Global patterns of healthy life expectancy for older women

This paper focuses on patterns of healthy life expectancy for older women around the globe in the year 2000, and on the determinants of differences in disease and injury for older ages. Our study uses data from the World Health Organization for women and men in 191 countries. These data include a summary measure of population health, healthy life expectancy (HALE), which measures the number of years of life expected to be lived in good health, and a complementary measure of the loss of health (disability-adjusted life years or DALYs) due to a comprehensive set of disease and injury causes. We examine two topics in detail: (1) cross-national patterns of female-male differences in healthy life expectancy at age 60; and (2) identification of the major injury and disability causes of disability in women at older ages. Globally, the male-female gap is lower for HALE than for total life expectancy. The sex gap is highest for Russia (10.0 years) and lowest in North Africa and the Middle East, where males and females have similar levels of healthy life expectancy, and in some cases, females have lower levels of healthy life expectancy. We discuss the implications of the findings for international health policy.     

Adjusting Life Expectancy to Account for Disability in a Population: A Comparison of Three Techniques

Sullivan (1971) first suggested weighting life expectancy (LE) to account for the health of a population using a single indicator. Known as disability free life expectancy (DFLEs), this measure was somewhat limited due to a overly simplistic weighting scheme. Its introduction, however, spurred the development of a whole new class of measures known as health expectancy indicators. One of the first, disability-adjusted life expectancy (DALEs) (Wilkins and Adams, 1983), identified the period of time in a particular level of disability and weighted each level accordingly. While the weighting allowed for a health related quality-of-life distinction to be introduced into the DALE measure, the weights, by level of disability, were arbitrarily chosen and fixed for all ages and gender. To overcome this limitation, a health-adjusted life expectancy (HALE) was developed based in large part on the DALE methodology but utilizes more refined weights. The McMaster Health Utility Index Mark III (HUI3)) scores health on a continuum from 0 to 1 and when included on a national health survey, provides estimates that reflect important age, gender, and socio-economic factors. All three measures were calculated for the years 1986, 1991, and 1994 (household and institutional populations). Analysis revealed that HALEs were more appropriate for policy purposes due to their ability to account for indirect morbidity in both a disabled and non-disabled population.     

Trends in life expectancy in wellbeing

Objectives: This paper describes anddiscusses trends in life expectancy inwellbeing between 1989 and 1998.Methods: Data on wellbeing by theBradburn Affect Balance Scale is obtained fromthe Netherlands Continuous Health InterviewSurveys for the calendar years from 1989 to1998. Using Sullivan's method, life expectancyin wellbeing is calculated.Results: For males at the age of 16, lifeexpectancy in wellbeing increases significantlyfrom 52.7 years in 1989 (90.1% of the totallife expectancy) to 54.4 years in 1998(90.8%). This increase is almost completelycaused by the increase in total lifeexpectancy. For females at the age of 16, lifeexpectancy in wellbeing raises significant from54.4 years in 1989 (84.1%) to 56.2 years in1998 (86.3%). This increase is almostcompletely caused by a decrease in the numberof years in a state of distress.For both males and females at the age of 65,the significant increase of life expectancy inwellbeing exceeds the increase in total lifeexpectancy and is mainly caused by the decreasein number of years in distress.Conclusion: Contrary to life expectancyin good perceived health and to disability freelife expectancy – which show a decreasing trend– the overall wellbeing of the population isincreasing. It seems that aspects in human lifethat contribute to wellbeing or quality of lifeother than physical health are gaining inimportance. This makes life expectancy inwellbeing a less appropriate instrument tomonitor changes in population health, but auseful instrument to measure population qualityof life.     

