World Population Prospects 2022: Summary of Results UN DESA/POP/2022/TR/NO. 3 (Population Division, Department of Economic and Social Affairs, United Nations, 2022).
Centers for Disease Control and Prevention. Trends in aging—United States and worldwide. MMWR Morb. Mortal. Wkly. Rep. 52, 101–104, 106 (2003).
Life Expectancy at Birth (Years) (World Health Organization, 2023); www.who.int/data/gho/data/indicators/indicator-details/GHO/life-expectancy-at-birth-(years)
Silva, A., Saiyed, N. S., Canty, E. & Benjamins, M. R. Pre-pandemic trends and Black:White inequities in life expectancy across the 30 most populous U.S. cities: a population-based study. BMC Public Health 23, 2310 (2023).
Google Scholar
Juan, S.-C., Awerbuch-Friedlander, T. & Levins, R. Ethnic density and mortality: aboriginal population health in Taiwan. Public Health Rev. 37, 11 (2016).
Google Scholar
Lim, R. B. T. et al. Ethnic and gender specific life expectancies of the Singapore population, 1965 to 2009—converging, or diverging? BMC Public Health 13, 1012 (2013).
Google Scholar
National Population Health Survey 2020 (Household Interview and Health Examination) (Policy, Research & Surveillance Group, Epidemiology & Disease Control Division, Ministry of Health and Health Promotion Board of Singapore, 2020).
Government Health Expenditure and Healthcare Financing (Ministry of Health of Singapore, 2022).
Percentage of Spending on Mental Health, Diabetes and Ageing Versus Total Healthcare Spending in 2018 Against Amount Budgeted for 2019 (Ministry of Health of Singapore, 2019).
Tan, K. W., Dickens, B. S. L. & Cook, A. R. Projected burden of type 2 diabetes mellitus-related complications in Singapore until 2050: a Bayesian evidence synthesis. BMJ Open Diabetes Res. Care 8, e000928 (2020).
Google Scholar
Reimers, C. D., Knapp, G. & Reimers, A. K. Does physical activity increase life expectancy? A review of the literature. J. Aging Res. 2012, 243958 (2012).
Google Scholar
Momma, H., Kawakami, R., Honda, T. & Sawada, S. S. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. Br. J. Sports Med. 56, 755–763 (2022).
Google Scholar
Li, Y., Tang, Y., Xie, Y., Liu, H. & Wu, H. Association of healthy lifestyle with life expectancy free of five major disabilities in Chinese older adults. J. Glob. Health 14, 04034 (2024).
Google Scholar
Messerli, F. H. et al. Sodium intake, life expectancy, and all-cause mortality. Eur. Heart J. 42, 2103–2112 (2021).
Google Scholar
Mehta, N. & Myrskylä, M. The population health benefits of a healthy lifestyle: life expectancy increased and onset of disability delayed. Health Aff. (2017).
Li, Y. et al. Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: prospective cohort study. BMJ 368, l6669 (2020).
Google Scholar
Lagström, H. et al. Diet quality as a predictor of cardiometabolic disease-free life expectancy: the Whitehall II cohort study. Am. J. Clin. Nutr. 111, 787–794 (2020).
Google Scholar
Population in Brief 2023 (Strategy Group, National Population and Talent Division, Prime Minister’s Office of Singapore, 2023).
Original Maturity: 30 Year or More (Monetary Authority of Singapore, 2020).
Gao, K., Shi, X. & Wang, W. The life-course impact of smoking on hypertension myocardial infarction and respiratory diseases. Sci. Rep. 7, 4330 (2017).
Google Scholar
Salihu, H. M., Bonnema, S. M. & Alio, A. P. Obesity: what is an elderly population growing into? Maturitas 63, 7–12 (2009).
Google Scholar
Fauziana, R. et al. Body mass index, waist–hip ratio and risk of chronic medical condition in the elderly population: results from the Well-being of the Singapore Elderly (WiSE) Study. BMC Geriatr. 16, 125 (2016).
Google Scholar
Wong, L. Y., Toh, M. P. H. S. & Tham, L. W. C. Projection of prediabetes and diabetes population size in Singapore using a dynamic Markov model. J. Diabetes 9, 65–75 (2017).
Google Scholar
Petrie, J. R., Guzik, T. J. & Touyz, R. M. Diabetes, hypertension, and cardiovascular disease: clinical insights and vascular mechanisms. Can. J. Cardiol. 34, 575–584 (2018).
