Healthy life expectancy in the EU 15

Carol JaggerEHEMU team

Europe Blanche XXVI Living Longer but Healthier lives Budapest November 2005

Monitoring population ageing

• Most countries are seeing year on year increase in life expectancy at birth and at older ages

• Are we exchanging longer life for poorer health (expansion of morbidity scenario) or are the extra years spent in good health (compression of morbidity)?

• Do these trends hold for all countries, all social groups, men and women?

• Health expectancies provide the answer as they extend the notion of life expectancy to different health dimensions, thus adding quality to quantity of life lived

Purpose

• To explore compression or expansion of healthy life and gender differences through cross-national comparisons of healthy life expectancy at birth and age 65 among EU countries between 1995 and 2003

• In preparation for the new EU structural indicator Healthy Life Years

• Using disability-free life expectancy (DFLE) as a measure of healthy life expectancy

Data and methods

Estimation of DFLE and 95% CI, using Sullivan method

• age specific probability of death: Eurostat life tables

• age specific disability prevalence: European Community Household Panel 1995-2001 question ‘Are you hampered in your daily activities by any physical or mental health problem, illness or disability? ‘

• Some interpolation for odd missing values and extrapolation of trends for 2002-3

DFLE calculation

Eurostat Life table

Life expectancy

Age specific disability prevalence from ECHP

LE free of disability (DFLE)

LE with disability

1995 1996 1997 1998 1999 2000 2001 2002 2003

70

75

80

85

1995 1996 1997 1998 1999 2000 2001 2002 2003

70

75

80

85

LE

Men Women

Distribution of LE and DFLE at birth EU(14), 1995-2003

1995 1996 1997 1998 1999 2000 2001 2002 2003

55

60

65

70

75

Distribution of LE and DFLE at birth EU(14), 1995-2003

1995 1996 1997 1998 1999 2000 2001 2002 2003

70

75

80

85

1995 1996 1997 1998 1999 2000 2001 2002 2003

70

75

80

85

LE

Men Women

DFLE

1995 1996 1997 1998 1999 2000 2001 2002 2003

55

60

65

70

75

• By 2003 LE at birth in the EU14 ranged from 74.2 (Portugal) to 78 (Sweden) years for men and 80.1 (Denmark) to 83.2 years (France) for women, following a steady increase from 1995.

• Compared to LE, trends in DFLE were more variable although gender differences were smaller

• Between 1995-2003 the gain in total years for men exceeded the gain in years free of disability

• In women there was only a slight improvement, on average, in life expectancy with a similar gain in disability-free life years.

Distribution of LE and DFLE at birth EU(14), 1995-2003

Trends in LE and DFLE at age 65 in EU (14), 1995-2003

Men

4

6

8

10

12

14

16

18

20

22

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Exp

ecte

d y

ears

of

life

Austria Belgium Denmark Finland France Germany Greece

Ireland Italy Netherland Portugal Spain Sweden United Kingdom

LE

DFLE

Trends in proportion of life spent disability-free at age 65

= gain of 5% + between 1995 and 2001

= loss of 5% + between 1995 and 2001

= gain or loss of less than 5% between 1995 and 2001

Men

30

35

40

45

50

55

60

65

70

75

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Year

Pro

po

rtio

n o

f L

E s

pen

t d

isab

ility

-fre

e at

ag

e 65

Austria Belgium Denmark Finland France Germany Greece

Ireland Italy Netherland Portugal Spain Sweden United Kingdom

Trends in proportion of life spent disability-free at age 65

= gain of 5% + between 1995 and 2001

= loss of 5% + between 1995 and 2001

= gain or loss of less than 5% between 1995 and 2001

Women

30

35

40

45

50

55

60

65

70

75

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Year

Pro

po

rtio

n o

f L

E s

pen

t d

isab

ility

-fre

e at

ag

e 65

Austria Belgium Denmark Finland France Germany Greece

Ireland Italy Netherland Portugal Spain Sweden United Kingdom

Trends in the proportion of life spent disability-free at age 65

Men

Austria, Belgium, Italy, Finland, Germany

- France, Greece, Ireland, Spain

Denmark, Portugal, Netherlands, Sweden, UK

Women

Belgium, Italy, Sweden

- Austria, Denmark, UK, Finland, France, Spain, UK

Germany, Greece, Ireland, Netherlands, Portugal

Trends in DFLE using the ECHP

1) Life expectancy:• Small variation in LE between these 14 MS• Increase between 1995-2003

2) Disability Free Life Expectancy and %DFLE/LE• Large variation in DFLE between these 14 MS• Diverging trends over 1995-2003: reduction /

stagnation / increase in the proportion of life with reported disability at age 65 while LE increases

• Gender differences in trends

Real or artefact?May be an artefact due to• Data problems• Sampling• Omission of institutionalised population• Not harmonised disability question• Cultural differences in reporting of disability• Confounding factors – socio-economic

But trends less sensitive to these

If real what is ‘cause’

Conclusions

Population aging has a different impact in the 14 Member States in Europe:

- different levels of reported disability (larger dispersion than LE) - variation in the magnitude of the gender difference- different trends over time

Need to improve cross-national comparisons in self-reported disability to ensure differences are not an artefact:

- improved harmonisation of the instruments- using different levels of severity - documenting differences in reporting- documenting differences in selection in the panel

Healthy life expectancy in the EU 15

Carol JaggerEHEMU team

Europe Blanche XXVI Living Longer but Healthier lives Budapest November 2005

Data and Methods

Problems in both mortality and the panel data

1) Data base• Probable data errors• Replacement with other sources• Missing

2) Interruption of data collection• No data for 2002 and 2003

Solutions

1) Data base• Linear imputation of age pecific

probabilities (death and disability)

• Shift of the prevalence trend to the ECHP level

• Imputation of data according to observed trends

2) Interruption of data collection • Linear extrapolation of the

disability prevalence

Trends in LE and DFLE at age 65 in EU (14), 1995-2003

Women

4

6

8

10

12

14

16

18

20

22

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Ex

pe

cte

d y

ea

rs o

f lif

e

Austria Belgium Denmark Finland France Germany Greece

Ireland Italy Netherland Portugal Spain Sweden United Kingdom

LE

DFLE