Patterns of Active Life Among Older Women: Differences Within and Between Groups

SUMMARY

This study examines the distribution of total, unimpaired, and impaired life for several groups of older women defined by race, education, and marital history. Using data from the 1984–1990 Longitudinal Study of Aging, we model transitions among functional statuses using discrete-time Markov chains, and use microsimulation to produce summary indices of active life. Remaining years of life and the proportion of remaining years with disability vary substantially, both within each group of women studied and between pairs of groups. Of all groups studied, never-married, more-educated white women live the longest, healthiest lives. Ever-married nonwhite women with low education have the shortest life expectancy, and experience the most disability. Our findings show that life expectancy is an incomplete indicator of the time women, in particular sub-groups, can expect to live with and without impairment. These findings highlight the heterogeneity of disability processes and life expectancy for older women.     

Gender Differences in Disability-Free Life Expectancy for Selected Risk Factors and Chronic Conditions in Canada

SUMMARY

This article shows how mortality and morbidity patterns differ for women and men 45 years of age and older. The impact on disability-free life expectancy was calculated for selected risk factors and chronic conditions: low income, low education, abnormal body mass index, lack of physical activity, smoking, cancer, diabetes, and arthritis. For each factor, the expected number of years free of disability was calculated for men and women using multi-state life tables. In terms of disability-free life expectancy, the greatest impacts on affected women were for diabetes (14.1 years), arthritis (8.8 years), and physical inactivity (6.0 years), while for affected men, the greatest impacts were for diabetes (10.5 years), smoking (6.9 years), arthritis (6.5 years), and cancer (6.4 years). The implications of these results are discussed from the perspective of developing programs designed to improve population health status.     

European Perspectives on Healthy Aging in Women

SUMMARY

Using data from the 1994 European Community Household Panel, we compare active life expectancy differentials at age 65 years between women and men in 12 European countries. We seek to explain the extent to which differences are a reflection of gender differentials in life expectancy at 65 years or reflect differences in active life expectancy earlier in life. Considerable variation in the gender differentials in both total and active life expectancies at age 65 years exist within Europe, with some countries experiencing 20% lower life expectancy at age 65 years for men compared to women. Some evidence was found to suggest that gender differentials in active life expectancy may continue from younger ages through to later life.     

Differences in Life Expectancy and Disability Free Life Expectancy in Italy. A Challenge to Health Systems

Background Measures of health expectancy such as Disability Free Life Expectancy are used to evaluate and compare regional/national health statuses. These indicators are useful for understanding changes in the health status and defining health policies and decisions on the provision of services because provide useful information on possible areas needing interventions and burden of care to health systems. Methods Two databases have been used for the analysis: the Italian Health Interview Survey and the European Community Household Panel. The data were analyzed by gender and geographic area. DFLE was calculated by the Sullivan method. Results In 2005 in Italy women have a longer life expectancy than men: 84 and 78 years, respectively. But if we consider life without disability in Italy the male disadvantage reduces: men live 85% of their years without disability, women only 75%. Geographic differences do exist because Disability Free Life Expectancy is longer in Northern and in Central regions; shorter in the South. At a European level similar data can be found: on average women live longer but they have a longer time of life with disability. Conclusion In Italy women live longer but have a worse quality of health than men; in the South there is a worse quality of health. Similar findings can be identified at a European level. The Italian situation with the highest percentage of DFLE at 65 out of the total LE at 65 and one of the longest LE witnesses ageing is not necessarily associated to a worsening of health.     

1994～2004年中国老年人的生活自理预期寿命及其变化

本文应用2004年和1994年国家统计局全国人口变动抽样调查中有关老年人生活自理能力的数据,采用Sullivan法对老年人的生活自理预期寿命进行了分析,并且比较了1994年到2004年生活自理预期寿命的变化。研究发现,2004年中国男性老年人平均有1.5年生活不能自理,女性老年人平均为2.5年。随着年龄的增长,中国老年人的生活自理预期寿命占余寿的比重也在逐渐下降。女性老年人的预期寿命比男性高,生活自理预期寿命在60~80岁也高于男性,但是85岁及以上女性的生活自理预期寿命低于男性,而且女性老年人生活自理预期寿命占余寿的比重在整个老年阶段均低于男性老年人。从10年间的变化看,中国老年人的预期寿命和生活自理预期寿命都有所增长,但是生活自理预期寿命在余寿中的比重反而下降了,而且随年龄的增长,下降得也越来越快,男性和女性均呈现同样的态势。就平均水平而言,健康状况改善的程度低于寿命的延长,高龄女性老年人在这个方面尤其处于劣势。     

