Health Profiles and Profile-Specific Health Expectancies of Older Women and Men: The Netherlands

SUMMARY

This study focuses on gender differences in health profiles, and examines which health profiles drive gender differences in remaining life expectancy in women and men aged 65 and over in The Netherlands. Data from the first two cycles of the Longitudinal Aging Study Amsterdam (n = 2,141 and 1,659, respectively) were used to calculate health profiles for individuals of 65–85 years. For both women and men, six profiles were found: I. cancer; II. “other” chronic diseases; III. cognitive impairment; IV. frailty or multimorbidity; V. cardiovascular diseases; and VI. good health. The further characterization of these types showed some gender differences. Remaining life expectancy for women was greater than for men in each health profile. A decomposition into health expectancies showed that both women and men could expect to live about 5 years in good health from age 66. The greatest gender differences in years spent with health problems were found for profile IV and for profile III. Their greater number of years spent in these health states have direct consequences for the type and cost of care women need.     

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.     

European perspectives on healthy aging in women

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.     

Life with and without disease: women experience more of both

This paper examines gender differences in life with and without six major diseases, including both mortal and morbid conditions. Disease prevalence and health behavior data are from the 1993-1995 National Health Interview Surveys for the United States. Vital registration data are the source of mortality rates used in computing life expectancy. The Sullivan method is used to estimate life lived with and without disease and risky behavior for men and women at various ages. Women live more years with each of the diseases examined, and, for arthritis, the extended years with disease are greatest. Women also live more years than men free of each of these diseases with the exception of arthritis. Gender differences in life without two health-risk behaviors are also discussed. Men spend more years of their lives overweight and have fewer years during which they see a doctor.     

Global Patterns of Healthy Life Expectancy for Older Women

SUMMARY

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.     

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.     

Measuring years of inactivity,years in retirement,time to retirement,and age at retirement within the Markov model

Retirement-related concepts are treated as random variables within Markov process models that capture multiple labor force entries and exits. The expected number of years spent outside of the labor force, expected years in retirement, and expected age at retirement are computed—all of which are of immense policy interest but have been heretofore reported with less precisely measured proxies. Expected age at retirement varies directly with a person’s age; but even younger people can expect to retire at ages substantially older than those commonly associated with retirement, such as age 60, 62, or 65. Between 1970 and 2003, men allocated most of their increase in life expectancy to increased time in retirement, but women allocated most of their increased life expectancy to labor force activity. Although people can exit and reenter the labor force at older ages, most 65-year-old men who are active in the labor force will not reenter after they eventually exit. At age 65, the probability that those who are inactive will reenter the labor force at some future time is .38 for men and .27 for women. Life expectancy at exact ages is decomposed into the sum of the expected time spent active and inactive in the labor force, and also as the sum of the expected time to labor force separation and time in retirement.     

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.     

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.     

The Legacy of the Great Recession in Italy: A Wider Geographical,Gender, and Generational Gap in Working Life Expectancy

Under the pressure of population aging the Italian pension system has undergone reforms to increase labor force participation and retirement age, and, thus, the length of working life. However, how the duration of working life has developed in recent years is not well understood. This paper is the first to analyze trends in working life expectancy in Italy. We use data from a nationally representative longitudinal sample of 880,000 individuals from 2003 to 2013 and estimate working life expectancy by gender, occupational category, and region of residence using a Markov chain approach. We document large and increasing heterogeneity in the length of working life. From 2003–2004 to 2012–2013, working life expectancy for men declined from 35.2 to 27.2 years and for women from 34.7 to 23.7 years, increasing the gender gap to 3.5 years. Both young and old were hit, as roughly half of the decline was attributable to ages below 40, half above 40. Working life expectancy declined for all occupational groups, but those in manual occupations lost most, 8.5 years (men) and 10.5 years (women). The North–South economic gradient widened such that men living in the North were expected to work 8 years longer than women living in the South. The fraction of working life of total life expectancy at age 15 declined to record lows at 40% for men and 34% for women in 2012–2013. Policies aiming at increasing total population working life expectancy need to take into consideration the socio-demographic disparities highlighted by our results.

     

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.     

