Differential inequity in health expectancy by region in Belgium

Summary. Objectives: To evaluate the size of social inequities in health between regions in Belgium using a composite health measure, the disability free life expectancy (DFLE). Methods: Mortality data (5-years follow-up of the 1991 census) are combined with the 1997 Health Interview Survey to estimate the DFLE by education. Differences in partial life expectancy_25–74 (LE_25–74) and in DFLE_25–74 between those at the bottom and those at the top of a relative social scale are used to compare the regional inequities. Results: The higher educated person has a longer LE, with more years free of disability and less years with disability (in years: Flemish males: LE = 46.48; DFLE = 42.08; Walloon males: LE = 44.92; DFLE = 39.80; Flemish females: LE = 47.90; DFLE =41.93; Walloon females: LE = 46.90; DFLE = 39.84) compared to the population at the bottom of the education hierarchy (in years: Flemish males: LE = 44.86; DFLE = 30.16; Walloon males: LE = 42.77; DFLE = 27.00; Flemish females: LE = 46.86; DFLE =28.30; Walloon females: LE = 45.44; DFLE = 25.30). The inequity in LE and in DFLE is larger in the Walloon Region than in the Flemish Region. Only the regional difference in inequity in LE is statistically significant. Conclusion: The DFLE can be used to monitor the size of health inequities. An erratum to this article is available at .     

中国老年人口健康预期寿命性别差异多元变化趋势的研究:2020―2050年

  目的  分析2020―2050年中国老年人口健康预期寿命(health expectancy,HE)及其性别差异的变化趋势,为中国人口长寿和健康之间的关系及其性别差异在未来的发展趋势提供证据和线索。  方法  基于2010年人口普查数据和1987年、2006年全国残疾人抽样调查数据,使用多状态人口预测模型(population-development-environment Analysis, PDE)和流行病学计算方法预测了死亡率和残疾率。使用Sullivan方法估计了2020―2050年50岁及以上人口分性别、年龄的无残疾预期寿命(disability-free life expectancy, DFLE)和伴随残疾预期寿命(life expectancy with disability, LwD)。  结果  中国老年人口的预期寿命(life expectancy,LE)在2020―2050年持续上升。其中,女性中LE的上升由LwD的上升所主导,而男性中DFLE的贡献略高。在75岁以下的女性和65岁以下的男性中呈现“功能残障扩张”且男性中更不明显;整个研究期间,80岁及以上女性的余寿中会有超过一半的时间伴随残疾度过,占比高于男性。女性的DFLE高于男性,绝对性别差异整体上随时期缩小,但在高龄老人中相对保持稳定;女性DLFE的占比低于男性,在2040年之后相对差异开始缩小,且在高龄老人中更明显。  结论  未来中国老年人口的功能状况可能会不断恶化。虽然在2040年之后DFLE的相对性别差异开始缩小,但这建立在LwD占比较高的情况下。在重点关注女性高龄老年人的功能状况的同时,应尽快建立起完备的长期照护体系。     

Does socio-economic advantage lead to a longer, healthier old age?

The effect of socio-economic disadvantage on mortality is well documented and differences exist even at older ages. However, whether this translates into differences in the quality of life lived at older ages is less well studied, and in particular in the proportion of remaining life spent without ill health (healthy life expectancy), a key UK Government target. Although there have been studies exploring socio-economic differences in disability-free life expectancy (DFLE) worldwide, these have tended to focus on a single measure of socio-economic advantage, for example, education, race, social class or income, with the majority based on cross-sectional data from younger populations. In this prospective study we examine differences in DFLE and total life expectancy (TLE) at older ages using a range of measures of socio-economic advantage. We use a longitudinal study of 1480 participants aged 75 years or over in 1988 registered with a UK primary care practice, who were followed up until 2003 with measurements at up to seven time points. Disability was defined as difficulty with any one of five activities of daily living. The largest differences in DFLE for both men and women were found for housing tenure. Women aged 75 years living in owned or mortgaged property could expect to live 1 year extra without disability compared with those living in rented accommodation, while for men the difference was almost 1.5 years. The effect of socio-economic advantage on disability-free and total life expectancies appeared to be larger for men than women. In women, socio-economic advantage had more effect on DFLE than total life expectancy for all indicators considered, thus the socio-economically advantaged experienced a compression of disability.     