The Patterns of Disability in the Peripheral Neighborhoods of Ouagadougou,Burkina Faso,and the Male–Female Health‐Survival Paradox

Disability is a crucial health and social concern in sub‐Saharan Africa, where a high prevalence of disabling diseases is compounded with insufficient care provision. There is a need for detailed analysis of the disability patterns. We provide a gender‐specific picture for the population in peripheral Ouagadougou (Burkina‐Faso), based on six disability dimensions following the United Nations’ recommendations. We computed disability‐free life expectancy (LE) using the Health and Demographic Surveillance System (Ouaga HDSS) (n = 1 902). Women have a longer partial LE in the 20–79 age range (+3.3 years), half of this LE being spent with a disability, versus 31% of the LE for men. Limitations in mobility, cognition, and eyesight occur in midadulthood and result in a considerable disadvantage for women in the number of years with these limitations. These findings highlight disability patterns that are detrimental to social participation and claim for better screening and care, especially for women.     

中国高龄老人健康预期寿命研究

用隶属等级 (GradeofMembership ,GOM)模型将反映 1998年被访高龄老人不同健康维度的 5 0个变量进行综合得到健康、比较健康、功能受限、体弱多病、极度虚弱五个纯类。用这五个纯类将高龄老人预期寿命进行了分析     

中国老年人口健康预期寿命差异的分解研究

健康预期寿命是反映人群健康长寿的重要指标,健康预期寿命差异反映了一个国家或地区的健康不平等状况。利用多状态生命表分析了中国老年人口健康预期寿命在过去十余年间的趋势与变动,并通过夏普利值分解法测算了人口社会学等11类因素对老年人口健康预期寿命差异的具体贡献值。得到以下四项重要研究结论:第一,从2005年到2018年,中国老年人口健康预期寿命差异的程度略有增加,女性、农村群体相比对应群体差距始终较高;泰尔指数分解发现,组内不平等(而非组间不平等)是造成上述差异的主要原因;老年人口健康预期寿命的性别差异呈现出高龄老人缩小而低龄老人扩大的趋势。第二,婚姻状况是健康预期寿命变动最重要的影响因素,但影响程度呈现逐年下降趋势,反之,受教育程度的影响在逐年上升;进一步将11类影响因素归类后发现:"个体特征"是最重要的影响因素,"经济因素"和"行为因素"的重要性次之,"环境因素"的影响最小。第三,上述影响因素对中国老年人口健康预期寿命的影响总体呈上升趋势,分城乡、分性别后依然呈现出相同的特征。最后,各因素在不同城乡、性别、婚姻状态的群体中的影响存在异质性。     

Trends in senescent life expectancy

The distinction between senescent and non-senescent mortality proves to be very valuable for describing and analysing age patterns of death rates. Unfortunately, standard methods for estimating these mortality components are lacking. The first part of this paper discusses alternative methods for estimating background and senescent mortality among adults and proposes a simple approach based on death rates by causes of death. The second part examines trends in senescent life expectancy (i.e., the life expectancy implied by senescent mortality) and compares them with trends in conventional longevity indicators between 1960 and 2000 in a group of 17 developed countries with low mortality. Senescent life expectancy for females rises at an average rate of 1.54 years per decade between 1960 and 2000 in these countries. The shape of the distribution of senescent deaths by age remains relatively invariant while the entire distribution shifts over time to higher ages as longevity rises.     

