..
Central America 80.3 69.2 8.7 6.0 .. 44.6 16.6 .. ..
Belize 88.3 70.4 14.1 10.5 64.6 40.3 11.1 65 65
Costa Rica 65.2 65.8 6.8 4.0 55.8 25.1 7.1 65 65
El Salvador 84.0 69.4 6.7 5.1 18.1 47.5 20.5 60 55
Guatemala 110.4 86.1 9.8 9.0 14.1 64.5 25.1 60 60
Honduras 91.5 67.4 10.8 8.0 8.4 57.9 18.9 65 60
Mexico 76.8 67.2 8.7 5.8 25.2 43.0 16.0 65 65
Nicaragua 82.0 67.2 10.8 6.7 23.7 48.0 16.9 60 60
Panama 77.1 73.6 7.4 5.0 37.3 40.4 14.2 62 57
South America 69.7 66.7 7.4 4.7 .. 37.5 17.6 .. ..
Argentina 78.7 75.2 5.1 4.3 90.7 25.9 9.6 65 60
Bolivia (Plurinational State of) 96.1 80.2 7.9 6.8 100.0 59.8 41.8 58 58
Brazil 64.7 62.3 7.7 4.5 86.3 33.8 14.5 65 60
Chile 62.6 68.1 5.6 3.4 74.5 36.3 12.5 65 60
Colombia 66.0 63.6 8.6 4.8 23.0 47.6 18.5 60 55
Ecuador 81.8 75.6 8.2 5.5 53.0 53.2 25.9 60 60
French Guiana 91.7 85.6 10.9 6.2 .. 9.4 2.6 .. ..
Guyana 85.9 77.3 10.7 5.9 100.0 24.7 14.0 60 60
Paraguay 86.8 74.9 8.9 6.6 22.2 46.4 24.5 60 60
Peru 77.2 71.3 8.3 5.7 33.2 56.8 57.2 65 65
Suriname 73.8 70.5 8.4 5.4 .. 13.6 3.9 .. ..
Uruguay 76.6 75.0 3.9 3.4 76.5 25.5 11.6 60 60
Venezuela (Bolivarian Republic of) 76.4 72.0 9.0 5.6 59.4 39.2 14.2 60 55
Northern America 66.5 81.3 4.0 2.6 .. 23.5 14.5 .. ..
Canada 61.3 80.7 3.8 2.4 97.7 17.5 9.1 65 65
United States of America 67.2 81.4 4.0 2.7 92.5 24.2 15.1 66 66
Oceania 74.8 81.5 4.8 3.5 .. 21.4 11.8 .. ..
Australia/New Zealand 67.4 80.2 4.0 2.8 .. 19.2 9.5 .. ..
Australia 66.5 79.5 4.0 2.9 83.0 18.0 8.5 65 65
New Zealand 72.0 84.1 3.9 2.6 98.0 25.5 15.1 65 65
Melanesia 99.9 85.1 14.2 11.1 .. 50.4 38.8 .. ..
Fiji 75.9 77.2 9.7 5.6 10.6 40.1 17.0 55 55
New Caledonia 66.9 68.4 5.9 4.2 .. 7.5 4.3 .. ..
Papua New Guinea 103.3 85.8 16.3 13.2 0.9 58.7 48.3 55 55
Solomon Islands 115.7 92.3 13.7 12.0 13.1 39.9 17.9 50 50
Vanuatu 102.0 88.4 11.8 8.6 3.5 68.0 48.2 55 55
Micronesia 83.4 80.3 9.0 5.1 .. .. .. .. ..
Guam 75.1 78.1 6.5 3.8 .. 34.5 17.3 .. ..
Kiribati 96.9 92.9 13.7 8.8 .. .. .. 50 50
Micronesia (Fed. States of) 103.5 87.7 11.3 7.9 .. .. .. 65 65
Polynesia 84.8 82.7 8.3 5.1 .. 19.7 8.9 .. ..
United Nations Department of Economic and Social Affairs ǀ Population Division 137
Country or area
Total
dependency
ratio (persons
aged 0-19 and
aged 65 or
over per 100
persons aged
20-64)
Potential
support ratio
(persons aged
20-64 per
person aged 65
or over)
Pension
coverage
(per cent of
persons of
statutory
pensionable
age)
Labour force
participation of
persons aged 65
years or over
(percentage)
Statutory
retirement age
(years)
2015 2030 2015 2030 2010
2015 latest available
Males Females Males Females
French Polynesia 61.3 68.9 8.2 4.4 .. 9.4 4.2 .. ..
Samoa 113.6 100.9 8.9 6.0 49.5 23.0 5.0 55 55
Tonga 114.9 93.1 7.9 7.1 1.0 55.7 29.2 55 55
Data sources: Estimates of the total dependency ratio and potential support ratio are from United Nations (2015). World Population
Prospects: The 2015 Revision. Pension coverage estimates are from the ILO Social Protection Department’s compilation of estimates at
http://www.social-protection.org/gimi/gess/RessourceDownload.action?ressource.ressourceId=44420 accessed 4 February 2015. Estimates of
labour force participation rates and statutory retirement ages are from ILO (2014). World Social Protection Report 2014/15.

138 World Population Ageing 2015
Table A.III.4. Ranking of countries or areas* according to the estimated
percentage of population aged 60 or over, 2000 and 2015
2000 2015
Rank Country or area
Percentage
aged 60 or
over Country or area
Percentage
aged 60 or
over
1 Italy 24.1 Japan 33.1
2 Japan 23.3 Italy 28.6
3 Germany 23.1 Germany 27.6
4 Greece 22.8 Finland 27.2
5 Sweden 22.2 Portugal 27.1
6 Bulgaria 22.2 Greece 27.0
7 Belgium 22.0 Bulgaria 26.9
8 Croatia 21.8 Martinique 26.2
9 Portugal 21.7 Croatia 25.9
10 Spain 21.4 Latvia 25.7
11 Latvia 21.2 Malta 25.6
12 Estonia 21.1 Sweden 25.5
13 United Kingdom 20.7 France 25.2
14 France 20.7 Estonia 25.2
15 Ukraine 20.7 Slovenia 25.2
16 Austria 20.4 Lithuania 25.0
17 Hungary 20.3 Czech Republic 24.9
18 Switzerland 20.2 Hungary 24.9
19 Finland 19.9 Denmark 24.7
20 Denmark 19.8 Netherlands 24.5
21 Channel Islands 19.3 Serbia 24.4
22 Norway 19.3 Romania 24.4
23 Slovenia 19.3 Spain 24.4
24 Lithuania 19.2 Austria 24.2
25 Romania 19.2 Belgium 24.1
26 Belarus 19.2 United States Virgin Islands 24.1
27 Serbia 18.9 Channel Islands 23.6
28 Luxembourg 18.8 Switzerland 23.6
29 Russian Federation 18.4 United Kingdom 23.0
30 Georgia 18.4 Poland 22.7
31 Netherlands 18.1 Ukraine 22.6
32 Czech Republic 18.1 Bosnia and Herzegovina 22.4
33 Uruguay 17.4 Canada 22.3
34 Poland 16.8 Norway 21.8
35 Montenegro 16.7 China, Hong Kong SAR 21.7
36 Canada 16.6 Curaçao 21.1
37 Malta 16.6 United States of America 20.7
38 Australia 16.5 Slovakia 20.5
39 Bosnia and Herzegovina 16.4 Australia 20.4
40 Martinique 16.3 New Zealand 20.3
41 United States of America 16.2 Belarus 20.3
42 New Zealand 15.7 Montenegro 20.3
43 Puerto Rico 15.6 Guadeloupe 20.2
44 Slovakia 15.3 Russian Federation 20.0
45 Armenia 15.1 Barbados 19.8
46 Barbados 15.1 Puerto Rico 19.6
47 Iceland 15.0 Cuba 19.4
48 China, Hong Kong SAR 14.8 Georgia 19.3
49 Curaçao 14.5 Iceland 19.2
50 Ireland 14.5 Uruguay 19.1
United Nations Department of Economic and Social Affairs ǀ Population Division 139
2000 2015
Rank Country or area
Percentage
aged 60 or
over Country or area
Percentage
aged 60 or
over
51 Cyprus 14.1 Luxembourg 19.1
52 Cuba 13.8 China, Taiwan Province of China 18.6
53 Guadeloupe 13.7 Republic of Korea 18.5
54 Republic of Moldova 13.7 TFYR Macedonia 18.5
55 TFYR Macedonia 13.6 Aruba 18.5
56 Argentina 13.5 Ireland 18.4
57 Israel 13.3 Cyprus 18.0
58 United States Virgin Islands 13.0 Singapore 17.9
59 China, Taiwan Province of China 11.9 Albania 17.8
60 Aruba 11.5 Republic of Moldova 16.6
61 Republic of Korea 11.2 Armenia 16.3
62 Kazakhstan 11.2 Israel 15.8
63 Chile 10.9 Thailand 15.8
64 Singapore 10.7 Chile 15.7
65 Albania 10.6 China 15.2
66 Seychelles 10.4 Réunion 15.1
67 Lebanon 10.4 Argentina 15.1
68 Grenada 10.4 China, Macao SAR 14.8
69 Jamaica 10.4 Mauritius 14.7
70 Dem. People’s Rep. of Korea 10.2 New Caledonia 14.5
71 Saint Lucia 10.1 Trinidad and Tobago 14.2
72 Thailand 9.9 Sri Lanka 13.9
73 China 9.9 Guam 13.0
74 St. Vincent and the Grenadines 9.7 Jamaica 12.8
75 Tunisia 9.6 Costa Rica 12.8
76 Trinidad and Tobago 9.6 Saint Lucia 12.5
77 China, Macao SAR 9.5 Bahamas 12.5
78 Réunion 9.5 Dem. People’s Rep. of Korea 12.5
79 Antigua and Barbuda 9.3 Brazil 11.7
80 Sri Lanka 9.3 Tunisia 11.7
81 New Caledonia 9.1 French Polynesia 11.6
82 Mauritius 8.9 El Salvador 11.5
83 Azerbaijan 8.8 Lebanon 11.5
84 Turkey 8.8 Turkey 11.2
85 Viet Nam 8.6 Panama 10.9
86 Gabon 8.4 St. Vincent and the Grenadines 10.9
87 Costa Rica 8.3 Seychelles 10.9
88 Guam 8.3 Colombia 10.8
89 El Salvador 8.3 Antigua and Barbuda 10.8
90 Suriname 8.3 Kazakhstan 10.7
91 Tonga 8.3 Viet Nam 10.3
92 Kyrgyzstan 8.2 Suriname 10.2
93 Bahamas 8.1 Grenada 10.2
94 Panama 8.0 Azerbaijan 10.0
95 Brazil 7.7 Peru 10.0
96 Morocco 7.7 Ecuador 9.9
97 Dominican Republic 7.5 Dominican Republic 9.7
98 Egypt 7.4 Morocco 9.6
99 Indonesia 7.4 Mexico 9.6
100 Cabo Verde 7.4 Venezuela (Bolivarian Republic of) 9.4
101 Peru 7.3 Fiji 9.3
102 Ecuador 7.2 Bolivia (Plurinational State of) 9.2
103 Bolivia (Plurinational State of) 7.2 Malaysia 9.2
140 World Population Ageing 2015
2000 2015
Rank Country or area
Percentage
aged 60 or
over Country or area
Percentage
aged 60 or
over
104 Mexico 7.1 Algeria 9.0
105 Uzbekistan 7.1 Paraguay 9.0
106 Myanmar 7.1 India 8.9
107 Colombia 6.9 Myanmar 8.9
108 India 6.9 Nepal 8.6
109 French Polynesia 6.8 Guyana 8.3
110 Sao Tome and Principe 6.7 Indonesia 8.2
111 Venezuela (Bolivarian Republic of) 6.6 Iran (Islamic Republic of) 8.2
112 Turkmenistan 6.6 Tonga 8.2
113 Samoa 6.6 Egypt 7.9
114 Paraguay 6.5 Samoa 7.9
115 Lesotho 6.5 French Guiana 7.8
116 Algeria 6.4 Nicaragua 7.8
117 Haiti 6.3 South Africa 7.7
118 Pakistan 6.2 Brunei Darussalam 7.6
119 South Africa 6.2 Micronesia (Fed. States of) 7.5
120 Iran (Islamic Republic of) 6.2 Uzbekistan 7.4
121 Guyana 6.2 Bhutan 7.4
122 Malaysia 6.2 Philippines 7.3
123 Maldives 6.1 Gabon 7.3
124 French Guiana 6.1 Honduras 7.2
125 Central African Republic 6.0 Timor-Leste 7.2
126 Bangladesh 6.0 Kyrgyzstan 7.1
127 Bhutan 5.9 Haiti 7.1
128 Nepal 5.9 Guatemala 7.0
129 Guatemala 5.8 Libya 7.0
130 Libya 5.8 Bangladesh 7.0
131 Fiji 5.7 Turkmenistan 6.9
132 Nicaragua 5.6 Maldives 6.8
133 Mongolia 5.6 Cambodia 6.8
134 Honduras 5.6 Cabo Verde 6.7
135 Belize 5.6 Pakistan 6.6
136 Congo 5.6 Vanuatu 6.5
137 Tajikistan 5.5 Syrian Arab Republic 6.4
138 Lao People’s Dem. Republic 5.4 Mongolia 6.4
139 Guinea 5.4 Djibouti 6.3
140 Equatorial Guinea 5.3 Lesotho 6.2
141 Kiribati 5.3 Kiribati 6.1
142 Micronesia (Fed. States of) 5.2 Lao People’s Dem. Republic 6.0
143 Cameroon 5.2 Belize 5.9
144 Iraq 5.2 Central African Republic 5.9
145 Guinea-Bissau 5.1 Botswana 5.9
146 Philippines 5.1 Mayotte 5.6
147 Vanuatu 5.0 Swaziland 5.5
148 Liberia 5.0 Congo 5.5
149 Jordan 5.0 Western Sahara 5.5
150 Senegal 5.0 Namibia 5.5
151 Mozambique 5.0 Jordan 5.4
152 Namibia 5.0 Guinea-Bissau 5.3
153 South Sudan 5.0 Ghana 5.3
154 Mali 4.9 Ethiopia 5.2
155 Mauritania 4.9 Solomon Islands 5.2
156 Cambodia 4.9 Sudan 5.2
United Nations Department of Economic and Social Affairs ǀ Population Division 141
2000 2015
Rank Country or area
Percentage
aged 60 or
over Country or area
Percentage
aged 60 or
over
157 Ghana 4.8 South Sudan 5.1
158 Djibouti 4.8 Mozambique 5.1
159 Syrian Arab Republic 4.8 Equatorial Guinea 5.1
160 Ethiopia 4.8 Guinea 5.1
161 Côte d’Ivoire 4.7 Mauritania 5.1
162 Swaziland 4.7 Papua New Guinea 5.1
163 Zimbabwe 4.7 Saudi Arabia 5.0
164 Somalia 4.7 Tajikistan 5.0
165 Nigeria 4.7 Iraq 5.0
166 Botswana 4.7 Malawi 4.9
167 Sudan 4.6 Côte d’Ivoire 4.8
168 Dem. Republic of the Congo 4.6 Cameroon 4.8
169 Benin 4.6 Liberia 4.8
170 Malawi 4.6 United Republic of Tanzania 4.8
171 Madagascar 4.6 Yemen 4.7
172 Comoros 4.6 Madagascar 4.7
173 Togo 4.6 Benin 4.6
174 Mayotte 4.5 Comoros 4.6
175 United Republic of Tanzania 4.5 Dem. Republic of the Congo 4.6
176 Chad 4.5 Rwanda 4.5
177 Solomon Islands 4.4 Kenya 4.5
178 Sierra Leone 4.4 Senegal 4.5
179 Burundi 4.3 State of Palestine 4.5
180 Zambia 4.3 Nigeria 4.5
181 Burkina Faso 4.3 Somalia 4.5
182 Rwanda 4.3 Togo 4.5
183 Saudi Arabia 4.3 Sao Tome and Principe 4.4
184 Papua New Guinea 4.2 Sierra Leone 4.4
185 Kenya 4.1 Zimbabwe 4.4
186 Niger 4.1 Oman 4.4
187 Uganda 4.1 Zambia 4.3
188 Gambia 4.1 Niger 4.2
189 Yemen 4.1 Burundi 4.2
190 Oman 4.0 Eritrea 4.2
191 Timor-Leste 4.0 Mali 4.0
192 Western Sahara 3.9 Afghanistan 4.0
193 Brunei Darussalam 3.9 Chad 4.0
194 Angola 3.9 Bahrain 3.9
195 Bahrain 3.8 Angola 3.8
196 State of Palestine 3.7 Burkina Faso 3.8
197 Afghanistan 3.6 Uganda 3.8
198 Eritrea 3.4 Gambia 3.7
199 Kuwait 3.2 Kuwait 3.4
200 Qatar 2.9 United Arab Emirates 2.3
201 United Arab Emirates 1.7 Qatar 2.3
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.

  • 201 countries or areas with at least 90,000 inhabitants in 2015.