Google Scholar
Gress, T. W., Nieto, F. J., Shahar, E., Wofford, M. R. & Brancati, F. L. Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus. Atherosclerosis Risk in Communities Study. N. Engl. J. Med. 342, 905–912 (2000).
Google Scholar
Seow, L. S. E., Subramaniam, M., Abdin, E., Vaingankar, J. A. & Chong, S. A. Hypertension and its associated risks among Singapore elderly residential population. J. Clin. Gerontol. Geriatr. 6, 125–132 (2015).
LaVeist, T. A., Thorpe, R. J. Jr, Galarraga, J. E., Bower, K. M. & Gary-Webb, T. L. Environmental and socio-economic factors as contributors to racial disparities in diabetes prevalence. J. Gen. Intern. Med. 24, 1144–1148 (2009).
Ojo, O. Diabetes in ethnic minorities in UK: the role of diet in glucose dysregulation and prevalence of diabetes. J. Food Nutr. Disord. (2013).
McBean, A. M., Li, S., Gilbertson, D. T. & Collins, A. J. Differences in diabetes prevalence, incidence, and mortality among the elderly of four racial/ethnic groups: whites, Blacks, Hispanics, and Asians. Diabetes Care 27, 2317–2324 (2004).
Google Scholar
Yeo, K. K. et al. Ethnicity modifies the association between diabetes mellitus and ischaemic heart disease in Chinese, Malays and Asian Indians living in Singapore. Diabetologia 49, 2866–2873 (2006).
Google Scholar
Mak, K.-H. et al. Ethnic differences in acute myocardial infarction in Singapore. Eur. Heart J. 24, 151–160 (2003).
Google Scholar
Singapore Myocardial Infarction Registry Annual Report 2020 (National Registry of Diseases Office, Health Promotion Board of Singapore, 2020).
Lee, J. et al. Risk factors and incident coronary heart disease in Chinese, Malay and Asian Indian males: the Singapore Cardiovascular Cohort Study. Int. J. Epidemiol. 30, 983–988 (2001).
Google Scholar
Hughes, K., Aw, T. C., Kuperan, P. & Choo, M. Central obesity, insulin resistance, syndrome X, lipoprotein(a), and cardiovascular risk in Indians, Malays, and Chinese in Singapore. J. Epidemiol. Community Health 51, 394–399 (1997).
Google Scholar
Chong, S. A., Abdin, E., Nan, L., Vaingankar, J. A. & Subramaniam, M. Prevalence and impact of mental and physical comorbidity in the adult Singapore population. Ann. Acad. Med. Singap. 41, 105–114 (2012).
Google Scholar
Abdin, E. et al. Changes in the prevalence of comorbidity of mental and physical disorders in Singapore between 2010 and 2016. Singapore Med. J. 63, 196–202 (2022).
Google Scholar
Erving, C. L. Physical–psychiatric comorbidity: patterns and explanations for ethnic group differences. Ethn. Health 23, 583–610 (2018).
Google Scholar
Erving, C. L. Physical–psychiatric comorbidity: implications for health measurement and the Hispanic epidemiological paradox. Soc. Sci. Res. 64, 197–213 (2017).
Google Scholar
Maresova, P. et al. Consequences of chronic diseases and other limitations associated with old age—a scoping review. BMC Public Health 19, 1431 (2019).
Google Scholar
Ng, T.-P., Niti, M., Chiam, P.-C. & Kua, E.-H. Prevalence and correlates of functional disability in multiethnic elderly Singaporeans. J. Am. Geriatr. Soc. 54, 21–29 (2006).
Google Scholar
Ng, T.-P., Niti, M., Chiam, P.-C. & Kua, E.-H. Physical and cognitive domains of the instrumental activities of daily living: validation in a multiethnic population of Asian older adults. J. Gerontol. A 61, 726–735 (2006).
Mahesh, M. et al. Disability in Singapore’s elderly population. Ann. Acad. Med. Singap. 45, 284–296 (2016).
Google Scholar
Ran, L. et al. Comparison of health-related quality of life between the Han and Yi ethnicity elderly in the Yi autonomous areas of Yunnan Province. BMC Geriatr. 19, 326 (2019).
