Are gaps in disability free life expectancies diminishing in Italy?

This paper studies gender differences in disability free life expectancy (DFLE), taking into account mortality and disability contributions. After analysing the types of disability that account for such differences, it goes on to examine temporal variability and age contributions to mortality and disability variation. The method used is an extension of Arriaga’s model proposed by Nusselder. In 2005, disability free life expectancy at age 30 was 46.23 years for men and 48.74 years for women, with a gender difference of 2.51 years. Decomposing this difference we find that the mortality effect is 3.70 years, while the disability effect is negative and equal to −1.19 years. Ten years earlier, in 1994, DFLE at age 30 was 43.24 years for men and 46.55 years for women, with a difference between genders of 3.32 years. This broke down to a mortality effect of 4.33 years and a disability effect of −1.02 years. In conclusion, the gap in DFLE between men and women is narrowing, thanks to the more rapid drop in mortality rates in men. With respect to disabilities women are disadvantaged, although the difference (in both total disability and different types of disability) has been almost stable in recent years.     

Gender differences in health of EU10 and EU15 populations: the double burden of EU10 men

This study compares gender differences in Healthy Life Years (HLY) and unhealthy life years (ULY) between the original (EU15) and new member states (EU10). Based on the number of deaths, population and prevalence of activity limitations from the Statistics of Living and Income Conditions Survey (SILC) survey, we calculated HLY and ULY for the EU10 and EU15 in 2006 with the Sullivan method. We used decomposition analysis to assess the contributions of mortality and disability and age to gender differences in HLY and ULY. HLY at age 15 for women in the EU10 were 3.1 years more than those for men at the same age, whereas HLY did not differ by gender in the EU15. In both populations ULY at age 15 for women exceeded those for men by 5.5 years. Decomposition showed that EU10 women had more HLY because higher disability in women only partially offset (−0.8 years) the effect of lower mortality (+3.9 years). In the EU15 women’s higher disability prevalence almost completely offset women’s lower mortality. The 5.3 fewer ULY in EU10 men than in EU10 women mainly reflected higher male mortality (4.5 years), while the fewer ULY in EU15 men than in EU15 women reflected both higher male mortality (2.9 years) and higher female disability (2.6 years). The absence of a clear gender gap in HLY in the EU15 thus masked important gender differences in mortality and disability. The similar size of the gender gap in ULY in the EU-10 and EU-15 masked the more unfavourable health situation of EU10 men, in particular the much stronger and younger mortality disadvantage in combination with the virtually absent disability advantage below age 65 in men.     

Gender Differences in Health and Health Expectancies of Older Adults in Singapore: An Examination of Diseases,Impairments, and Functional Disabilities

Using a nationally representative sample of 4,511 Singaporeans aged 55+ from the 2005 National Survey of Senior Citizens (NSSC), this paper examines gender differences in specific diseases, impairments, and disabilities, and computes health expectancies for these health dimensions. Results show that women have higher prevalence for hypertension, bone/joint, eye/vision, and walking problems, while heart diseases and stroke are more common among men, particularly at younger ages. At ages 75+, women have more disabilities related to basic activities of daily living (bathing, dressing, toileting, transferring, and feeding) than men. Health expectancies computations by the Sullivan method reveal that while women live longer than men, they can also expect more years of life both without and with diseases, impairments, and disabilities. At age 65, a larger proportion of women’s remaining life is with hypertension, bone/joint problems, vision impairments, walking difficulties, and functional disabilities compared to same-aged men. The findings largely support the gender health-survival paradox found in Western countries—that women have higher morbidity rates despite longer life expectancy. The morbidity differences between men and women, however, vary depending on the particular health dimension and measure examined. Older women in Singapore tend to be advantaged in prevalence of diseases and disease-free life expectancy, but have more impairments and functional disabilities, and a larger proportion of remaining life with these difficulties compared to older men. Health policies and programs in Singapore will need to cater to these gender differences in specific health dimensions and measures.     

