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.     

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.     

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.     

Patterns of active life among older women: differences within and between groups

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.     

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.     

Gender differences in disability-free life expectancy for selected risk factors and chronic conditions in Canada

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.     

US mortality in an international context: age variations

Compared to other developed countries, the United States ranks poorly in terms of life expectancy at age 50. We seek to shed light on the US's low life expectancy ranking by comparing the age-specific death rates of 18 developed countries at older ages. A striking pattern emerges: between ages 40 and 75, US all-cause mortality rates are among the poorest in the set of comparison countries. The US position improves dramatically after age 75 for both males and females. We consider four possible explanations of the age patterns revealed by this analysis: (1) access to health insurance; (2) international differences in patterns of smoking; (3) age patterns of health care system performance; and (4) selection processes. We find that health insurance and smoking are not plausible sources of this age pattern. While we cannot rule out selection, we present suggestive evidence that an unusually vigorous deployment of life-saving technologies by the US health care system at very old ages is contributing to the age-pattern of US mortality rankings. Differences in obesity distributions are likely to be making a moderate contribution to the pattern but uncertainty about the risks associated with obesity prevents a precise assessment.     

Differentials in Adult Mortality and Activity Limitation by Years of Education in the United States at the End of the 1990s

This study examines mortality differentials and health disparities between educational groups within the 1998 adult population (ages 25 and older) in the United States. Mortality differentials are measured using average life expectancy and health disparities by expected years without activity limitation. The results indicate that for both sexes, higher education is associated with higher life expectancy. Those with higher levels of education also have higher life expectancy without activity limitation. Adults with higher education can also expect to enjoy a greater percentage of their expected lives free of any form of activity limitation. At each level of education, adult females have a higher level of activity limitation compared to adult males. At the same level of education, adult females expect to enjoy smaller percentages of their remaining lives free of activity limitation compared to adult males of the same age.     

Understanding the age and cause drivers of recent longevity trends in Australia

Longevity continues to increase in Australia. The period 1979–2011 saw increases in life expectancy at birth of 6.9 years to 84.7 years for females, and 9.5 years to 80.2 years for males. A decomposition analysis reveals that the majority of the increase, particularly for females, is attributable to mortality improvement at older ages, and that gains are being made at increasingly older ages over time. Improvements in circulatory disease mortality account for a very significant component of life expectancy gains over the period—75 % for females and 60 % for males—with land transport accidents, congenital and perinatal mortality, and neoplasms also making significant positive contributions. Dementia and Alzheimer’s disease, and lung neoplasms for females, have had a negative impact. Females currently outlive males by 4.5 years on average, with ischaemic heart disease and prostate and other neoplasms the important positive contributors to this differential, and breast cancer having a negative effect. With 93 % of females and 88 % of males now surviving to age 65 in Australia, continued life expectancy improvements will depend to a large extent on success in delaying death at the older ages.     

Active life expectancy estimates for the U.S. elderly population: A multidimensional continuous-mixture model of functional change applied to completed Cohorts, 1982–1996

An increment-decrement stochastic-process life table model that continuously mixes measures of functional change is developed to represent age transitions among highly refined disability states interacting simultaneously with mortality. The model is applied to data from the National Long Term Care Surveys of elderly persons in the years 1982 to 1996 to produce active life expectancy estimates based on completed-cohort life tables. At ages 65 and 85, comparisons with extant period estimates for 1990 show that our active life expectancy estimates are larger for both males and females than are extant period estimates based on coarse disability states.     

Disability among older women and men in Fiji: concerns for the future

This study examines the composition of elderly population at risk of disability and speculates the impact of disability on the quality of their lives and their longevity. Using census and survey data collected in Fiji, life table estimates of unimpaired life expectancy across time are presented for older people and the potential costs of disability, in terms of productive years of life lost. From a planning perspective, the study discusses medical and support services that may be needed to support older individuals in Fiji. The study also describes policy implications of the findings, focusing on the older women, and considers the implications for older women of other developing countries.     

Disability Among Older Women and Men in Fiji: Concerns for the Future

SUMMARY

This study examines the composition of elderly population at risk of disability and speculates the impact of disability on the quality of their lives and their longevity. Using census and survey data collected in Fiji, life table estimates of unimpaired life expectancy across time are presented for older people and the potential costs of disability, in terms of productive years of life lost. From a planning perspective, the study discusses medical and support services that may be needed to support older individuals in Fiji. The study also describes policy implications of the findings, focusing on the older women, and considers the implications for older women of other developing countries.     

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.     

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.     

Decomposition of differences in health expectancy by cause

Health expectancy is a widely used measure for monitoring trends in the health of a population and assessing differences in health among population groups. However, no decomposition method is available to examine the contribution made by causes of death and disability to differences in health expectancy among population groups or periods. We present a method for decomposing differences in health expectancy, based on the Sullivan method. This method is an extension of the decomposition method for life expectancy developed by Arriaga. We illustrate the method and its added value by decomposing male-female differences in health expectancy for the Netherlands.     

Trends in health expectancies in Australia 1981–1993

Health expectancy indices combine the mortality and morbidity experience of a population into a single composite indicator. This paper summarizes and evaluates methods for the calculation of health expectancies and presents trends in the expectation of life with disability and handicap in Australia from 1981 to 1993. Unlike other countries for which recent health expectancy time series are available, Australian results indicate that the expectation of years with disability has increased for both males and females. Possible explanations for this are examined.     

Steep increase in best-practice cohort life expectancy

We analyze trends in best-practice life expectancy among female cohorts born from 1870 to 1950. Cohorts experience declining rather than constant death rates, and cohort life expectancy usually exceeds period life expectancy. Unobserved mortality rates in non-extinct cohorts are estimated using the Lee-Carter model for mortality in 1960–2008. Best-practice cohort and period life expectancies increased nearly linearly. Across cohorts born from 1870 to 1920 the annual increase in cohort length of life was 0.43 years. Across calendar years from 1870 to 2008, the annual increase was 0.28 years. Cohort life expectancy increased from 53.7 years in the 1870 cohort to 83.8 years in the 1950 cohort. The corresponding cohort/period longevity gap increased from 1.2 to 10.3 years. Among younger cohorts, survival to advanced ages is substantially higher than could have been anticipated by period mortality regimes when these cohorts were young or middle-aged. A large proportion of the additional expected years of life are being lived at ages 65 and older. This substantially changes the balance between the stages of the life cycle.