Was there compression of disability for older Americans from 1992 to 2003?

Medical advances and the growth of the elderly population have focused interest on trends in the health of the elderly. Three theories have been advanced to describe these trends: compression of morbidity, expansion of morbidity, and dynamic equilibrium. We applied multistate life table methods to the Medicare Current Beneficiary Survey to estimate active and disabled life expectancy from 1992 to 2003, defining disability as having difficulty with instrumental activities of daily living or activities of daily living. We found increases in active life expectancy past age 65 and decreases in life expectancy with severe disability. These trends are consistent with elements of both the theory of compression of morbidity and the theory of dynamic equilibrium.     

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.     

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。     

Change in disability-free life expectancy for Americans 70 years old and older*

In this article, we examine changes in life expectancy free of disability using longitudinal data collected from 1984 through 2000 from two cohorts who composed the Longitudinal Studies of Aging I and II. Life expectancies with and without ADL and/or IADL disability are calculated using a Markov-based multistate life table approach. At age 70, disability-free life expectancy increased over a 10-year period by 0.6 of a year in the later cohort, which was the same as the increase in total life expectancy, both increases marginally statistically significant. The average length of expected life with IADL and ADL disability did not change. Changes in disability-free life expectancy resulted from decreases in disability incidence and increases in the incidence of recovery from disability across the two survey cohorts. Age-specific mortality among the ADL disabled declined significantly in the later cohort after age 80. Mortality for the IADL disabled and the nondisabled did not change significantly. Those with ADL disability at age 70 experienced substantial increases in both total life expectancy and disability-free life expectancy. These results indicate the importance of efforts both to prevent and delay disability and to promote recovery from disability for increasing life expectancy without disability. Results also indicate that while reductions in incidence and increases in recovery work to decrease population prevalence of disability, declining mortality among the disabled has been a force toward increasing disability prevalence.     

Longevity and Lifespan Variation by Educational Attainment in Spain: 1960–2015

For a long time, studies of socioeconomic gradients in health have limited their attention to between-group comparisons. Yet, ignoring the differences that might exist within groups and focusing on group-specific life expectancy levels and trends alone, one might arrive at overly simplistic conclusions. Using data from the Spanish Encuesta Sociodemográfica and recently released mortality files by the Spanish Statistical Office (INE), this is the first study to simultaneously document (1) the gradient in life expectancy by educational attainment groups, and (2) the inequality in age-at-death distributions within and across those groups for the period between 1960 and 2015 in Spain. Our findings suggest that life expectancy has been increasing for all education groups but particularly among the highly educated. We observe diverging trends in life expectancy, with the differences between the low- and highly educated becoming increasingly large, particularly among men. Concomitantly with increasing disparities across groups, length-of-life inequality has decreased for the population as a whole and for most education groups, and the contribution of the between-group component of inequality to overall inequality has been extremely small. Even if between-group inequality has increased over time, its contribution has been too small to have sizable effects on overall inequality. In addition, our results suggest that education expansion and declining within-group variability might have been the main drivers of overall lifespan inequality reductions. Nevertheless, the diverging trends in longevity and lifespan inequality across education groups represent an important phenomenon whose underlying causes and potential implications should be investigated in detail.     

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.     

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.     

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。     

Spatial Inequality in Mortality in France over the Past Two Centuries

This article analyzes the evolution of spatial inequalities in mortality across 90 French territorial units since 1806. Using a new database, we identify a period from 1881 to 1980 when inequalities rapidly shrank while life expectancy rose. This century of convergence across territories was mainly due to the fall in infant mortality. Since 1980, spatial inequalities have levelled out or occasionally widened, due mainly to differences in life expectancy among the elderly. The geography of mortality also changed radically during the century of convergence. Whereas in the 19th century high mortality occurred mainly in larger cities and along a line from North-west to South-east France, it is now concentrated in the North, and Paris and Lyon currently enjoy an urban advantage.     

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.     

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.     

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.     

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。     

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.     

