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.     

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.     

Impact of selected risk factors on expected lifetime without long-standing, limiting illness in Denmark

OBJECTIVE: To estimate the impacts of tobacco smoking, high alcohol consumption, physical inactivity and overweight on expected lifetime with and without long-standing, limiting illness. METHODS: Life tables for each level of exposure to the risk factors were constructed, mainly on the basis of the Danish National Cohort Study. Expected lifetime without long-standing, limiting illness was estimated for exposed and unexposed persons by combining life tables and prevalence data from the Danish Health Interview Survey 2000 (14,503 participants aged 25+). RESULTS: The life expectancy of 25-year-olds was 9-10 years shorter for heavy smokers than for those who never smoke, and all the lifetime lost would have been without long-standing, limiting illness. Similarly, all 5 years of expected lifetime lost by men with high alcohol consumption would have been without illness. The expected lifetime without long-standing, limiting illness was 8-10 years shorter among sedentary than physically active people. Obesity shortened lifetime without illness by 5 years for men and ten years for women. CONCLUSION: The results of this study could be used in health policy-making, as the potential gains in public health due to interventions against these risk factors could be evaluated, when the prevalence of exposure to the risk factor is available.     

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     

Social gradient in life expectancy and health expectancy in Denmark

Summary 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.Results: Life expectancy was 4.3 years longer for 30-year-old men with a high educational level than for those with a low level. At age 30, the proportion of expected lifetime in self-rated good health was 67.7%, 76.1% and 82.3% for men with a low, medium and high educational level, respectively. Among women, life expectancy differed by 2.7 years between low and high educational level, and the proportion of expected lifetime in self-rated good health was 62.5% at the low and 80.5% at the high educational level.Conclusions: Educational level and life expectancy are clearly related. The social gradient in terms of health expectancy is even greater than that in terms of life expectancy.     

Trends in life expectancy with care needs based on long-term care insurance data in Japan

Background

Using a previously developed method for calculating expected years of life with care needs based on data from the Japanese long-term care insurance system, we examined recent trends in expected years of life with care needs by age group and prefecture.

Methods

Information on care needs was available from the long-term care insurance system of Japan. Expected years of life with care needs by age group and prefecture in 2005–2009 were calculated.

Results

Expected years of life with care needs at age 65 increased from 1.43 years in 2005 to 1.62 years in 2009 for men, and from 2.99 to 3.44 years for women. As a proportion of total life expectancy, these values show an increase from 7.9% to 8.6% in men and from 12.9% to 14.4% in women. Expected years with care needs did not increase in the age groups of 65 to 69 and 70 to 74 years but markedly increased in the age group of 85 years or older. Expected years with care needs increased in every prefecture during the period studied. The difference in 2005 between the 25th and 75th percentiles in prefectural distributions was 0.16 years for men and 0.35 years for women. The difference remained nearly constant between 2005 and 2009.

Conclusions

Expected number of years of life with care needs increased among Japanese from 2005 to 2009, and there was a wide range in distribution among prefectures. Further studies on coverage of care needs under the long-term insurance program are necessary.Key words: disability-free life expectancy, life expectancy, care needs, health statistics     

Measuring the impact of HIV/AIDS, heart disease and malignant neoplasms on life expectancy in the USA from 1987 to 2000

OBJECTIVES: Quantifying the impact of a disease on society is an important issue for setting priorities for better allocation of healthcare resources and for evaluating the effectiveness of prevention and control of the disease. STUDY DESIGN: The potential gains in life expectancy due to the elimination of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), heart disease and malignant neoplasms were compared for the US population by age and ethnicity from 1987 to 2000. METHODS: The potential gain in life expectancy after hypothetical elimination of cause-specific deaths is an effective indicator of measuring the impact of a disease on a population. Official age-specific mortality rates, by ethnicity, due to HIV/AIDS, heart disease and malignant neoplasms of the US population from the National Center for Health Statistics were used, and multiple decremental life tables were constructed to find the corresponding potential gains in life expectancy. RESULTS: The potential gains in life expectancy for the US population at birth by complete elimination of HIV/AIDS, heart disease and malignant neoplasms were 0.14, 3.71 and 3.06 years in 1987, respectively. In 1995, the potential gain in life expectancy due to the elimination of HIV/AIDS increased from 0.14 years in 1987 and achieved its highest value (0.41 years), whereas the elimination of heart disease and malignant neoplasms led to potential gains in life expectancy of 3.05 and 3.10 years, respectively. Since 1995, the potential gains in life expectancy at birth by eliminating deaths from HIV/AIDS and heart disease have decreased to 0.13 and 2.67 years, respectively, in 2000. However, the potential gain in life expectancy due to elimination of malignant neoplasms remained relatively stable (3.01 years in 2000). It is well known that HIV/AIDS tends to have a greater impact on people of working age, whereas heart disease and malignant neoplasms have a greater impact on people over 65 years of age. To measure the impact of these diseases on life expectancy in people of working age, a partial multiple decremental life table was constructed and the potential gains in life expectancy were computed by partial or complete elimination of various causes of death during the working years. shows the impact on life expectancy of the US working-age population by eliminating deaths from HIV/AIDS, heart disease and malignant neoplasms by race and sex groups. CONCLUSIONS: Since 1995, there has been a rapid reduction in the burden of HIV/AIDS on the life expectancy for the US population, especially for black males of working age. These results could provide useful information when evaluating public health improvements and allocating resources for future disease control programmes.     

