Measuring inequalities in health: the case for healthy life expectancy

OBJECTIVE: To evaluate healthy life expectancy (HLE) as a measure of health inequalities by comparing geographical and area-based deprivation-related inequalities in healthy and total life expectancy (TLE). DESIGN: Life table analysis based on ecological cross-sectional data. Setting and population: Council area quarters and postcode sector-based deprivation fifths in Scotland. MAIN OUTCOME MEASURES: Expectation of life in good self-assessed general health, or free from limiting long-term illness, and TLE, for females and males at birth. RESULTS: Women in Scotland have a life expectation of 70.3 years in good health, 61.6 years free from limiting long-term illness, and a TLE of 78.9 years. Comparable figures for men are 66.3, 58.6 and 73.5 years. TLE and HLE decrease with increasing area deprivation. Differences are substantially wider for HLE. A 4.7-year difference is seen in TLE between women living in the most and least deprived fifth of areas. The difference in HLE is 10.7 years in good health and 11.6 years free from limiting long-term illness. The degree of deprivation-related inequality in HLE is 2.5 times wider for women and 1.8 times wider for men than in TLE. CONCLUSIONS: Differences in TLE underestimate health inequalities substantially. By including morbidity and mortality, HLE reflects the excess burden of ill health experienced by disadvantaged populations better. Inequalities in length of life and health status during life should be taken into account while monitoring inequalities in population health.     

Impact of diabetes mellitus on life expectancy and health-adjusted life expectancy in Canada

ABSTRACT: The objectives of this study were to estimate life expectancy (LE) and health-adjusted life expectancy (HALE) for Canadians with and without diabetes and to evaluate the impact of diabetes on population health using administrative and survey data.Mortality data from the Canadian Chronic Disease Surveillance System (2004 to 2006) and Health Utilities Index data from the Canadian Community Health Survey (2000 to 2005) were used. Life table analysis was applied to calculate LE, HALE, and their confidence intervals using the Chiang and the adapted Sullivan methods.LE and HALE were significantly lower among people with diabetes than for people without the disease. LE and HALE for females without diabetes were 85.0 and 73.3?years, respectively (males: 80.2 and 70.9?years). Diabetes was associated with a loss of LE and HALE of 6.0?years and 5.8?years, respectively, for females, and 5.0?years and 5.3?years, respectively, for males, living with diabetes at 55?years of age. The overall gains in LE and HALE after the hypothetical elimination of prevalent diagnosed diabetes cases in the population were 1.4?years and 1.2?years, respectively, for females, and 1.3?years for both LE and HALE for males.The results of the study confirm that diabetes is an important disease burden in Canada impacting the female and male populations differently. The methods can be used to calculate LE and HALE for other chronic conditions, providing useful information for public health researchers and policymakers.     

The contribution of medical care to changing life expectancy in Germany and Poland

This paper assesses the impact of medical care on changes in mortality in east Germany and Poland before and after the political transition, with west Germany included for comparison. Building upon Rutstein's concept of unnecessary untimely deaths, we calculated the contribution of conditions considered responsive to medical care or health policy to changes in life expectancy between birth and age 75 [e(0-75)] for the periods 1980/1983-1988 and 1991/1992-1996/1997.Temporary life expectancy, between birth and age 75, has been consistently higher in west Germany, intermediate in east Germany and lowest in Poland. Although improving in all three regions between the early 1980s and the late 1990s, the pace of change differed between countries, resulting in a temporary widening of an initial east-west gap by the late 1980s and early 1990s. In the 1980s, in east Germany, 50-60% of the improvement was attributable to declining mortality from conditions responsive to medical care (west Germany: 30-40%). A net positive effect was also observed in Poland, although counterbalanced by deterioration in ischaemic heart disease mortality.In the former communist countries, improvements attributable to medical care in the 1980s were due, largely, to declining infant mortality. In the 1990s, they benefited also adults, specifically those aged 35+ in Poland and 55+ in Germany. A persisting east-west gap in temporary life expectancy in Germany was due, largely, to higher mortality from avoidable conditions in the east, with causes responsive to health policy contributing about half, and medical care 16% (men) to 24% (women) to the differential in 1997.The findings indicate that changes in the health care system related to the political transition were associated with improvements in life expectancy in east Germany and, to a lesser extent, in Poland. Also, differences in the quality of medical care as assessed by the concept of "unnecessary untimely deaths" appear to contribute to a persisting east-west health gap. Especially in Poland and the former German Democratic Republic there remains potential for further progress that would narrow the health gap with the west.     

中国人均预期寿命时空变化及影响因素分析

运用变异系数和灰色关联分析法,对中国人均预期寿命时空变化特征及影响因素的强度进行研究。结果表明:(1) 1981—2015年,我国人均预期寿命增长经历了慢—快—慢—快的四个阶段,预期寿命增长指数上升到113,其中男性上升到111,女性上升到115,男女预期寿命差距逐步增大。(2) 1990—2010年,全国31个省份人均预期寿命变异系数从0. 051降低到0. 036,预期寿命水平较低省份的增长速度明显高于较高的省份。(3)我国人均预期寿命的地域分布大体上分为东南部高预期寿命水平区、中北部中预期寿命水平区、西南部低预期寿命水平区。2010年我国人均预期寿命水平绝大多数省份处于第二级(76～80岁)和第三级(71～75岁),相对于1990年提高了两级。到2020年,我国将有北京、天津和上海3市处于第一级寿命水平(81～85岁),其余为第二和第三级预期寿命水平。影响我国省际人均预期寿命时空差异的因素是多方面的,其中最主要的是各地区的经济发展、医疗服务和医疗保障水平。     