142 World Population Ageing 2015
Table A.III.5. Ranking of countries or areas* according to the projected
percentage of population aged 60 or over, 2030 and 2050
2030 2050
Rank Country or area
Percentage
aged 60 or
over Country or area
Percentage
aged 60 or
over
1 Martinique 38.5 China, Taiwan Province of China 44.3
2 Japan 37.3 Japan 42.5
3 Italy 36.6 Republic of Korea 41.5
4 Germany 36.1 Spain 41.4
5 Portugal 34.7 Portugal 41.2
6 China, Hong Kong SAR 33.6 China, Hong Kong SAR 40.9
7 Spain 33.5 Greece 40.8
8 Greece 33.2 Italy 40.7
9 Slovenia 32.7 Bosnia and Herzegovina 40.5
10 Austria 32.4 Singapore 40.4
11 United States Virgin Islands 32.2 Cuba 39.7
12 Netherlands 32.0 Poland 39.3
13 Cuba 31.6 Germany 39.3
14 Finland 31.5 Slovenia 39.0
15 Republic of Korea 31.4 Austria 37.1
16 China, Taiwan Province of China 31.3 Thailand 37.1
17 Croatia 31.0 Czech Republic 37.0
18 Channel Islands 31.0 Croatia 36.8
19 Singapore 30.7 China 36.5
20 Switzerland 30.6 Bulgaria 36.4
21 Bosnia and Herzegovina 30.6 Romania 36.4
22 Guadeloupe 30.5 Slovakia 36.2
23 Malta 30.4 Malta 36.2
24 Bulgaria 30.1 Martinique 35.9
25 France 29.9 Estonia 35.1
26 Romania 29.8 Channel Islands 34.9
27 Belgium 29.5 Hungary 34.6
28 Denmark 29.4 Switzerland 34.5
29 Canada 29.4 China, Macao SAR 34.5
30 Estonia 29.1 Guadeloupe 34.0
31 Latvia 29.0 Puerto Rico 33.8
32 Czech Republic 28.9 Republic of Moldova 33.6
33 Lithuania 28.7 Netherlands 33.2
34 Poland 28.6 Cyprus 33.2
35 Sweden 28.6 Latvia 33.1
36 Curaçao 28.4 Armenia 33.1
37 Aruba 28.4 Georgia 33.0
38 United Kingdom 27.8 Chile 32.9
39 Barbados 27.7 TFYR Macedonia 32.8
40 Hungary 27.6 Belgium 32.6
41 Serbia 27.2 Canada 32.4
42 New Zealand 27.0 Finland 32.4
43 Thailand 26.9 Serbia 32.3
44 Slovakia 26.4 United States Virgin Islands 32.1
45 Norway 26.2 France 31.8
46 United States of America 26.1 Ukraine 31.5
47 Iceland 25.8 Iran (Islamic Republic of) 31.2
48 China, Macao SAR 25.7 Barbados 31.1
49 Ukraine 25.7 Ireland 31.0
50 Réunion 25.5 Brunei Darussalam 30.9
United Nations Department of Economic and Social Affairs ǀ Population Division 143
2030 2050
Rank Country or area
Percentage
aged 60 or
over Country or area
Percentage
aged 60 or
over
51 Puerto Rico 25.5 Albania 30.9
52 Albania 25.5 Iceland 30.9
53 China 25.3 Réunion 30.9
54 Montenegro 25.2 Lebanon 30.8
55 Belarus 25.2 United Kingdom 30.7
56 Georgia 25.1 Mauritius 30.6
57 TFYR Macedonia 24.8 Montenegro 30.5
58 Luxembourg 24.7 Costa Rica 30.4
59 Australia 24.6 Denmark 29.9
60 Ireland 24.4 Lithuania 29.9
61 Russian Federation 24.0 Belarus 29.7
62 Armenia 23.8 Sweden 29.6
63 Cyprus 23.7 Norway 29.5
64 Chile 23.7 New Zealand 29.4
65 Mauritius 23.3 Brazil 29.3
66 Republic of Moldova 22.4 Luxembourg 29.0
67 Uruguay 22.1 Aruba 28.8
68 Sri Lanka 21.0 Russian Federation 28.8
69 Costa Rica 20.5 Curaçao 28.7
70 Trinidad and Tobago 20.2 Sri Lanka 28.6
71 Bahamas 20.1 French Polynesia 28.4
72 Guam 19.9 Australia 28.3
73 French Polynesia 19.7 Trinidad and Tobago 28.2
74 Antigua and Barbuda 19.7 Jamaica 28.0
75 New Caledonia 19.6 Viet Nam 27.9
76 Dem. People’s Rep. of Korea 19.4 United States of America 27.9
77 Lebanon 19.2 Colombia 27.6
78 Saint Lucia 19.1 Uruguay 27.5
79 Seychelles 19.1 Seychelles 27.4
80 Brazil 18.8 Saint Lucia 27.3
81 Jamaica 18.7 Bahamas 27.1
82 St. Vincent and the Grenadines 18.3 Turkey 26.6
83 Colombia 18.3 Tunisia 26.5
84 Israel 18.1 St. Vincent and the Grenadines 25.6
85 Tunisia 17.7 Maldives 25.3
86 Azerbaijan 17.6 Grenada 25.1
87 Viet Nam 17.5 New Caledonia 24.9
88 Argentina 17.5 Guam 24.9
89 Brunei Darussalam 17.1 Antigua and Barbuda 24.9
90 Turkey 17.0 Mexico 24.7
91 Panama 16.2 Bhutan 24.5
92 El Salvador 15.8 Oman 24.5
93 Suriname 15.7 Azerbaijan 24.4
94 Morocco 15.1 Dem. People’s Rep. of Korea 24.4
95 Mexico 14.9 El Salvador 24.1
96 Guyana 14.9 Bahrain 23.7
97 Venezuela (Bolivarian Republic of) 14.8 Argentina 23.6
98 Peru 14.7 Malaysia 23.6
99 Ecuador 14.5 Panama 23.5
100 Iran (Islamic Republic of) 14.4 United Arab Emirates 23.5
101 Kazakhstan 14.4 Morocco 23.4
102 Malaysia 14.4 Nicaragua 23.4
103 Grenada 14.3 Peru 23.2
144 World Population Ageing 2015
2030 2050
Rank Country or area
Percentage
aged 60 or
over Country or area
Percentage
aged 60 or
over
104 Fiji 14.3 Algeria 23.0
105 Dominican Republic 14.2 Western Sahara 22.0
106 Algeria 13.3 Venezuela (Bolivarian Republic of) 21.9
107 Myanmar 13.2 Israel 21.9
108 Indonesia 13.2 Ecuador 21.8
109 French Guiana 12.7 Libya 21.8
110 India 12.5 Bangladesh 21.5
111 Nicaragua 12.5 Suriname 21.4
112 Western Sahara 12.4 Mongolia 21.1
113 Samoa 12.1 Dominican Republic 21.1
114 Libya 12.0 Saudi Arabia 20.9
115 Paraguay 12.0 Cabo Verde 20.5
116 Mongolia 11.9 Kuwait 20.1
117 Uzbekistan 11.8 Fiji 19.9
118 Maldives 11.7 Qatar 19.8
119 Bhutan 11.6 Honduras 19.5
120 Bangladesh 11.5 India 19.4
121 Bolivia (Plurinational State of) 11.4 Indonesia 19.2
122 Turkmenistan 11.4 Uzbekistan 19.1
123 United Arab Emirates 11.3 Myanmar 18.8
124 Kyrgyzstan 11.3 Kazakhstan 18.6
125 Saudi Arabia 11.1 Paraguay 18.3
126 Bahrain 10.8 Turkmenistan 18.2
127 Nepal 10.8 Nepal 17.9
128 Honduras 10.7 Cambodia 17.6
129 Tonga 10.5 French Guiana 17.0
130 South Africa 10.5 Bolivia (Plurinational State of) 17.0
131 Cambodia 10.4 Syrian Arab Republic 16.4
132 Cabo Verde 10.4 Kyrgyzstan 16.1
133 Philippines 10.3 Jordan 15.8
134 Egypt 9.9 Botswana 15.7
135 Oman 9.4 Djibouti 15.5
136 Haiti 9.3 South Africa 15.4
137 Kiribati 9.3 Haiti 15.3
138 Djibouti 9.2 Egypt 15.3
139 Micronesia (Fed. States of) 9.1 Belize 14.7
140 Vanuatu 9.1 Lao People’s Dem. Republic 14.7
141 Syrian Arab Republic 8.9 Guatemala 14.2
142 Belize 8.9 Vanuatu 14.2
143 Kuwait 8.9 Samoa 14.1
144 Tajikistan 8.6 Philippines 14.0
145 Jordan 8.6 Guyana 13.8
146 Guatemala 8.6 Mayotte 13.3
147 Equatorial Guinea 8.5 Tajikistan 13.2
148 Pakistan 8.4 Tonga 12.9
149 Lao People’s Dem. Republic 8.1 Pakistan 12.9
150 Mayotte 8.0 Micronesia (Fed. States of) 12.2
151 Botswana 8.0 Rwanda 12.0
152 Qatar 7.9 Kiribati 12.0
153 Gabon 7.8 Gabon 11.8
154 Namibia 7.1 Namibia 11.0
155 Solomon Islands 6.9 Solomon Islands 10.8
156 Timor-Leste 6.8 Ethiopia 10.4
United Nations Department of Economic and Social Affairs ǀ Population Division 145
2030 2050
Rank Country or area
Percentage
aged 60 or
over Country or area
Percentage
aged 60 or
over
157 Papua New Guinea 6.7 State of Palestine 10.4
158 Mauritania 6.5 Zimbabwe 10.2
159 Ghana 6.5 Central African Republic 10.0
160 Sudan 6.4 Papua New Guinea 10.0
161 Rwanda 6.3 Yemen 9.9
162 Central African Republic 6.2 Ghana 9.7
163 State of Palestine 6.2 Sao Tome and Principe 9.6
164 Ethiopia 6.1 Kenya 9.6
165 Congo 6.1 Comoros 9.2
166 Comoros 6.0 Sudan 9.2
167 Iraq 5.8 Equatorial Guinea 9.2
168 Madagascar 5.8 Eritrea 9.2
169 Sao Tome and Principe 5.8 Lesotho 9.0
170 Guinea-Bissau 5.7 Afghanistan 9.0
171 Swaziland 5.7 Mauritania 9.0
172 South Sudan 5.7 Iraq 8.8
173 Liberia 5.6 Guinea-Bissau 8.3
174 Benin 5.6 Congo 8.3
175 Guinea 5.6 Madagascar 8.2
176 Kenya 5.5 Togo 8.1
177 Yemen 5.3 Cameroon 8.1
178 Lesotho 5.3 Senegal 8.1
179 Cameroon 5.2 Timor-Leste 8.1
180 Togo 5.2 Liberia 8.0
181 United Republic of Tanzania 5.2 Benin 7.9
182 Mozambique 5.2 Swaziland 7.7
183 Côte d’Ivoire 5.1 Sierra Leone 7.7
184 Afghanistan 5.1 Malawi 7.6
185 Senegal 5.1 Guinea 7.6
186 Dem. Republic of the Congo 4.9 South Sudan 7.5
187 Burundi 4.9 United Republic of Tanzania 7.2
188 Sierra Leone 4.8 Burundi 6.8
189 Nigeria 4.8 Zambia 6.6
190 Eritrea 4.6 Côte d’Ivoire 6.5
191 Malawi 4.6 Dem. Republic of the Congo 6.5
192 Zimbabwe 4.6 Burkina Faso 6.4
193 Somalia 4.5 Nigeria 6.3
194 Burkina Faso 4.4 Mozambique 6.2
195 Gambia 4.4 Uganda 6.0
196 Angola 4.2 Gambia 5.9
197 Niger 4.2 Mali 5.8
198 Zambia 4.1 Angola 5.5
199 Mali 4.0 Chad 5.4
200 Chad 4.0 Somalia 5.2
201 Uganda 3.7 Niger 4.1
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.

  • 201 countries or areas with at least 90,000 inhabitants in 2015.

146 World Population Ageing 2015
Table A.III.6. Ranking of countries or areas* according to the percentage point
change in the proportion of the population aged 60 years or over, 2000-2015 and
2015-2030
2000-2015 2015-2030
Rank Country or area
Change in
percentage aged
60 or over
(percentage
points) Country or area
Change in
percentage aged
60 or over
(percentage
points)
1 United States Virgin Islands 10.9 Cuba 12.8
2 Japan 9.9 Republic of Korea 12.7
3 Malta 9.3 China, Hong Kong SAR 12.3
4 Finland 7.3 China, Taiwan Province of China 12.1
5 Republic of Korea 7.2 Curaçao 11.7
6 Aruba 7.0 China, Macao SAR 11.4
7 Martinique 6.9 Thailand 11.2
8 China, Hong Kong SAR 6.9 Martinique 11.0
9 China, Taiwan Province of China 6.7 Brunei Darussalam 11.0
10 Curaçao 6.6 Singapore 9.9
11 Singapore 6.3 Aruba 9.8
12 Netherlands 6.2 Guadeloupe 9.5
13 Czech Republic 6.1 Antigua and Barbuda 8.9
14 Albania 6.0 China 8.9
15 Thailand 5.9 Germany 8.5
16 Mauritius 5.8 Chile 8.4
17 Slovenia 5.8 Seychelles 8.4
18 Cuba 5.7 United States Virgin Islands 8.2
19 Poland 5.6 Réunion 8.1
20 Canada 5.6 Azerbaijan 8.1
21 Guadeloupe 5.6 Mauritius 8.1
22 New Caledonia 5.4 Lebanon 8.0
23 China, Macao SAR 5.4 Spain 8.0
24 Bosnia and Herzegovina 5.3 Costa Rica 7.9
25 Slovakia 5.0 Viet Nam 7.9
26 Trinidad and Tobago 4.9 French Polynesia 7.9
27 China 4.9 Albania 7.6
28 Chile 4.8 St. Vincent and the Grenadines 7.5
29 French Polynesia 4.8 Netherlands 7.4
30 Denmark 4.8 Bahamas 7.3
31 Guam 4.7 Barbados 7.3
32 Germany 4.7 Tunisia 7.3
33 Bulgaria 4.6 Qatar 7.2
34 Hungary 4.4 Channel Islands 7.2
35 Bahamas 4.4 Austria 7.2
36 Brunei Darussalam 4.4 Armenia 7.1
37 United States of America 4.3 Portugal 7.1
38 Croatia 4.3 Bosnia and Herzegovina 6.9
39 New Zealand 4.3 Dem. People’s Rep. of Korea 6.9
40 France 4.3 Italy 6.9
41 Channel Islands 4.2 Bahrain 6.9
42 Serbia 4.2 Guam 6.8
43 TFYR Macedonia 4.1 Brazil 6.8
44 Sri Lanka 4.1 Slovenia 6.7
45 Puerto Rico 4.1 Western Sahara 6.7
46 Réunion 4.0 Georgia 6.6
47 Cyprus 3.9 Trinidad and Tobago 6.6
United Nations Department of Economic and Social Affairs ǀ Population Division 147
2000-2015 2015-2030
Rank Country or area
Change in
percentage aged
60 or over
(percentage
points) Country or area
Change in
percentage aged
60 or over
(percentage
points)
48 Portugal 3.9 TFYR Macedonia 6.6
49 Australia 3.8 Jamaica 6.5
50 Austria 3.8 Saint Lucia 6.5
51 Brazil 3.8 Canada 6.3
52 Iceland 3.7 Sri Lanka 6.3
53 Republic of Moldova 3.7 Colombia 6.2
54 Switzerland 3.6 Malta 6.1
55 Costa Rica 3.6 Iran (Islamic Republic of) 6.1
56 Greece 3.6 Saudi Arabia 6.1
57 Fiji 3.6 Greece 6.1
58 Sweden 3.5 Suriname 6.0
59 Italy 3.4 Turkey 5.9
60 Estonia 3.4 New Zealand 5.9
61 Colombia 3.3 Mexico 5.9
62 Latvia 3.3 Iceland 5.7
63 Venezuela (Bolivarian Republic of) 3.3 Ireland 5.6
64 South Africa 3.1 Puerto Rico 5.6
65 Mexico 3.1 Indonesia 5.5
66 Montenegro 3.1 Cyprus 5.5
67 Malaysia 2.9 Slovakia 5.5
68 Panama 2.9 Belgium 5.4
69 United Kingdom 2.8 Morocco 5.4
70 Tunisia 2.8 Cabo Verde 5.4
71 Norway 2.7 Maldives 5.3
72 Turkey 2.7 Guyana 5.3
73 French Guiana 2.6 Mongolia 5.3
74 Ecuador 2.6 Poland 5.2
75 Cambodia 2.6 Croatia 5.1
76 Romania 2.6 Panama 5.1
77 Belgium 2.6 Libya 5.1
78 Peru 2.6 Fiji 5.1
79 Iran (Islamic Republic of) 2.5 Malaysia 5.1
80 Saint Lucia 2.4 Myanmar 5.1
81 Ireland 2.4 New Caledonia 5.1
82 Dem. People’s Rep. of Korea 2.3 United States of America 5.1
83 Micronesia (Fed. States of) 2.3 Dominican Republic 5.0
84 Dominican Republic 2.2 Romania 5.0
85 Israel 2.2 Venezuela (Bolivarian Republic of) 4.9
86 Nepal 2.2 Belarus 4.9
87 Paraguay 2.1 Luxembourg 4.9
88 El Salvador 2.0 Montenegro 4.9
89 Lebanon 2.0 French Guiana 4.8
90 Spain 2.0 Lithuania 4.7
91 Georgia 2.0 Peru 4.7
92 Myanmar 2.0 Ecuador 4.7
93 Lithuania 2.0 Serbia 4.7
94 Syrian Arab Republic 1.9 United Kingdom 4.7
95 Argentina 1.9 Grenada 4.6
96 Algeria 1.9 Uzbekistan 4.6
97 India 1.9 Bangladesh 4.6
98 Barbados 1.9 Switzerland 4.6
99 Nicaragua 1.9 Turkmenistan 4.5
148 World Population Ageing 2015
2000-2015 2015-2030
Rank Country or area
Change in
percentage aged
60 or over
(percentage
points) Country or area
Change in
percentage aged
60 or over
(percentage
points)
100 Jamaica 1.9 Republic of Moldova 4.5
101 Viet Nam 1.8 Cambodia 4.4
102 Philippines 1.7 France 4.4
103 Uruguay 1.6 Japan 4.3
104 Suriname 1.6 Kiribati 4.2
105 Libya 1.6 Nicaragua 4.2
106 Morocco 1.6 Samoa 4.2
107 Botswana 1.6 Australia 4.2
108 Kiribati 1.5 Norway 4.1
109 Antigua and Barbuda 1.5 Mayotte 4.1
110 Ukraine 1.4 Finland 4.0
111 Western Sahara 1.4 Belize 3.9
112 Djibouti 1.4 Denmark 3.9
113 Bhutan 1.4 Bhutan 3.9
114 Samoa 1.3 Kyrgyzstan 3.9
115 Russian Federation 1.3 Algeria 3.8
116 Vanuatu 1.3 Jordan 3.7
117 Bolivia (Plurinational State of) 1.3 Kazakhstan 3.7
118 St. Vincent and the Grenadines 1.2 Russian Federation 3.6
119 Indonesia 1.2 Equatorial Guinea 3.6
120 Honduras 1.2 India 3.5
121 Timor-Leste 1.2 El Salvador 3.2
122 Bangladesh 0.9 Uruguay 3.1
123 Egypt 0.9 Nepal 3.1
124 State of Palestine 0.9 Bulgaria 3.1
125 Papua New Guinea 0.9 Kuwait 3.1
126 Luxembourg 0.8 Syrian Arab Republic 3.1
127 Haiti 0.8 Tajikistan 3.0
128 Swaziland 0.8 Estonia 3.0
129 Belarus 0.8 Djibouti 3.0
130 Guinea-Bissau 0.8 Israel 3.0
131 Guatemala 0.8 Honduras 2.9
132 Saudi Arabia 0.8 Ukraine 2.8
133 Solomon Islands 0.7 Czech Republic 2.8
134 Zimbabwe 0.7 Argentina 2.7
135 Maldives 0.7 Philippines 2.7
136 Namibia 0.6 Egypt 2.7
137 Afghanistan 0.6 Paraguay 2.6
138 Pakistan 0.6 Oman 2.5
139 Mongolia 0.6 Vanuatu 2.5
140 Lao People’s Dem. Republic 0.6 United Arab Emirates 2.5
141 Eritrea 0.6 Tonga 2.4
142 Sudan 0.5 Latvia 2.4
143 Ghana 0.5 Sweden 2.3
144 Jordan 0.5 Lao People’s Dem. Republic 2.3
145 Uzbekistan 0.4 Pakistan 2.3
146 Ethiopia 0.4 Namibia 2.0
147 Yemen 0.4 Hungary 2.0
148 Oman 0.4 Bolivia (Plurinational State of) 2.0
149 Kenya 0.4 South Africa 2.0
150 Azerbaijan 0.4 State of Palestine 2.0
151 United Republic of Tanzania 0.3 Haiti 1.9
United Nations Department of Economic and Social Affairs ǀ Population Division 149
2000-2015 2015-2030
Rank Country or area
Change in
percentage aged
60 or over
(percentage
points) Country or area
Change in
percentage aged
60 or over
(percentage
points)
152 Turkmenistan 0.3 Solomon Islands 1.7
153 Cabo Verde 0.3 Papua New Guinea 1.6
154 South Sudan 0.2 Mauritania 1.5
155 Côte d’Ivoire 0.2 Ghana 1.5
156 Seychelles 0.2 Micronesia (Fed. States of) 1.4
157 Rwanda 0.2 Sao Tome and Principe 1.4
158 Mauritania 0.2 Rwanda 1.4
159 Malawi 0.1 Comoros 1.3
160 Mozambique 0.1 Iraq 1.3
161 Madagascar 0.1 Sudan 1.2
162 Niger 0.0 Madagascar 1.2
163 Sierra Leone 0.0 Kenya 1.2
164 Benin 0.0 Afghanistan 1.2
165 Armenia 0.0 Benin 1.0
166 Belize 0.0 Guatemala 0.9
167 Dem. Republic of the Congo -0.1 Ethiopia 0.9
168 Angola -0.1 Liberia 0.8
169 Iraq -0.1 Eritrea 0.8
170 Tonga -0.1 Yemen 0.8
171 Comoros -0.1 Congo 0.8
172 Togo -0.1 South Sudan 0.8
173 Liberia -0.2 Togo 0.7
174 Somalia -0.2 Sierra Leone 0.7
175 Bahrain -0.2 Burkina Faso 0.7
176 Nigeria -0.2 Gambia 0.6
177 Guinea -0.2 Burundi 0.6
178 Grenada -0.3 Botswana 0.6
179 Lesotho -0.3 Angola 0.5
180 Uganda -0.3 Senegal 0.5
181 Equatorial Guinea -0.3 Guinea 0.5
182 Congo -0.3 Côte d’Ivoire 0.4
183 Gambia -0.3 Central African Republic 0.4
184 Burundi -0.3 Cameroon 0.4
185 Cameroon -0.3 Dem. Republic of the Congo 0.4
186 Central African Republic -0.4 Uganda 0.3
187 Zambia -0.4 Gabon 0.3
188 Burkina Faso -0.5 United Republic of Tanzania 0.2
189 Tajikistan -0.5 Mozambique 0.2
190 Senegal -0.5 Nigeria 0.2
191 Mayotte -0.5 Zambia 0.2
192 Kazakhstan -0.5 Swaziland 0.1
193 United Arab Emirates -0.6 Chad 0.0
194 Chad -0.6 Somalia 0.0
195 Guyana -0.9 Niger -0.1
196 Kuwait -0.9 Timor-Leste -0.2
197 Mali -1.1 Mali -0.2
198 Gabon -1.2 Malawi -0.3
199 Qatar -1.3 Guinea-Bissau -0.5
200 Sao Tome and Principe -1.4 Zimbabwe -0.6
201 Kyrgyzstan -1.5 Lesotho -0.9
Data source: United Nations (2015). World Population Prospects: The 2015 Revision.

