Increase in social inequality in health expectancy in Denmark

AIMS: Health expectancy represents the average lifetime in various states of health and differs among social groups. The purpose of the study was to determine trends in social inequality in health expectancy since 1994 between groups with high, medium and low educational levels in Denmark. METHODS: The study was based on data from nationwide registers on educational level and mortality during the period 1994-2005 and data on health status derived from the Danish Health Interview Surveys carried out in 1994, 2000 and 2005. Expected lifetime in self-rated good and poor health, lifetime without and with longstanding illness and expected lifetime without and with long-lasting difficulties or restrictions were estimated by Sullivan's method. RESULTS: Between 1994 and 2005, life expectancy at age 30 years increased by 1.9 years for men and 1.5 years for women with a low educational level. For people with a high educational level, the increase was 2.7 years for men and 2.2 years for women. The difference between people with low and high educational level in expected lifetime in self-rated good health increased by 2.0 and 1.3 years for 30-year-old men and women, respectively. The social gap also increased for other indicators. CONCLUSIONS: During the past 12 years, social inequality in life expectancy and health expectancy has increased in Denmark, but the proportion of the population with a low educational level has decreased.     

Social gradient in life expectancy and health expectancy in Denmark

Objectives: Health status of a population can be evaluated by health expectancy expressed as average lifetime in various states of health. The purpose of the study was to compare health expectancy in population groups at high, medium and low educational levels.Methods: Health interview data were combined with life table figures using Sullivans method.     

Impact of smoking on the social gradient in health expectancy in Denmark

STUDY OBJECTIVE: Health expectancy is arrived at by dividing life expectancy into average lifetime in different states of health. The purpose of the study was to estimate health expectancy among never smokers and smokers in groups at high, medium, and low educational levels in Denmark. DESIGN: Life tables for never smokers and smokers with a high, medium, and low educational level were constructed on the basis of Statistics Denmark registers and combined with data from the Danish Health Interview Survey 2000. Health expectancy was calculated by Sullivan's method. MAIN RESULTS: Life expectancy at age 30 differs on average by 8.5 years between never smokers and heavy smokers. Expected lifetime in self rated good health was 39.4 years for a never smoking man corresponding to 82.0% of the rest of his life. For male lifelong heavy smokers these figures were reduced to 27.3 years and 69.2%. The proportion of expected lifetime in self rated good health was 89.5% and 71.3% among male never smokers and lifelong heavy smokers with a high educational level, respectively; and the proportion among male never smokers and heavy smokers with a low educational level was 73.4% and 63.6%, respectively. Similar results were seen as regards expected lifetime without longstanding illness. For women the social gradient in health expectancy was intensified among smokers. CONCLUSIONS: Within each educational group smoking reduces expected lifetime in a healthy state. The social gradient in health expectancy cannot be explained by a reverse social gradient in smoking prevalence.     

Health expectancy in Denmark, 1987-2000

BACKGROUND: While life expectancy quantifies average length of life, health expectancy represents the average lifetime in different health states and offers the possibility to evaluate quality of life with respect to health. The purpose of the study was to estimate changes in health expectancy in Denmark from 1987 to 2000 and to assess theories about the relation between increased total lifetime and lifetime in various health states. METHODS: Data on health status derived from the Danish Health Interview Surveys carried out in 1987, 1991, 1994 and 2000 were combined with life-table data. Expected lifetime in selfrated good health, life expectancy without longstanding illness and disabilityfree life expectancy were estimated by Sullivan's method. RESULTS: In 1987, the life expectancy of a 65-year-old man was 14.1 years, 8.9 years of which were expected to be disabilityfree. In 2000, life expectancy had increased to 15.0 years, 11.3 years of which were disabilityfree. Thus, life expectancy had increased by 0.9 years, whereas disabilityfree life expectancy had increased by 2.4 years. Among 65-year-old women, life expectancy had increased by 0.2 years and disabilityfree life expectancy by 1.1 years. Expected lifetime in selfrated good health had also improved, but the trend in life expectancy without longstanding illness went in the opposite direction, and expected lifetime with longstanding illness had increased. CONCLUSION: The recent rise in life expectancy in Denmark after many years of stagnation appears to be accompanied by generally improved health status among the elderly, but health expectancy trends depend on the health indicator chosen. KEY POINTS: Health expectancy expresses average lifetime in various states of health. The study examines changes in expected lifetime in selfrated good health, lifetime without longstanding illness and lifetime without longterm disability. Among 65-year-olds the percentage of disabilityfree life expectancy increased from 63.4% to 74.9% for men and from 55.6% to 61.0% for women between 1987 and 2000. Health status among elderly Danes has apparently improved, but secular trends in health expectancy depend on the choice of health indicator.     