Physio-social activities and active life expectancy, life expectancy in Japanese elderly]

PURPOSE: Incidence of loss of activity and death in elderly people living at home were investigated to attempt to determine their relationship to physio-social activities in elderly. METHOD: This longitudinal study of life expectancy and active life expectancies is a thirty-six months follow up study. Loss of activities were classified as follows: Long term (over six months) treatment at home, long term (over six months) admission to hospital or intermediate institute for the elderly, admission to nursing home, and death. Subjects were persons living at home in Ogi, Saga prefecture, aged 70 years or older not requiring help in active daily living (ambulating, bathing, dressing, discharging, eating). RESULTS: 6,274 (male = 2,383, female = 3,891) subjects were followed for thirty six months, and 178 people experienced long term treatment at home, 310 people had long term admission to a hospital or intermediate institute for elderly, 28 people were admitted to a nursing home and 449 people experienced death. The main results were as follows: (1) From the Cox proportional hazards model using the likelihood-ratio method of survival and active life loss, significant hazard ratios for reduction active life expectancy for male were found for age, disability score for ADL, speech disorder, inconvenient bathroom design, with attention to health, and daily activity were associated with extension of active life expectancy. Age, disability score for ADL, speech disorder, inconvenient bathroom design were associated with reduced life expecting, while, attention to health, choosing to undergo regular health examinations, and daily were associated with increased activity in life expectancy. (2) Hazard ratios for reduction active life expectancy for females were age, disability score for ADL, defect of memory deficits, inconvenient design for hallway and stairs. Participating in health examinations, Purpose in life were associated with life expectancy increase. For females were age, disability score for ADL, speech disorder, inconvenient design of bathroom were associated with decrease in life expectancy, while having a person in life was associated with increase in life expectancy. DISCUSSION: Relationship between physio-social activities in elderly is a significant factor in many studies on elderly health. This study suggests that age, disability score for ADL, inconvenient for housing design, active health behavior, daily activities, and Losing a sense of worth in living, affect active life expectancy and life expectancy.     

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...     

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.     

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.     

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。     

Corneal arcus and life expectancy

In 1964-66, the authors completed the comprehensive medical screening of 1412 persons. Apart from the indicators of health state they also recorded their social and cultural parameters. The diagnoses they registered included AC, which has been covered in literature in rather contradicting ways. They found no data concerning survival; as analysing such a correlation is only possible within the frame-work of a several-decade follow-up study. By the end of the follow-up stage (31:12:1994), after 30 years, 1375 persons had died. Their death certificates and--if there were any--necropsy records have been processed and thoroughly analysed. They examined the occurrence of AC, life duration and survival probability--all in correlation with age, gender, constitution, certain diseases (hypertonia, ostheoarthrosis) and diagnoses at death (ischaemic heart diseases, acute myocardiac infarction, cerebrovascular diseases). They point it out that the occurrence of AC is significantly higher among males, but it increases in strong correlation with age in both sexes. Those who had AC were found to be older at the time of death, but it doesn't mean that AC correlates with better life expectancy--it means that AC occurs at older age. The survival probability of men over 75 was better than that of women. On the whole, AC is unfavourable concerning life expectancy, but the later it occurs, the less it can be used as an indicator of life expectancy. It was found that greater average weight correlated with longer average life duration, while among females the more a person weighed, the less frequent AC became. It was true for each weight group that those with AC had worse life expectancy. Altogether those with no AC were found to suffer from hypertonia significantly more frequently. The life expectancy of those with both AC and hypertonia, however, was always worse than those with hypertonia only, regardless of age and the type of hypertonia. Generally women are in a more favourable position, but in the 'serious' and 'very serious' hypertonia groups there is practically no difference in the survival of the two sexes. The authors have also found that AC has a significant negative prognostical value concerning survival and correlation with ostheoarthrosis, ischaemic heart diseases and cerebrovascular diseases. The correlation of AC with acute myocardiac infarction could not be proved convincingly.     

Dementia-free life expectancy in Australia

Abstract: Dementia-free life expectancy is a synthetic indicator of an important aspect of mental health which may have considerable use in public health decision making. Dementia expectancies were derived from senile dementia prevalence rates in Australia in 1991–1992 in conjunction with national life tables using Sullivan's method. Dementia-free life expectancy for Australian women aged 70 years was found to be 14 years within a total life expectancy of 15 years, and 11 years for men within a total life expectancy of 12 years. Between 70 and 85 years there is a constant average expectation of about one year of life expectancy with dementia. The age at which the largest number of persons with dementia is found is 82 years. Australians appear to have very similar dementia-free life expectancies to those reported in the European studies, with small differences probably due to sampling variation or to differences in case-finding methods.     

Dementia-free life expectancy in Belgium

To monitor the influence of dementia on the health of the populationthe concept of Dementia-Free Life Expectancy (DemFLE) was introduced.The DemFLE was estimated using Sullivan's method on the dataof the ERDA study 1991 (Epidemiology Research on Dementia, Antwerp,Belgium). At the age of 65 years, elderly people in Belgiumhad a life expectancy of 16.4 years, a DemFLE of 15.3 years,and 1.1 years with at least moderate dementia. In absolute yearsthe life expectancy with dementia remained constant beyond theage of 65: it was about 1.7 years for women, 0.7 years for men.The proportion of the remaining life that will be lived in ademented state increased with age: 4% and 9% in men and womenat age 65, but 20% and 30% at the age of 85. The results confirmdementia as an important public health problem in the elderly.