  • 201 countries or areas with at least 90,000 inhabitants in 2015.

Accurate, consistent and timely data on global trends in population age structure are critical
assessing current and future needs with respect to population ageing and for setting policy
priorities to promote the well-being of the growing number and share of older persons in the
population. This publication summarizes the trends in population aging drawn from the latest
United Nations estimates and projections of population by age and sex of 233 countries or
areas, as published in the World Population Prospects: the 2015 Revision. The report focuses
in particular on the period from 2015 to 2030, the implementation period identified for the 2030
Agenda for Sustainable Development and discusses some implications of trends in the number
and share of older persons for development planning, including with respect to poverty eradication and economic growth, social protection and the health and well-being of older persons.
for
ISBN 978-92-1-057854-7

World
Population
Ageing
2019
Highlights

ST/ESA/SER.A/430
Department of Economic and Social Affairs
Population Division
World Population Ageing 2019
Highlights
United Nations
New York, 2019
The Department of Economic and Social Affairs of the United Nations Secretariat is a vital interface between global
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The Population Division of the Department of Economic and Social Affairs provides the international community
with timely and accessible population data and analysis of population trends and development outcomes for
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characteristics and of all three components of population change (fertility, mortality and migration). Founded
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Notes
The designations employed in this report and the material presented in it do not imply the expression of any
opinions whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any
country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.
The term “country” as used in this report also refers, as appropriate, to territories or areas.
This report is available in electronic format on the Division’s website at http://www.unpopulation.org. For further
information about this report, please contact the Office of the Director, Population Division, Department
of Economic and Social Affairs, United Nations, New York, 10017, USA, by Fax: 1 212 963 2147 or by email at
population@un.org.
Suggested citation:
United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Ageing
2019: Highlights (ST/ESA/SER.A/430).
Official symbols of United Nations documents are composed of capital letters combined with numbers, as
illustrated in the above citation.
Front cover photo credit: “Family vacation at Cameron Highlands, Malaysia”, 2019, UN/Nicole Mun Sim Lai
Back cover photo credit: “Two chess players enjoying an outdoor game in New York City’s Central Park “, 1976,
UN Photo/Grunzweig
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Rethinking population ageing in the SDG era
According to World Population Prospects 2019 (United Nations, 2019), by 2050, 1 in 6 people in the world
will be over the age of 65, up from 1 in 11 in 2019.
All societies in the world are in the midst of this longevity revolution—some are at its early stages and some
are more advanced. But all will pass through this extraordinary transition, in which the chance of surviving
to age 65 rises from less than 50 per cent—as was the case in Sweden in the 1890s—to more than 90 per
cent at present in countries with the highest life expectancy. What is more, the proportion of adult life spent
beyond age 65 increased from less than a fifth in the 1960s to a quarter or more in most developed countries
today.
These changes for individuals are mirrored in societal changes: older persons are a growing demographic
group in society. Older people account for more than one fifth of the population in 17 countries today, and
the United Nations Department of Economic and Social Affairs Population Division’s projections to the end
of the century indicate that this will be the case in 2100 for 155 countries, covering a majority (61 per cent)
of the world’s population.
Traditionally, the United Nations and most researchers have used measures and indicators of population
ageing that are mostly or entirely based on people’s chronological age, defining older persons as those aged
60 or 65 years or over. This provides a simple, clear and easily replicable way to measure and track various
indicators of population ageing.
However, there has been increasing recognition that the mortality risks, health status, type and level of
activity, productivity and other socioeconomic characteristics of older persons have changed significantly in
many parts of the world over the last century, and, in particular, in the last few decades. This has led to the
development of alternative concepts and measures to offer a more nuanced perspective of what population
ageing means in different contexts.
New measures and concepts of population ageing have significant implications for assessing the living
conditions and living arrangements of older persons, their productive and other contributions to society
and their needs for social protection and health care.
These new approaches to understanding and measuring ageing also carry important implications for the
review of internationally agreed development goals, including those contained in the Programme of Action
of the International Conference on Population and Development (ICPD), the Madrid International Plan of
Action on Ageing (MIPAA) and, most recently, the 2030 Agenda for Sustainable Development.
Contents
Rethinking population ageing in the SDG era …………………………………………… iii
World Population Ageing 2019: Key messages …………………………………………….. 1
Introduction …………………………………………………………………………………………………….. 3
Global and regional trends in population ageing ……………………………………… 5
Measures of population ageing …………………………………………………………………..11
How does population ageing affect assets, transfers and work? ……………21
Policy implications for achieving the Sustainable Development Goals ..27
References ……………………………………………………………………………………………………….29
Annex table …………………………………………………………………………………………………….31
World Population Ageing 2019: Highlights 1
United Nations, Department of Economic and Social Affairs, Population Division