Recent Perspectives on Active Life Expectancy for Older Women

SUMMARY

This article provides a critical review of recent active life expectancy literature, describing trends of special interest to women. We review findings from leading perspectives used to study life expectancy and active life expectancy, including gender, racial and socioeconomic differences, disease-specific effects, and biodemography. We examine three competing theories of population health that frame active life expectancy research—compression of morbidity, expansion of morbidity, and dynamic equilibrium—concluding there is support for both the compression of morbidity and dynamic equilibrium theories. Policy implications for women include a greater understanding of the role of education and racial and ethnic diversity in active life trends, and an increased public policy emphasis on prevention and treatment of chronic disease, together with adoption of more healthy lifestyles.     

A Comparative Study of Handicap-free Life Expectancy of China in 1987 and 2006

After the first large scale national sampling survey on handicapped persons in 1987, China conducted its second national sampling survey in 2006. Using the data from these two surveys and the national life tables, we computed and compared the expected years of life free of handicapped condition by the Sullivan method. The expected years of life lived with handicap for the Chinese population increased from 4.87 years for males and 5.81 years for females in 1987 to 5.55 years and 6.32 years in 2006, respectively. The same trend was observed for people in working ages (15–64) and old ages (65+). However, the expected years of life lived with handicap decreased for children (0–14). Our results also showed that the effect of skeletal handicap increased notably for both sexes. Healthy life expectancy is an important indicator in measuring quality of life of a population. Our study utilized this measurement to quantify one aspect of quality of life of the Chinese population.     

中国老年人带残预期寿命及疾病影响的城乡差异分析

为了明确各种疾病对我国城乡老年人残疾以及带残预期寿命的影响,本文基于第二次全国残疾人抽样调查数据,首先对残疾现患率进行归因分析,得到分疾病的残疾现患率,然后结合死亡率数据,利用苏利文方法计算分疾病的带残预期寿命。结果显示,在60岁时,城市男性预期将有4.08年(城市女性:4.95年)生活在残疾状态中,低于农村男性的4.72年(农村女性:5.46年)。老年性耳聋、白内障、脑血管疾病、骨关节炎和未分类的伤害是老年人的最重要的5种致残疾病。而且,各种疾病对老年人的残疾现患率和带残预期寿命的影响存在明显的城乡差异。本研究为政府在城乡老年人中提出具有针对性的残疾预防战略提供了实证支持。     

Modeling Quality-Adjusted Life Expectancy Loss Resulting from Tobacco use in the United States

Purpose  To describe the development of a model for estimating the effects of tobacco use upon Quality Adjusted Life Years (QALYs) and to estimate the impact of tobacco use on health outcomes for the United States (US) population using the model. Method  We obtained estimates of tobacco consumption from 6 years of the National Health Interview Survey (NHIS). In addition, NHIS data were used to impute the Quality of Well-Being (QWB) Scale using a new methodology known as QWBX1. The QWB places health status on a continuum ranging from death (0.0) to full functioning without symptoms (1.0). The method allows the adjustment of life expectancy for reduced quality of life associated with health conditions. NHIS data were matched to the National Death Index for 14,464 deaths occurring by December 31, 1997. The analysis is limited to adults between the ages of 18 and 70 years. Results  Quality of Well-Being scores were broken down by age and for six smoking categories: (1) non-smokers, (2) those who smoke 1–10 cigarettes per day, (3) 11–20 cigarettes per day, (4) 21–30 cigarettes per day, and (5) 31–40 cigarettes per day, and (6) 40 or greater cigarettes per day. There was a systematic relationship between current tobacco use and health-related quality of life at each point along the age spectrum and there was a clear and systematic separation of quality-adjusted life expectancy by number of cigarettes smoked per day. Teenagers who continue to smoke loose 3.5 QALYs between ages 18 and 70 in comparison to non-smokers. A greater portion in the loss in QALE is attributable to quality of life than to shorten life expectancy. Conclusions  The overall goal of Healthy People 2010 is to increase Years of Healthy Life (or QALE) in the United States. Each year, tobacco use results in hundreds of thousands of quality-adjusted life years lost. Combined models of morbidity and mortality incorporating a range of tobacco consumption levels are required to best represent the impact of tobacco use. Supported by a Grant 11RT-0243 from the Californian Tobacco Related Disease Research Program (TRDRP)     

