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.     

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...     

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.     

Differences in disability-free life expectancy by gender and autonomous regions in Spain

BACKGROUND: Improvement of population health is the main aim and an important challenge for the health system. To monitor the population health indicators like disability-free life expectancy (DFLE) have been implemented. The purpose of this paper was to analyze the geographical distribution of DFLE according to autonomous regions in Spain. METHODS: Data of mortality, population and disability for the year 1999, provided by the National Institute of Statistics (INE), were used. To calculate DFLE by gender and region we used the Sullivan method that weights the expected time to live according to the status of disablement of the population. The standard error of DFLE, the expectation of disability and the proportion of time lived free of disability have also been estimated. RESULTS: In 1999 the DFLE at birth in Spain was 68.5 year for men and 72.2 years in women. Men lived proportionally more time free of disability than women (91% versus 87.7%) with an expectation of disability of 6.8 and 10.1 years respectively. Variability among regions was higher in DFLE than in life expectancy (LE). The regions with highest LE are not always those with the highest proportion of time lived without disability. CONCLUSIONS: Highest life expectancy does not always mean best health as it has been assumed currently. The DFLE indicator is a useful tool to show health status differences among the Spanish population.     

居民健康期望寿命测算研究——以湖北宜昌市为例

目的:以宜昌市居民特定健康状况流行水平、健康期望寿命(HE)及其占比情况,验证健康期望寿命综合测量方法。方法:采用网格化分层抽样抽取调查对象,以第五次全国卫生服务家庭健康询问调查表为基础,参考欧洲基本健康模块(MEHM),嵌入基本健康模块,并经过方法验证,使用自评健康、活动限制指标分别计算自评健康期望寿命和无活动限制期望寿命两项指标。结果:2016年,宜昌市居民出生自评健康期望寿命(HE-sp)及其占比分别为71.90岁(男性69.66岁,女性74.44岁)、91.89%。宜昌市居民出生健康寿命年(HLY)及其占比分别为75.58(男性73.60岁,女性77.82岁)、96.60%。宜昌市居民出生HLY女性高于男性(Z=9.21,P0.05),男女HLY占比基本一致。男女性HE-sp有差异(Z=7.68,P0.05),出生HE-SP占比无差异,健康期望寿命呈现等比例下降趋势。结论:计算机网格化抽样面访适宜基层推广,基本健康模块适合国内居民健康调查使用。建议全国统一地市级人群健康综合测量工具,明确健康期望寿命指标类别,推荐采取类似欧盟的基本健康模块监测指标,并纳入中国居民健康核心指标体系。     

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。     

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...     

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,...     

北京市居民健康期望寿命测算研究

目的：基于卫生系统现有数据测算北京市居民健康期望寿命,对该指标本土化研究与应用提出建议。资料与方法：利用2008年北京市年度人口和死亡资料,第四次国家卫生服务调查和第二次全国残疾人抽样调查资料,基于沙利文法测算常用健康期望寿命指标。结果：2008年北京市居民0岁自评健康期望寿命为72．75岁,男性71．22岁,女性73．89岁。0岁无失能期望寿命75．18岁,男性73．85岁,女性76．56岁。0岁无慢性病期望寿命62．73岁,男性61．87岁,女性63．75岁。北京居民健康期望寿命在期望寿命中的占比男性通常高于女性,但老年人口中,男性健康期望寿命在期望寿命中的占比低于女性。政策建议：使用健康期望寿命作为居民健康状况评价的重要指标,借鉴国外成熟经验建立本土化的数据报告和收集制度,推进居民全生命周期人口相关信息数据的整合与利用,重视老年人口的长期照护需求及其健康支持体系建设。     

Is the different time trend (1997–2008) of the obesity prevalence among adults in the three Belgian regions associated with lifestyle changes?

Background

Obesity is a major public health issue with increasing prevalence among adults. However, in Belgium the regional time trends (1997–2008) differed: the prevalence of obesity increased in the Flemish and Brussels Regions, but remained stable in the Walloon Region, the latter still showing the highest prevalence. The purpose of the present study is to explore if the different time trends of obesity prevalence in the three Belgian regions is associated with lifestyle changes.

Methods

We used data from four successive cross-sectional waves (1997, 2001, 2004 and 2008) of the Belgian Health Interview Survey. The study was restricted to the adult population, resulting in samples of respectively 8,071, 9,391, 10,319 and 8,831 individuals. In line with the WHO definition, obesity was defined as having a BMI ≥ 30. Differences in regional trends of obesity were investigated through stratified analyses. The association between obesity and survey year, adjusted for lifestyle factors (alcohol consumption, smoking, fruit and vegetables consumption and leisure time physical activity), was assessed via logistic regression models. Interactions were added to the models to explore if the association between lifestyle factors and obesity varied over time.