Men: good health and high mortality. Sex differences in health and aging

This review examines sex differences in health and survival, with a focus on the Nordic countries. There is a remarkable discrepancy between the health and survival of the sexes: men are physically stronger and have fewer disabilities, but have substantially higher mortality at all ages compared with women: the so-called male-female health-survival paradox. A number of proposed explanations for this paradox are rooted in biological, social, and psychological interpretations. It is likely to be due to multiple causes that include fundamental biological differences between the sexes such as genetic factors, immune system responses, hormones, and disease patterns. Behavioral differences such as risk-taking and reluctance to seek and comply with medical treatment may also play a role. Another consideration is that part of the difference may be due to methodological challenges, such as selective non-participation and under-reporting of health problems, and delayed seeking of treatment by men. The Nordic countries provide a unique opportunity for such studies, as they have good-quality data in their national health registers, which cover the whole population, and a long tradition of high participation rates in surveys.     

Disability-free life expectancy of older French people: gender and education differentials from the PAQUID cohort

In countries with low mortality rates, the quality of the years of life is more important to consider than total life expectancy (TLE). Disability-free life expectancy (DFLE) is one of the most relevant indicators of health and the quality of life. This paper aims to estimate TLE and DFLE with four levels of severity of disability and to explore gender and educational differences in older French people. In this cohort study, four levels of disability severity were distinguished, disability being evaluated for mobility, instrumental and basic activities of daily living. For each level, TLE and DFLE were calculated using multi-state models from transition probabilities. From the population of two areas of South West France 3,777 subjects were randomly selected from the electoral rolls. At the baseline, they were aged 65 years and over, living in the community and were interviewed 6 times over the 10-year follow-up. At age 65, women lived longer than men (4.5 extra years), but shorter fully independent lives (−2.2 years). They also lived longer in each of the three degrees of disability (+4.2 years with moderate or severe disability). The higher educated lived longer (1.3 extra years at age 65), with the additional years free of disability. Regardless of age, gender and education, there appeared to be a 1-year incompressible time spent with severe disability. To conclude, these are the first health expectancies based on the longitudinal data for France. Whilst most of the studies were based on cross-sectional data, this paper gives a more realistic indicator of the health and socio-economic inequalities in France in the 1990 s.     

Trends in healthy life expectancy in Hong Kong SAR 1996–2008

Although Hong Kong has one of the best life expectancy (LE) records in the world, second only to Japan for women, we know very little about the changes in the health status of the older adult population. Our article aims to provide a better understanding of trends in both chronic morbidity and disability for older men and women. The authors compute chronic morbidity-free and disability-free life expectancy and the proportion of both in relation to total LE using the Sullivan method to examine whether Hong Kong older adults are experiencing a compression of morbidity and disability and whether there is any gender difference in relation to mortality and morbidity. The results of this study show that Hong Kong women tend to outlive Hong Kong men but are also more likely to suffer from a ‘double disadvantage’, namely more years of life with more chronic morbidity and disability. There has also been a significant expansion of chronic morbidity, as chronic morbidity-free life expectancy (CMFLE) decreased substantially for both genders from 1996 to 2008. Although disability-free life expectancy (DFLE) increased during this period, it increased at a slower pace compared to LE. The proportion of life without chronic morbidity also declined remarkably during these 12 years. Among the advanced ages, the proportion of remaining life in good health without disability has decreased since 1996, indicating a relative expansion of disability.     

Epidemiology of major age-related diseases in women compared to men

Many observations indicate that women have a longer life expectancy than men. Population-based studies report that mortality and morbidity are higher in men than in women. The gender difference is constant in cardiovascular disease, cancer and dementia, the more frequent diseases in industrialized countries; these chronic conditions strongly influence longevity and quality of life in old persons. Biological, behavioral and environmental factors emerge as major contributors to the difference in mortality, morbidity and case fatality. However, the causes of gender differences remain poorly understood.     

Subjective health and mortality in French elderly women and men

OBJECTIVES: To examine the predictive value of subjective health on mortality separately in women and men, independently of other health measures, and to explain the differences between sexes by way of cognition, depression, and disability. METHODS: The PAQUID (Personnes Agées QUID) cohort is a representative sample of 3,660 nondemented elderly community residents, aged 65 and older. The relationship between subjective health and 5-year mortality was studied using the Cox model with delayed entry. RESULTS: In men, subjective health was a predictor of mortality, independent of sociodemographic characteristics, physical health status, depressive symptomatology, cognitive function, and disability, particularly in the middle-range categories of subjective health. In women, the relationship between subjective health and mortality was explained by physical health status and disability. DISCUSSION: Self-rated health seems to be a better predictor of mortality in men than in women. In men, the way in which self-ratings of health are produced remains unknown. In order to better understand sex differences, the pathways from healthy life to dependency and death, and their related changes in subjective health, should be explored further.     