Google Scholar
Melvin, J., Hummer, R., Elo, I. & Mehta, N. Age patterns of racial/ethnic/nativity differences in disability and physical functioning in the United States. Demogr. Res. 31, 497–510 (2014).
Google Scholar
Franse, C. B. et al. Ethnic differences in frailty: a cross-sectional study of pooled data from community-dwelling older persons in the Netherlands. BMJ Open 8, e022241 (2018).
Google Scholar
Tables on CPI and Percentage Changes up to Class Level and Average Retail Prices of Selected Consumer Items (Department of Statistics of Singapore, 2023).
Healthcare Inflation (Ministry of Health of Singapore, 2018); moh.gov.sg/news-highlights/details/healthcare-inflation
Ng, R. J. Singapore 2018 healthcare cost inflation hits 10%, 10 times the economic inflation rate: Mercer report. The Business Times (10 June 2019); www.businesstimes.com.sg/international/singapore-2018-healthcare-cost-inflation-hits-10-10-times-economic-inflation-rate
Cheow, S.-A. Insurance linked to high medical inflation: experts. The Straits Times (28 June 2019); www.straitstimes.com/singapore/health/insurance-linked-to-high-medical-inflation
White Paper on Healthier SG (Ministry of Health of Singapore, 2022).
McPhee, J. S. et al. Physical activity in older age: perspectives for healthy ageing and frailty. Biogerontology 17, 567–580 (2016).
Google Scholar
Gregg, E. W. et al. Impact of intensive lifestyle intervention on disability-free life expectancy: the Look AHEAD study. Diabetes Care 41, 1040–1048 (2018).
Google Scholar
Rapsomaniki, E. et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people. Lancet 383, 1899–1911 (2014).
Google Scholar
Xia, X. et al. Cardiovascular health and life expectancy with and without cardiovascular disease in the middle-aged and elderly Chinese population. BMC Public Health 23, 2528 (2023).
Google Scholar
Wilkins, J. T. et al. Lifetime risk and years lived free of total cardiovascular disease. JAMA 308, 1795–1801 (2012).
Google Scholar
Bouchard, D. R., Baillargeon, J.-P. & Langlois, M.-F. The independent effect of age groups on the effectiveness of lifestyle intervention. Curr. Obes. Rep. 2, 107–119 (2013).
Smoking Prohibition (National Environment Agency of Singapore, 2025); www.nea.gov.sg/our-services/smoking-prohibition/overview
War on Diabetes (Ministry of Health of Singapore, 2024); www.moh.gov.sg/others/public-consultation/war-on-diabetes
Collection of Data by Working Group on Health for Ethnic Minorities to Examine Root Causes of Poor Health in Such Communities (Ministry of Health of Singapore, 2021).
Collection of Data by Working Group on Health for Ethnic Minorities to Examine Root Causes of Poor Health in Such Communities (Ministry of Health of Singapore, 2021); www.moh.gov.sg/newsroom/collection-of-data-by-working-group-on-health-for-ethnic-minorities-to-examine-root-causes-of-poor-health-in-such-communities
Tan, C. S., Lee, J. & Tan, J. National Steps Challenge, Singapore: a nationwide mHealth physical activity intervention. Br. J. Sports Med. 54, 1047–1048 (2020).
Google Scholar
Chin, M. H., Walters, A. E., Cook, S. C. & Huang, E. S. Interventions to reduce racial and ethnic disparities in health care. Med. Care Res. Rev. 64, 7S–28S (2007).
Google Scholar
Kim, S. S. et al. A culturally adapted smoking cessation intervention for Korean Americans: a mediating effect of perceived family norm toward quitting. J. Immigr. Minor. Health 17, 1120–1129 (2015).
Google Scholar
Wilkinson-Meyers, L. et al. Estimating the additional cost of disability: beyond budget standards. Soc. Sci. Med. 71, 1882–1889 (2010).
Google Scholar
Burgess, E., Hassmén, P. & Pumpa, K. L. Determinants of adherence to lifestyle intervention in adults with obesity: a systematic review. Clin. Obes. 7, 123–135 (2017).
Google Scholar
Tan, K. H. X. et al. Cohort profile: the Singapore Multi-Ethnic Cohort (MEC) study. Int. J. Epidemiol. 47, 699–699j (2018).
Google Scholar
Subramaniam, M. et al. Prevalence of dementia in people aged 60 years and above: results from the WiSE Study. J. Alzheimers Dis. 45, 1127–1138 (2015).