Changes in the age dependence of mortality and disability: Cohort and other determinants

Though the general trend in the United States has been toward increasing life expectancy both at birth and at age 65, the temporal rate of change in life expectancy since 1900 has been variable and often restricted to specific population groups. There have been periods during which the age- and gender-specific risks of particular causes of death have either increased or decreased. These periods partly reflect the persistent effects of population health factors on specific birth cohorts. It is important to understand the ebbs and flows of cause-specific mortality rates because general life expectancy trends are the product of interactions of multiple dynamic period and cohort factors. Consequently, we first review factors potentially affecting cohort health back to 1880 and explore how that history might affect the current and future cohort mortality risks of major chronic diseases. We then examine how those factors affect the age-specific linkage of disability and mortality in three sets of birth cohorts assessed using the 1982, 1984, and 1989 National Long Term Care Surveys and Medicare mortality data collected from 1982 to 1991. We find large changes in both mortality and disability in those cohorts. providing insights into what changes might have occurred and into what future changes might be expected.     

多维度失能测度指标体系构建及失能分级研究

以ICF理论框架的交互影响理念为依据,从多维度视角构建了失能测度指标体系。首先,通过赋值法,得到多维度下的失能总分,依据得分将其划分为重度失能、偏重度失能、中度失能、轻度失能及健康五种功能状态,构造死亡概率模型及失能状态转移概率模型,结果显示,失能分级标准是可靠的。其次,利用CLHLS数据库2011年及2014年追踪调查数据,通过构造多状态转移概率矩阵,实证测算了多状态失能转移概率;借助第六次全国人口普查数据,估算了中国65岁及以上失能人口规模、各状态维持时间及预期寿命等。结果显示,初始健康的老人三年期转移概率维持在健康的概率最高,其死亡率也最低;而初始状态为重度失能的老人死亡率最高,其维持重度失能及转移到偏重度等失能状态的概率也最高。研究结论表明,直接依据数据的失能状态转移概率测算比建模估计要准确;基于多状态转移概率矩阵评估的失能规模、预期寿命等均比已有分级测度结果可靠性更高。     

Life Potential as a Basic Demographic Indicator

This paper proposes an indicator that integrates life expectancy with the demographic structure of the population for a given society. By doing this, we have a simple indicator of mortality and aging combined, which could be very useful for developed societies. As is widely known, life expectancy at birth is independent of the demographic structure of the population, and therefore is adequate for measuring overall mortality. However, it neglects to take into account the fact that as life expectancy increases society ages, and so looking at life expectancy alone can produce an overly optimistic view of the development process, especially if we pay attention to future sustainability. Aging can in fact affect quality of life and sustainability in the long run. The indicators for aging are usually very crude, such as providing information on the share of the population who are 65 and over. We propose a simple indicator that integrates life expectancy at different ages, not only at birth, with the demographic structure of the population at a given point in time. The indicator has an intuitive interpretation in terms of the life potential, or biological capital, of society; and given that it is a weighted average, its changes can be easily decomposed into reductions in mortality (gains in life expectancy) and aging for different age intervals.     

Resolving inconsistencies in trends in old-age disability: Report from a technical working group

In September 2002, a technical working group met to resolve previously published inconsistencies across national surveys in trends in activity limitations among the older population. The 12-person panel prepared estimates from five national data sets and investigated methodological sources of the inconsistencies among the population aged 70 and older from the early 1980s to 2001. Although the evidence was mixed for the 1980s and it is difficult to pinpoint when in the 1990s the decline began, during the mid- and late 1990s, the panel found consistent declines on the order of 1%-2.5% per year for two commonly used measures in the disability literature: difficulty with daily activities and help with daily activities. Mixed evidence was found for a third measure: the use of help or equipment with daily activities. The panel also found agreement across surveys that the proportion of older persons who receive help with bathing has declined at the same time as the proportion who use only equipment (but not personal care) to bathe has increased. In comparing findings across surveys, the panel found that the period, definition of disability, treatment of the institutionalized population, and age standardizing of results were important to consider. The implications of the findings for policy, national survey efforts, and further research are discussed.     

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.