Health-life expectancy according to various functional levels

OBJECTIVES: To estimate disability-free life expectancy according to three functional levels. DESIGN: A 2-year prospective study of older residents in a rural Japanese community. The functional ability of each individual was determined with self-completed questionnaires at baseline (1994) and at follow-up (1996). SETTING AND PARTICIPANTS: All residents of Wakuya Town, Japan, who were aged 65 years or older at the start of the study in 1994 (n = 3590). MEASUREMENTS: Single-year increment-decrement life tables were constructed from mortality rates and incidence of disability rates. Independent life expectancies in three functional areas: basic activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility, were estimated for each sex and each year of age. RESULTS: The incidence and prevalence of disability were similar in men and women. For both sexes, independent life in IADL was shorter than independent life in ADL and mobility. The development and progression of disability were different between sexes: men experienced disability at a younger age and at a faster rate than women. CONCLUSIONS: The slow progress of disability, with a longer duration in a disabled state among women, induces a heavy burden on health and welfare resources. Interventions to delay the onset of disability in women should reduce the economic burden to society as well as improve the quality of life. Prospective studies to look at the process of disablement, based on direct observation, are needed to confirm the gender differences.     

Trends in health expectancy indicators in the older adult population in Belgium between 1997 and 2004

The objective is to assess if longer life in Belgium is associated with more healthy years through the evaluation of trends (1997–2004) in health expectancy indicators at ages 65 and 80 covering different health domains: self-perceived health, chronic morbidity, disease clusters, and disability. Information was obtained from Belgian Health Interview Surveys. Health expectancies were calculated using the Sullivan method. Among males at age 65, the increase in years expected to live without chronic morbidity, without a disease cluster or without disability exceeded the increase of the life expectancy (LE). The rise in LE in good self-perceived health was equal to the gain in LE. Among women at age 65 and among men and women at age 80, none of the changes in the expected years of life in good health in any health domain were statistically significant. At age 65 among women, the increase in LE was smaller than the increase in years without chronic disease or without disability. The increase in years without disease clusters was less that the LE increase. At age 80 among men, the years without disability increased as the LE, with a shift toward years with moderate limitations. In any other health domains for men (except co-morbidity) and in all domains for women the years in good health either decreased or increased less than the LE. The recent rise in life expectancy in Belgium is, among the youngest old and especially among males, accompanied by an improved health status. At age 80 and particularly among women expansion of unhealthy years prevails.

Trends in health expectancy at age 65 for various health indicators, 1987–2005, Denmark

Record life expectancy does not appear to be approaching its limit—it is still increasing, as is the maximum life span. An important question is whether the longer life is accompanied by an increasing lifetime in good health. The aim of the study was to determine the trends in health expectancy at age 65 in Denmark during the period 1987–2005, including the end of a period of stagnation (until 1995) and the beginning of a new period with increasing life expectancy (after 1994). The study was based on nationwide register data on mortality and data on health status from the Danish Health Interview Surveys carried out in 1987, 1994, 2000, and 2005. Expected lifetime in various health states was estimated with Sullivan’s method. Life expectancy at age 65 increased only after 1994 by almost 2 years among men and by about 1 year among women. The increase in expected lifetime without long-standing, limiting illness, lifetime without functional limitations, and lifetime with self-rated good health was all substantial in both genders (1.4–3 years depending on gender and health indicator), and was followed by a decrease in lifetime with the unhealthy state resulting in increasing proportions of lifetime in a healthy state. Overall, expected lifetime in good health increased more than life expectancy in both genders during the second half of the period 1987–2005, i.e. after the stagnation period.     