  1. Population ageing is a global phenomenon:
    Virtually every country in the world is
    experiencing growth in the size and
    proportion of older persons in their
    population. There were 703 million persons
    aged 65 years or over in the world in 2019. The
    number of older persons is projected to double
    to 1.5 billion in 2050. Globally, the share of the
    population aged 65 years or over increased
    from 6 per cent in 1990 to 9 per cent in 2019.
    That proportion is projected to rise further to
    16 per cent by 2050, so that one in six people in
    the world will be aged 65 years or over.
  2. Population ageing has been fastest in
    Eastern and South-Eastern Asia and Latin
    America and the Caribbean. The percentage
    of the population aged 65 years or over almost
    doubled from 6 per cent in 1990 to 11 per cent
    in 2019 in Eastern and South-Eastern Asia, and
    from 5 per cent in 1990 to 9 per cent in 2019
    in Latin America and the Caribbean. Between
    2019 and 2050, the share of older persons is
    projected at least to double in four regions:
    Northern Africa and Western Asia, Central
    and Southern Asia, Latin America and the
    Caribbean, and Eastern and South-Eastern Asia.
  3. Throughout most of the world, survival
    beyond age 65 is improving. Globally, a
    person aged 65 years in 2015-2020 could expect
    to live, on average, an additional 17 years. By
    2045-2050, that figure will have increased to 19
    years. Between 2015-2020 and 2045-2050, life
    expectancy at age 65 is projected to increase in
    all countries. Women currently outlive men by
    4.8 years, but this global gender gap is expected
    to narrow over the next three decades.
  4. Conventional indicators of population
    ageing that are based on chronological age
    (years since birth), with a fixed threshold of
    “old age” at age 65, show that populations
    are becoming older in all regions of the
    world. The old-age dependency ratio, the
    number of persons aged 65 years or above
    relative to number of persons aged 20 to 64
    years, is projected to more than double in
    Eastern and South-Eastern Asia, Latin America
    and the Caribbean, Northern Africa and
    Western Asia, and Central and Southern Asia.
  5. New measures of population ageing
    based on prospective age (years of life
    remaining), with a dynamic threshold of “old
    age” that rises progressively with increasing
    life expectancy, point toward a slower
    process of population ageing than what is
    indicated by the conventional measures. For
    example, the prospective old-age dependency
    ratio is rising more slowly than the old-age
    dependency ratio in all regions of the world.
  6. Indicators that incorporate both demographic and economic information suggest
    that the extent of population ageing
    depends on age-patterns of production
    and consumption. The economic old-age
    dependency ratio, which integrates measured
    levels of consumption and production by age,
    shows that population ageing has the greatest
    impact in countries or regions with high
    proportions of older people and high levels of
    old-age consumption, such as in Europe and
    Northern America and in Australia and New
    Zealand.
  7. The consumption of older persons is
    financed in various ways around the world,
    including through public transfers, private
    transfers and income from assets and labour.
    Older persons in Europe and Latin America rely
    heavily on public transfers and fund more than
    two thirds of their consumption with those
    transfers. However, assets are the primary
    means of financing consumption in countries
    World Population Ageing 2019:
    Key messages
    World Population Ageing 2019: Highlights 2
    United Nations, Department of Economic and Social Affairs, Population Division
    where public transfers are relatively low, such
    as in Southern Asia and South-Eastern Asia, as
    well as in Australia, the United Kingdom and
    the United States.
  8. Population ageing will put increased
    financial pressure on old-age support
    systems. In countries where public transfers
    are high, including many in Europe and Latin
    America, population ageing will increase the
    fiscal pressure on public transfer systems,
    especially if patterns of taxation and benefits
    remain unchanged. In countries where public
    transfers are relatively low, such as many
    in Southern Asia and South-Eastern Asia,
    individuals and families face greater pressure
    to finance their consumption during old-age.
    It is important to establish social protection
    programmes that can be sustained over the
    long term to prevent poverty, reduce inequality
    and promote social inclusion among older
    persons.
  9. Population ageing does not lead
    inevitably to macroeconomic decline—with
    well-chosen policies, just the opposite may
    be true. To maximize the benefits and manage
    the risks associated with population ageing,
    governments should support continuing
    and lifelong education and health care for all;
    encourage savings behaviour and healthy
    lifestyles throughout the life course; promote
    employment among women, older persons and
    others traditionally excluded from the labour
    force, including through a gradual increase in
    the official retirement age; and support familyfriendly policies to facilitate work-life balance
    and increased gender equality in both public
    and private life.
    World Population Ageing 2019: Highlights 3
    United Nations, Department of Economic and Social Affairs, Population Division
    Population ageing is a human success story, a
    reason to celebrate the triumph of public health,
    medical advancements, and economic and social
    development over diseases, injuries and early deaths
    that have limited human life spans throughout
    history.
    Population ageing has been recognized as one of the
    four global demographic “megatrends”—population
    growth, population ageing, international migration
    and urbanization—with continued and lasting
    impacts on sustainable development.1
    Declining
    fertility and increasing longevity lead to rising
    numbers of older persons as well as a continuously
    growing share of older persons in the population.
    Preparing for the economic and social shifts
    associated with an ageing population is essential
    to ensure progress towards the achievement of the
    Sustainable Development Goals (SDGs) included
    in the 2030 Agenda for Sustainable Development.2
    Trends in population ageing are particularly
    relevant for the Goals on eradicating poverty (SDG
    1), ensuring healthy lives and well-being at all ages
    (SDG 3), promoting gender equality (SDG 5) and
    full and productive employment and decent work
    for all (SDG 8), reducing inequalities between and
    within countries (SDG 10), and making cities and
    human settlements inclusive, safe, resilient and
    sustainable (SDG 11).
    To describe changes in the population age structure,
    demographers apply measures that compare the
    relative sizes of different age groups. In discussions
    around the challenges of social protection associated
    with population ageing, the most common measure
    is the old-age dependency ratio, which equals the
    number of persons aged 65 years or over divided
    by the number of persons aged 20-64 years. This
    measure is often used as a proxy for the economic
    dependency of the older population. Given the
    diversity among older persons with respect to
    1 Report of the Secretary-General on the review and appraisal of the
    Programme of Action of the International Conference on Population
    and Development and its contribution to the follow-up and review of
    the 2030 Agenda for Sustainable Development (E/CN.9/2019/2).
    2 Transforming our world: the 2030 Agenda for Sustainable
    Development (A/RES/70/1).
    economic activity and functional capacity,3
    and the
    fact that not all persons in the traditional working
    ages are economically active, researchers have
    proposed alternative measures to track changes
    in economic dependency as a result of population
    ageing. Some of these alternative measures featured
    in this present document, focus on measures for
    which comprehensive data are available at the global
    level or at least for a large number of countries.
    This publication presents the highlights of the
    report World Population Ageing 2019 and draws
    on the latest population estimates and projections
    as published in the World Population Prospects
    2019 (United Nations 2019). These Highlights are
    organized into four parts. The first part provides
    an overview of key global and regional trends
    and dynamics of population ageing based on
    conventional measures. The second part elaborates
    alternative measures of population ageing that offer
    a more nuanced view of changes over time in the
    population age structure. This section describes
    the conventional old-age dependency ratio based
    on chronological age; an alternative “prospective”
    measure that adjusts the threshold of old age based
    on years of remaining life expectancy; and an
    economic measure that incorporates information
    about age patterns of consumption and production.
    Additionally, the third part discusses how older
    persons in various countries and regions finance
    their consumption, both currently and in the future,
    through public transfers, private transfers, assets
    and work. Finally, these Highlights conclude with
    evidence-based recommendations to assist policy
    makers in addressing both the challenges and the
    opportunities of population ageing in the context
    of the 2030 Agenda for Sustainable Development.
    3 Functional ability is about having the capabilities that enable all
    people to be and do what they have reason to value. This includes
    a person’s ability to meet their basic needs to learn, grow and make
    decisions; to be mobile; to build and maintain relationships; and to
    contribute to society (World Health Organization, 2015).
    Introduction
    Interviews for the Multi Indicator Survey on Ageing (MISA) in Malawi, 2017, UN/Karoline Schmid
    World Population Ageing 2019: Highlights 5
    United Nations, Department of Economic and Social Affairs, Population Division
    The world’s older population is growing in absolute
    and relative terms.
    Globally, there were 703 million older persons aged
    65 or over in 2019.4
    Eastern and South-Eastern Asia
    was home to the largest number of the world’s older
    population (260 million), followed by Europe and
    Northern America (over 200 million) (table 1).
    Over the next three decades, the global number
    of older persons is projected to more than double,
    reaching over 1.5 billion persons in 2050. All
    regions will see an increase in the size of their older
    population between 2019 and 2050.5 The largest
    increase (+312 million persons) is projected to occur
    in Eastern and South-Eastern Asia, growing from
    261 million in 2019 to 573 million persons aged 65
    years or over in 2050. The number of older persons
    is expected to grow fastest in Northern Africa and
    4 This publication defines “older persons” as persons aged 65 years
    or over.
    5 In this report, data for countries or areas have been aggregated in
    six continental regions: Africa, Asia, Europe, Latin America and the
    Caribbean, Northern America, and Oceania (as illustrated in annex
    table). Countries or areas are also grouped into geographic regions
    based on the classification being used to track progress towards the
    Sustainable Development Goals of the United Nations (see: https://
    unstats.un.org/sdgs/indicators/regional-groups/).
    Western Asia from 29 million in 2019 to 96 million
    in 2050 (+226 per cent). The second fastest rise in
    the number of older persons is foreseen in subSaharan Africa (+218 per cent), with an expected
    growth from 32 million in 2019 to 101 million in
  10. In contrast, the projected increase is relatively
    small in Australia and New Zealand (+84 per cent)
    and Europe and Northern America (+48 per cent),
    regions where the population is already significantly
    older than in other parts of the world.
    Among development groups,6
    less developed
    countries excluding the least developed countries
    will be home to more than two-thirds of the world’s
    older population (1.1 billion) in 2050. The fastest
    increase of the older population between 2019 and
    2050 is projected to happen in the least developed
    6 The designation of “more developed” and “less developed” regions
    is intended for statistical purposes and does not express a judgment
    about the stage reached by a particular country or area in the
    development process. More developed regions comprise all regions
    of Europe plus Northern America, Australia and New Zealand and
    Japan. Less developed regions comprise all regions of Africa, Asia
    (excluding Japan), and Latin America and the Caribbean as well as
    Oceania (excluding Australia and New Zealand). The group of least
    developed countries includes 47 countries: 32 in Sub-Saharan Africa,
    2 in Northern Africa and Western Asia, 4 in Central and Southern
    Asia, 4 in Eastern and South-Eastern Asia, 1 in Latin America and the
    Caribbean, and 4 in Oceania. Other less developed countries comprise
    the less developed regions excluding the least developed countries.
    Global and regional trends in population
    ageing
    Table 1.
    Number of persons aged 65 years or over by geographic region, 2019 and 2050
    Source: United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Prospects 2019.
    Excluding Australia and New Zealand. Region Number of persons aged 65 or over in 2019 (millions) Number of persons aged 65 or over in 2050 (millions) Percentage change between 2019 and 2050 World 702.9 1548.9 120 Sub-Saharan Africa 31.9 101.4 218 Northern Africa and Western Asia 29.4 95.8 226 Central and Southern Asia 119.0 328.1 176 Eastern and South-Eastern Asia 260.6 572.5 120 Latin America and the Caribbean 56.4 144.6 156 Australia and New Zealand 4.8 8.8 84 Oceania, excluding Australia and New Zealand 0.5 1.5 190 Europe and Northern America 200.4 296.2 48 World Population Ageing 2019: Highlights 6 United Nations, Department of Economic and Social Affairs, Population Division countries (+225 per cent), rising from 37 million in 2019 to 120 million persons aged 65 years or over in 2050. About one in three older persons is living in Eastern and South-Eastern Asia today and in 2050. Eastern and South-Eastern Asia are home to the largest share (37 per cent) of the world’s older population in 2019 and this is expected to remain so in 2050 (figure 1). The second largest share of older persons currently lives in Europe and Northern America (28.5 per cent), which is expected to shrink to 19.1 per cent in 2050. Central and Southern Asia host one-sixth of the global older population (16.9 per cent) in 2019, a figure that is foreseen to increase to one fifth (21 per cent) in 2050. Between 2019 and 2050, Latin America and the Caribbean will see an increase in its share of the world’s older population from 8 per cent in 2019 to 9 per cent in 2050. Sub-Saharan Africa and Northern Africa and Western Asia will also experience a rise in their share of older persons, from 5 to 7 per cent, and from 4 to 6 per cent, respectively. As populations age, shares of working-age (25 to 64 years) and older (65+ years) persons rise, while shares of children (0 to 14 years) and youth (15 to 24 years) fall. In 1990, the working age population (25 to 64 years) constituted the largest share of the global population (42 per cent), followed by children aged 0 to 14 years (33 percent), youth aged 15 to 24 years (19 per cent) and older persons aged 65 years or over (6 per cent) (figure 2). Between 1990 and 2050, the share of the older as well as the working age population will increase to 16 per cent and to 49 per cent of the world’s population respectively, while the share of children and youth will drop to 21 per cent and 14 per cent respectively. The speed of population ageing is fastest in Eastern and South-Eastern Asia. Between 2019 and 2050, 9 out of the 10 countries with the largest percentage point increase in the share of older persons in the world will be in Eastern and South-Eastern Asia (figure 3). The Figure 1. Distribution of population aged 65 years or over by region, 2019 and 2050 (percentage) 5 4 17 37 8 1 0 29 Sub-Saharan Africa Northern Africa and Western Asia Central and Southern Asia Eastern and South-Eastern Asia Latin America and the Caribbean Australia and New Zealand Oceania Europe and Northern America
    2019
    2050 7
    6
    21
    37
    9
    1
    0
    19
    2050
    Source: United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Prospects 2019.
    *Excluding Australia and New Zealand.
    World Population Ageing 2019: Highlights 7
    United Nations, Department of Economic and Social Affairs, Population Division
    largest increase is foreseen in the Republic of Korea
    (23 percentage points), followed by Singapore
    (20.9 percentage points) and Taiwan Province of
    China (19.9 percentage points). Spain will be the
    only country in Europe to remain among the 10
    countries with the largest increase in the share of
    older persons by 2050.
    All regions have experienced an increase of life
    expectancy, with the largest gains in sub-Saharan
    Africa.
    In addition to the significant role of fertility decline,
    improvements in survival into older ages have also
    contributed significantly to population ageing (Lee
    and Zhou, 2017; Murphy, 2017; Preston and Stokes,
    2012). This refers not only to improvements in life
    expectancy at birth, but also to the even more rapid
    improvements in life expectancy at older ages.
    Between 1990-1995 and 2015-2020, the global
    average life expectancy at birth has increased by 7.7
    years (12 per cent) and is projected to increase by an
    additional 4.5 years (6 per cent) between 2015-2020
    and 2045-2050 (figure 4). Sub-Saharan Africa has
    experienced the largest increase from 49.1 years in
    1990-1995 to 60.5 years in 2015-2020 (11.4 years)
    and is projected to encounter a further gain of 7.6
    years between 2015-2020 and 2045-2050.
    Throughout most of the world, survival beyond age
    65 is improving.
    Life expectancy at age 65 reflects the average
    number of additional years of life a 65-year-old
    person would live if subjected to the age-specific
    mortality risks of a given period throughout the
    remainder of his or her life. Globally, a person
    aged 65 could expect to live an additional 17 years
    in 2015-2020 and an additional 19 years by 2045-
  11. The life expectancy at age 65 is presently
    highest in Australia and New Zealand at 17.5 years
    and it is expected to increase further to 23.9 years in
    Figure 2.
    Global population by broad age groups, 1990-2050 (percentage)
    0
    20
    40
    60
    80
    100
    1990 2000 2010 2020 2030 2040 2050
    age 0-14 age 15-24 age 25-64 age 65+
    Estimates Projections
    Year
    Source: United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Prospects 2019.
    World Population Ageing 2019: Highlights 8
    United Nations, Department of Economic and Social Affairs, Population Division
    16.5
    17.0
    17.2
    17.2
    17.2
    17.2
    17.7
    19.9
    20.9
    23.0
    Brunei Darussalam
    Kuwait
    Spain
    China, Hong Kong SAR
    Thailand
    Maldives
    China, Macao SAR
    China, Taiwan Province of China
    Singapore
    Republic of Korea
    Eastern and South-Eastern Asia Europe and Northern America
    Central and Southern Asia Northern Africa and Western Asia
    Figure 3.
    Countries or areas with the largest percentage point increase in the share of older persons aged 65 years or over
    between 2019 and 2050
    Source: United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Prospects 2019.
    Figure 4.
    Life expectancy at birth by region, both sexes combined (years), 1990-2050
    Source: United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Prospects 2019.
    Excluding Australia and New Zealand. 40 50 60 70 80 90 100 1990-1995 2000-2005 2010-2015 2015-2020 2020-2025 2030-2035 2040-2045 2045-2050 Life expectancy at birth (years) Year World Sub-Saharan Africa Northern Africa and Western Asia Central and Southern Asia Eastern and South-Eastern Asia Latin America and the Caribbean Australia and New Zealand Oceania
    Europe and Northern America
    Estimates Projections
    World Population Ageing 2019: Highlights 9
    United Nations, Department of Economic and Social Affairs, Population Division
  12. At the lower end, older persons in Oceania*
    and sub-Saharan Africa are foreseen to only live an
    additional 14.0 and 14.2 years respectively in 2050.
    Women’s longevity advantage over men leads to a
    predominately female older population.
    Women tend to live longer than men. At the global
    level, in 2015-2020, women’s life expectancy at
    birth exceeds that of men by 4.8 years (table 2).
    The female advantage in average longevity was
    largest in Latin America and the Caribbean (6.5
    years), Europe and Northern America (6.1 years),
    and Eastern and South-Eastern Asia (5.3 years). In
    contrast, the female advantage is smaller in Central
    and Southern Asia (2.7 years), Oceania (3.0 years),
    and sub-Saharan Africa (3.5 years). The female
    survival advantage persists into older ages.
    Globally, women at age 65 are expected to live
    another 18 years, while men at the same age add on
    the average an additional 16 years to their lives in
    2015-2020. The gender gap in life expectancy at age
    65 is largest in regions with high life expectancy at
    birth, such as Eastern and South-Eastern Asia (3.4
    years), Europe and Northern America (3.1 years),
    and Latin America and the Caribbean (2.8 years).
    In contrast, the gender gap is smallest in regions
    with generally low life expectancy at birth, such as
    Oceania (0.6 years), Central and Southern Asia (1.1
    years), and sub-Saharan Africa (1.3 years).
    Projections indicate that in 2050 women will
    comprise 54 per cent of the global population
    aged 65 or over. Since the gender gap in survival
    rates between men and women is narrowing, the
    sex balance among persons aged 80 years or over
    will become more even. In 2050, the proportion of
    women among the total population aged 80 years
    or over is projected to slightly decline to 59 per cent
    from 61 per cent in 2019.
    Table 2.
    Life expectancy at birth and at age 65 by sex, world and regions, 2015-2020 (years)
    Source: United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Prospects 2019.
    *Excluding Australia and New Zealand.
    Life expectancy at birth (years) Life expectancy at age 65 (years)
    Region Both sexes Female Male
    Difference
    between
    female and
    male Both sexes Female Male
    Difference
    between
    female and
    male
    World 72.3 74.7 69.9 4.8 17.0 18.3 15.6 2.7
    Sub-Saharan Africa 60.5 62.3 58.8 3.5 12.8 13.4 12.1 1.3
    Northern Africa and Western Asia 73.5 75.7 71.3 4.4 16.0 17.1 14.8 2.3
    Central and Southern Asia 69.5 70.9 68.2 2.7 14.7 15.2 14.1 1.1
    Eastern and South-Eastern Asia 76.3 79.0 73.7 5.3 17.2 18.9 15.5 3.4
    Latin America and the Caribbean 75.2 78.5 72.0 6.5 18.2 19.5 16.7 2.8
    Australia and New Zealand 83.0 85.0 81.1 3.9 21.2 22.6 19.9 2.7
    Oceania, excluding Australia and
    New Zealand 66.3 67.8 64.9 3.0 12.6 12.9 12.3 0.6
    Europe and Northern America 78.5 81.6 75.4 6.1 19.1 20.5 17.4 3.1
    A group of older persons seated outside a tourist hotel in Gueong-Ju, 1981, UN Photo/ Hanns Maier
    World Population Ageing 2019: Highlights 11
    United Nations, Department of Economic and Social Affairs, Population Division
    The percentage of older persons is often used as
    the main indicator to analyse population ageing.
    In understanding the socioeconomic implications
    of population ageing, several measures have
    been developed to account for the diversity
    of capacities and dependencies across ages.
    While earlier concepts focused on the simple
    relationship between older and younger agegroups, more recently developed measures take
    into consideration increased life-expectancies
    or combine economic and demographic data to
    analyse the interrelationships between economic
    contribution and dependency and age structure.
    The latter have become possible with the increased
    availability of data necessary to assess the socioeconomic realities of ageing societies. There are
    three measures of population ageing that are used
    to examine the shifting population age structures
    for intergenerational support systems, namely,
    old-age dependency ratio, the prospective oldage dependency ratio and the economic old-age
    dependency ratio.
    A. Population ageing seen from a
    conventional perspective: the old-age
    dependency ratio
    The old-age dependency ratio (OADR) is defined
    as the number of old-age dependents (persons aged
    65 years or over) per 100 persons of working age
    (aged 20 to 64 years). This metric approximates the
    implied economic dependency associated with a
    growing share of the population at older ages. The
    OADR is one of the most commonly used indicators
    for monitoring changes in the age structure of
    populations. With declining fertility and increased
    longevity, the relative size of older age groups is
    increasing while the proportion of younger age
    groups is declining. Indeed, another way to assess
    population ageing is to consider the dependency
    ratio associated to the younger population, defined
    as the number of persons under age 20 relative to
    the number of persons aged 20-64. The long-term
    decline of this child dependency ratio is another
    indicator of population ageing.
    The old-age dependency ratio is projected to
    increase in all regions of the world, particularly in
    Eastern and South-Eastern Asia and Latin America
    and the Caribbean.
    Figure 5 presents the estimated and projected
    OADR for the world and by region. Since 1990s,
    the OADR has continuously increased across
    all regions, although the level and speed of this
    increase vary. Globally, there were 16 persons aged
    65 years or over per 100 persons aged 20-64 years
    in 2019. In 2050, the global OADR is projected to
    increase to 28 older persons for every 100 workingage persons.
    In Europe and Northern America, there were 30
    older persons per 100 working age persons in 2019,
    a ratio that is projected to rise sharply, reaching 49
    in 2050. In Australia and New Zealand, the OADR
    is projected to increase from 27 in 2019 to 42 in
    2050.
    The OADR is expected to more than double between
    2019 to 2050 in Eastern and South-Eastern Asia,
    Latin America and the Caribbean, Northern Africa
    and Western Asia, and Central and Southern Asia.
    In Eastern and South-Eastern Asia, the OADR
    will rise from 18 older persons per 100 workers in
    2019 to 43 in 2050, while in Latin America and the
    Caribbean it will increase from 15 in 2019 to 33 in
  13. In Northern Africa and Western Asia as well
    as in Central and Southern Asia the ratios are also
    expected to more than double from around 10 in
    2019 to 22 per 100 in 2050.
    In contrast, the OADR is relatively low in Oceania
    (excluding Australia and New Zealand) and subSaharan Africa but is expected to increase gradually
    from 8 and 7 persons in 2019 to 14 and 9 in 2050,
    respectively.
    Measures of population ageing
    World Population Ageing 2019: Highlights 12
    United Nations, Department of Economic and Social Affairs, Population Division
    Figure 5.
    Estimated and projected old-age dependency ratios by region, 1990-2050
    Source: United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Prospects 2019.
    *Excluding Australia and New Zealand
    Figure 6.
    Ten countries or areas with the highest old-age dependency ratio (65+/20-64), 2019 and 2050
    Source: United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Prospects 2019.
    *Excluding Australia and New Zealand.
    ** China, Taiwan Province of China.
    36
    36
    37
    37
    37
    37
    38
    39
    39
    51
    Bulgaria
    Germany
    France
    US Virgin Islands
    Greece
    Martinique
    Portugal
    Italy
    Finland
    Japan
    2019
    Eastern and South-Eastern Asia
    Europe and Northern America
    65
    68
    71
    71
    71
    74
    75
    78
    79
    81
    Slovenia
    Martinique
    China, Hong Kong SAR
    China, Taiwan**
    Portugal
    Italy
    Greece
    Spain
    Rep. of Korea
    Japan
    2050
    Latin America and the Caribbean
    0
    10
    20
    30
    40
    50
    1990 2000 2010 2020 2030 2040 2050
    OADR
    Year
    World Sub-Saharan Africa
    Northern Africa and Western Asia Central and Southern Asia
    Eastern and South-Eastern Asia Latin America and the Caribbean
    Australia and New Zealand Oceania*
    Europe and Northern America
    Estimates Projections
    World Population Ageing 2019: Highlights 13
    United Nations, Department of Economic and Social Affairs, Population Division
    While the countries or areas with the highest oldage dependency ratio are predominantly European
    at present, more Asian countries and areas will be
    among this group in 2050.
    Figure 6 presents the 10 countries or areas with the
    highest OADR in 2019 and 2050. With 51 persons
    aged 65 years or over per 100 persons aged 20 to 64
    years, Japan currently has the highest OADR in the
    world.
    Among the countries with the highest OADR today,
    seven countries are in Europe, and two countries or
    areas are in Latin America and the Caribbean. All
    of the ten most aged countries or areas in the world
    have at present an OADR above 35.
    Projections indicate that in 2050, Japan will remain
    the country with the highest OADR (81), followed
    by countries or areas in Eastern and South-Eastern
    Asia (3), Europe and Northern America (5), and
    Latin America and the Caribbean (1).
    B. Measuring population ageing
    considering remaining years to live: The
    prospective old-age dependency ratio
    While the OADR is useful as a simple metric to
    describe changes in the population structure, it
    is based on chronological age, usually using a set
    threshold of age 65 or older. However, the OADR is a
    poor proxy for the level of dependency experienced
    in a population and it does not take into account
    that, first, older persons are quite diverse with
    respect to both economic activity, including labour
    force participation and functional capacity, and,
    second, not all persons in the traditional working
    ages are active in the labour force with some being
    economically dependent themselves.
    Prospective measures that redefine population
    ageing based on remaining life expectancy instead
    of basing it on the number of years lived, capture
    increases in life expectancy in a population over
    time. One such measure is the prospective old age
    dependency ratio (POADR) that defines old age
    based on remaining life expectancy of 15 years
    (Sanderson and Scherbov, 2005 and 2007).7
    The
    7