Results

Obesity was associated with daily alcohol use in the Brussels (OR 0.66, 95% CI 0.50-0.88) and Walloon Regions (OR 0.8, 95% CI 0.6-0.9), with lower tendencies of being obese for daily drinkers. The probability of being obese was lower among smokers in the Flemish (OR 0.7, 95% CI 0.6-0.8) and Walloon Regions (OR 0.7, 95% CI 0.6-0.9) than among non-smokers. A lack of leisure time physical activity was associated with the probability of being obese in all regions (Brussels Region: OR 1.6, 95% CI 1.3-1.8; Flemish Region: OR 1.6, 95% CI 1.4-1.9; Walloon Region: OR 1.8, 95% CT 1.6-2.1). This association decreased significantly between 1997 and 2008 only in the Walloon Region.

Conclusion

The decreasing association between obesity and a lack of leisure time physical activity in the Walloon Region between 1997 and 2008 could indicate that there is an increasing awareness of risk factors for obesity in the Walloon population, which may have resulted in a more favourable evolution of the obesity epidemic.     

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。     

Divergent mortality trends by ethnicity in Fiji

Objective : To examine trends in infant mortality rate (IMR), adult mortality and life expectancy (LE) in the two major Fijian ethnic groups since 1975. Methods : Estimates of IMR, adult mortality (15–59 years) and LE by ethnicity are calculated from previously unreported Fiji Ministry of Health data and extracted from published sources. Results : Over 1975–2008: IMR decreased from 33 to 20 deaths/1,000 live births in i‐Taukei (Fiji Melanesians); and 38 to 18 in Fijians of Indian descent. Increased adult male mortality among i‐Taukei and decline among Fijians of Indian descent led to an equal probability of dying in 2007 of 29%; while in female adults the probability trended upwards in i‐Taukei to 25%, and declined in Fijians of Indian descent to 17%. Life expectancy in both ethnicities increased until 1985 (to 64 years for males; 68 for females) then forming a plateau in males of both ethnicities, and Fijian females of Indian descent, but declining in i‐Taukei females to 66 years in 2007. Conclusions : Despite IMR declines over 1975–2008, LE for i‐Taukei and Fijians of Indian descent has not increased since 1985, and has actually decreased in i‐Taukei women, consistent with trends in adult mortality (15–59 years). Mortality analyses in Fiji that consider the entire population mask divergent trends in the major ethnic groups. This situation is most likely a consequence of non‐communicable disease mortality, requiring further assessment and a strengthened response.     

Association Between Social Participation and Disability-free Life Expectancy in Japanese Older People: The Ohsaki Cohort 2006 Study

BackgroundAlthough social participation has been reported to be associated with significantly lower risks of mortality and disability, to our knowledge, no study has estimated its impact on disability-free life expectancy (DFLE). Therefore, this study aimed to investigate the association between social participation and DFLE in community-dwelling older people.MethodsWe analyzed 11-year follow-up data from a cohort study of 11,982 Japanese older adults (age ≥65 years) in 2006. We collected information on the number of social participations using a questionnaire. Using this information, we categorized the participants into four groups. DFLE was defined as the average number of years a person could expect to live without disability. The multistate life table method using a Markov model was employed for calculating DFLE.ResultsThe results revealed that DFLE according to the number of social participations was 17.8 years (95% confidence interval [CI], 17.3–18.2) for no activities, 20.9 (95% CI, 20.4–21.5) for one activity, 21.5 (95% CI, 20.9–22.0) for two activities, and 22.7 (95% CI, 22.1–23.2) for three activities in men, and 21.8 (95% CI, 21.5–22.2), 25.1 (95% CI, 24.6–25.6), 25.3 (95% CI, 24.7–25.9), and 26.7 years (95% CI, 26.1–27.4), respectively, in women. This difference in DFLE did not change after the participants were stratified for smoking, body mass index, physical activity, and depression.ConclusionSocial participation is associated with longer DFLE among Japanese older people; therefore, encouraging social participation at the population level could increase life-years lived in good health.Key words: social participation, community activity, disability-free life expectancy, life expectancy, prospective study     

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.     