基于多状态Markov模型的我国老年人无失能期望寿命及其影响因素

目的 了解我国老年人无失能期望寿命（DFLE）现状及其影响因素和影响程度。方法 利用中国老年人口健康长寿调查研究2011-2018年数据,采用多状态Markov模型和微观仿真法计算我国≥65岁老年人的期望寿命（LE）、DFLE、DFLE占比（DFLE/LE）及危险因素所致的DFLE损失,利用Bootstrap法估计95%CI。结果 我国≥65岁老年人DFLE为14.27（95%CI：13.85~14.74）年,女性高于男性,经济状况较好者高于经济状况较差者;DFLE/LE为86.33%（95%CI：85.52%~87.18%）,男性高于女性,农村高于城镇。未定期体检、蔬菜水果摄入不足、吸烟和压力分别造成男性0.74、0.41、0.62、0.12年和女性0.82、0.42、0.19、0.20年的DFLE损失。消除以上4种危险因素,可使我国男女性老年人的DFLE分别增长1.73年和1.45年。结论 提高我国老年人DFLE应重点关注男性、经济状况较差的人群。促进老年人定期体检和足量的蔬菜水果摄入、禁烟、缓解老年人压力等措施可提高我国老年人的DFLE。     

Factors explaining disability-free life expectancy in Japan: the proportion of older workers, self-reported health status, and the number of public health nurses

BACKGROUND: Disability-free life expectancy (DFLE) data for 47 prefectures in Japan were reported in 1999; however, few studies have identified the factors associated with the length of the DFLE. The objective of this study was to elucidate the primary factors that explain differences in DFLEs in Japan. METHODS: In our ecological study, 47 prefectures in Japan were used as units of analysis. The DFLEs for men and women at 65 years of age (DFLE65), calculated by Hashimoto et al using Sullivan's method, were set as dependent variables. From various national surveys, 181 factors associated with demographics, socioeconomic status, health status and health behaviors, medical environment, social relationships, climate, and other areas were gathered as independent variables. Pearson's or Spearman's correlation coefficients were calculated to screen independent variables potentially associated with the DFLE65s. Then, multivariate linear regression analyses were conducted for the selected 24 independent variables after adjusting for the proportion of older people (65 years or more) and population density. RESULTS: Multivariate linear regression analyses revealed that the large number of public health nurses per 100,000 population, a good self-reported health status, and a high proportion of older workers were significantly associated with long DFLE65s for both genders. CONCLUSIONS: These three factors could potentially explain the differences in DFLE of the older population in Japan.     

Inequalities in healthy life expectancy between ethnic groups in England and Wales in 2001

Objectives. We aim to develop robust estimates of disability-free life expectancy (DFLE) and healthy life expectancy (HLE) for ethnic groups in England and Wales in 2001 and to examine observed variations across ethnic groups.

Design. DFLE and HLE by age and gender for five-year age groups were computed for 16 ethnic groups by combining the 2001 Census data on ethnicity, self-reported limiting long-term illness and self-rated health using mortality by ethnic group estimated by two methods: the Standardised Illness Ratio (SIR) method and the Geographically Weighted Method (GWM).

Results. The SIR and GWM methods differed somewhat in their estimates of life expectancy (LE) at birth but produced very similar estimates of DFLE and HLE by ethnic group. For the more conservative method (GWM), the range in DFLE at birth was 10.5 years for men and 11.9 years for women, double that in LE. DFLE at birth was highest for Chinese men (64.7 years, 95% CI 64.0–65.3) and women (67.0 years, 95% CI 66.4–67.6). Over half of the ethnic minority groups (men: 10; women: 9) had significantly lower DFLE at birth than White British men (61.7 years, 95% CI 61.7–61.7) or women (64.1 years, 95% CI 64.1–64.2), mostly the Black, Asian and mixed ethnic groups. The lowest DFLE observed was for Bangladeshi men (54.3 years, 95% CI 53.7–54.8) and Pakistani women (55.1 years, 95% CI 54.8–55.4). Notable were Indian women whose LE was similar to White British women but who had 4.3 years less disability-free (95% CI 4.0–4.6).

Conclusions. Inequalities in DFLE between ethnic groups are large and exceed those in LE. Moreover, certain ethnic groups have a larger burden of disability that does not seem to be associated with shorter LE. With the increasing population of the non-White British community, it is essential to be able to identify the ethnic groups at higher risk of disability, in order to target appropriate interventions.     