Google Scholar
Satghare, P. et al. Prevalence and correlates of pain in people aged 60 years and above in Singapore: results from the WiSE study. Pain Res. Manag. 2016, 7852397 (2016).
Google Scholar
Ng, T. P. et al. Mortality of older persons living alone: Singapore Longitudinal Ageing Studies. BMC Geriatr. 15, 126 (2015).
Google Scholar
Singapore Census of Population 2020: Statistical Release 1 – Demographic Characteristics, Education, Language and Religion (Department of Statistics of Singapore, 2021).
Tysinger, B. Design, Validation, and an Application of the Future Adult Model: A Dynamic Microsimulation Model of Health-Related Outcomes in the United States (RAND School of Public Policy, RAND Corporation, 2021).
Leaf, D. E., Tysinger, B., Goldman, D. P. & Lakdawalla, D. N. Predicting quantity and quality of life with the Future Elderly Model. Health Econ. 30, 52–79 (2021).
Gonzalez-Gonzalez, C., Tysinger, B., Goldman, D. P. & Wong, R. Projecting diabetes prevalence among Mexicans aged 50 years and older: the Future Elderly Model-Mexico (FEM-Mexico). BMJ Open 7, e017330 (2017).
Google Scholar
Chen, C. et al. Educational gradients in disability among Asia’s future elderly: projections for the Republic of Korea and Singapore. Asian Dev. Rev. 39, 51–89 (2022).
Google Scholar
Obesity: HPB–MOH Clinical Practice Guidelines (1/2016) (Health Promotion Board, Ministry of Health of Singapore, 2016).
CareShield Life Claims (CareShield Life, 2020); www.careshieldlife.gov.sg/careshield-life/careshield-life-claims.html
WHO-CHOICE Estimates of Cost for Inpatient and Outpatient Health Service Delivery (World Health Organization, 2021); cdn.who.int/media/docs/default-source/health-economics/who-choice-estimates-of-cost-for-inpatient-and-outpatient-health-service-delivery.pdf?sfvrsn=b814d37e_3&download=true
Curtis, L. Unit Costs of Health and Social Care (Personal Social Services Research Unit, Univ. Kent, 2013).
Subramaniam, M. et al. Comorbid diabetes and depression among older adults—prevalence, correlates, disability and healthcare utilisation. Ann. Acad. Med. Singap. 46, 91–101 (2017).
Google Scholar
Abdin, E. et al. The societal cost of dementia in Singapore: results from the WiSE study. J. Alzheimers Dis. 51, 439–449 (2016).
Google Scholar
Singapore dollar to US dollar spot exchange rates for 2020 (Exchange Rates UK, 2023); www.exchangerates.org.uk/SGD-USD-spot-exchange-rates-history-2020.html
Promoting Healthier Living for All Ages and Families (Ministry of Health of Singapore, 2023); www.moh.gov.sg/news-highlights/details/promoting-healthier-living-for-all-ages-and-families#:~:text=Healthier%20SG%20benefits%20will%20commence,aged%2060%20years%20and%20above
Antonakoudis, G., Poulimenos, L., Kifnidis, K., Zouras, C. & Antonakoudis, H. Blood pressure control and cardiovascular risk reduction. Hippokratia 11, 114–119 (2007).
Google Scholar
Malhotra, R., Chan, A., Malhotra, C. & Østbye, T. Prevalence, awareness, treatment and control of hypertension in the elderly population of Singapore. Hypertens. Res. 33, 1223–1231 (2010).
Google Scholar
Bennie, J. A., De Cocker, K., Teychenne, M. J., Brown, W. J. & Biddle, S. J. H. The epidemiology of aerobic physical activity and muscle-strengthening activity guideline adherence among 383,928 U.S. adults. Int. J. Behav. Nutr. Phys. Act. 16, 34 (2019).
Google Scholar
National Population Health Survey 2022 (Household Interview and Health Examination) (Epidemiology & Disease Control Division, Ministry of Health of Singapore, 2022).
National Health Surveys Highlight Need to Focus on Healthy Diets and Lifestyles (Ministry of Health of Singapore, 2023); www.moh.gov.sg/newsroom/national-health-surveys-highlight-need-to-focus-on-healthy-diets-and-lifestyles
Cook, N. R. et al. Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP). BMJ 334, 885–888 (2007).
Google Scholar
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