Terminal costs, improved life expectancy and future public health expenditure

This paper presents an empirical analysis of public health expenditure on individuals in Denmark. The analysis separates out the individual effects of age and proximity to death (reflecting terminal costs of dying) and employs unique micro data from the period 2000 to 2009, covering a random sample of 10% of the Danish population. Health expenditure includes treatment in hospitals, subsidies to prescribed medication and health care provided by general practitioners and specialists and covers about 80% of public health care expenditure on individuals. The results confirm findings from previous studies showing that proximity to death has a significant impact on health care expenditure. However, it is also found that cohort effects (the baby boom generation) as well as improvements in life expectancy have a substantial effect on future health care expenditure even when proximity to death is controlled for. These results are obtained by combining the empirical estimates with a long term population forecast. When life expectancy increases, terminal costs are postponed but the increases in health expenditure that follow from longer life expectancy are not as large as the increase in the number of elderly persons would suggest (due to “healthy ageing”). Based on the empirical estimates, healthy ageing is expected to reduce the impact of increased life expectancy on real health expenditure by 50% compared to a situation without healthy ageing.     

期望寿命及健康寿命应用分析

目的　对居民期望寿命和健康寿命的应用进行分析。　方法　采用宁波市城乡 2 0 0 0年居民病伤死因年报表和 2 0 0 1年宁波市城市居民慢性病调查数据 ,分析全死因、去死因期望寿命及健康寿命。　结果　全死因、去死因期望寿命分布均表现为女性高于男性 ,城市高于农村。宁波市 35岁以上城市居民不健康寿命平均为 9.2 1岁 ,占期望寿命的比例各年龄组从 4 3.4 3%到 6 9.88%不等 ,随年龄增长比例逐渐下降。各年龄组健康寿命女性均高于男性 ,平均高 3.0 8岁。　结论　健康寿命是评价人群健康状况的有用指标     

Health expectancy in Canada, late 1970s: demographic, regional, and social dimensions.

Based on estimates of activity restriction from the Canada Health Survey, institutional data on long-term care, and survival data from vital statistics, we have calculated an index of health expectancy (life expectancy in each state of health), and a summary of these indices which we have called quality-adjusted life expectancy. At birth, expected years of long-term institutionalization were 0.8 for men and 1.5 for women. Expected years of activity restriction not involving long-term institutionalization were 10.8 for men and 14.0 for women; 3.0 of the expected years of activity restriction for men and 1.3 of these years for women were in the most severe category of restriction (unable to do major activity). For both sexes together, quality-adjusted life expectancy was 1.4 years greater in Ontario and the Prairies than in the Atlantic region, 3.2 years greater in Canada's three largest cities than in rural areas and small towns, and 7.7 years greater among persons from high-income families than among persons from low-income families.     

Life expectancy without chronic morbidity: trends in gender and socioeconomic disparities

OBJECTIVE: Life expectancy without chronic morbidity, or morbidity-free life expectancy (MFLE), was calculated to measure changes in population health status between 1989 and 2000 on the basis of gender and socioeconomic status. METHODS: Sullivan's method was used to calculate morbidity-free life expectancy. Prevalence rates for chronic morbidity were derived from the Netherlands Continuous Health Interview Survey. Four socioeconomic groups were distinguished on the basis of educational level. RESULTS: Between 1989 and 2000, total life expectancy increased for males and females and for all socioeconomic groups. Morbidity-free life expectancy decreased significantly for males (from 54.7 years to 53.9 years) and females (from 55.3 years to 51.0 years). The gap between males and females in MFLE has reversed, from 0.6 years in favor of females in 1989 to 2.9 years in favor of males in 2000. The gap between the upper and lower classes seems to have narrowed (for males from 11 years to 8.5 years and for females from 4.7 years to 4.0 years). CONCLUSIONS: The results indicate that morbidity-free life expectancy is falling for males and females and in all socioeconomic groups. Part of this decrease could be attributed to earlier diagnosis of chronic diseases. A widening gap in MFLE was observed between males and females in favor of males. The gap between the upper and lower socioeconomic groups seems to be narrowing.     

