life expectancies when healthy - instituto nacional de ... · life expectancies when healthy...

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Life expectancies when healthy

Life expectancies

when healthy

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Health expectancies provide a measure ofdividing life expectancy into fractions livedin different situations: for example in goodand bad health. These measures representthe growing interest in obtaining quality oflife indicators (life when healthy) instead ofexclusively quantity indicators (lifeexpectancy). Health expectancies extend tothe concept of life expectancy to morbidityand disability. The calculation of Healthexpectancies in particular life expectancy freeof disability (LEFD) was developed to dealwith the question of whether the increase inlife expectancy was accompanied by anincrease in time lived with poor health.

One of the main and more extended indicatorsto evaluate the quality of the health of a

population is the rate of disability. The surveyon disabilities, impairments and state ofhealth 1999 reaches 9% for disabled personsin Spain. Graph 1 shows the distribution byage and sex of the general population anddisabled population.

The inversion of these pyramids highlightsthe main characteristic of disability: it is aphenomenon associated with age thatincreases with age. Differences can also beseen between men and women. The latterhave higher rates than men from the age of45 which increase with age.

Due to the fact that health expectancy is acombination of life expectancy and a healthconcept, there are so many expectancies as

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health concepts. From the initial model forthe calculation of LEFD several improvementshave been presented which broaden theavailable information on the health of thepopulation. In this way, we can calculateindicators such as health expectancy “ingood health“ in agreement with the WHOdefinition; life expectancy free of chronicdiseases, etc. Moreover different levels ofseverity may be introduced to calculate forexample life expectancy “free of severedisability“ or to calculate expectancies for aspecific type of disability, such as lifeexpectancy “free of visual disabilities“.

Graph 2 shows the proportions of survivorsat different events. Distinction is madebetween total survival, survival free ofdisability, survival in good perceived healthand survival without chronic disease. Viathese concepts life expectancy may becalculated (LE; the area under the mortalitycurve), life expectancy free of disability (LEFD;the area under the disability curve), lifeexpectancy in good perceived health (LEGH;the area under the perceived health curve) andlife expectancy free of chronic disease(LEFCD; the area under the chronic diseasecurve).

The difference between each pair ofexpectancies gives rise to new definitions.In this way, for example the differencebetween LE and LEFD measures lifeexpectancy with disability (LEFD); thedifference between LEFD and LELEC measuresLife Expectancy with at least a chronic diseasebut without disability; the difference betweenLEFD and LEGH measures Life Expectancy inbad health but without disability.

The sum of complementary healthexpectancies is always equal to lifeexpectancy (LE). For example, Life ExpectancyFree of Disability (LEFD) plus Life Expectancywith Disability (LEWD) is equal to total lifeexpectancy (LEFD + LEWD = LE); LE may alsobe obtained, using three indicators: LE =LEBS + (LEFD – LEGH) + LEWD.

Health expectancies proportions may becalculated. For example, the proportion of lifeexpectancy free of disability on lifeexpectancy indicates the fraction of lifeexpectancy lived without disability (generallyexpressed as a percentage).

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From a general point of view graph 3.1 showsthat the process of health problems appearingis gradual. In the first place chronic diseasesappear which brings with it a subsequent selfperception of a bad state of general health.Later limitations in activities appear, in otherwords disability presents; finally , theseverest disabilities appear which need helpand make reference to domestic activities andself care. Self care activities (washing andtaking care of one’s appearance, controllingneeds and using the lavatory alone, dressing-undressing, eating and drinking) are the mostbasic in the daily life of a person, thereforethey are the last to appear.

For practically all the health expectancies fromgraph 3.1, the number of years that womenlive without disabilities is greater than thatfor men. From graphs 3.2 and 3.3 it can beseen that despite the fact that women expect

to live without disabilities more years thanmen they suffer for longer due to their greaterlife expectancy.

There are two exceptions to this differencebetween men and women. This deals withLife Expectancy Free of Chronic Disease(LEFCD) and Life Expectancy in GoodPerceived Health (LEGH). Women suffer fromchronic diseases before men and also havepoorer general health. The number of yearsexpected without chronic disease is 38 forwomen and 41 for men. With good health,women live a little over 58 compared with 60for men. The difference between these twoindicators is due, among other factors, to theexistence of relatively light chronic diseasessuch as some types of allergy, migraines. badcirculation. If these diseases are not bornein mind the LEFCD indicator increases up to47 years in men and 45 in women.

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Women are not expected to have disabilitiesup to 72 compared with 68 In men. Up to 45the difference in LEFD between men andwomen is maintained but from 45 thedifference in gender for LEFD is fromattenuated to almost negligible. Thedifference of 3,6 years observed in the LEFDat birth reduced to 1 year at age 65 and redu-ces to 0,12 years at 80 (table 1).

The prolonging of life that has occurred inthe last few decades should be accompaniedby some good health conditions, in such away that the number of years gained are livedwith individual, family and social autonomy.To ascertain the real effect of ageing on thehealth of the population and given that thereare big differences in gender as to lifeexpectancy, analysis of the LEFD must bedone with respect to LE.