Inequalities in longevity and quality of life between Andalusia and Spain

BACKGROUND: Because of the increase in life expectancy (LE) throughout the twentieth century, indicators providing information on quality of life and its distribution in distinct geographical areas are required. We describe LE and life expectancy without disability (LEWD) by age and sex and estimate the magnitude of inequalities between Andalusia and Spain. MATERIAL AND METHOD: Mortality data from the Natural Population Movement, the Survey of Disabilities, Deficiencies and Health Status, and the populations of the National Institute of Statistics for Andalusia and Spain in 1999 were used. Abbreviated life tables were constructed and were used to calculate LEWD through Sullivan's method. LE and LEWD by age and sex were obtained for Andalusia and Spain. RESULTS: LE was lower in Andalusia than in Spain in all age groups and in both sexes. At birth, LE was 73.9 years for men and was 80.9 years for women in Andalusia and was 75.0 years and 82.1 years in Spain respectively. Inequalities between Andalusia and Spain in LEWD were greater in all age groups both in men and in women: at birth LEWD was 66.0 years and 69.0 years for men and women in Andalusia and was 68.3 years and 72.0 years in Spain. CONCLUSIONS: Longevity and quality of life are lower in Andalusia than the mean for Spain, especially in elderly women.     

The contribution of specific diseases to educational disparities in disability-free life expectancy

OBJECTIVES: We examined the contribution that specific diseases, as causes of both death and disability, make to educational disparities in disability-free life expectancy (DFLE). METHODS: We used disability data from the Belgian Health Interview Survey (1997) and mortality data from the National Mortality Follow-Up Study (1991-1996) to assess education-related disparities in DFLE and to partition these differences into additive contributions of specific diseases. RESULTS: The DFLE advantage of higher-educated compared with lower-educated persons was 8.0 years for men and 5.9 years for women. Arthritis (men, 1.3 years; women, 2.2 years), back complaints (men, 2.1 years), heart disease/stroke (men, 1.5 years; women, 1.6 years), asthma/chronic obstructive pulmonary disease (COPD) (men, 1.2 years; women, 1.5 years), and "other diseases" (men, 2.4 years) contributed the most to this difference. CONCLUSIONS: Disabling diseases, such as arthritis, back complaints, and asthma/COPD, contribute substantially to differences in DFLE by education. Public health policy aiming to reduce existing disparities in the DFLE and to improve population health should not only focus on fatal diseases but also on these nonfatal diseases.     

Educational differences in the dynamics of disability incidence, recovery and mortality: Findings from the MRC Cognitive Function and Ageing Study (MRC CFAS)

BACKGROUND: This study aims to establish the extent of educational differences in the disability transitions of incidence, recovery and mortality in people aged 65 years and over, whether these can be explained by differentials in disease burden and their relative contribution to educational differences in prevalence and disability-free life expectancy (DFLE). METHODS: A stratified random sample of 13 004 participants in five areas in England and Wales were interviewed in 1991-94 and followed up at 2, 6 (one centre only) and 10 years. Two levels of disability were analysed: mobility difficulty and activities of daily living (ADL) disability. We fitted logistic regression models to model educational differences in disability prevalence, incidence, recovery and mortality transitions. DFLE was calculated to assess the combined effect of the dynamic transitions. RESULTS: Those with < or =9 years education had higher ADL and mobility disability prevalence and higher incidence and lower recovery of mobility disability. Differences in disability incidence remained after adjustment for comorbidity. Women with the lowest education had shorter life expectancies (1.7 years less at the age of 65 years) than the most educated and had even shorter DFLE (1.9 years free of ADL disability and 2.8 years free of mobility difficulty at the age of 65 years). CONCLUSIONS: Differentials in education continue to contribute to prevalence of disability at ages beyond 65 years in both men and women and independently of diseases. These appear to be driven predominantly by differentials in disability incidence that also compound to produce greater differentials in DFLE between education groups than in total years lived.     

Indicators of disability-free life expectancy. Global indicators of the health status of populations

Disability free life expectancy (DFLE) is an index of mean length of healthy life. It aims at measuring the evolution in the populations state of health. The first calculations were achieved at the end of the 60s and about ten experimental calculations have been made until now, mostly in the United States, Canada, Japan and France. Nowadays this index is very well accepted. Its major qualities are its usefulness for setting health targets and determining the present and future needs. Is DFLE destined for becoming a conjonctural index of health state? The circumstances are undoubtedly propitious. Nevertheless, in order to be used in routine the DFLE index must answer three conditions, which the current approach does not fulfil i.e. the viability of disability measurement for comparisons in time; a registration of period data which is based on the incidence of entrance in disability; a calculation which is adapted to the disability whether it is reversible or not.     