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.     

上海市成年人健康期望寿命测算研究

目的:评价上海市居民健康状况,测算健康期望寿命,分析影响居民健康相关因素,为卫生决策提供有力的信息和依据。方法:采用多阶段分层随机抽样方法随机抽取上海市≥18岁户籍居民作为调查对象,采用WHO在世界健康调查中使用的自评健康调查问卷,进行居民自评健康状况调查。应用CHOHT模型校正自评健康调查数据,获得人群自报伤残测度,...     

山东省居民高盐饮食对死亡和期望寿命的影响

目的分析山东省居民归因高盐饮食相关疾病死亡和寿命损失。方法利用2016年山东省与原卫生部联合减盐防控高血压项目终末期评估调查获得的24 h尿钠和血压值,结合2016年全省居民死因监测数据,按照比较风险评估理论,计算各类疾病归因分值(PAF)和因高盐饮食导致死亡,利用寿命表法计算归因期望寿命损失。结果2016年山东省因高盐饮食导致死亡32987人,占相关疾病死亡的11.74%,占全部死亡的4.95%。男性因高盐死亡比例(13.51%)高于女性(9.17%)。高盐饮食导致死亡的疾病主要是心脑血管疾病(90.82%),其次为胃癌(8.10%)和慢性肾病(1.08%)。城市居民PAF(13.87%)高于农村(10.87%)。高盐饮食导致山东省居民期望寿命减少0.58岁。高盐饮食所致不同疾病对期望寿命损失作用不同,缺血性心脏病位居首位,其次为脑出血和脑梗死。结论山东省居民归因高盐饮食死亡的比例较高,心脑血管疾病是高盐饮食导致死亡的重要原因。高盐饮食严重影响山东省居民健康,还需加强减盐干预工作。     

上海市居民期望寿命与健康期望寿命的差异分析

目的:分析不同年龄、性别的上海市居民期望寿命和健康期望寿命的差异。方法:分析比较上海市和全球长寿国家/地区期望寿命的变化趋势;利用全球疾病负担研究建立的疾病和健康结局的失能权重,应用Sullivan法测算上海市居民健康期望寿命,并分析不同年龄、性别人群的健康寿命损失。结果:近40年,上海市期望寿命增长了10.86岁,2...     

Inequalities in life expectancy by educational level and its decomposition in Barcelona, 2004-2018

ObjectiveTo analyse the gap in life expectancy by educational level in the city of Barcelona from 2004 to 2018 and to decompose this gap by age and causes of death.MethodWe computed abridged life tables at the age of 25 years by sex from 2004 to 2018 using standard methods. Educational level was categorised in two groups (lower secondary or less vs. upper secondary or higher education). The life expectancy gap was further decomposed by age and by causes of death based in Arriaga's method in 5-year age blocks up to the age of ≥ 90 years and broad causes of death using ICD-10 codes.ResultsThe life expectancy gap at 25 years by educational level oscillated without trend at around 3.08 years for men and 1.93 years for women. Decomposition by age showed a favourable significant shift in the contribution to this gap from young to older ages for men, with few changes for women. Decomposition by causes of death showed that the diseases concentrating the largest share of the contribution were neoplasms and respiratory and circulatory disease. There was a significant downward trend in external causes for men and in infectious diseases for both men and women but a significant upward trend for respiratory disease for both sexes.ConclusionsThe stability of the life expectancy gap by educational level during the period analysed resulted from a combination of divergent trends by age and causes of death among high and low educational levels.     