The effect of obesity on disability vs mortality in older Americans

BACKGROUND: The association between obesity and mortality is reduced or eliminated in older subjects. In addition to mortality, disability is an important health outcome. The objectives of this study were to examine the association between body mass index (BMI), calculated as weight in kilograms divided by height in meters squared, and subsequent disability and mortality among older Americans, as well as to estimate the effect of BMI on life expectancy and disability-free life expectancy among older Americans. METHODS: We studied 8359 non-Hispanic white Americans, 1931 African Americans, and 2435 Mexican Americans 65 years or older who were not disabled at baseline from 5 sites of the Established Populations for Epidemiologic Studies of the Elderly. Measures included BMI, medical conditions, activities of daily living, and demographic information. Cox proportional hazards regression analysis was used to estimate the hazard ratios (HRs) for subsequent disability and mortality during 7 years of follow-up. Total life expectancy and disability-free life expectancy were estimated using the interpolation of Markov chain approach. RESULTS: The lowest HR (1.02; 95% confidence interval [CI], 0.94-1.10) for disability was at a BMI of 25 to less than 30. Subjects with BMIs of lower than 18.5 or 30 or higher at baseline were significantly more likely to experience disability during the follow-up period. In contrast, the lowest HRs for mortality were seen among subjects with BMIs of 25 to less than 30 (HR, 0.78; 95% CI, 0.72-0.85) and 30 to less than 35 (HR, 0.80; 95% CI, 0.72-0.90), with subjects with BMIs of lower than 25 or 35 or higher experiencing higher hazards for mortality. Disability-free life expectancy is greatest among subjects with a BMI of 25 to less than 30. CONCLUSION: Assessments of the effect of obesity on the health of older Americans should account for mortality and incidence of disability.     

Dietary effects on sex-specific health dynamics of medfly: support for the dynamic equilibrium model of aging

We examined experimentally the relationship between the period of unhealthy life and longevity in the medfly by using the first sign of supine behavior (upside down; immobile) in medflies as an indication of their poor health and by altering cohort longevity through dietary manipulations. Our main findings included the following: i) for longer lived medflies it was more likely to observe the supine behavior while shorter lived flies would more likely die before exhibiting the supine behavior. ii) males have similar total life expectancy as females but a longer healthy life expectancy; iii) the total number of healthy days, spent in the pre-supine period, and the amount of healthy life span as a fraction of the total lifespan varied with both sex and diet; iv) despite the large difference in longevity between both male and female medflies when reared on sugar-only diets versus on full diets, the differences in the fraction of their lifespans in the disabled state were relatively modest (64 vs 61% in females and 77 vs 72% in males). This finding that there is no significant change in the proportion of the life course in the unhealthy state is consistent with the ‘dynamic equilibrium’ model of healthy aging.     

Gender differences in time to first hospital admission at age 60 in Denmark, 1995–2014

Women have consistently lower mortality rates than men at all ages and with respect to most causes. However, gender differences regarding hospital admission rates are more mixed, varying across ages and causes. A number of intuitive metrics have previously been used to explore changes in hospital admissions over time, but have not explicitly quantified the gender gap or estimated the cumulative contribution from cause-specific admission rates. Using register data for the total Danish population between 1995 and 2014, we estimated the time to first hospital admission for Danish men and women aged 60. This is an intuitive population-level metric with the same interpretive and mathematical properties as period life expectancy. Using a decomposition approach, we were able to quantify the cumulative contributions from eight causes of hospital admission to the gender gap in time to first hospital admission. Between 1995 and 2014, time to first admission increased for both, men (7.6 to 9.4 years) and women (8.3 to 10.3 years). However, the magnitude of gender differences in time to first admission remained relatively stable within this time period (0.7 years in 1995, 0.9 years in 2014). After age 60, Danish men had consistently higher rates of admission for cardiovascular conditions and neoplasms, but lower rates of admission for injuries, musculoskeletal disorders, and sex-specific causes. Although admission rates for both genders have generally declined over the last decades, the same major causes of admission accounted for the gender gap. Persistent gender differences in causes of admission are, therefore, important to consider when planning the delivery of health care in times of population ageing.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10433-021-00614-w.     