POADR is calculated as the number of persons
above the age closest to a remaining life expectancy
of 15 years relative to the number of persons
between age 20 and that age.8
Trends in the prospective old-age dependency ratio
suggest slower increases in dependency in many
countries compared to the traditional old-age
dependency ratio.
Trends in the POADR suggest slower increases or
even declines in dependency in many countries
with substantial older populations compared to the
projections of the traditional old-age dependency
ratio (figure 5). This pattern can be observed at
the global level, where the prospective old-age
dependency ratio has slightly declined from 12.9
in 1990 to 11.6 in 2019, (-10 per cent), but it is
projected to increase from 11.6 in 2019 to 17.3
by 2050 (+50 per cent) (figure 7). Compared to
the OADR, the POADR generally increases at a
slower pace. For example, while the global OADR
is projected to increase by 79 per cent from 2019
to 2050 (figure 8), the global POADR will increase
only by about 50 per cent (figure 10).
The fastest increase will occur in Eastern and
South-Eastern Asia, where the POADR is projected
to increase from 12 in 2019 to 25 in 2050 (+107
per cent). The slowest increase will occur in subSaharan Africa, where the POADR remains almost
unchanged at around 10 in both 2019 and 2050.
Countries or areas with the highest prospective oldage dependency ratio are predominantly in Europe.
Figure 8 presents the 10 countries or areas with the
highest prospective old-age dependency ratios in
2019 and 2050. In 2019, 9 out of 10 countries with
prospective old-age dependency ratios above 21
were in Europe. Bulgaria has the highest POADR
with a value of 30 in 2019 and will maintain in
the lead with a ratio of 36 in 2050. Among the 10
countries or areas with a POADR of over 32 in
2050, 7 are projected to be in Europe, 1 (Republic
of Korea) will be in Eastern and South-Eastern
8
A detailed description of the methodology to calculate the prospective
old age dependency ratio can be found in Sanderson and Scherbov
(2005 and 2007).
World Population Ageing 2019: Highlights 14
United Nations, Department of Economic and Social Affairs, Population Division
Figure 7.
Estimated and projected prospective old-age dependency ratios by region, 1990-2050
Source: Calculations provided by Warren Sanderson and Sergei Scherbov using World Population Prospects 2019 data based on the methods
developed by Sanderson and Scherbov (Sanderson and Scherbov, 2005, 2010, 2015).
Figure 8.
Ten countries or areas with the highest prospective old-age dependency ratio, in 2019 and 2050
22
22
22
23
24
25
25
26
27
30
Japan
Germany
Hungary
Romania
Georgia
Latvia
Croatia
Ukraine
Serbia
Bulgaria
2019
32
32
33
33
33
33
34
35
36
36
US Virgin Islands
Greece
Bosnia and Herzeg.
Romania
Ukraine
Portugal
Rep. of Korea
Italy
Martinique
Bulgaria
2050
Eastern and South-Eastern Asia Latin America and the Caribbean
Europe and Northern America
Source: provided by Warren Sanderson and Sergei Scherbov based on the methods outlined in Sanderson and Scherbov (2005, 2010, 2015).
0
5
10
15
20
25
30
1990 2000 2010 2020 2030 2040 2050
World Sub-Saharan Africa
Northern Africa and Western Asia Central and Southern Asia
Eastern and South-Eastern Asia Latin America and the Caribbean
Australia and New Zealand Oceania*
Europe and Northern America
Projections
Year
POADR
Estimates
World Population Ageing 2019: Highlights 15
United Nations, Department of Economic and Social Affairs, Population Division
Asia, and 2 (Martinique and United States Virgin
Islands) in Latin America and the Caribbean.9
C. Measuring population ageing from an
economic perspective: The economic oldage dependency ratio
In addition to chronological age and prospective
age measures discussed earlier, population ageing
can also be understood and measured from an
economic perspective. Economic measures related
to population ageing use labour force participation
rates or full lifecycle economic behaviour of
National Transfer Accounts, abbreviated as NTA
9
Sanderson and Scherbov explain these differences as follows:
When looking across countries in one time period, the age structure
underlying the OADR and the POADR is the same. Differences in the
values of both measures arise from differences in the old-age threshold.
The OADR assumes old-age begins at age 65 while the POADR
assumes that it begins at the age when the remaining life-expectancy
is 15 years. Eastern European and Central Asian countries with lower
life expectancy at older ages do worse when the prospective OADR is
used (e-mail correspondence 2 July 2019).
(United Nations, 2013; Lee and Mason, 2011; Mason
and others, 2017) (box 1). This section employs the
concepts of NTA, which is a comprehensive system
of age-based accounting of economic flows that
draws from analytical methods of demography and
economics to examine how economic resources
are reallocated across individuals of different ages
through the family, the government and the market.
In capturing the interactions between demography
and economy, the economic old-age dependency
ratio (economic OADR) uses information about
the population, consumption and production
in a given economy, disaggregated by age. The
economic OADR is defined as the effective number
of consumers aged 65 years or over divided by the
effective number of workers at all ages (in practice,
the ratio is often multiplied by 100).10
10
Box 1. What are national transfer accounts (NTA)?
The national transfer accounts (NTAs) provide a linkage between population and the economy. It examines
economic lifecycle of individuals and analyses the interaction between various support mechanisms of
individuals, such as public and private transfer systems, capital markets or own work. This body of work
has become increasingly important for policy makers as they are looking for responses on how to address
concerns about the consequences for standards of living and the sustainability of government programmes
arising from the fertility decline and population ageing.
Individuals go through extended periods of dependency at the beginning and end of their life: children and
older persons consume more resources than they produce through their own labour. Conversely, workingage adults produce more than they consume. The relative size of these age groups as well as the extent of their
dependency determine the support needed from the working-age population. What makes this economic
lifecycle possible is the flow of resources over time and across generations through a complex system of
social, economic and political institutions. NTA provides methodologies to improve the understanding of
how population growth and changing age structures influence economic growth, gender and generational
equity, public finances and other important macro-economic features.
In analysing changing age structures in relation to the economy, the NTA creates age profiles of labour income
and consumption across countries using a standardized approach (United Nations, 2013). One important
feature of NTA is the estimation of economic resource flows between age groups, which shows how each age
group relies on sharing and saving to support consumption at all stages of life-transfers and assets.
NTAs are compiled from a variety of data sources, ranging from national income and product accounts,
government financial statistics and administrative records to nationally representative income and expenditure
surveys, labour-force surveys, health-expenditure surveys and special purpose household surveys. Details
on the methodology are explained in the National Transfer Accounts Manual (United Nations, 2013) and
other publications (Lee and Mason, 2011, 2010, 2006). By 2018, more than 90 countries had research teams
to create NTA estimates that map the generational economy, with teams located at universities, research
organizations and government agencies.
World Population Ageing 2019: Highlights 16
United Nations, Department of Economic and Social Affairs, Population Division
One of the advantages of this measure is that it
incorporates age-specific variations in labour
income and consumption that result from differences
across countries in labour force participation,
unemployment, hours worked, productivity and
consumption. The ratio reflects the resource
needs (namely, the consumption) of older persons
relative to the resources (namely, labour income)
produced by all workers irrespective of their age.
An increasing economic OADR means that the
number of effective older consumers per effective
worker is increasing. This in turn can change the
demand for and the financing of goods and services,
such as pensions and health care. To sustain a given
level of old-age consumption, older persons have in
principle the following options: 1) work (i.e., earn
labour income); 2) draw income from their assets,
3) get economic support from their families and/or
from public transfer programmes. As an alternative
or complementary financial strategy, older person
may decide to reduce their consumption.
The economic old-age dependency ratio is
increasing around the world.
According to the latest NTA calculations,
population ageing leads to a global increase from
20 effective older consumers (age 65+) per 100
effective workers (all ages) in 2019 to 33 by 2050
(figure 9). Currently, two regions, namely Europe
and Northern America, and Australia and New
Zealand, have the highest economic OADR of 43
and 36, respectively. These high ratios are explained
by the high consumption at older ages relative to
younger ages, and by an increasing share of older
persons in the population. Similar high ratios at
around 40 effective older consumers for every
100 effective workers are projected for two other
regions: Eastern and South-Eastern Asia by 2040
and Latin America and the Caribbean by 2050.
Sub-Saharan Africa and Oceania* are currently
experiencing the lowest economic OADR at 7 and
9 respectively, although these ratios are projected
to increase gradually to 10 (sub-Saharan Africa)
Figure 9.
Estimated and projected economic old-age dependency ratios by region, 1990-2050
Source: Andrew Mason and Ronald Lee, based on the method outlined in Mason and others (2017). Support ratios and demographic dividends:
Estimates for the world. United Nations Population Division Technical Paper No. 2017/1.
Note: These economic ratios employ population estimates and projections from United Nations World Population Prospects 2019 and
consumption and labour income age profiles from 60 countries with NTA plus 106 modelled countries, yielding NTA estimates for 166 countries.
0
10
20
30
40
50
60
70
1990 2000 2010 2020 2030 2040 2050
Economic OADR
World Sub-Saharan Africa
Latin America and the Caribbean Northern Africa and Western Asia
Australia/New Zealand Central and Southern Asia
Oceania* Eastern and South-Eastern Asia
Europe and Northern America
Year
Estimates Projections
World Population Ageing 2019: Highlights 17
United Nations, Department of Economic and Social Affairs, Population Division
and 15 (Oceania) in 2050 (figure 9). Policies such as increasing employment opportunities for young people, enhancing the productivity of the current workforce, investing in health and education, and creating conditions conducive to sustained economic growth are imperative to maintain or even increase standards of living of all. Countries or areas with the highest economic oldage dependency ratio are mostly located in Europe and Northern America. Countries or areas with the highest economic OADR are mostly found in Europe and Northern America. Japan is the most aged country in the world and will continue to hold this lead by 2050, based both on the conventional OADR (figure 6) and the economic OADR (figure 10). Other countries or areas in the list of 10 countries with the highest economic OADR are Finland, France, Germany, Denmark, Greece, Sweden, Italy, the Netherlands and the United States Virgin Islands (figure 10). All these countries have economic ratios of 50 or more effective older consumers per 100 effective workers in 2019. By 2050, the economic OADRs in these countries or areas are projected to reach values of 89 or higher. By mid-century, Slovenia, Spain, Puerto Rico, Portugal, Switzerland and the Republic of Korea are expected to replace Finland, France, Denmark, Sweden, the Netherlands and the United States Virgin Islands among the 10 countries with the highest economic OADRs, while Japan, Germany, Greece and Italy are expected to remain in this group. Figure 10. Ten countries or areas with the highest economic old-age dependency ratio, 2019 and 2050 Source: Andrew Mason and Ronald Lee, based on the method outlined in Mason and others (2017). Support ratios and demographic dividends: Estimates for the world. United Nations Population Division Technical Paper No. 2017/1. Note: These economic ratios employ population estimates and projections from United Nations World Population Prospects 2019 and consumption and labour income age profiles from 60 countries with NTAs plus 106 modelled countries, yielding NTA estimates for 166 countries. 50 50 50 52 53 53 54 55 57 78 US Virgin Islands Netherlands Italy Sweden Greece Denmark Germany France Finland Japan 2019 Eastern and South-Eastern Asia Europe and Northern America 89 89 89 91 92 93 93 97 107 127 Rep. of Korea Germany Switzerland Portugal Puerto Rico Spain Slovenia Italy Greece Japan 2050 Latin America and the Caribbean World Population Ageing 2019: Highlights 18 United Nations, Department of Economic and Social Affairs, Population Division Box 2. How much do we consume and produce over our lifecycle? The economic life cycle is a universal feature of all contemporary societies. At the beginning and the end of our lives when we generally consume more than we produce through own labour, while in the middle years of our lifecycle, we generally produce more than we consume. Figure 11 compares the per capita consumption and labour income of Sweden and Republic of Korea. The labour income age profile, an inverse U-shape, is broadly similar for Sweden and the Republic of Korea, with labour income rising steeply for those in their 20s, reaching a peak around age 40 and declining thereafter. The largest differences in labour income by age between the two countries occur at older ages. In Sweden, labour income is more concentrated within the later middle years, between age 40 and 60, while it is concentrated in earlier life cycle between age 30 and 50 in the Republic of Korea. Consumption patterns also vary substantially. In Sweden, consumption increases at older ages as a consequence of high healthcare costs. In contrast, consumption remains flat at older ages in the Republic of Korea at about 60 per cent of a prime working-age adult’s labour income. Consumption among children in the Republic of Korea takes up a higher proportion of labour income than in Sweden, with about 80 per cent in the Republic of Korea compared to about 60 per cent in Sweden. When do we become economically independent? One way to determine when we become economically independent is to examine at what age we produce more than we consume. Figure 11 shows that individuals become economically independent between age 26 and 63 in Sweden, while it is between age 28 and 56 in the Republic of Korea (the age range between the first and second crossing of the two lines). Figure 11. Per capita consumption and labour income across the lifecycle, Sweden (2003) and Republic of Korea (2012) Source: NTA Database. Available from http://www.ntaaccounts.org. Accessed on 3 June 2019. NOTE: NTA defines labour income comprehensively to include the value of most productive work: the earnings of employees, employer-provided benefits, taxes paid to the government by employers on behalf of employees, the proportion of entrepreneurial income that is a return to labour, and the estimated value of unpaid family labour. Consumption in NTA includes goods and services from both public and private sources. 0.0 0.2 0.4 0.6 0.8 1.0 1.2 Relative to per capita labour income for ages 0 10 20 30 40 50 60 70 80 30-49 Sweden, 2003 Consumption Labour Income Labour income exceeds consumption 26 63 Age 0.0 0.2 0.4 0.6 0.8 1.0 1.2 0 10 20 30 40 50 60 70 80 Relative to per capita labour income for ages 30-49 Republic of Korea, 2012 Labour income exceeds consumption 28 56 World Population Ageing 2019: Highlights 19 United Nations, Department of Economic and Social Affairs, Population Division D. Comparing the three measures: The OADR, POADR and economic ratios The three measures presented above, old-age dependency ratio (OADR), prospective old age dependency ratio (POADR) and the economic oldage dependency ratio examine population ageing from different perspectives applying different methods resulting at different levels and pace of population ageing. Depending on the objectives of users, each measure offers a different perspective and serves a different purpose. The following paragraphs present a comparative analysis of the results of the three measures discussed. Comparing the POADR with the OADR, the POADR is found to be lower in all regions, except in sub-Saharan Africa and Oceania (table 3). In
2019, the POADR ratio is only half of the ratio
of the OADR in Australia and New Zealand, and
more than half (60 percent) of the OADR in Europe
and Northern America, and Latin America and
the Caribbean. POADR values are the same as the
OADR values for Central and South-Eastern Asia
in 2019. That is, the POADR shows that population
ageing is less severe than computed by using the
OADR in these regions when lifespans lengthen.
Similar trends are found in the coming decades in
all regions except sub-Saharan Africa and Oceania.
The economic old-age dependency ratio is slightly
higher than the OADR in all regions (table 3).
Europe and Northern America, and Australia and
New Zealand have larger economic OADRs than
others, implying that from an economic perspective,
population ageing is more advanced in these
regions than compared to other regions (table 3).
This result is not surprising given the relatively high
old-age consumption in these regions. In contrast,
population ageing in sub-Saharan Africa, Northern
Africa and Western Asia, Eastern and SouthEastern Asia and Oceania at present is relatively
less severe economically compared to other regions
and will remain so for the foreseeable future. This
is because older persons in most countries in these
regions continue to work longer11 and consume
relatively less than other age groups.
Measures of population ageing inform policy
makers about the shift of population age structures
towards older populations over time and allow
for comparisons across countries and regions,
spurring the development of public policy. Each
measure offers different perspectives and fits
different purposes, with its own advantages and
disadvantages.
The OADR is an indicator of the changing
population age structure that is simple to compute
and easy to comprehend. The data for calculating
this indicator are available for all countries and
11 NTA measures work in both formal and informal sectors. The
labour income measure is comprehensive to take into account of full
time and part-time employment in both formal and informal sectors,
unemployment, and productivity.
Table 3.
A comparison of the different methods of old-age dependency ratios by region, 2019 and 2050
Source: OADR is tabulated from United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Prospects