Indeed, although graph 4.1 indicates thatwomen live more years free of disabilities,graph 4.2 shows that of the total of 99 lifeyears women will live a greater proportionwith disabilities than men at all ages. This,together with the fact that life expectancy ofwomen is 7 years greater puts the woman ina situation of clear disadvantage as to the

quality of health. For example, at 65 menexpect to live with some disability around 5years as opposed to nearly 8 years thatwomen live (graph 3.3).

In comparing graphs 4.1 and 4.2 opposingtrends in the lines can be seen. The LEFD ofmen and women tends to converge with agewhilst the proportion of remaining years tobe lived without disability for men andwomen tends to diverge with age. At birth,men will live 91% of their life without

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disability and women 88%, at 45 years thedifference between men and women isgreater (82% compared with 76%), at 65 itkeeps increasing (70% compared with 61%)and at 80 men will live 50% of their remainingyears without disability compared with 42%of women.

Very similar guidelines appear when severedisabilities and those that need help areanalysed. The severity of disabilities as wellas the need for help are directly related to thephenomenon of dependence. The Council ofEurope defines it as a state in which peoplefind themselves for reasons linked to the lackor loss of physical, psychic or intellectualautonomy, have the need for care and/orsignificant help in order to carry out normallife activities. There is notable worry for thephenomenon of dependence since it hassignificant family and social implications.Foreseeing the time that people will havesevere disabilities and will need help is fun-damental for planning care and futuresupport.

In this sense, up to 65 women live on avera-ge more years than men without severedisability and without needing help (graphs5.1 and 6.1); from this age, the number of yearslived free of these problems tends to be equal.At birth, women theoretically are free of severedisabilities and do not need help for 75 years.Conversely, men can expect not to have severedisabilities or need help up to 71 years.

The disabilities most linked to dependenceare those related with Activities of Daily Li-ving (ADL) which include mobility, self careand domestic tasks. Instrumental activitiesrelated with domestic tasks are morecomplex than activities based on self care,therefore the first difficulties that come up areusually, after mobility, domestic tasks andsubsequently, self care.

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Specifically, it is in two of the ADL disabledgroups where age causes greater genderdifferences: these are those related todomestic tasks and mobility. Men, at birthexpect to have 97% of their life free ofdisabilities to carry out domestic tasks; inwomen 93%. However, men of 65 can expect89% of their life without disabilities of thistype, compared with 76% of women. And at80, 75% of the remaining life of a man is freeof these disabilities and only 58% in women.

This large difference may be due, in part, tothe lesser coincidence that older men havein the possibility of having disabilities relatedto household tasks.

Other groups of disabilities are hearing andsight. For these expectancies as well thereare significant differences between men andwomen at birth, around 6 years. However,there is a different guideline to that observedup to now in these indicators: the lines fromgraphs 10,1 and 11,1 only converge clearlyat the end. On the other hand, with respect tothe life percentage of a person withoutdisabilities in hearing or seeing (graphs 10.2and 11.2) significant gender differencescannot be discerned . In other words, men

and women are equal with respect to hearingand seeing problems. At the age of 80, menand women with respect to hearing and sightproblems. At the age of 80 it is expected thatthey will live 80% of the time remainingwithout significant difficulties for hearing andaround 79% (with a mild difference betweensexes) without problems for seeing.

Autonomous Communities that have LifeExpectancy Free of Disability at birth moreelevated in men are La Rioja and Madrid with71,59 and 71,06 respectively. Ten AutonomousCommunities are below the 68,52 years, the

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national average. Of them, only four have lifeexpectancies more than one year less thanthe national: Andalucía, Murcia, Asturias andCeuta, that vary from 66,03 years in Andalu-cía and Murcia to 67,30 years in Ceuta.

Although geographical differences can beappreciated in the data corresponding to men,there is quite a lot less variability than thatobserved in women.

Women live more years without disability inLa Rioja (7665 years), Navarra (74,76 years),Madrid (74,70 years) and Aragón (74,58 years).There are 8 Autonomous Communities witha LEFD less than the national average, 72,12years. Of these those that have the lowestvalues are Melilla (64,15 years), Murcia (68,75years), Andalucía (68,98 years) and Ceuta(69,99 years).

From age 65, men from the La Rioja and Ma-drid communities will live nearly two yearsmore without disability than the national ave-rage which is at 11,39 years. Conversely, menresident in Murcia and Andalucía areexpected to live 9,51 and 9,70 yearsrespectively without disability.

Women who are expected to live more yearswithout disability from age 65 are residentsin La Rioja (16,44 years), País Vasco (14,46years), Madrid (14,31 years) and the BalearicIslands (14,15 years). Communities in whichwomen have a lower LEFD are Melilla (8,12years), Murcia (9,95 years) and Andalucía(10,15 years), the national average being 12,39years.

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