1990-2015年中国分省期望寿命和健康期望寿命分析

目的 分析中国及各省期望寿命和健康期望寿命现状及其变化情况。方法 利用2015年全球疾病负担研究结果,对2015年中国居民与全球主要国家期望寿命和健康期望寿命进行比较;分析全国及各省期望寿命和健康期望寿命的差异和1990-2015年全国及各省期望寿命和健康期望寿命的变化幅度。结果 2015年中国居民的期望寿命为76.2岁,健康期望寿命为68.0岁,分别比全球平均水平高出4.4岁和5.2岁。2015年中国人均期望寿命和健康期望寿命,女性均高于男性。我国期望寿命和健康期望寿命较高的省份有上海、北京、香港、澳门、浙江、江苏、天津和广东等东部发达省份,较低的省份有西藏、青海、贵州、新疆和云南等西部省份。1990-2015年,中国居民期望寿命和健康期望寿命均呈上升趋势,期望寿命增加了9.5岁,健康期望寿命增加了8.4岁。全国及各省期望寿命增加的岁数均高于健康期望寿命增加的岁数。结论 1990-2015年中国居民的期望寿命和健康期望寿命有了较大程度的提高,但各省之间差异较大。     

Social differences in the burden of long-standing illness in Denmark

Summary. Objectives To estimate the impact of diseases on social differences in life expectancy and expected lifetime with illness among Danes in 1995–99. Methods Expected lifetime with and without long-standing illness were calculated for groups with low, medium and high educational levels. Estimates based on observed rates of mortality and prevalence of illness were compared with those based on rates from which a specific disease had been eliminated. Results Partial life expectancy (age 30–75) would increase by almost 1.5 years if cancer were eliminated. Expected lifetime without long-standing illness would increase by approximately 1 year. Elimination of cardiovascular diseases would increase partial life expectancy, mainly among men with a low educational level. If diseases of the musculoskeletal system were eliminated the benefit would be greatest for persons with a low educational level. Conclusions The gain in life expectancy to be expected by eliminating certain diseases decreased with educational level. Elimination of cancer would extend lifetime both with and without illness for all educational levels. Submitted: 27 June 2005; Accepted: 7 March 2006     

Question order sensitivity of subjective well-being measures: focus on life satisfaction,self-rated health,and subjective life expectancy in survey instruments

Purpose

This study examines the effect of question context created by order in questionnaires on three subjective well-being measures: life satisfaction, self-rated health, and subjective life expectancy.

Methods

We conducted two Web survey experiments. The first experiment (n = 648) altered the order of life satisfaction and self-rated health: (1) life satisfaction asked immediately after self-rated health; (2) self-rated health immediately after life satisfaction; and (3) two items placed apart. We examined their correlation coefficient by experimental condition and further examined its interaction with objective health. The second experiment (n = 479) asked life expectancy before and after parental mortality questions. Responses to life expectancy were compared by order using ANOVA, and we examined interaction with parental mortality status using ANCOVA. Additionally, response time and probes were examined.

Results

Correlation coefficients between self-rated health and life satisfaction differed significantly by order: 0.313 (life satisfaction first), 0.508 (apart), and 0.643 (self-rated health first). Differences were larger among respondents with chronic conditions. Response times were the shortest when self-rated health was asked first. When life expectancy asked after parental mortality questions, respondents reported considering parents more for answering life expectancy; and respondents with deceased parents reported significantly lower expectancy, but not those whose parents were alive.

Conclusion

Question context effects exist. Findings suggest placing life satisfaction and self-rated health apart to avoid artificial attenuation or inflation in their association. Asking about parental mortality prior to life expectancy appears advantageous as this leads respondents to consider parental longevity more, an important factor for true longevity.

     

2013年中国居民预期寿命和去死因预期寿命分析

目的 系统分析2013年我国不同地区、不同人群预期寿命及主要疾病对预期寿命的影响程度,揭示我国经济和社会发展对居民健康水平及公平性提高的影响和作用。方法 综合利用国家统计局人口普查及国家卫生和计划生育委员会人口死亡登记数据,采用指数模型、漏报调整及简略寿命表等方法,系统估算我国居民2013年人均预期寿命水平及疾病影响程度。结果 2013年我国居民预期寿命为75.8岁,较2010年的74.8岁提高约1岁。其中城市约为77.4岁,农村约为75.1岁,城乡差距约为2.3岁;东部地区约为77.2岁,中部地区约为75.8岁,西部地区约为73.5岁,东西地区差距约为3.6岁。2013年造成我国居民预期寿命损失的前10位疾病分别为脑血管病,缺血性心脏病,慢性阻塞性肺病,肺、气管和支气管癌,道路伤害,肝癌,胃癌,高血压心脏病,下呼吸道感染,食道癌,共造成寿命损失7.97岁。结论 我国居民预期寿命已处于较高水平,地区间差异依然存在,应制定针对不同地区的疾病管理、医疗救治及危险因素干预政策,使预期寿命进一步提高,并提高生存质量。     