  1. POADR is provided by Warren Sanderson and Sergei Scherbov based on the methods outlined in Sanderson and Scherbov (2005, 2010 and
    2015). Economic ratio is provided by Andrew Mason and Ronald Lee based on the method outlined in Mason and others (2017).
    Excluding Australia and New Zealand. POADR divided by OADR Economic OADR divided by OADR Region 2019 2050 2019 2050 World 0.7 0.6 1.2 1.2 Sub-Saharan Africa 1.4 1.1 1.1 1.0 Northern Africa and Western Asia 0.9 0.6 1.1 1.1 Central and Southern Asia 1.0 0.8 1.2 1.2 Eastern and South-Eastern Asia 0.7 0.6 1.1 1.1 Latin America and the Caribbean 0.6 0.5 1.2 1.1 Australia and New Zealand 0.5 0.5 1.3 1.3 Oceania 1.5 1.1 1.1 1.1
    Europe and Northern America 0.6 0.5 1.4 1.4
    World Population Ageing 2019: Highlights 20
    United Nations, Department of Economic and Social Affairs, Population Division
    areas of the world over a long period of time. The
    OADR, however, does not fit well with studying a
    particular health or pension reforms nor should it
    be used as a measure of strict economic dependency.
    The POADR examines population ageing in the
    context of increasing life expectancies. It suggests
    that population ageing is not as advanced and is not
    proceeding as fast as the conventional measure of
    population ageing (the OADR), especially in highincome countries. While the average life expectancy
    in a population increases, lower income groups and
    certain disadvantaged groups may not have the same
    experience, for example, in the United Kingdom
    and the United States. A number of studies have
    found that better-educated, higher-income people
    enjoy longer life expectancies than less-educated,
    lower-income people (Auerbach and others, 2017;
    Bennet and others, 2018; NASEM, 2015; Waldron,
    2007) and have suggested that policy reforms should
    consider the longevity gaps within countries.
    The economic OADR integrates the patterns of
    consumption and production and the changes
    of the population age structure into a synthetic
    “economic” dependency ratio. This approach allows
    for an explicit linkage between population ageing
    and the generational economy, providing useful
    information for fiscal and social planning. The
    use of NTAs has been expanding during the last
    few decades (the current membership includes 90
    countries), and an increasing number of countries
    have been generating multiple country data
    estimates, for different points in time.
    World Population Ageing 2019: Highlights 21
    United Nations, Department of Economic and Social Affairs, Population Division
    age financing is based on assets and either public
    transfers or private transfers, found in Australia,
    Mexico, Spain, United Kingdom, United States
    as well as in Jamaica and Singapore; (4) Balanced,
    where old-age consumption is financed by drawing
    on all four sources, namely assets, labour income,
    both public and private transfers, consisting of
    countries found mainly in Eastern Asia.
    Older persons in Europe and Latin America rely
    on public transfers to fund more than two thirds of
    their consumption.
    In Public transfer dominant countries (figure 12a)
    the contribution of public transfers to finance
    consumption in old age ranges from slightly more
    than 50 per cent in the case of Chile and Uruguay to
    almost 100 per cent in Sweden. Net public transfers,
    that is, the net of transfer inflows and outflows,
    support about 70 per cent or more of old-age
    consumption in many European countries such as
    Austria, Germany, France, Finland, Hungary, Italy
    and Sweden. In Latin America, net public transfers
    fund about two thirds of old-age consumption in
    Costa Rica, Ecuador and Peru. The exception is
    Brazil, where the generous public transfer systems
    (social security and others) finance about 90 per
    cent of old-age consumption.
    Assets are the primary source of support for older
    persons in countries where transfers are low, such as
    in Southern Asia and South-Eastern Asia.
    In the Asset dominant cluster, countries rely only
    to a limited extent on transfers and thus assets
    become the primary source for support in old age.
    When public transfer systems are less established
    and private transfers are limited, individuals need
    to save and accumulate assets for retirement.
    This phenomenon is found in several countries
    in Southern Asia and South-Eastern Asia such
    as Cambodia, India, Indonesia, Philippines, and
    Thailand (Asset dominant cluster in figure 12a). In
    addition, El Salvador and South Africa face similar
    experiences.
    The objective of this section of these highlights
    is to illustrate how older persons finance their
    consumption in different countries through
    transfers, assets and work. It investigates the effect
    of demographic change on each of the financing
    mechanisms by employing the National Transfer
    Accounts (NTA) projections on transfers, assets
    and work for 29 countries with available data.12,
    13 The present analysis assesses the impact of
    population ageing on assets, transfers and work
    should the current old-age funding mechanisms in
    these countries remain in place. While it provides
    useful insights of changes across space and time, it
    does not substitute for country-specific analysis and
    forecasting.
    A. How older persons fund their
    consumption: Transfers, assets, and work
    Consumption of older persons is funded in different
    ways around the world.
    Older persons fund their consumption from four
    different sources: (1) Public programmes such
    as pensions, health care and other social welfare
    programmes, (2) transfers from family members or
    other private sources (3) own assets and wealth, and
    (4) their own labour income.
    Figures 12a and 12b illustrate the shares of
    consumption of persons aged 65 or over according to
    four sources of funding mentioned above, clustered
    into four groups: (1) Public transfer dominant,
    where old-age financing relies predominantly
    on public transfers, mainly found in Europe and
    Latin America; (2) Asset dominant, where old-age
    financing depends mainly on income from assets,
    prevalent in countries in Southern Asia and SouthEastern Asia; (3) Dual balanced, where old12 The calculations were generously provided by Andrew Mason and
    Ronald Lee (2018) using estimates and projections from the World
    Population Prospects and NTA age-profiles for the 29 countries.
    13 Australia and New Zealand (1 country), Central and Southern Asia
    (1 country), Eastern and South-Eastern Asia (8 countries and areas),
    Europe and Northern America (11 countries), Latin America and the
    Caribbean (7 countries), Sub-Saharan Africa (1 country).
    How does population ageing affect assets,
    transfers and work?
    World Population Ageing 2019: Highlights 22
    United Nations, Department of Economic and Social Affairs, Population Division
    Figure 12a.
    Income sources to finance old-age consumption at ages 65 years or over, public transfer dominant and asset
    dominant clusters, circa 2005 (percentage)
    54
    98
    66 60 64 58
    73
    92
    68 70 79
    64 62
    53
    89 83
    -18 -13
    4
    5
    -20 -3
    6
    -7 -7
    2
    0
    -9
    3
    -34
    48
    5
    24 25 33
    29
    20
    -5
    36 33 14
    -7
    31
    22
    26
    12
    15 10
    6 10
    23
    17 8
    8 3 3
    5
    43
    16
    23
    18
    6
    Uruguay
    Sweden
    Slovenia
    Poland
    Peru
    Moldova
    Italy
    Hungary
    Germany
    France
    Finland
    Ecuador
    Costa Rica
    Chile
    Brazil
    Austria
    Public transfer dominant
    Percentage of consumption
    -1 6
    -11
    1
    2
    15 5
    -24 -17
    19
    -27
    1
    9
    18
    113 92 69
    81 70
    57 61
    12
    19
    23
    44
    27 19 16
    South Africa Thailand Philippines Indonesia India El Salvador Cambodia
    Asset dominant
    Public transfers Private transfers Asset-based reallocation Labour income
    Percentage of consumption
    Source: Computed using data obtained from the NTA database. Available from http://www.ntaccounts.org. Accessed on 3 June 2019.
    Note: Both public and private transfers are net of inflows and outflows. Private transfers include both interhousehold and intrahousehold transfers.
    Data are based on the latest available year, ranging from 1998-2015.
    World Population Ageing 2019: Highlights 23
    United Nations, Department of Economic and Social Affairs, Population Division
    Assets and public transfers finance the bulk of oldage consumption in some high-income countries.
    In selected high-income countries in the Dual
    balanced cluster, assets play an important role,
    while public transfers play a more moderate role
    funding old-age consumption. More specifically,
    assets support about half of the consumption of
    older persons in Australia, Mexico, Spain, United
    Kingdom and United States, as presented in the
    Dual balanced cluster (figure 12b). In addition to
    public transfers and assets, labour income is an
    important mechanism in this cluster.14
    14 Singapore is a special case with private transfers and labour income
    as the two main funding mechanisms due to low public transfers and
    low accumulated assets for old-age.
    Figure 12b.
    Income sources of old-age consumption at aged 65 or over, dual balanced and balanced clusters, circa 2005
    (percentage)
    31 40 43
    25
    26 14
    24
    17
    18
    20 17 25
    China, Taiwan Province of China Republic of Korea China
    Balanced
    Percentage of consumption
    26
    44
    60
    -1
    27
    8
    36
    -4
    0
    -12
    46
    -20
    51 2
    57
    48
    46
    19
    66
    18
    47
    22 8
    6
    36
    26
    22 15
    United States United
    Kingdom
    Spain Singapore Mexico Jamaica Australia
    Dual balanced
    Public transfers Private transfers Asset-based reallocation Labour income
    Percentage of consumption
    Source: computed using data obtained from the NTA database. Available from http://www.ntaccounts.org. Accessed on 3 June 2019.
    Note: Both public and private transfers are net of inflows and outflows. Private transfers include both interhousehold and intrahousehold transfers.
    Data are based on the latest available year, ranging from 1998-2015. Negative private transfers occur when individuals gave private transfers more
    than receiving them.
    World Population Ageing 2019: Highlights 24
    United Nations, Department of Economic and Social Affairs, Population Division
    Private transfers finance as much as one fourth of
    the consumption of older persons in Eastern Asia,
    while such transfers are mostly small or negative in
    other regions.
    In the Balanced cluster, private or familial transfers
    play an important secondary role in Eastern Asia
    where the fiduciary duty of supporting older parents
    continues to hold. Older persons in the Republic
    of Korea and in Taiwan, Province of China, on
    average, have about one-fourth (25 per cent) of
    their consumption financed by their families,
    while the proportion in China is about 14 per cent
    (Balanced cluster in figure 12b). Private transfers
    are also important in South-Eastern Asia, financing
    about one fifth of consumption in Cambodia and
    the Philippines. In Jamaica and Singapore private
    transfers are the main sources of income for older
    persons.
    Elsewhere in other regions such as Europe and
    Northern America, and Latin America and the
    Caribbean, private transfers are minimal in
    supporting old-age consumption.15 In fact, older
    persons are giving to the younger generations
    in many countries, including Brazil, Costa Rica,
    Germany, Indonesia, France, Mexico, Republic
    of Moldova, Peru, South Africa, Spain, Sweden,
    Thailand, and United States (Public transfer
    dominant, Dual balanced and Asset dominant
    clusters in figure 12a and 12b).
    Labour income is an important tertiary or
    quaternary source that funds about 15 to 25 per cent
    of consumption of older persons in most countries
    and regions, except Europe.
    Labour force participation typically declines as
    people age. Older populations in Europe are less
    likely to be in the labour force than populations
    in other regions, due to its more developed and
    generous social security systems (World Bank,
    2014). Therefore, it is not a surprise that labour
    income is low, and that it finances 10 per cent or
    less of old-age consumption (figure 12a). However,
    labour income in other regions is quite substantial
    across all clusters (figure 12a and 12b). Some cases
    15 The exception is El Salvador and Jamaica, where private transfers
    are important.
    of relatively high labour income at the older ages
    are those of Ecuador, India and Singapore, where
    about one-third of old-age consumption is financed
    through own work (figure 12a and figure 12b).
    B. Financing old-age in coming decades:
    Projecting transfers, assets, and work
    In countries with low intergenerational transfers,
    population ageing will put substantial pressure on
    older persons to be self-reliant.
    As populations age, countries in the Asset dominant
    cluster (Cambodia, El Salvador, India, Indonesia,
    Philippines, South Africa, and Thailand) will
    experience increasing asset reallocations to finance
    consumption in old-age (figure 13). Specifically,
    asset reallocations are projected to double from
    8 per cent of total labour income in 2019 to 17
    per cent in 2050. In addition, labour income, a
    secondary source of income will gain proportional
    importance, while the shares of private and public
    transfers are projected to remain modest.
    In Europe and Latin America, population ageing
    will test the fiscal sustainability of public transfer
    systems in the long run.
    Public systems of countries in the Public dominant
    cluster (Austria, Brazil, Costa Rica, Ecuador,
    Finland, France, Germany, Hungary, Italy, Peru,
    Slovenia, Sweden, and Uruguay) will face mounting
    pressure from the rising importance of public
    transfers to finance old-age consumption (figure 13).
    As illustrated in the Public dominant cluster, the
    share of public transfers per total labour income
    is projected to almost double from 18 per cent in
    2019 to 34 per cent in 2050 (figure 13). The shares
    of assets and private transfers will remain relatively
    small at around 7 percent and negative 3 percent16,
    respectively. Measures such as increasing tax
    revenue through raising the effective retirement
    age, adjusting benefits, or increasing other (nontax) public revenues, could balance the fiscal budget
    and dampen the adverse macroeconomic effects of
    population ageing.
    16 Negative private transfers occur when older persons are giving
    more than they receive in private transfers.
    World Population Ageing 2019: Highlights 25
    United Nations, Department of Economic and Social Affairs, Population Division
    In Eastern Asia, where private transfers are
    important, population ageing will create budgetary
    pressures for families.
    Countries or areas in the Balanced cluster (China,
    Republic of Korea, and Taiwan Province of China)
    will continue to rely on all sources, with public
    transfers contributing the largest share to finance
    old-age, followed by assets, private transfers and
    work. Public transfers as a share of the total labour
    income of all ages is forecasted to more than double
    from 10 percent in 2019 to 22 percent in 2050, while
    the asset share will double from 8 percent to 17
    percent (Balanced cluster in figure 13). The largest
    percentage increase is projected to occur in the
    private transfer share; it is projected to triple from 3
    percent in 2019 to 10 percent in 2050.
    In countries where public transfers are moderate,
    both public transfers and assets are projected to
    primarily finance old-age.
    Countries in the Dual balanced cluster (Australia,
    Mexico, Spain, United Kingdom and United
    States) continue to have assets and public transfers
    as the main support sources. Assets and public
    transfers are projected to double from 12 percent
    to 21 percent, and from 10 percent to 19 percent
    respectively between 2019 and 2050 (figure 13).
    More realistically, it is expected that current age
    profiles for tax and benefit purposes will shift
    due to pension reforms that can be expected to
    be implemented in many countries in Europe
    and in Latin America, including increases in
    Figure 13.
    Estimated and projected sources of consumption of (persons aged 65 or over) as a percentage of total labour income
    of all ages, 1950-2100
    Source: Estimates and projections provided by Andrew Mason and Ronald Lee using the population estimates and medium variant projections
    of World Population Prospects 2019 and the latest available age profiles of National Transfers Accounts. The method is outlined in Mason and Lee
    (2018). Intergenerational transfers and the older population.
    Note: Asset dominant cluster: Cambodia, El Salvador, India, Indonesia, Philippines, South Africa and Thailand. Public Dominant cluster: Austria,
    Brazil, Costa Rica, Ecuador, Finland, France, Germany, Hungary, Italy, Peru, Slovenia, Sweden and Uruguay. Dual balanced cluster: Australia,
    Mexico, Spain, United Kingdom and United States. Balanced cluster: China, Japan, Republic of Korea and China, Taiwan Province of China.
    -10
    0
    10
    20
    30
    40
    50
    1950 2000 2050 2100
    Asset dominant
    Year
    Percentage of labour income
    -10
    0
    10
    20
    30
    40
    50
    1950 2000 2050 2100
    Dual balanced
    Percentage of labour income
    Year -10
    0
    10
    20
    30
    40
    50
    1950 2000 2050 2100
    Balanced
    Public transfers
    Private transfers
    Asset-based reallocation
    Labor income
    Year
    Percentage of labour income
    -10
    0
    10
    20
    30
    40
    50
    1950 2000 2050 2100
    Public transfers dominant
    Percentage of labour income
    Year
    World Population Ageing 2019: Highlights 26
    United Nations, Department of Economic and Social Affairs, Population Division
    retirement age and adjustments in pension
    benefits (European Union 2018; ECLAC 2016).
    These reforms will lead to a significant shift in
    the burden of population ageing away from
    public programmes and toward individual
    labour earnings, savings and family resources.
    In addition, the age profiles of healthcare and
    education may be shifting in some countries
    due to additional investments as the population
    ages.
    World Population Ageing 2019: Highlights 27
    United Nations, Department of Economic and Social Affairs, Population Division
    Progress toward the achievement of the Sustainable
    Development Goals (SDG) is closely linked to
    demographic trends. The present analysis has
    shown that countries or areas across the various
    regions of the world have reached different stages
    of population ageing. Forward-looking policies and
    programmes that take into account current and
    future population dynamics are needed to attain
    sustainable development as articulated in the 2030
    Agenda for Sustainable Development, including to
    fulfil the pledge to leave no one behind.
    Key policy issues and recommendations include the
    following:
  2. Population ageing can spur economic growth
    while maintaining fiscal sustainability, but
    policies and behaviour play critical roles. There
    is no single best policy response (“silver bullet”)
    to respond to population ageing in all countries.
    How countries address population ageing depends
    on the fiscal space available to implement their
    tax and benefit programmes, the extent to which
    societies agree on the values of redistribution and
    intergenerational equity, and the role they assign to
    government, families and individuals in financing
    consumption, particularly during old-age.
  3. Promoting gender equality in employment
    and adopting family-friendly policies can improve
    labour force participation and lead to more rapid
    economic growth (SDGs 5 and 8). Increasing
    women’s participation in the formal labour market
    can compensate, at least partially, for the expected
    reduction in the growth of the workforce caused
    by population ageing. In many countries, cultural,
    legal, and structural barriers prevent women from
    entering and continuing in the formal workforce at
    the same level as men. Policies to enhance female
    labour force participation include implementing
    family-friendly programmes such as affordable
    child-care, paternal and maternal leave, and parttime and flexible employment opportunities for
    both men and women.
  4. Eliminating age-related discrimination,
    including age barriers in employment, can reduce
    inequality, increase productivity and promote
    economic growth (SDGs 8, 10 and 16). Provided
    that older persons are covered by social protection
    programmes, ensuring access to employment
    opportunities to those who want to work is a key
    policy priority in promoting and protecting the
    rights and dignity of older persons. Policies in
    this area include those aimed at eliminating age
    barriers in the formal labour market, promoting
    the recruitment of and flexible employment
    opportunities for older workers, as well as
    facilitating access to microcredit and providing
    other incentives for self-employment.
  5. Investing in education and health and wellbeing for all, including lifelong learning, can
    improve productivity and maintain economic
    growth even as the share of working-age
    population shrinks (SDGs 3 and 4). Public
    investments in children and youth need to be
    maintained or increased, especially in countries at
    the initial or intermediate stages of the demographic
    transition, while governments respond to rising
    fiscal pressures for the health care and social
    security systems linked to the growing numbers of
    older persons. These investments in human capital
    for all generations, including children and youth,
    are needed to maintain and strengthen present
    and future economic prosperity and well-being. As
    employment is shifting towards jobs that require
    high-level cognitive and socio-emotional skills
    in this digital age, more emphasis will need to be
    placed on lifelong learning to keep up with changes
    in technology and maintain flexibility in skills.
  6. Promoting retirement savings can improve
    financial independence of individuals and
    increase aggregate capital accumulation (SDGs 3
    and 8). In many middle and low-income countries,
    individuals secure their financial wellbeing in old
    age mainly through their accumulated savings and
    family transfers. In fostering life-cycle savings,
    governments should ensure equal opportunity to
    Policy implications for achieving the
    Sustainable Development Goals
    World Population Ageing 2019: Highlights 28
    United Nations, Department of Economic and Social Affairs, Population Division
    access financial products that are safe, properly
    designed and actuarially fair, starting at young ages.
    Enhancing financial literacy, providing incentives
    for saving and easy or default enrolment schemes
    can greatly enhance retirement savings.
  7. Adopting social security reforms that consider
    the widening gap in longevity by socioeconomic
    status can help to reduce inequality (SDG 10).
    Increasing the retirement age as life expectancy
    increases is a well-known tool to promote the
    fiscal sustainability of retirement pension systems.
    It can also support labour force participation at
    the older working ages. When reforming social
    security systems, it is equally important to consider
    the welfare implications of a widening gap in life
    expectancy by socioeconomic status. Governments
    may wish to consider indexing the statutory age
    at retirement by socioeconomic status, whereby
    the better-educated, higher income groups that
    enjoy longer life expectancies can expect to pay
    contributions longer and receive pensions later
    compared to the less educated, lower income
    populations.
  8. Establishing universal social protection with
    adequate benefits is key to reducing poverty and
    inequality and to promoting social inclusion
    (SDGs 1, 8 and 10). Although comprehensive social
    protection systems require significant investments,
    the recurrent costs of providing basic social
    protection floors are affordable in most countries.
    Universal coverage can be achieved through either
    contributory and non-contributory schemes or a
    mix of the two, and a minimum set of tax-financed
    schemes available to all throughout the life cycle.
    Special measures tailored to the needs of certain
    disadvantaged groups may be necessary to ensure
    effective coverage and sufficient benefits for all.
