Healthy life expectancy in the EU 15

1
Healthy life expectancy in the EU 15

• Carol Jagger
• EHEMU team

Europe Blanche XXVI Living Longer but Healthier
lives Budapest November 2005
2
Monitoring population ageing

• Most countries are seeing year on year increase
  in life expectancy at birth and at older ages
• Are we exchanging longer life for poorer health
  (expansion of morbidity scenario) or are the
  extra years spent in good health (compression of
  morbidity)?
• Do these trends hold for all countries, all
  social groups, men and women?
• Health expectancies provide the answer as they
  extend the notion of life expectancy to different
  health dimensions, thus adding quality to
  quantity of life lived

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Purpose

• To explore compression or expansion of healthy
  life and gender differences through
  cross-national comparisons of healthy life
  expectancy at birth and age 65 among EU countries
  between 1995 and 2003
• In preparation for the new EU structural
  indicator Healthy Life Years
• Using disability-free life expectancy (DFLE) as a
  measure of healthy life expectancy

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Data and methods

• Estimation of DFLE and 95 CI, using Sullivan
  method
• age specific probability of death Eurostat life
  tables
• age specific disability prevalence European
  Community Household Panel 1995-2001 question Are
  you hampered in your daily activities by any
  physical or mental health problem, illness or
  disability?
• Some interpolation for odd missing values and
  extrapolation of trends for 2002-3

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DFLE calculation
Age specific disability prevalence from ECHP
Eurostat Life table
Life expectancy
LE free of disability (DFLE)
LE with disability
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Distribution of LE and DFLE at birth EU(14),
1995-2003
Women
Men
LE
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Distribution of LE and DFLE at birth EU(14),
1995-2003
Women
Men
LE
DFLE
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Distribution of LE and DFLE at birth EU(14),
1995-2003

• By 2003 LE at birth in the EU14 ranged from 74.2
  (Portugal) to 78 (Sweden) years for men and 80.1
  (Denmark) to 83.2 years (France) for women,
  following a steady increase from 1995.
• Compared to LE, trends in DFLE were more variable
  although gender differences were smaller
• Between 1995-2003 the gain in total years for men
  exceeded the gain in years free of disability
• In women there was only a slight improvement, on
  average, in life expectancy with a similar gain
  in disability-free life years.

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Trends in LE and DFLE at age 65 in EU (14),
1995-2003 Men
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Trends in proportion of life spent
disability-free at age 65
Men
gain of 5 between 1995 and 2001
gain or loss of less than 5 between 1995 and
2001
loss of 5 between 1995 and 2001
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Trends in proportion of life spent
disability-free at age 65
Women
gain of 5 between 1995 and 2001
gain or loss of less than 5 between 1995 and
2001
loss of 5 between 1995 and 2001
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Trends in the proportion of life spent
disability-free at age 65

• Men
• Austria, Belgium, Italy, Finland, Germany
• France, Greece, Ireland, Spain
• Denmark, Portugal, Netherlands, Sweden, UK

• Women
• Belgium, Italy, Sweden
• Austria, Denmark, UK, Finland, France, Spain, UK
• Germany, Greece, Ireland, Netherlands, Portugal

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Trends in DFLE using the ECHP

• Life expectancy
• Small variation in LE between these 14 MS
• Increase between 1995-2003
• Disability Free Life Expectancy and DFLE/LE
• Large variation in DFLE between these 14 MS
• Diverging trends over 1995-2003 reduction /
  stagnation / increase in the proportion of life
  with reported disability at age 65 while LE
  increases
• Gender differences in trends

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Real or artefact?

• May be an artefact due to
• Data problems
• Sampling
• Omission of institutionalised population
• Not harmonised disability question
• Cultural differences in reporting of disability
• Confounding factors socio-economic
• But trends less sensitive to these
• If real what is cause

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Conclusions

• Population aging has a different impact in the 14
  Member States in Europe
• - different levels of reported disability
  (larger dispersion than LE)
• - variation in the magnitude of the gender
  difference
• - different trends over time
• Need to improve cross-national comparisons in
  self-reported disability to ensure differences
  are not an artefact
• - improved harmonisation of the instruments
• - using different levels of severity
• - documenting differences in reporting
• - documenting differences in selection in the
  panel

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Healthy life expectancy in the EU 15

• Carol Jagger
• EHEMU team

Europe Blanche XXVI Living Longer but Healthier
lives Budapest November 2005
17
Data and Methods

• Problems in both
• mortality and the panel data
• 1) Data base
• Probable data errors
• Replacement with other sources
• Missing
• 2) Interruption of data collection
• No data for 2002 and 2003

• Solutions
• 1) Data base
• Linear imputation of age pecific probabilities
  (death and disability)

• Shift of the prevalence trend to the ECHP level
• Imputation of data according to observed trends

• 2) Interruption of data collection
• Linear extrapolation of the disability prevalence

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Trends in LE and DFLE at age 65 in EU (14),
1995-2003 Women