Differential inequity in health expectancy by region in Belgium

Objectives: To evaluate the size of social inequities in health between regions in Belgium using a composite health measure, the disability free life expectancy (DFLE). Methods: Mortality data (5-years follow-up of the 1991 census) are combined with the 1997 Health Interview Survey to estimate the DFLE by education. Differences in partial life expectancy_25–74 (LE_25–74) and in DFLE_25–74 between those at the bottom and those at the top of a relative social scale are used to compare the regional inequities.     

Total and occupationally active life expectancies in relation to social class and marital status in men classified as healthy at 20 in Finland.

STUDY OBJECTIVE: To study differences in total life expectancy and in occupationally active life expectancy in relation to social class and marital status in men classified as healthy as young adults. DESIGN: Historical cohort study. SETTING: Finland. PARTICIPANTS: Altogether 1662 men classified as completely healthy at the time of induction to military service (mean birth year 1923), who had been selected as referents for a study of former athletes. Mean follow up time was 46 years. MEASUREMENTS: Vital status was determined by follow up through local parish data up to 1990. Mortality data were obtained from the Cause of Death bureau of the Central Statistical Office of Finland. Occurrence of work disability was assessed from nationwide disability pension register data. Mean total life expectancy and mean occupationally active life expectancy (end points disability pension or death before age 65 years) were estimated. Social class was based on the major lifetime occupation, while marital status was classified as "never married" or "ever married" at the end of follow up. MAIN RESULTS: Mean total life expectancy was highest among executives and managers (73.2 (95% confidence interval (CI): 70.3, 76.1) years), next highest in clerical (white collar) workers (72.0 (70.0, 74.1) years), and lowest in unskilled blue collar workers (63.65 (61.1, 66.2) years). Skilled workers and farmers were intermediate. For the occupationally active life expectancy estimates, a similar gradient was observed: highest for executives (61.9 (60.7, 63.1) years) and lowest for the unskilled (52.2 (50.2, 54.2) years). The ratio of occupationally active life expectancy to total life expectancy was highest for executives (85%) and lowest for farmers (81%) and unskilled workers (82%). CONCLUSIONS: The social class gradient known to exist for mortality is also present for occupational disability. Social class and marital status differences in mortality are already evident in early adulthood and continue into old age. Those with the highest life expectancy also have the largest proportion of their life span free of occupationally incapacitating disability.     

Smoking and the compression of morbidity

OBJECTIVE: To examine whether eliminating smoking will lead to a reduction in the number of years lived with disability (that is, absolute compression of morbidity). DESIGN: Multistate life table calculations based on the longitudinal GLOBE study (the Netherlands) combined with the Longitudinal Study of Aging (LSOA, United States of America). SETTING: the Netherlands. SUBJECTS: Dutch nationals aged 30-74 years living in the city of Eindhoven and surrounding municipalities (GLOBE) and United States citizens age 70 and over (LSOA). MAIN OUTCOME MEASURES: Life expectancy with and without disability and total life expectancy at ages 30 and 70. RESULTS: A non-smoking population on balance spends fewer years with disability than a mixed smoking-non-smoking population. Although non-smokers have lower mortality risks and thus are exposed to disability over a longer period of time, their lower incidence of disability and higher recovery from disability yield a net reduction of the length of time spent with disability (at age 30: -0.9 years in men and -1.1 years in women) and increases the length of time lived without disability (2.5 and 1.9 years, for men and women, respectively). These outcomes indicate that elimination of smoking will extend life and the period of disability free life, and will compress disability into a shorter period. CONCLUSIONS: Eliminating smoking will not only extend life and result in an increase in the number of years lived without disability, but will also compress disability into a shorter period. This implies that the commonly found trade off between longer life and a longer period with disability does not apply. Interventions to discourage smoking should receive high priority.     