  9. Promoting lifelong health and preventive
    care to maintain maximum functional capacity
    of individuals can improve health and wellbeing
    (SDG 3). As populations age, it is essential to
    ensure continued and equitable access to disease
    prevention, treatment and rehabilitation during
    all stages of life. Healthy ageing is more than the
    absence of disease, but also entails the maintenance
    of functional ability throughout the lifespan. Health
    and long-term care systems need to be aligned to
    meet the needs of ageing populations by providing
    age-appropriate integrated care and by focusing on
    maintaining the intrinsic capacity of older persons.17
  10. Fostering a balanced approach to financing
    old-age consumption can help to ensure
    generational equity and fiscal sustainability
    (SDGs 8 and 10). Public policies affect both
    current and future generations. Current generations
    bequeath future generations a wealth of tangible
    assets and knowledge. At the same time, current
    generations pass onto future generations public debt
    they will be responsible for. Balanced approaches to
    financing old-age consumption include a mixture of
    public transfers, private transfers, work and savings
    in order to spread the fiscal stress associated with
    population ageing over time and across institutions.
  11. Improving data collection and analysis of
    population and economic linkages can provide
    vital new evidence for policy making (SDG 17).
    Because economic activity varies by age, the shift in
    the age distribution of populations is bound to have
    significant economic effects. In order to achieve
    inclusive and sustainable development as societies
    undergo this demographic transformation, new
    types of data must be collected and analysed.
    National economic data, such as those routinely
    collected in national accounts and similar
    accounting systems, should be disaggregated by age,
    sex and socio-economic group to serve as a basis
    for developing evidence-based policies responding
    to the challenges of population ageing.
    17 Functional capacity is being explained in footnote 3. Intrinsic
    capacity comprises all the mental and physical capacities that a person
    can draw on and includes their ability to walk, think, see, hear and
    remember. The level of intrinsic capacity is influenced by a number
    of factors such as the presence of diseases, injuries and age-related
    changes. (World Health Organization, 2015).
    World Population Ageing 2019: Highlights 29
    United Nations, Department of Economic and Social Affairs, Population Division
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    European Union (2018). The 2018 Ageing Report. Institutional Paper 079, May 2018.
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    World Population Ageing 2019: Highlights 31
    United Nations, Department of Economic and Social Affairs, Population Division
    Annex table
    Population aged
    65 years or over
    (thousands)
    Percentage
    aged 65 years
    or over
    Old-age
    dependency
    ratio (65+
    /20-64) a
    Prospective
    old-age
    dependency
    ratio b
    Economic
    old-age
    dependency
    ratio c
    Region, development group
    country or area 2019 2030 2019 2030 2019 2030 2019 2030 2019 2030
    WORLD 702 935 997 488 9.1 11.7 15.9 20.5 11.6 13.7 19.5 24.9
    Sub-Saharan Africa 31 867 46 535 3.0 3.3 6.8 7.1 9.5 9.2 7.3 7.6
    Northern Africa and Western Asia 29 375 46 452 5.7 7.6 10.2 13.6 8.7 10.1 11.1 14.6
    Central and Southern Asia 119 046 178 841 6.0 8.0 10.5 13.5 10.9 12.6 13.0 16.5
    Eastern and South-Eastern Asia 260 582 383 337 11.2 15.8 17.8 26.2 12.3 16.6 20.2 30.2
    Latin America and the Caribbean 56 411 84 577 8.7 12.0 14.8 20.1 9.2 11.2 17.0 22.7
    Oceania (excluding Australia and New Zealand) 504 779 4.2 5.3 8.1 10.0 11.9 13.2 8.4 10.4
    Australia and New Zealand 4 778 6 507 15.9 19.5 27.1 34.9 13.1 16.2 35.4 45.5
    Europe and Northern America 200 372 250 461 18.0 22.1 30.1 39.2 17.7 21.1 41.8 54.4
    Developed regions 240 674 294 247 18.9 22.9 32.0 40.7 18.0 21.3 45.2 57.5
    Less developed regions 462 261 703 242 7.2 9.7 12.6 16.9 10.8 13.0 14.1 19.0
    Less developed regions, excluding least developed
    countries 425 440 647 924 7.9 10.9 13.3 18.5 11.1 13.8 15.0 20.9
    Less developed regions, excluding China 292 807 448 424 5.9 7.8 10.8 13.9 9.8 11.3 13.6 17.9
    Least developed countries 36 821 55 318 3.6 4.2 7.6 8.5 8.8 8.9 8.0 8.9
    Land-locked Developing Countries (LLDC) 19 505 29 848 3.7 4.5 8.0 9.1 9.1 9.4 8.3 9.4
    Small island developing States (SIDS) 6 228 9 312 8.7 11.9 15.2 20.8 10.3 12.3 16.5 22.3
    High-income countries 226 626 285 952 18.0 22.0 30.2 38.7 16.0 19.0 43.8 55.7
    Middle-income countries 451 110 674 261 7.9 10.8 13.5 18.4 11.6 14.2 15.1 20.6
    Upper-middle-income countries 275 611 409 445 10.4 14.8 16.7 24.6 12.6 16.5 18.0 27.1
    Lower-middle-income countries 175 499 264 816 5.7 7.6 10.4 13.3 10.8 12.5 12.3 15.6
    Low-income countries 24 878 36 780 3.3 3.7 7.4 7.8 9.1 8.7 7.7 8.0
    AFRICA 45 526 67 750 3.5 4.0 7.6 8.4 9.5 9.4 8.2 9.0
    Eastern Africa 12 583 18 979 2.9 3.3 6.6 7.0 7.9 7.7 6.5 6.9
    Burundi 267 455 2.3 2.9 5.5 6.5 7.4 7.7 5.3 6.1
    Comoros 26 41 3.1 3.8 6.5 7.6 8.9 9.9 6.9 8.1
    Djibouti 45 72 4.6 6.4 8.1 10.8 8.7 10.6 8.7 11.3
    Eritrea 158 179 4.5 4.2 10.3 8.6 12.7 9.7 9.6 8.2
    Ethiopia 3 941 5 546 3.5 3.8 7.9 7.7 8.3 7.6 7.6 7.4
    Kenya 1 274 2 276 2.4 3.4 5.1 6.5 6.0 7.1 5.9 7.6
    Madagascar 821 1 329 3.0 3.7 6.7 7.7 8.2 8.5 6.4 7.3
    Malawi 492 702 2.6 2.8 6.2 6.0 8.0 7.1 5.5 5.3
    Mauritius* 152 229 12.0 18.0 19.0 29.0 13.0 18.6 19.7 29.4
    Mayotte* 11 18 4.1 5.2 9.0 10.3 4.9 4.9 .. ..
    Mozambique 874 1 170 2.9 2.8 6.9 6.3 9.6 8.2 4.9 4.5
    World Population Ageing 2019: Highlights 32
    United Nations, Department of Economic and Social Affairs, Population Division
    Population aged
    65 years or over
    (thousands)
    Percentage
    aged 65 years
    or over
    Old-age
    dependency
    ratio (65+
    /20-64) a
    Prospective
    old-age
    dependency
    ratio b
    Economic
    old-age
    dependency
    ratio c
    Region, development group
    country or area 2019 2030 2019 2030 2019 2030 2019 2030 2019 2030
    Réunion* 108 174 12.2 18.2 21.4 33.1 10.0 13.5 .. ..
    Rwanda 382 709 3.0 4.4 6.5 8.8 7.0 8.3 5.8 7.8
    Seychelles 8 13 7.8 12.6 12.6 21.7 11.0 16.3 .. ..
    Somalia 446 624 2.9 2.9 7.4 7.0 10.0 9.1 7.9 7.5
    South Sudan 374 495 3.4 3.6 7.6 7.5 9.7 9.4 8.6 8.5
    Uganda 869 1 388 2.0 2.3 4.9 5.1 6.7 6.6 4.4 4.6
    United Republic of Tanzania* 1 520 2 375 2.6 3.0 6.1 6.6 7.9 8.0 6.6 7.2
    Zambia 378 598 2.1 2.5 5.0 5.3 6.4 6.5 6.4 6.8
    Zimbabwe 437 585 3.0 3.3 6.8 6.8 9.1 8.8 8.3 8.5
    Middle Africa 4 817 7 033 2.8 3.0 6.7 6.7 9.1 8.5 7.0 7.0
    Angola 700 1 115 2.2 2.5 5.4 5.8 8.7 8.3 6.9 7.4
    Cameroon 705 977 2.7 2.9 6.2 6.1 9.7 9.2 7.0 6.9
    Central African Republic 134 172 2.8 2.9 6.9 6.3 12.1 10.2 5.3 4.9
    Chad 397 554 2.5 2.6 6.3 5.9 9.0 7.9 6.9 6.4
    Congo 146 242 2.7 3.4 6.0 7.2 8.2 9.6 7.3 8.9
    Democratic Republic of the Congo 2 618 3 814 3.0 3.2 7.5 7.4 9.1 8.4 7.1 7.1
    Equatorial Guinea 33 41 2.4 2.2 4.7 4.2 7.2 6.3 5.3 4.6
    Gabon 77 107 3.5 3.9 7.0 7.6 8.5 9.2 8.0 8.3
    Sao Tome and Principe 6 10 3.0 3.9 6.8 8.2 7.9 8.6 7.2 8.9
    Northern Africa 13 659 21 215 5.6 7.4 10.6 13.8 9.9 11.3 11.5 14.7
    Algeria 2 821 4 504 6.6 8.9 11.6 16.4 7.6 9.7 12.2 16.9
    Egypt 5 297 7 711 5.3 6.4 10.1 12.2 11.5 12.2 10.8 12.7
    Libya 302 481 4.5 6.3 7.5 10.2 7.8 9.2 9.4 13.0
    Morocco 2 663 4 563 7.3 11.2 12.7 19.6 10.4 13.9 14.2 21.4
    Sudan 1 553 2 318 3.6 4.2 8.0 8.6 8.8 9.1 8.7 9.3
    Tunisia 1 005 1 594 8.6 12.5 14.2 21.5 11.4 14.7 15.7 23.2
    Western Sahara 19 43 3.2 5.8 5.2 9.4 6.5 9.8 .. ..
    Southern Africa 3 512 4 864 5.3 6.5 9.3 11.1 12.1 13.5 10.2 11.8
    Botswana 101 157 4.4 5.6 8.3 10.1 7.8 9.3 10.1 11.9
    Eswatini 46 50 4.0 3.8 8.5 7.2 10.9 9.0 8.1 6.7
    Lesotho 105 129 4.9 5.6 9.4 10.2 14.5 13.8 10.8 11.5
    Namibia 90 124 3.6 4.1 7.3 8.0 10.0 10.1 7.8 8.4
    South Africa 3 171 4 404 5.4 6.7 9.4 11.4 12.3 13.9 10.3 12.0
    Western Africa 10 955 15 659 2.8 3.0 6.5 6.6 11.1 10.6 7.7 7.9
    Benin 385 565 3.3 3.6 7.4 7.7 8.9 8.9 8.1 8.4
    Burkina Faso 489 738 2.4 2.7 5.7 6.0 8.9 8.6 5.4 5.7
    Cabo Verde 26 44 4.7 7.2 8.1 11.8 8.0 9.9 9.1 12.9
    Côte d’Ivoire 739 1 027 2.9 3.0 6.5 6.5 11.4 10.4 7.6 7.5
    World Population Ageing 2019: Highlights 33
    United Nations, Department of Economic and Social Affairs, Population Division
    Population aged
    65 years or over
    (thousands)
    Percentage
    aged 65 years
    or over
    Old-age
    dependency
    ratio (65+
    /20-64) a
    Prospective
    old-age
    dependency
    ratio b
    Economic
    old-age
    dependency
    ratio c
    Region, development group
    country or area 2019 2030 2019 2030 2019 2030 2019 2030 2019 2030
    Gambia 60 85 2.6 2.7 6.0 5.9 9.1 8.8 5.4 5.4
    Ghana 942 1 585 3.1 4.2 6.3 8.1 9.6 11.6 7.2 9.1
    Guinea 376 523 2.9 3.1 7.0 6.6 10.9 9.4 8.9 8.2
    Guinea-Bissau 55 73 2.9 3.0 6.4 6.3 10.8 9.6 5.7 5.5
    Liberia 162 241 3.3 3.8 7.3 7.8 9.2 9.4 7.8 8.4
    Mali 490 651 2.5 2.4 6.4 5.7 9.6 8.4 7.3 6.7
    Mauritania 143 220 3.2 3.7 6.7 7.5 8.7 9.4 7.6 8.3
    Niger 605 905 2.6 2.6 7.1 6.7 9.9 8.7 10.1 9.8
    Nigeria 5 513 7 629 2.7 2.9 6.4 6.4 12.4 11.7 7.8 7.9
    Senegal 505 729 3.1 3.4 7.1 7.2 9.0 8.4 8.0 8.1
    Sierra Leone 230 302 2.9 3.1 6.5 6.3 11.3 10.4 8.0 7.6
    Togo 233 341 2.9 3.3 6.4 6.7 10.2 10.2 6.9 7.3
    ASIA 395 344 587 415 8.6 11.8 14.3 19.7 11.4 14.2 16.7 22.8
    Central Asia 3 791 6 717 5.2 8.0 9.1 14.4 9.8 13.7 9.7 14.9
    Kazakhstan 1 420 2 284 7.7 11.1 13.3 20.4 11.5 15.8 13.8 21.1
    Kyrgyzstan 295 538 4.6 7.2 8.3 13.5 10.7 14.3 8.9 14.0
    Tajikistan 288 585 3.1 5.1 6.0 10.1 8.1 11.1 6.2 10.1
    Turkmenistan 273 480 4.6 7.1 8.1 12.7 9.2 13.2 10.5 15.6
    Uzbekistan 1 516 2 829 4.6 7.6 7.8 13.0 9.3 13.6 8.4 13.4
    Eastern Asia 215 204 308 392 12.9 18.1 20.0 29.8 13.4 18.4 23.4 35.9
    China* 164 487 246 986 11.5 16.9 17.7 27.4 13.9 19.1 18.7 30.9
    China, Hong Kong SAR* 1 301 2 072 17.5 25.8 26.3 46.4 10.6 15.3 41.8 70.4
    China, Macao SAR* 72 148 11.2 20.3 15.8 33.5 5.6 11.3 26.3 53.3
    China, Taiwan Province of China* 3 594 5 611 15.1 23.4 22.7 39.2 11.1 16.9 26.9 44.8
    Dem. People’s Republic of Korea 2 376 3 383 9.3 12.7 14.6 20.6 16.3 19.3 14.9 20.5
    Japan 35 524 37 278 28.0 30.9 51.0 57.7 21.8 27.9 77.7 90.5
    Mongolia 135 255 4.2 6.9 7.2 12.4 8.3 12.1 7.5 13.2
    Republic of Korea 7 715 12 658 15.1 24.7 22.4 41.0 11.2 16.5 26.0 46.4
    South-Eastern Asia 45 378 74 945 6.9 10.3 11.5 17.3 9.4 12.6 12.1 18.2
    Brunei Darussalam 23 48 5.2 10.2 8.1 16.0 5.7 10.0 9.6 18.9
    Cambodia 778 1 256 4.7 6.7 8.5 11.8 9.8 11.9 8.0 11.2
    Indonesia 16 374 27 438 6.1 9.2 10.2 15.4 10.5 13.8 10.5 15.6
    Lao People’s Democratic Republic 299 464 4.2 5.6 7.8 9.8 9.7 11.1 6.8 8.5
    Malaysia* 2 211 3 620 6.9 10.0 11.4 16.4 8.5 11.0 12.6 17.5
    Myanmar 3 249 4 984 6.0 8.5 10.2 14.0 13.1 16.6 11.4 15.5
    Philippines 5 746 9 407 5.3 7.6 9.7 13.3 8.0 10.3 12.3 16.6
    Singapore 719 1 409 12.4 22.5 17.6 36.6 6.3 12.9 21.4 42.6
    Thailand 8 638 13 797 12.4 19.6 19.3 32.3 10.9 15.8 20.1 33.7
    World Population Ageing 2019: Highlights 34
    United Nations, Department of Economic and Social Affairs, Population Division
    Population aged
    65 years or over
    (thousands)
    Percentage
    aged 65 years
    or over
    Old-age
    dependency
    ratio (65+
    /20-64) a
    Prospective
    old-age
    dependency
    ratio b
    Economic
    old-age
    dependency
    ratio c
    Region, development group
    country or area 2019 2030 2019 2030 2019 2030 2019 2030 2019 2030
    Timor-Leste 55 78 4.3 5.0 9.2 9.8 11.0 10.8 12.5 13.0
    Viet Nam 7 286 12 446 7.6 11.9 12.1 20.0 7.4 10.6 11.3 19.4
    Southern Asia 115 255 172 124 6.0 8.0 10.6 13.5 10.9 12.6 13.2 16.5
    Afghanistan 995 1 508 2.6 3.1 6.1 6.3 8.2 7.9 5.9 6.0
    Bangladesh 8 446 13 332 5.2 7.4 8.9 12.1 8.1 8.5 9.3 12.6
    Bhutan 47 66 6.1 7.8 10.3 12.3 7.3 7.5 11.6 13.5
    India 87 149 128 877 6.4 8.6 11.0 14.1 11.5 13.5 14.1 17.8
    Iran (Islamic Republic of) 5 272 8 849 6.4 9.6 10.2 15.8 9.3 12.0 14.1 20.8
    Maldives 19 35 3.6 6.7 5.1 9.9 4.1 5.2 7.9 14.4
    Nepal 1 654 2 362 5.8 7.1 10.8 11.6 12.4 11.7 12.8 13.1
    Pakistan 9 361 13 697 4.3 5.2 8.5 9.8 9.6 10.6 9.2 10.4
    Sri Lanka 2 311 3 397 10.8 15.4 18.9 27.4 13.7 18.0 19.9 29.2
    Western Asia 15 716 25 237 5.7 7.9 9.9 13.5 7.8 9.2 10.8 14.5
    Armenia 340 501 11.5 16.9 18.5 29.2 16.4 22.5 19.8 29.8
    Azerbaijan* 648 1 266 6.4 11.8 10.1 19.6 10.5 17.8 10.9 20.3
    Bahrain 41 112 2.5 5.6 3.4 7.7 3.0 5.5 4.0 9.1
    Cyprus* 168 232 14.0 18.2 22.3 29.5 14.6 17.0 24.1 30.5
    Georgia* 602 714 15.1 18.5 25.3 33.4 23.6 27.5 31.4 40.6
    Iraq 1 336 1 899 3.4 3.8 7.1 7.3 7.8 7.8 7.7 7.9
    Israel 1 040 1 361 12.2 13.6 23.4 26.1 11.3 13.4 33.2 37.4
    Jordan 393 591 3.9 5.6 7.4 9.5 7.2 7.9 8.0 10.3
    Kuwait 116 360 2.8 7.6 3.9 11.0 5.1 11.7 4.5 13.8
    Lebanon 499 743 7.3 12.0 12.4 20.0 8.4 11.4 13.1 20.4
    Oman 122 263 2.4 4.4 3.5 6.5 2.2 3.1 4.2 7.7
    Qatar 43 157 1.5 4.7 1.9 6.0 0.9 2.2 2.3 7.1
    Saudi Arabia 1 169 2 379 3.4 6.0 5.2 9.3 5.2 7.7 6.0 10.7
    State of Palestine* 158 263 3.2 4.1 6.6 8.0 6.5 6.8 7.5 8.9
    Syrian Arab Republic 801 1 614 4.7 6.0 8.5 10.8 7.5 8.1 10.5 12.8
    Turkey 7 280 11 003 8.7 12.3 14.8 20.8 10.0 12.1 14.2 19.4
    United Arab Emirates 113 548 1.2 5.1 1.4 6.8 1.0 3.3 1.7 8.4
    Yemen 846 1 231 2.9 3.4 6.2 6.5 8.2 8.2 7.1 7.2
    EUROPE 140 410 170 273 18.8 23.0 31.3 40.6 19.2 22.6 41.5 54.1
    Eastern Europe 48 187 58 346 16.4 20.5 26.5 35.6 20.6 26.1 30.9 41.1
    Belarus 1 437 1 899 15.2 20.5 24.1 36.2 20.1 26.4 24.9 37.4
    Bulgaria 1 488 1 504 21.3 23.4 35.6 40.6 30.1 32.3 39.5 45.3
    Czechia 2 117 2 387 19.8 22.2 33.0 38.5 20.9 24.7 43.6 51.6
    Hungary 1 907 2 053 19.7 22.0 32.4 37.3 22.5 26.7 43.8 50.4
    Poland 6 864 8 579 18.1 23.2 29.2 40.2 16.1 22.6 41.4 56.5
    World Population Ageing 2019: Highlights 35
    United Nations, Department of Economic and Social Affairs, Population Division
    Population aged
    65 years or over
    (thousands)
    Percentage
    aged 65 years
    or over
    Old-age
    dependency
    ratio (65+
    /20-64) a
    Prospective
    old-age
    dependency
    ratio b
    Economic
    old-age
    dependency
    ratio c
    Region, development group
    country or area 2019 2030 2019 2030 2019 2030 2019 2030 2019 2030
    Republic of Moldova* 486 659 12.0 17.0 17.9 26.8 19.4 25.7 20.1 28.4
    Romania 3 639 3 851 18.8 21.0 31.1 35.5 23.5 26.9 30.7 35.7
    Russian Federation 22 019 28 101 15.1 19.6 24.3 34.7 19.3 25.9 27.3 38.6
    Slovakia 883 1 134 16.2 21.0 25.5 35.6 17.3 23.5 37.1 51.5
    Ukraine* 7 349 8 179 16.7 20.0 26.6 33.3 25.7 29.5 28.6 35.0
    Northern Europe 19 845 24 004 18.8 21.8 32.2 39.1 18.5 20.4 47.6 58.2
    Channel Islands* 30 41 17.6 22.1 28.4 37.9 14.9 17.4 .. ..
    Denmark* 1 152 1 357 20.0 22.6 34.6 40.5 20.3 22.6 53.4 64.5
    Estonia 265 301 20.0 23.5 33.9 42.3 21.0 24.3 50.5 63.0
    Finland* 1 225 1 450 22.1 26.0 39.2 47.5 19.2 24.5 57.2 70.4
    Iceland 52 72 15.2 20.1 25.8 35.4 13.2 17.0 40.4 54.7
    Ireland 694 952 14.2 18.1 24.4 31.1 12.5 15.9 36.7 48.6
    Latvia 388 430 20.3 25.0 34.5 46.4 24.6 28.9 47.7 63.9
    Lithuania 556 655 20.2 26.4 33.5 50.4 21.8 26.0 51.8 75.8
    Norway* 929 1 191 17.3 20.3 29.1 35.0 15.4 17.9 45.4 55.1
    Sweden 2 027 2 355 20.2 22.2 35.5 40.3 19.2 21.2 52.2 61.4
    United Kingdom* 12 499 15 166 18.5 21.5 31.7 38.5 18.5 19.9 46.5 56.5
    Southern Europe 32 111 38 564 21.1 26.0 35.1 45.4 19.7 22.3 44.2 58.2
    Albania 409 578 14.2 20.7 23.2 36.0 16.7 22.6 28.1 40.2
    Bosnia and Herzegovina 568 753 17.2 24.1 27.4 40.8 20.9 27.9 34.2 49.4
    Croatia 862 972 20.9 25.1 35.0 44.2 25.0 28.5 50.2 62.9
    Greece 2 298 2 630 21.9 26.5 37.1 46.0 20.9 22.4 51.2 64.8
    Italy 13 934 16 462 23.0 27.9 39.0 49.5 20.9 23.1 50.1 65.9
    Malta 92 114 20.8 25.3 34.7 45.6 17.5 23.7 50.5 66.4
    Montenegro 97 120 15.4 19.2 25.6 33.1 21.3 25.0 31.3 39.5
    North Macedonia 293 374 14.1 18.2 22.1 29.9 20.1 24.7 .. ..
    Portugal 2 286 2 681 22.4 27.0 37.8 47.8 21.1 24.0 43.9 55.1
    Serbia* 1 644 1 747 18.7 21.2 31.3 35.6 27.1 29.0 35.4 39.6
    Slovenia 420 524 20.2 25.5 33.5 45.9 18.5 23.6 46.7 65.4
    Spain* 9 183 11 575 19.6 25.0 32.2 43.2 16.9 19.1 37.8 52.4
    Western Europe 40 267 49 358 20.6 24.9 35.3 45.5 19.4 21.7 52.7 68.5
    Austria 1 708 2 174 19.1 23.7 31.0 41.7 18.7 20.0 40.4 54.9
    Belgium 2 193 2 734 19.0 23.0 32.5 41.5 18.0 20.2 50.5 64.2
    France* 13 281 16 094 20.4 24.1 36.5 44.9 17.0 20.6 54.5 67.9
    Germany 18 009 21 767 21.6 26.2 36.1 47.7 21.9 23.0 54.4 72.0
    Luxembourg 88 125 14.3 18.0 22.2 29.5 12.3 13.6 35.1 46.1
    Netherlands* 3 352 4 295 19.6 24.6 33.5 44.6 17.9 22.3 50.4 68.4
    Switzerland 1 618 2 148 18.8 23.4 30.8 41.2 15.5 18.2 47.7 64.5
    World Population Ageing 2019: Highlights 36
    United Nations, Department of Economic and Social Affairs, Population Division
    Population aged
    65 years or over
    (thousands)
    Percentage
    aged 65 years
    or over
    Old-age
    dependency
    ratio (65+
    /20-64) a
    Prospective
    old-age
    dependency
    ratio b
    Economic
    old-age
    dependency
    ratio c
    Region, development group
    country or area 2019 2030 2019 2030 2019 2030 2019 2030 2019 2030
    LATIN AMERICA AND THE CARIBBEAN 56 411 84 577 8.7 12.0 14.8 20.1 9.2 11.2 17.0 22.7
    Caribbean 4 495 6 298 10.4 13.7 18.1 23.9 11.7 13.6 19.5 25.5
    Antigua and Barbuda 9 14 9.1 13.7 14.7 23.1 10.9 14.6 .. ..
    Aruba* 15 23 14.1 20.7 22.9 36.6 18.3 25.9 .. ..
    Bahamas 29 50 7.5 11.8 12.1 18.8 10.3 14.2 14.9 23.0
    Barbados 47 64 16.2 22.1 27.0 38.7 14.0 18.2 28.2 39.3
    Cuba 1 764 2 413 15.6 21.7 24.9 37.0 15.3 18.2 24.7 36.8
    Curaçao* 28 39 17.2 22.9 29.8 41.7 16.2 20.7 .. ..
    Dominican Republic 784 1 205 7.3 10.2 13.0 17.9 7.5 9.6 13.0 17.5
    Grenada 11 14 9.7 12.4 16.2 21.3 16.6 19.7 .. ..
    Guadeloupe* 75 103 18.8 25.7 34.1 49.7 14.6 19.1 .. ..
    Haiti 570 804 5.1 6.3 9.7 11.4 9.3 10.5 10.9 12.7
    Jamaica 263 365 8.9 12.0 15.1 20.2 12.3 14.6 16.1 21.3
    Martinique* 79 107 21.0 29.2 37.3 56.7 17.6 22.2 .. ..
    Puerto Rico* 578 731 19.7 25.2 34.1 42.7 16.8 20.3 50.2 66.6
    Saint Lucia 18 28 10.0 14.6 15.6 23.0 10.2 12.9 16.5 23.0
    Saint Vincent and the Grenadines 11 15 9.7 13.4 16.3 22.3 14.6 17.6 19.8 26.6
    Trinidad and Tobago 155 228 11.1 16.1 17.8 26.8 13.2 18.8 26.4 39.7
    United States Virgin Islands* 21 26 19.9 26.1 36.7 51.6 21.4 28.2 49.5 73.5
    Central America 12 574 19 157 7.1 9.6 12.5 16.4 8.2 9.6 13.1 17.0
    Belize 19 33 4.9 7.1 8.8 12.0 5.4 6.5 8.9 11.8
    Costa Rica 499 826 9.9 15.1 16.0 25.1 8.0 10.6 19.9 30.3
    El Salvador 547 722 8.5 10.6 15.3 18.5 10.6 11.7 18.2 21.5
    Guatemala 867 1 299 4.9 6.1 9.8 11.1 6.2 6.6 9.5 10.6
    Honduras 471 763 4.8 6.7 9.1 11.5 5.4 6.3 9.5 11.8
    Mexico 9 462 14 367 7.4 10.2 12.9 17.2 8.7 10.4 13.2 17.4
    Nicaragua 357 590 5.5 8.0 9.8 13.8 6.4 8.0 11.1 15.3
    Panama 353 557 8.3 11.3 14.7 19.9 6.8 8.3 19.1 25.2
    South America 39 343 59 122 9.2 12.8 15.4 21.3 9.4 11.6 18.3 24.8
    Argentina 5 035 6 249 11.2 12.7 20.0 22.3 14.0 14.5 24.3 26.9
    Bolivia (Plurinational State of) 845 1 163 7.3 8.8 14.1 15.8 7.9 8.9 15.1 16.6
    Brazil 19 526 30 413 9.3 13.6 14.9 22.0 8.6 11.4 18.2 26.2
    Chile 2 252 3 338 11.9 17.2 19.2 28.8 10.1 13.2 26.2 38.2
    Colombia 4 413 6 962 8.8 13.0 14.6 21.5 8.1 10.9 17.0 24.6
    Ecuador 1 281 2 001 7.4 10.1 13.2 17.7 7.4 9.0 13.6 17.8
    French Guiana* 15 31 5.3 8.1 10.0 15.1 5.5 7.8 .. ..
    Guyana 53 85 6.7 10.3 12.1 18.6 7.4 11.4 13.8 20.5
    Paraguay 466 678 6.6 8.5 12.1 15.0 8.3 10.2 12.5 15.0
    World Population Ageing 2019: Highlights 37
    United Nations, Department of Economic and Social Affairs, Population Division
    Population aged
    65 years or over
    (thousands)
    Percentage
    aged 65 years
    or over
    Old-age
    dependency
    ratio (65+
    /20-64) a
    Prospective
    old-age
    dependency
    ratio b
    Economic
    old-age
    dependency
    ratio c
    Region, development group
    country or area 2019 2030 2019 2030 2019 2030 2019 2030 2019 2030
    Peru 2 729 4 123 8.4 11.4 14.3 19.6 9.3 11.1 17.8 24.1
    Suriname 41 63 7.0 10.0 12.2 17.3 11.6 14.6 14.5 20.4
    Uruguay 517 612 14.9 17.2 26.0 30.0 16.5 16.9 33.5 38.0
    Venezuela (Bolivarian Republic of) 2 171 3 405 7.6 10.1 13.5 17.2 10.6 12.4 11.8 15.0
    NORTHERN AMERICA 59 962 80 188 16.4 20.5 27.7 36.4 14.4 18.0 42.5 54.8
    Canada 6 602 9 317 17.6 22.8 28.9 40.0 13.8 17.9 44.2 60.1
    United States of America* 53 340 70 842 16.2 20.3 27.6 36.0 14.4 18.0 42.3 54.2
    OCEANIA 5 282 7 286 12.5 15.2 22.1 27.5 11.7 13.8 28.4 35.3
    Australia and New Zealand 4 778 6 507 15.9 19.5 27.1 34.9 13.1 16.2 35.4 45.5
    Australia* 4 013 5 445 15.9 19.3 27.1 34.5 12.8 15.8 34.4 43.8
    New Zealand* 765 1 062 16.0 20.5 27.5 37.0 13.9 17.5 41.2 55.9
    Melanesia 420 643 3.8 4.9 7.5 9.1 12.2 13.4 7.8 9.5
    Fiji 50 79 5.6 8.1 9.9 14.5 14.7 19.3 11.7 17.0
    New Caledonia* 27 42 9.4 13.4 15.6 22.1 11.8 14.1 20.4 29.2
    Papua New Guinea 308 468 3.5 4.4 6.9 8.2 12.5 13.6 7.0 8.3
    Solomon Islands 24 38 3.6 4.4 7.9 9.3 7.3 7.8 8.9 10.5
    Vanuatu 11 16 3.6 4.2 7.5 8.3 11.0 11.4 8.6 9.7
    Micronesia 36 61 6.6 10.1 12.1 18.4 9.6 13.1 25.2 37.0
    Guam* 17 27 10.2 14.6 17.8 26.1 10.6 13.4 25.2 37.0
    Kiribati 5 9 4.1 6.2 7.9 12.0 7.3 10.2 .. ..
    Micronesia (Fed. States of) 5 8 4.2 6.3 7.7 11.3 15.1 18.1 .. ..
    Polynesia* 48 75 7.1 10.3 13.1 18.6 11.5 13.9 15.5 22.1
    French Polynesia* 24 40 8.7 13.4 14.2 22.1 10.1 13.4 17.9 27.3
    Samoa 10 15 4.9 6.8 10.4 13.8 11.8 14.1 11.1 15.2
    Tonga 6 8 5.9 6.7 12.3 13.0 14.7 14.7 14.0 15.1
    Notes
    The designations employed in this publication and the material presented in it do not imply the expression of any opinion whatsoever
    on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area or of its authorities,
    or concerning the delimitation of its frontiers or boundaries. The term “country” as used in this publication also refers, as appropriate, to
    territories or areas.
    In this table, data for countries or areas have been aggregated in six continental regions: Africa, Asia, Europe, Latin America and the
    Caribbean, Northern America, and Oceania. Further information on continental regions is available from https://unstats.un.org/unsd/
    methodology/m49/. Countries or areas are also grouped into geographic regions based on the classification being used to track progress
    towards the Sustainable Development Goals of the United Nations (see: https://unstats.un.org/sdgs/indicators/regional-groups/).
    The designation of “more developed” and “less developed” regions is intended for statistical purposes and does not express a judgment about
    the stage reached by a particular country or area in the development process. More developed regions comprise all regions of Europe plus
    Northern America, Australia and New Zealand and Japan. Less developed regions comprise all regions of Africa, Asia (excluding Japan),
    and Latin America and the Caribbean as well as Oceania (excluding Australia and New Zealand).
    The group of least developed countries includes 47 countries located in sub-Saharan Africa (32), Northern Africa and Western Asia
    (2), Central and Southern Asia (4), Eastern and South-Eastern Asia (4), Latin America and the Caribbean (1), and Oceania (4). Further
    information is available at http://unohrlls.org/about-ldcs/.
    World Population Ageing 2019: Highlights 38
    United Nations, Department of Economic and Social Affairs, Population Division
    The group of Landlocked Developing Countries (LLDCs) includes 32 countries or territories located in sub-Saharan Africa (16), Northern
    Africa and Western Asia (2), Central and Southern Asia (8), Eastern and South-Eastern Asia (2), Latin America and the Caribbean (2), and
    Europe and Northern America (2). Further information is available at http://unohrlls.org/about-lldcs/.
    The group of Small Island Developing States (SIDS) includes 58 countries or territories located in the Caribbean (29), the Pacific (20), and
    the Atlantic, Indian Ocean, Mediterranean and South China Sea (AIMS) (9). Further information is available at http://unohrlls.org/aboutsids/.
    The classification of countries or areas by income level is based on the gross national income (GNI) per capita as reported by the World Bank
    (June 2018). These income groups are not available for all countries or areas.
    Two dots (..) indicate that data are not available or are not reported separately
  • For country notes, please refer to: https://population.un.org/wpp/Download/Metadata/Documentation
    a
    Old-age dependency ratio: Number of persons aged 65 or over per 100 persons of working age 20-64.
    b
    Prospective old-age dependency ratio: Number of persons above the age at which the remaining life expectancy is 15 years relative to the
    number of persons between age 20 years and the age at which the remaining life expectancy is 15 years.
    c
    Economic old-age dependency ratio: Effective number of consumers aged 65 or over relative to the effective number of workers of all
    ages.