Changing Life Expectancy and Health Expectancy Among Russian Adults: Results from the Past 20 Years

The decade following the collapse of the Soviet Union was characterized by wide fluctuations in Russian mortality rates, but since the early 2000s, life expectancy has improved progressively. Recent upturns in longevity have promoted policy debates over extending the retirement age in the country. However, whether observed gains in life expectancy are accompanied by improving health remains to be addressed. Using data from the 1994–2014 Russian Longitudinal Monitoring Survey of the Higher School of Economics, this study investigates trends over 20 years in healthy life expectancy (HLE) and illness-free life expectancy (IFLE) for men and women at adult ages. Analyses using the Sullivan method show that men and women at adult ages have experienced large increases in health expectancies during the post-Soviet period. Increases in HLE exceeded increases in total life expectancy for both genders. Further, health expectancies have evolved over time through cycles of increases and decreases, just like life expectancy. These results suggest increases in good-quality years among men and women at working ages, offering support for changing the official retirement age. The extent of the change in the retirement age, however, needs to be carefully considered, given that, despite recent improvements, the health expectancy of the Russian population still remains low.     

Diverging Trends in Female Old‐Age Mortality: The United States and the Netherlands versus France and Japan

In the most advanced countries, child mortality and adult mortality under age 65 years have fallen so low that further improvement in life expectancy relies almost completely on the decline of mortality at older ages. This phenomenon is particularly pronounced among women, who are far ahead of men in survival rates. Thus, to project the future of life expectancy, this study focuses on trends in female life expectancy at ages 65 and older. Four countries are selected for this analysis: the United States, Netherlands, France, and Japan. It is particularly interesting to understand why American and Dutch trends in female old‐age mortality have been diverging from those in France and Japan for two decades. It is shown here that most of the divergence derives from the fact that decline in cardiovascular mortality is more and more offset by increases in other causes of death in the United States and the Netherlands, while the other two countries are more successful in reducing mortality from all causes at increasingly older ages. This latter phenomenon could represent a new stage of the health transition.     

Unmet Needs for Assistance with ADLs and IADLs: A Measure of Healthy Life Expectancy

Measures of healthy life expectancy have beendeveloped over the last thirty years to evaluate thequality of life of an increasing life expectancy.These measures are usually accounting for prevalencerates of either disability or physical dependence inperforming everyday activities. Although they allowfor a better assessment of quality of life, they arenot reflecting the fact that a disabled person mightbe receiving adequate or inadequate assistance forthese activities. In a context of population aging,where our health care system will have to deal moreand more with chronic disease instead of acutedisease, it is imperative to develop a measure thatwill account for the adequacy of the assistanceprovided to the disabled elderly population. Usingdata from the 1986 Health and Activity LimitationSurvey, we are introducing a measure of healthy lifeexpectancy which will fill this gap. We present theconstruction of this measure of population health anddiscuss its usefulness in assessing policies at amacro level.     

Potential support ratios: Cohort versus period perspectives

The ‘prospective potential support ratio’ has been proposed by researchers as a measure that accurately quantifies the burden of ageing, by identifying the fraction of a population that has passed a certain measure of longevity, for example, 17?years of life expectancy. Nevertheless, the prospective potential support ratio usually focuses on the current mortality schedule, or period life expectancy. Instead, in this paper we look at the actual mortality experienced by cohorts in a population, using cohort life tables. We analyse differences between the two perspectives using mortality models, historical data, and forecasted data. Cohort life expectancy takes future mortality improvements into account, unlike period life expectancy, leading to a higher prospective potential support ratio. Our results indicate that using cohort instead of period life expectancy returns around 0.5 extra younger people per older person among the analysed countries. We discuss the policy implications implied by our cohort measures.