Contribution of obesity to international differences in life expectancy

Objectives. The United States has the highest prevalence of obesity and one of the lowest life expectancies among high-income countries. We investigated the relationship between these 2 phenomena.Methods. We estimated the fraction of deaths attributable to obesity by country, age, and sex and reestimated life tables after removing these deaths. To allow for a possible secular decline in obesity risks, we employed alternative risks from a more recent period.Results. In our baseline analysis, obesity reduced US life expectancy at age 50 years in 2006 by 1.54 years (95% confidence interval [CI] = 1.37, 1.93) for women and by 1.85 years (95% CI = 1.62, 2.10) for men. Removing the effects of obesity reduced the US shortfall by 42% (95% CI = 36, 48) for women and 67% (95% CI = 57, 76) for men, relative to countries with higher life expectancies. Using more recently recorded risk data, we estimated that differences in obesity still accounted for a fifth to a third of the shortfall.Conclusions. The high prevalence of obesity in the United States contributes substantially to its poor international ranking in longevity.Life expectancy in the United States has fallen below that of most other industrialized countries and ranked 32nd in the world in 2008.¹ As President Obama has noted, the relatively low level of life expectancy in the United States coexists with the highest per capita expenditure on health care in the world.² Explanations of the low US ranking range from a history of high levels of cigarette smoking to low levels of physical activity, a poorly performing health care sector, high levels of income inequality, and high levels of obesity.³ Identifying the responsible factors would help to clarify the critical public health domains where the United States has fallen furthest behind its peers.We estimated the extent to which the high level of obesity in the United States is contributing to its low longevity. According to World Health Organization estimates, men and women in the United States had a higher prevalence of obesity in 2005—defined as having a body mass index (BMI; defined as weight in kilograms divided by the square of height in meters) of 30.00 or higher—than did any other country in Europe, North America, or East Asia.⁴ Because many studies demonstrate that obese individuals suffer an elevated risk of death,⁵ it is reasonable to suppose that the high level of obesity in the United States is contributing to its comparatively low life expectancy.The years of life lost by an individual as a result of his or her obesity have been estimated in several studies.^5,6 In this study, we ask a question about population health rather than individual health: how many years of life are forfeited, on average, by members of a population as a result of the level of obesity in that population? Answering this question involves combining the prevalence of obesity in a population with the risks of mortality for people in a particular BMI category to estimate the effects of obesity on age-specific mortality rates. Estimates of the impact of obesity on a population''s level of life expectancy are uncommon; an exception is Olshansky et al., whose effort was limited to the United States.⁷ However, these estimates are important because they provide a basis for conducting cross-national comparisons that can be used to determine why some countries achieve better health outcomes than others.We estimated the fraction of deaths attributable to obesity by age and sex for 16 countries, including the United States, and the extent of international variation in life expectancy attributable to differences in BMI distributions. We focused on persons aged 50 years and older because 94% of newborns survive to age 50 years in the current US life table, and variation in life expectancy at birth is dominated by variation in mortality above this age.^8,9     

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.     

Increasing social inequality in life expectancy in Denmark

Background: The purpose of the study was to determine trendsin social inequality in mortality and life expectancy in Denmark.Methods: The study was based on register data on educationallevel and mortality during the period 1981–2005 and comprisedall deaths among Danes aged 30–60. Sex- and age-specificdeath rates for each of three levels of education were calculatedand age-standardized to allow comparisons over time and betweengroups. As data obtained since 1996 included ages up to 74,partial life expectancy (i.e. expected lifetime of 30-year-oldsbefore the age of 75) was calculated for the period 1996–2005.Results: Between 1981 and 2005, the difference in death ratesbetween people aged 30–60 with low and high educationallevel increased by two-thirds for men and was doubled for women.During the period 1996–2005, the gap in partial life expectancyfrom age 30 to 75 between people with low and high educationallevel increased by 0.3 years. Conclusion: During the past 25years, the social gap in mortality has widened in Denmark. Inparticular, women with a low educational level have been leftbehind.     