From healthy survivors to sick survivors--implications for the twenty-first century

BACKGROUND: Hypotheses concerning compression of morbidity have gained support, particularly due to improved lifestyles from 1950 to date, but now the increase is largely due to improvements in healthcare. METHODS: Survey data from Sweden were used to test whether the older population aged 65-84 years during 1995-2002 had more longstanding illnesses than the older population of 1980-87 or 1988-94. RESULTS: There was an increased prevalence of many longstanding illnesses among the elderly in Sweden between 1988-94 and 1995-2002. The increase was especially pronounced among those with at least three longstanding illnesses. For diabetes, heart disease, and hypertension, the prevalence among elderly men increased by over 20%. However, those reporting these kinds of longstanding illnesses perceive improved health and are less restricted in their daily activities. CONCLUSIONS: Results from Sweden indicate that many countries approaching Sweden's life expectancy will have an increased need for care for the oldest population in the future. The compression-of-morbidity hypothesis is being challenged, probably due to improvements in healthcare.     

Does geography explain ethnic inequalities in health in New Zealand?

OBJECTIVE: To quantify the potential contribution of inter-district relative to intradistrict variation to the Maori disparity in life expectancy in 2000-02, by counterfactual modelling. SETTING, DATA SOURCES AND METHODS: The setting was New Zealand's 21 health districts (District Health Boards, DHBs). All data (population estimates and life expectancy estimates) were sourced from Statistics New Zealand and relate to the 2000-02 period. Maori life expectancy (nationally) was recalculated under the counterfactual that Maori life expectancy in each DHB did not differ from total population life expectancy in the corresponding DHB (so eliminating intra-district variation). The difference between the observed total population and counterfactual Maori life expectancies therefore represents the contribution of inter-district variation to the Maori life expectancy disparity. RESULTS: Observed total population and Maori life expectancies at birth in 2000-02, pooling sexes, were 78.7 and 71.1 years respectively, giving a total disparity of 7.6 years. Under the counterfactual, Maori life expectancy increased to 78.4 years (and total population life expectancy to 79.0 years). Inter-district variation was therefore estimated to potentially contribute only 0.6 years or 8% to the total Maori disparity. Allowing for imprecision, inter-district variation almost certainly accounts for less than 10.5% of the total disparity. CONCLUSION: Inter-district or geographic variation makes only a small contribution to the total Maori disparity in life expectancy. Adjustment or standardisation for district is not necessary when comparing Maori and non-Maori health outcomes. If the policy goal is to reduce ethnic inequalities in health, then the focus of policy (e.g. funding formulae) needs to be on factors directly linked to ethnicity, rather than on geographic variations in health and health care that have an impact on all ethnic groups more-or-less alike.     

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.     

Health, life expectancy, and mortality patterns among immigrant populations in the United States

BACKGROUND: The US immigrant population has grown considerably in the last three decades, from 9.6 million in 1970 to 32.5 million in 2002. However, this unprecedented population rise has not been accompanied by increased immigrant health monitoring. In this study, we examined the extent to which US- and foreign-born blacks, whites, Asians, and Hispanics differ in their health, life expectancy, and mortality patterns across the life course. METHODS: We used National Vital Statistics System (1986-2000) and National Health Interview Survey (1992-1995) data to examine nativity differentials in health outcomes. Logistic regression and age-adjusted death rates were used to examine differentials. RESULTS: Male and female immigrants had, respectively, 3.4 and 2.5 years longer life expectancy than the US-born. Compared to their US-born counterparts, black immigrant men and women had, respectively, 9.4 and 7.8 years longer life expectancy, but Chinese, Japanese, and Filipino immigrants had lower life expectancy. Most immigrant groups had lower risks of infant mortality and low birthweight than the US-born. Consistent with the acculturation hypothesis, immigrants' risks of disability and chronic disease morbidity increased with increasing length of residence. Cancer and other chronic disease mortality patterns for immigrants and natives varied considerably, with Asian Immigrants experiencing substantially higher stomach, liver and cervical cancer mortality than the US-born. Immigrants, however, had significantly lower mortality from lung, colorectal, breast, prostate and esophageal cancer, cardiovascular disease, cirrhosis, diabetes, respiratory diseases, HIV/AIDS, and suicide. INTERPRETATION: Migration selectivity, social support, socio-economic, and behavioural characteristics may account for health differentials between immigrants and the US-born.     