北京市老年人健康预期寿命及其变化

目的了解北京地区老年人的健康预期寿命和变化。方法采用纵向研究方法对北京城区（宣武区）、郊区（大兴区）和山区（怀柔县）一个有代表性老年人群（3257人）进行了12年追踪，调查其健康和存活状况。用WHO的基本生活能力评估量表（ADL），评估老年人躯体功能健康状况及变化，采用IMaCH多状态法分析多次调查结果及不同健康状况的转变，计算老年人的健康预期寿命及不同时段的变化。结果纵向结果显示一些基本特征在不同时段维持不变：老年人的平均预期寿命（LE）、健康预期寿命（ALE）和健康预期寿命比值（ALE／LE）在城区显著高于农村；女性平均预期寿命高于男性，但ALE／LE低于男性。纵向观察的变化表现为：老年人的平均预期寿命有所提高，增加的幅度在农村大于城区，男性大于女性；城区高龄女性老年人的健康预期寿命近年有明显下降；所有老年人的ALE／LE近年呈下降趋势，尤其是城区老年人和高龄老年人更突出。结论北京地区老年人的健康预期寿命未与预期寿命同步增长，加强心脑血管疾病等慢性病防治，预防残疾和加强功能康复，是提高老年人健康预期寿命和生活质量的基础。     

Estimating the value of disability-free life expectancy for western countries in the last decade. How can this new health status indicator be used?

Disability-free life expectancy (DFLE) is an indicator of the mean duration of life in good health, based on the measurement of mortality combined with the measurement of disability. To date, some experimental calculations have been carried out mainly in Canada, England, France, the Netherlands and the United States of America. Taking these studies as a whole, disability-free life expectancy in the last decade can be estimated at about 59 years for men and about 63 years for women. The share of years of disability within life expectancy ranges from 11% to 27%. The calculations show that women suffer disability for a greater part of their life expectancy than men. The calculations also reveal social inequalities in health. Health authorities in Western countries are showing increasing interest in this indicator today. The main points in its favour are its simplicity in practice, its usefulness for determining objectives, allocating resources, measuring the success or failure of health policies, assessing current needs and defining future scenarios.     

Health expectancy calculations: a novel approach to studying population health in Bulgaria.

The measurement of life expectancy in terms of either good or poor health is a novel approach to studying the health of the population in Bulgaria. The pilot study reported here-carried out among people aged > or = 60 years in a middle-sized Bulgarian town-was designed to obtain information on the years of functional restrictions expected among the elderly. In accordance with the answers to a series of questions (recommended by WHO), subjects were categorized as disabled, handicapped, or having different states of perceived health. The indicators "disability-free life expectancy", "handicap-free life expectancy" and "healthy life expectancy" (based on self-perceived health) were calculated according to Sullivan''s method. The results show, for example, that 8.0 of the 16.0 years that men aged 60 years may expect to live, on average, will be free of disability. For men aged 80 years the figures are 1.3 of 5.5 years. For women at 60 years and 80 years the results are 7.3 and 0.5 disability-free years of 19.2 and 7.3 expected life years, respectively. Similar results were found for handicap-free life expectancies and healthy life expectancies. At all ages, the proportion of life in a condition free of disability, free of handicap, or in perceived good health is substantially lower for women than for men. Women may expect to live longer, but a greater proportion of their life will be spent in poor health. The approach presented here for measuring the health status of the elderly may be helpful as an aid to planning medical and social care and for the development of public health policies.     

Compression,expansion, or dynamic equilibrium? The evolution of health expectancy in New Zealand

STUDY OBJECTIVE: To evaluate the New Zealand evidence for three theories of population health change: compression of morbidity, expansion of morbidity, and dynamic equilibrium. DESIGN: Using the Sullivan method, repeated cross sectional survey information on functional limitation prevalence was combined with population mortality data and census information on the utilisation of institutional care to produce health expectancy indices for 1981 and 1996. SETTING: The adult population of New Zealand in 1981 and 1996. PARTICIPANTS: 6891 respondents to the 1981 social indicators survey; 8262 respondents to the 1996 household disability survey. MAIN RESULTS: As a proportion of overall life expectancy at age 15 the expectation of non-institutionalised mobility limitations increased from 3.5% to 6% for men, and from 4.5% to 8% for women; the expectation of agility limitation increased from 3% to 7.5% for men and from 4.5% to 8.5% for women, and the expectation of self care limitations increased from 2.0% to 4.5% for men and from 3.0% to 6.0% for women. These changes were primarily attributable to increases in the expectation of moderate functional limitation. CONCLUSION: The dynamic equilibrium scenario provides the best fit to current New Zealand evidence on changes in population health. Although an aging population is likely to lead to an increase in demand for disability support services, the fiscal impact of this increase may be partially offset by a shift from major to moderate limitations, with a consequential reduction in the average levels of support required.     