中国流动老人的健康期望寿命研究

目的 了解流动老人的健康期望寿命,包括自评健康期望寿命和生活自理期望寿命, 并探索其影响因素。方法 利用2015年流动人口动态监测调查中的老年人数据,采用Sullivan法分析流动老人的自评健康期望寿命和生活自理期望寿命,logistic回归分析其影响因素。结果 60～64岁流动老人的自评健康期望寿命约为17.7岁,生活自理期望寿命约为20.6岁。女性的健康期望寿命比男性高,但是健康期望寿命损失率也比男性高。慢性病会对老年人的健康产生重要的负面影响, 家庭收入高、教育水平高、流动范围大、参加健康体检、有伴侣、本地朋友多、锻炼时间长都是流动老人健康的保护因素。结论 流动老人健康状况整体较好,相关部门需要提升流动老人卫生服务的利用率,加强对流动老人的慢病管理,鼓励老年人养成健康的生活方式。对高龄女性、社会经济地位低、无伴侣、少数民族的流动老人应给予重点关注。     

Socio-economic inequalities in health expectancy in Belgium

Various international studies have demonstrated socio-economic differences in health. Linking the 1991 Census to the National Register and using the Health Interview Survey 1997 has enabled assessment of the association between the level of education and health in Belgium using the composite indicator 'health expectancy'. The Sullivan method was used to calculate health expectancy on the basis of current probability of death and prevalence of perceived health. Two measures of educational attainment were used: absolute educational attainment and the position on a relative hierarchical educational scale obtained by a regression-based method. The latter measure enables international comparisons. Differences in health expectancy by education were spread over the whole range of the educational hierarchy, and were consistently larger among females than males. At 25 years of age, the difference in health expectancy between different levels of education reached up to 17.8 and 24.7 years in males and females, respectively. Compared with people with the highest educational attainment, males and females at the lowest level of education spent more than 10 and 20 additional years in poor perceived health, respectively. Between ages 25 and 75 years, the difference in health expectancy between people with the lowest and highest levels of education was 17 years among males and 21 years among females. Compared with people at the top of the relative educational scale, males and females at the bottom of the scale had 13.6 and 19.7 additional years in poor perceived health, respectively. The conclusions of this study in Belgium are consistent with studies in other countries. People with a low level of education have shorter lives than people with a higher level of education. They also have fewer years in good perceived health, and can expect more years in poor health in their shorter lives. The inequality in health expectancy seems to be greater in females than males.     

Self-rated life expectancy and lifetime socio-economic position: cross-sectional analysis of the British household panel survey

BACKGROUND: The association between mortality risk and socio-economic position (SEP) across the lifecourse is established. This study investigates whether people's own ratings of their life expectancy are also associated with lifetime SEP. Health behaviour messages, which often emphasize the long-term benefits of behavioural change, may be received differently depending on people's perceptions of their life chances. METHODS: Cross-sectional analysis of 4780 adults aged 25-64 interviewed in the British Household Panel Survey in 2001. RESULTS: Just under a quarter of respondents did not think it likely they would live to 75 or older. People in lower SEPs were more likely to be pessimistic about their life expectancy. This applied across a number of socio-economic measures (father's social class, educational achievement, own social class, and household income). Eight socio-economic lifecourse pathways were compared. In comparison to those following the most advantaged pathway, those experiencing sustained socio-economic disadvantage were most likely to be pessimistic about their longevity, but those experiencing sustained upward mobility did not differ. Comparisons with measures of self-rated general health and limiting illness suggest that self-rated life expectancy is at least partially independent of current health status. CONCLUSIONS: This study shows that people's own perceptions of their life expectancy are associated with lifetime SEP. Self-rated life expectancy, in part, appears to reflect something over and above current health status and smoking behaviour. Given its ease of collection, it would be informative to include self-rated life expectancy in future studies.