The characteristics of mobile families with young children in England and the impact of their moves on neighbourhood inequalities in maternal and child health

This study compares the health and socio-demographic characteristics of residentially mobile families with young children in England to families that do not move and assesses the impact of their moves upon inequalities in health between neighbourhoods. The analysis uses data from the first two waves of the Millennium Cohort Study describing 9022 cohort members, born in 2000-2002, and their families. A third of the families moved between the waves of the survey when the children were aged nine months and three years. Mobile families moved disproportionately toward less deprived areas but had disadvantaged socio-economic characteristics and poor outcomes for infant's birth weight and accidents and mother's self-rated health, limiting longstanding illness and mental health. Health outcomes were worst among the minority moving to more deprived neighbourhoods. Families' moves moderately increased health inequalities between neighbourhoods with high and low deprivation.     

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.     

Health tests and health consultations reduced cardiovascular risk without psychological strain, increased healthcare utilization or increased costs. An overview of the results from a 5-year randomized trial in primary care. The Ebeltoft Health Promotion Project (EHPP)

BACKGROUND: Few randomized controlled trials (RCT) have evaluated health tests and health consultations in primary care with a long follow-up period. The Ebeltoft Health Promotion Project (EHPP) evaluated health tests and health consultations over a period of 5 years in the frame of a health technology assessment. OBJECTIVE: To review the results of EHPP. DESIGN: RCT with a control group answering questionnaires and two intervention groups having questionnaires, a comprehensive health test with written advice followed by either a normal consultation on demand or a planned 45 minutes patient-centred consultation. Setting: Primary care. Participants: The target population was all 30-49 year old persons in the municipality of Ebeltoft, Denmark. Invitations were received by 2000 randomly selected persons. Intervention: A comprehensive biomedical health test including a cardiovascular risk score (CVRS) followed by written advice and health consultations. Main outcome measures: Biomedical measures, psychological measures, healthcare contacts, life years gained, direct and total health costs. RESULTS: At baseline 75% participated. During the 5 years 85% participated at least once. Elevated CVRS was found in 19% in the control group compared to 10% in the intervention groups (p<0.01) after 5 years. There were no measurable long term psychological reactions. Numbers of contacts to the healthcare system were not increased. Significantly better life expectancy was found without extra direct and total costs. CONCLUSIONS: An offer of health tests and patient-centred health consultations to the middle-aged population can be cost-effective and may be considered in the fight against the increasing burden of lifestyle diseases.     

Active life expectancy for elderly Japanese by chewing ability

OBJECTIVE: Panel interview surveys of nationally representative elderly people aged 65 years or above in Japan were conducted three times at 2-year intervals since 1999 (Nihon University Japanese Longitudinal Study of Aging) to estimate health expectancy for males and females separately according to their chewing ability. METHOD: Multistate life table methods were applied to estimate health expectancy. Three health states, namely, active, inactive and dead, were defined according to the ability to perform specified daily activities. Living respondents were considered to be in an "inactive state" if they responded "very difficult" or "unable" for performance of at least one ADL or IADL. Otherwise they were considered to be in an "active state". 4,323 sampled persons who responded to the baseline survey were included in the study. Based on estimated transition probabilities over the survey period between active and inactive states, and active and inactive states to death, both population- and status-based multistate life tables were constructed according to chewing ability. Those who could chew relatively hard foods at the baseline survey were classified as Group A and those who could chew only relatively soft foods were classified as Group B. RESULTS: The population-based multistate life tables indicated that at age 65, total life expectancy was 19.3/23.2 (males/females) years for Group A and 16.7/21.1 years for Group B. Active life expectancy was 16.8/18.6 years and 13.6/16.3 years, and inactive life expectancy was 2.4/4.6 years and 3.1/4.8 years for Groups A and B respectively. A statistically significant difference was observed between the two groups only in terms of active life expectancy. From status-based multistate life tables, similar patterns were observed for those whose status at the baseline was "active". CONCLUSION: These results suggest that maintenance or recovery of sufficient chewing ability for elderly people is related to a longer total life expectancy and even more strongly related to a longer active life expectancy.     

评价健康水平的新指标—伤残调整期望寿命

伤残调整期望寿命年（DALE）是新的健康综合衡量指标,WHO将其用于各成员国卫生系统的绩效评价。DALE是一种衡量人们相当于在完全健康状况下生活年数的指标,计算时通常使用沙利文（Sullivan）法,人群伤残现患率和伤残严重性权重是关键数据,其来源有多种。与伤残调整寿命年（DALY）相比,DALE的作用更加广泛。