The contribution of a history of heavy smoking to Scotland's mortality disadvantage

Scotland has a lower life expectancy than any country in Western Europe or North America, and this disadvantage is concentrated above age 50. According to the Human Mortality Database, life expectancy at age 50 has been lower in Scotland than in any other developed country since 1980. Relative to 15 developed countries that we have chosen for comparison, Scotland's life expectancy in 2009 at age 50 was lower by an average of 2.5?years for women and 1.6?years for men. We estimate that Scottish women lost 3.6?years of life expectancy at age 50 as a result of smoking, compared to 1.4?years for the comparison countries. The equivalent figures among men are 3.1 and 2.1?years. These differences are large enough for the history of heavy smoking in Scotland to account both for most of the shortfall in life expectancy for both sexes and for the country's unusually narrow sex differences in life expectancy.     

Recent perspectives on active life expectancy for older women

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.     

Working Life Expectancy at Age 50 in the United States and the Impact of the Great Recession

A key concern about population aging is the decline in the size of the economically active population. Working longer is a potential remedy. However, little is known about the length of working life and how it relates to macroeconomic conditions. We use the U.S. Health and Retirement Study for 1992–2011 and multistate life tables to analyze working life expectancy at age 50 and study the impact of the Great Recession in 2007–2009. Despite declines of one to two years following the recession, in 2008–2011, American men aged 50 still spent 13 years, or two-fifths of their remaining life, working; American women of the same age spent 11 years, or one-third of their remaining life, in employment. Although educational differences in working life expectancy have been stable since the mid-1990s, racial differences started changing after the onset of the Great Recession. Our results show that although Americans generally work longer than people in other countries, considerable subpopulation heterogeneity exists. We also find that the time trends are fluctuating, which may prove troublesome as the population ages. Policies targeting the weakest performing groups may be needed to increase the total population trends.     

The Contribution of Health Care and Other Interventions to Black–White Disparities in Life Expectancy, 1980–2007

Black–white mortality disparities remain sizable in the United States. In this study, we use the concept of avoidable/amenable mortality to estimate cause-of-death contributions to the difference in life expectancy between whites and blacks by gender in the United States in 1980, 1993, and 2007. We begin with a review of the concept of “avoidable mortality” and results of prior studies using this cause-of-death classification. We then present the results of our empirical analyses. We classified causes of death as amenable to medical care, sensitive to public health policies and health behaviors, ischemic heart disease, suicide, HIV/AIDS, and all other causes combined. We used vital statistics data on deaths and Census Bureau population estimates and standard demographic decomposition techniques. In 2007, causes of death amenable to medical care continued to account for close to 2 years of the racial difference in life expectancy among men (2.08) and women (1.85). Causes amenable to public health interventions made a larger contribution to the racial difference in life expectancy among men (1.17 years) than women (0.08 years). The contribution of HIV/AIDS substantially widened the racial difference among both men (1.08 years) and women (0.42 years) in 1993, but its contribution declined over time. Despite progress observed over the time period studied, a substantial portion of black–white disparities in mortality could be reduced given more equitable access to medical care and health interventions.     

The Association Between Individual Income and Remaining Life Expectancy at the Age of 65 in the Netherlands

This article quantifies the association between individual income and remaining life expectancy at the statutory retirement age (65) in the Netherlands. For this purpose, we estimate a mortality risk model using a large administrative data set that covers the 1996–2007 period. Besides age and marital status, the model includes as covariates individual and spouse’s income as well as a random individual specific effect. It thus allows for dynamic selection based on both observed and unobserved characteristics. We find that conditional on marital status, individual income is about equally strong and negatively associated with mortality risk for men and women and that spouse’s income is only weakly associated with mortality risk for women. For both men and women, we quantify remaining life expectancy at age 65 for low-income individuals as approximately 2.5 years less than that for high-income individuals.     

Caregiving and Care-Receiving:

Many aspects of aging are women's issues. Yet research on aging has, until recently, focussed little attention of gender differences in the experience of growing old. Older women are more likely than older men to be poor, widowed, living alone in poor health, receiving assistance from both formal and informal supports, as well as being institutionalized in long-term care facilities. This secondary analysis of data from the 1982 Survey of the Elderly in the Waterloo Region attempts to address a gap in our knowledge concerning gender differences in the giving and receiving of social support in later years. Gender differences in (1) need for social support, (2) turning to formal assistance, (3) amount of formal assistance used, and (4) amount of informal assistance received were examined using analysis of variance and logistic regression procedures. The profile of social support that emerged suggests both similarities and differences in the way elderly men and women experience the giving and receiving of social support. Older women in this sample were found to be disadvantaged in the areas of income, health, years lived alone, and loneliness, relative to older men. Low-income was related to formal service use for older women, but not for older     

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.