Accurate, consistent and timely data on population ageing are critical for setting policy
priorities to promote the well-being of the growing number of older persons. This is
particularly important in the framework of the 2030 Agenda for Sustainable Development,
which pledges to leave no one behind. This publication presents the highlights of World
Population Ageing 2019, which draws on the latest population estimates and projections
published in World Population Prospects 2019. This Highlights report provides an overview
of key global and regional trends and dynamics of population ageing and discusses
different measures of ageing that include conventional measures as well as prospective
and economic measures. A set of Annex tables provides global, regional and national data
for selected indicators discussed in the report.
ISBN 978-92-1-148325-3

Genomics is an interdisciplinary field of biology focusing on the structure, function, evolution, mapping, and editing of genomes. A genome is an organism’s complete set of DNA, including all of its genes. In contrast to genetics, which refers to the study of individual genes and their roles in inheritance, genomics aims at the collective characterization and quantification of all of an organism’s genes, their interrelations and influence on the organism.[1] Genes may direct the production of proteins with the assistance of enzymes and messenger molecules. In turn, proteins make up body structures such as organs and tissues as well as control chemical reactions and carry signals between cells. Genomics also involves the sequencing and analysis of genomes through uses of high throughput DNA sequencing and bioinformatics to assemble and analyze the function and structure of entire genomes.[2][3][4] Advances in genomics have triggered a revolution in discovery-based research and systems biology to facilitate understanding of even the most complex biological systems such as the brain.[5]

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