广东省居民健康、伤残、死亡三者间的量效关系研究

目的采用图谱法解析居民健康、伤残、死亡三者间的量效关系.方法以居民年龄别为横坐标,以年龄别期望寿命（LE）、健康期望寿命（DALE）、伤残调整寿命年（DALY）为纵坐标,分别绘制出健康、伤残、死亡三者关系的量效图谱.结果居民健康、伤残、死亡三者关系量效图谱中LE=A＋B,DALE=A＋f（B）,DALY=C＋g（B）.女性的心血管疾病负担明显高于男性,男性的损伤与中毒疾病负担则明显高于女性.男性在呼吸疾病、恶性肿瘤、脑血管疾病和糖尿病等4类疾病的疾病负担上也均较女性为重.结论f（B）、g（B）是一种量效关系函数,它根据居民伤残状态的严重性权重,将在这种伤残状态下生活的年数转化成相当于在完全健康状态下生活的年数与死亡状态下损失的年数,从而直观反映居民健康、伤残与死亡的量效关系.     

Cohort changes in active life expectancy in the U.S. elderly population: experience from the 1982-2004 National Long-Term Care Survey

OBJECTIVES: To understand declines in chronic disability prevalence in the U.S. elderly population, we examined cohort changes in active life expectancy, a health measure relating population disability and longevity dynamics. METHODS: We computed active life expectancy and life expectancy using the six National Long-Term Care Surveys done from 1982 to 2004 and linked to continuous-time Medicare service data for the same time period by using a stochastic process model based on disability scores calculated using grade of membership analyses. We simultaneously estimated continuous-time disability dynamic and mortality functions to calculate life tables for specific disability states and for temporally changing mixtures of disability states. RESULTS: Disability dynamics, measured as changes in grade of membership scores, showed significant variation across two birth cohorts followed for 24 years. Disability dynamics and disability-specific hazard functions were significantly improved in the younger cohort (persons aged 65-74 in 1982). DISCUSSION: Our results, supporting the hypothesis of morbidity compression, indicate that younger cohorts of elderly persons are living longer in better health. The methods describe individual disability transitions and mortality and other factors associated with disability changes, making it possible to better evaluate interventions to promote future declines in disability.     

Past and future life expectancy increases at later ages: their implications for the linkage of chronic morbidity, disability, and mortality

Recently life expectancy increases have been noted at advanced ages in the United States. This means a more rapid growth of the elderly U.S. population in general, and of the "oldest-old" population in particular. Thus it is of considerable social and health policy interest to forecast the direction and magnitude of future changes in life expectancy at later ages and the changes in the prevalence of health and disability at later ages consequent to the increases in life expectancy. In the analysis, several prior efforts to predict life expectancy changes using standard demographic techniques are reviewed and reasons for the limitations of such efforts suggested. Results show that mortality changes at advanced ages have very different relations to risk factors than at earlier ages. The analysis also shows that linking morbidity, disability, and mortality in a complete projection of population health changes will require the extension of standard demographic methodologies to utilize information from multiple data sources.     

Education-specific estimates of life expectancy and age-specific disability in the U.S. elderly population: 1982 to 1991

The authors used mortality data for 1982 to 1991 linked to survey records from the 1982, 1984, and 1989 National Long Term Care Surveys to calculate gender differences over age in mortality and functional status for high (8 or more years of schooling) and low (less than 8 years of schooling) education subgroups. Males and females with high education maintained better functioning at later ages than those with low education. The authors also found that mortality was higher, after conditioning on disability, in both the male and female low-education than the male and female high-education groups. The size of the education effect on both disability and mortality was large, for example, about 7.6 years difference in female life expectancy at age 65; a roughly 2-year difference for males.     

Basis for Sex-Dependent Outcomes in Acute Coronary Syndrome

This review aims to provide new insights into the basis for sex differences in acute coronary syndrome (ACS). Sex differences in mortality after ACS depend on age and the type of ACS, with the greatest gap being observed among younger adults and patients with ST-segment elevation myocardial infarction (STEMI). The sex gap diminishes with increasing age and does not appear to exist to the same extent among patients with non–STEMI or unstable angina. Although it is clear that younger women with acute myocardial infarction have higher mortality than do men in the short term; whether this difference is present in the long term remains unclear. Furthermore, women with ACS face delays in diagnosis and treatment, undergo less invasive management, have more bleeding complications, and receive less evidence-based medical therapy than do their male counterparts. Finally, women with ACS consistently report lower health-related quality of life than do men. To date, our understanding of the sex differences in ACS remains limited. The impact of biological factors and nonbiological factors (especially gender roles) need to be explored to elucidate the disparities in health outcomes between men and women.