Modelling changes in small area disability free life expectancy: trends in London wards between 2001 and 2011

Existing analyses of trends in disability free life expectancy (DFLE) are mainly at aggregate level (national or broad regional). However, major differences in DFLE, and trends in these expectancies, exist between different neighbourhoods within regions, so supporting a small area perspective. However, this raises issues regarding the stability of conventional life table estimation methods at small area scales. This paper advocates a Bayesian borrowing strength technique to model trends in mortality and disability differences across 625 small areas in London, using illness data from the 2001 and 2011 population Censuses, and deaths data for two periods centred on the Census years. From this analysis, estimates of total life expectancy and DFLE are obtained. The spatio‐temporal modelling perspective allows assessment of whether significant compression or expansion of morbidity has occurred in each small area. Appropriate models involve random effects that recognise correlation and interaction effects over relevant dimensions of the observed deaths and illness data (areas, ages), as well as major spatial trends (e.g. gradients in health and mortality according to area deprivation category). Whilst borrowing strength is a primary consideration (and demonstrated by raised precision for estimated life expectancies), so also is model parsimony. Therefore, pure borrowing strength models are compared with models allowing selection of random age‐area interaction effects using a spike‐slab prior, and in fact borrowing strength combined with random effects selection provides better fit. Copyright © 2014 John Wiley & Sons, Ltd.     

Stroke and active life expectancy in the United States, 1999–2009

BackgroundStroke reduces active life expectancy, both years lived and their proportion without disability. However, active life expectancy studies have provided limited information about strokes in the United States, those occurring throughout older life, or those affecting African Americans.ObjectiveTo measure associations between strokes throughout older life and active life expectancy for African American and White women and men.MethodsUsing data from the Panel Study of Income Dynamics, 1999–2009 (n = 1862, 13,603 person-years), we estimated monthly probabilities of death and disability in activities of daily living with multinomial logistic Markov models adjusted for age, sex, ethnicity, stroke in the past two years, earlier stroke, and education. A random effect accounted for the panel data repeated measures. Microsimulation created large populations with stroke incidence throughout older life, identifying life expectancy and the proportions of remaining life with and without disability. We matched individuals with strokes with randomly selected persons without strokes by age at first stroke, sex, ethnicity, and previous disability.ResultsAverage age at first stroke was higher for women, lower for African Americans. African American and White women were disabled for about two-thirds of life after stroke; results for men were 61.8% for African Americans and 37.2% for Whites. Compared to matched participants, those with strokes lived 33% fewer remaining years (95% confidence interval, CI 30.9%–34.7%) with a 31.6% greater proportion of remaining life with disability (CI 14.4%–55.6%).ConclusionsStroke greatly reduces both life expectancy and the proportion of life without disability, particularly for women and African Americans.     

Gender development inequalities epidemiology in Spain (1990-2000)

BACKGROUND: Gender is an important health determinant for public health policies. This study describes the changes in gender development inequalities in Spain and its autonomous regions from 1990 to 2000. METHODS: An ecological study using the Human Development Index (HDI) and the Gender Development Index (GDI) was done. IDG both men and women was analysed according to indexes of education, income and life expectancy at birth. RESULTS: Although the GDI has had an increase of 5,05% in the 90 s, 51,5% of the population was located above the global GDI of Spain in 1990, moreover this number decreased to 46,3% in 2000. Gender inequalities have been reduced both at national and regional levels. The regions with the lowest increase were Asturias (3.37%), Cantabria (3.68%) and Baleares Islands (3.71%). The regions with the highest increase were Madrid (6,46%) and Extremadura (6,75%). All the autonomous regions showed a number of GDI lower than the value of HDI. Both sexes achieved similar increase in life expectancy (Men: 5% and Women: 4%). An unequal variation was detected according to the autonomous region (Basque Country; Men: 7% and Women: 3%; Madrid; Men:8% and Women:5%). Women have improved their educational level in comparison to men (Men: 3% and Women: 6%). In the 90 s, men obtained more income than women, but women improved their situation three times more than men. CONCLUSIONS: Inequalities in Human Development analysed by gender have been reduced in the 90 s in Spain. However, the improvement of education, income and life expectancy occurred only in some autonomous regions. This situation shows the differences among Spanish autonomous regions.