achieving national health objectives: the impact on life expectancy and healthy life expectancy...
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Achieving National Health Objectives: Achieving National Health Objectives: The impact on Life Expectancy and The impact on Life Expectancy and Healthy Life ExpectancyHealthy Life Expectancy
Elsie Pamuk, PhDElsie Pamuk, PhDDiane Wagener, PhDDiane Wagener, PhDMichael Molla, PhDMichael Molla, PhD
National Center for Health Statistics National Center for Health Statistics Centers for Disease Control and PreventionCenters for Disease Control and Prevention
What is Healthy People 2010 ?What is Healthy People 2010 ?
A comprehensive set of A comprehensive set of national health national health objectivesobjectives for the decade for the decade
Developed by a Developed by a collaborative processcollaborative process
Designed to Designed to measure progressmeasure progress over time over time
A public health document that is part A public health document that is part strategic planstrategic plan, part textbook on public , part textbook on public health prioritieshealth priorities
History of Healthy PeopleHistory of Healthy People
19791979 -- Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention
1980 1980 -- Promoting Health/Preventing Disease: Objectives for the Nation
19901990 -- Healthy People 2000: National Healthy People 2000: National Health Promotion and Disease Health Promotion and Disease Prevention Objectives Prevention Objectives
20002000 - - Healthy People 2010Healthy People 2010
Components ofComponents ofHealthy People 2010Healthy People 2010
2828 focus areas focus areas
467 467 specific objectives specific objectives
supportingsupporting
22 overarching objectivesoverarching objectives
Overarching goals Overarching goals of Healthy People 2010of Healthy People 2010
Goal 1:Goal 1: Increase Quality and Increase Quality and Years of Healthy Years of Healthy
LifeLife
Overarching goals Overarching goals of Healthy People 2010of Healthy People 2010
Goal 1:Goal 1: Increase Quality and Increase Quality and Years of Healthy Years of Healthy
LifeLife
Goal 2:Goal 2: Eliminate Health Eliminate Health Disparities Disparities
PurposePurpose::
to quantify the impact of to quantify the impact of
achieving specific Healthy People 2010 achieving specific Healthy People 2010 objectivesobjectives
and of and of
eliminating racial/ethnic health eliminating racial/ethnic health disparities disparities
on summary measures of healthon summary measures of health
MethodsMethods
Life table methodsLife table methods
• Life expectancyLife expectancy Age-specific death rates applied to Age-specific death rates applied to
a hypothetical cohort of 1000a hypothetical cohort of 1000
• Healthy life expectancyHealthy life expectancy Sullivan’s method: Sullivan’s method:
adds in age-specific adds in age-specific prevalence of morbidityprevalence of morbidity
Impact on life expectancy of Impact on life expectancy of achieving specific HP2010 targets:achieving specific HP2010 targets:
Baseline = age-specific death rates Baseline = age-specific death rates for 1998 for 1998
applied mortality reductions applied mortality reductions specified in 38 objectivesspecified in 38 objectives
Impact on life expectancy of Impact on life expectancy of eliminating racial/ethnic eliminating racial/ethnic differences:differences:
Adjusted the age-specific death rates for Adjusted the age-specific death rates for Asian or Pacific Islanders for 1997-1999 Asian or Pacific Islanders for 1997-1999 for race misreportingfor race misreporting
Applied to the U.S. populationApplied to the U.S. population
Age-specific mortality reductions implied by Age-specific mortality reductions implied by achieving alternative objectivesachieving alternative objectives
10
100
1000
10000
100000
<1 1-9 10-19
20-29
30-39
40-49
50-59
60-69
70-79
80+
Age
Death rate
U.S. 1998HP 2010API
Additional years of expected life gained at specific ages by achieving alternative national health
objectives
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
0 1 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85
Age
additionalyears of
expected life
Adjusted Asian/Pacific Islander rates
HP 2010 mortality targets
Impact on healthy life expectancy of Impact on healthy life expectancy of achieving HP2010 morbidity targets:achieving HP2010 morbidity targets:
Baseline = age-specific rates of Baseline = age-specific rates of chronic conditions causing activity chronic conditions causing activity limitation for 1998 limitation for 1998
Implied morbidity reductions of:Implied morbidity reductions of:25% at ages <5025% at ages <5033% at ages 50+33% at ages 50+
Impact on healthy life Impact on healthy life expectancy of eliminating expectancy of eliminating racial/ethnic differences:racial/ethnic differences:
Age-specific activity limitation rates for Age-specific activity limitation rates for Asian or Pacific Islanders for 1997-1999Asian or Pacific Islanders for 1997-1999
Applied to the U.S. populationApplied to the U.S. population
Age-specific morbidity reductions implied by Age-specific morbidity reductions implied by achieving alternative objectivesachieving alternative objectives
0
10
20
30
40
50
60
<1 1-9 10-19
20-29
30-39
40-49
50-59
60-69
70-79
80+
Age
Percent with activity
limitation
U.S. 1998HP 2010API
Additional years of expected healthy life gained at specific ages by achieving alternative national health objectives
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
0 1 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85
Age
years of expected
healthylife
Asian/Pacific Islander mortality & activity limitation rates
Healthy People 2010 mortality & activity limitation targets
Asian/Pacific Islander mortality rates
Healthy People 2010 mortality targets
SummarySummary
Achieving HP2010 targets:Achieving HP2010 targets:• Increases life expectancy by 2.8 yrs Increases life expectancy by 2.8 yrs • Increases healthy life expectancy by 5.8 yrsIncreases healthy life expectancy by 5.8 yrs
Elimination of racial and ethnic disparityElimination of racial and ethnic disparity• Increases life expectancy by 4.1 yrsIncreases life expectancy by 4.1 yrs• Increases health life expectancy by 8.1 yrsIncreases health life expectancy by 8.1 yrs
Usefulness of the exerciseUsefulness of the exercise
Summarizes the impact of many Summarizes the impact of many diverse objectives and allows diverse objectives and allows tracking of overall progresstracking of overall progress
Identifies areas that need attention Identifies areas that need attention
For more information….For more information….
Pamuk ERPamuk ER, Wagener DK, Molla MT. , Wagener DK, Molla MT. Achieving national health objectives: Achieving national health objectives: the impact on life expectancy and the impact on life expectancy and on healthy life expectancy. on healthy life expectancy. American Journal of Public Health, American Journal of Public Health, 2004; 94(3):378-83.2004; 94(3):378-83.