上海市某区老年人健康期望寿命分析

目的：计算上海市静安区60岁以上老年人的健康期望寿命,分析10年间老年人健康期望寿命的损害。方法：采用随机整群抽样的方法在2011年选择3049位老年人进行调查,采用Sullivan法计算健康期望寿命。结果：2011年该地区60岁组老年人的期望寿命和健康期望寿命分别为26．30岁和18．94岁,各年龄组的女性期望寿命均高于男性,但各年龄组的男性健康期望寿命均高于女性。疾病是影响老年人的生活质量的主要因素,其中脑血管病导致的健康期望寿命损失率最大为60．9％。结论：为了提高老年人的健康期望寿命,应加强防治慢性非传染性疾病和女性老年人的保健服务。     

Time trends in cancer mortality in central Serbia

Summary. Objective To examine cancer mortality trends in Central Serbia (1985–2002). Methods Cancer mortality rates were based on the official death certificates (n = 192849). They were standardized for age and sex. Results In the observed period, mortality rates showed a tendency to increase in both males (y = 118.54 + 2.27x, p = 0.0001) and females (y = 83.32 + 1.02x, p = 0.0001). Mortality of lung cancer increased in both sexes (y = 32.38 + 0.86x, p < 0.001 for males, y = 6.25 + 0.25y, p < 0.001 for females), as did colorectal cancer (y = 10.87 + 033x, p < 0.001 for males, y = 8.51 + 0.09x, p < 0.05 for females). Breast cancer mortality rates increased (y = 14.48 + 0.35x, p = 0.0001), and so did cervical cancer (y = 5.14 + 0.14x, p < 0.01). Mortality of gastric cancer in males has been moderately decreasing after 1990s (y_(1990-2002) = 13.67–0.20x, p < 0.01), while prostate cancer mortality remained relatively stable. Conclusions Increasing cancer mortality trends in the last 18 years in Central Serbia indicate the extremely urgent needs for health authorities to adopt measures of cancer prevention that proved effective in other countries. Submitted: 30 March, 2005 Accepted: 28 November, 2005     

Disability,mental health,sexual orientation and gender identity: understanding health inequity through experience and difference

Background

This paper focuses on inequities in health in the context of disability, mental health, sexual orientation and gender identity (The authors’ location outside of these identities is acknowledged as a serious limitation in discussing experience as a framework to understand health inequity in the dimensions of disability, mental health, sexual orientation and gender identity). These are dimensions that lead to health inequity primarily through the pathways of stigma and discrimination. The aim here is to distinguish the unique characteristics of these groups and thereby try and articulate a new understanding of health and health equity with identity and difference in the foreground. We aim to bring attention to experience as a crucial parameter to discuss health equity in this context.

Discussion

Health inequity can be approached in two ways. One is to look at the lacuna in the current public health discourse in addressing the specific health concerns along the dimensions of disability, mental health, sexual orientation and gender identity. The second approach involves a more organic way of taking on board the concerns of these groups, rather than as after-thoughts; this involves a framework that gives a central role to the lived experience of stigma and discrimination.The dimensions of disability, mental health, sexual orientation and gender identity affect health inequities constitutively, instrumentally through co-morbidities, and through stigma either directly or indirectly. Experience of stigma also forms the basis of identities and the difference between identities, which emerges as an important concept in the articulation of health inequities beyond measurable gaps. Recognition and representation of these differences then form the basis of an inclusive articulation on health.

Conclusion

The centrality of difference and experience prompts us to problematise the idea of equity that rests on ‘avoidable and unfair’, ‘differentials’ and even to argue that such a definition based on differentials, used in a quantitative sense, seriously limits our understanding of health inequity. Health equity will therefore not merely mean ‘closing avoidable health gaps,’ but mandate an inclusive social arrangement that celebrates difference.

     

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.     

广东省慢性病患者生存质量及健康调整期望寿命分析

目的 分析广东省慢性病患者生存质量及健康调整期望寿命。方法 基于广东省第五次全国卫生服务调查数据,通过欧洲五维度三水平健康量表对人群生存质量进行评价。运用多重线性回归和等级logistic回归评价慢性病对人群生存质量的影响,并用期望寿命和健康调整期望寿命指标评价慢性病对人群健康的综合影响。结果 共纳入68 550名居民数据进行分析,等级logistic回归显示在校正了社会人口学特征后,慢性病对生存质量各个维度的影响均有统计学意义,其中对疼痛/不舒服维度的影响最大[OR=4.48（95% CI：4.20~4.77）],其余依次为焦虑/抑郁[OR=3.95（95% CI：3.62~4.31）]、日常活动[OR=3.69（95% CI：3.37~4.04）]、行动[OR=3.63（95% CI：3.34~3.94）]和自我照顾[OR=3.30（95% CI：2.98~3.66）]。慢性病患者期望寿命比非慢性病人群平均少12.7年,健康调整寿命平均减少14.6年（男性减少17.8年,女性减少9.7年）。人群去慢性病健康调整期望寿命收益为3.8年（男性为5.1年,女性为2.0年）。结论 慢性病会影响患者生存质量的各维度,从而减少患者的健康调整期望寿命,给人群和社会带来沉重的健康负担。从卫生政策和卫生资源优化配置的角度看,需为慢性病患者尤其是为老年患者提供更全面可及的医疗照护,照护需不仅关注生理健康也要注重心理健康。