An international comparison of trends in disability-free life expectancy

Disability trajectories in activities of daily living of elderly Chinese before death

This study aims to analyze the changes in activities of daily living (ADL) of the Chinese elderly before death, and to explore the heterogeneity in this process. Using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), we quantify disability trajectories of ADL using a group-based trajectory model and find that there are three types of disability trajectory for ADL. The elderly who differ by socioeconomic status, childhood experiences, health behaviors, ages and birth cohorts show significant differences in their disability trajectories. Long duration of disability is found to be more prevalent in older females and people with high socioeconomic status. Good and stable status of ADL is more common among males and people of low socioeconomic status, while the elderly in an early cohort who died at older ages were more likely to have experienced a long duration of disability. Selective and protective effects contribute to the observed differences in trajectories.

Trends Over 4 Decades in Disability-Free Life Expectancy in the United States

OBJECTIVES

To examine changes over 40 years (1970-2010) in life expectancy, life expectancy with disability, and disability-free life expectancy for American men and women of all ages.

METHODS

We used mortality rates from US Vital Statistics and data on disability prevalence in the community-dwelling population from the National Health Interview Survey; for the institutional population, we computed disability prevalence from the US Census. We used the Sullivan method to estimate disabled and disability-free life expectancy for 1970, 1980, 1990, 2000, and 2010.

RESULTS

Over the 40 years, there was a steady increase in both disability-free life expectancy and disabled life expectancy. At birth, increases in disabled life and nondisabled life were equal for men (4.5 years); for women, at birth the increase in life with disability (3.6 years) exceeded the increase in life free of disability (2.7 years). At age 65 years, the increase in disability-free life was greater than the increase in disabled life.

CONCLUSIONS

Across the life cycle, there was no compression of morbidity, but at age 65 years some compression occurred.

Disability-free life expectancy of older French people: gender and education differentials from the PAQUID cohort

In countries with low mortality rates, the quality of the years of life is more important to consider than total life expectancy (TLE). Disability-free life expectancy (DFLE) is one of the most relevant indicators of health and the quality of life. This paper aims to estimate TLE and DFLE with four levels of severity of disability and to explore gender and educational differences in older French people. In this cohort study, four levels of disability severity were distinguished, disability being evaluated for mobility, instrumental and basic activities of daily living. For each level, TLE and DFLE were calculated using multi-state models from transition probabilities. From the population of two areas of South West France 3,777 subjects were randomly selected from the electoral rolls. At the baseline, they were aged 65 years and over, living in the community and were interviewed 6 times over the 10-year follow-up. At age 65, women lived longer than men (4.5 extra years), but shorter fully independent lives (-2.2 years). They also lived longer in each of the three degrees of disability (+4.2 years with moderate or severe disability). The higher educated lived longer (1.3 extra years at age 65), with the additional years free of disability. Regardless of age, gender and education, there appeared to be a 1-year incompressible time spent with severe disability. To conclude, these are the first health expectancies based on the longitudinal data for France. Whilst most of the studies were based on cross-sectional data, this paper gives a more realistic indicator of the health and socio-economic inequalities in France in the 1990 s.

A "fair innings" between the sexes: are men being treated inequitably?

In most modern developed communities, women are known to live longer than men. A less known fact is that in many statistics reporting differences in life expectancy between socio-economic classes, on average women in the worst-off social class live as long as men in the best-off social class, if not longer. It is true that women tend to have higher morbidity, or lower health-related quality of life, especially at advanced age, but this female disadvantage does not offset the life expectancy advantage sufficiently to lead to the conclusion that men and women enjoy comparable lifetime health prospects in these communities. Although there is much public and policy discussion about the inequity of health inequalities between the social classes, there is relatively little discussion about such inequalities between the sexes. The paper first discusses the applicability of the fair innings argument to the issue of inequality in health between the sexes. It critically examines six arguments concerning why inequality in health between the sexes may or may not be an inequity. Next, special attention is given to the argument that it is wrong to judge the fairness or unfairness of health inequalities in isolation, but that this judgement should be made only after considering other inequalities relevant to overall human well-being, many of which are believed to work to the disadvantage of women. An analytical framework based on the Gender-related Development Index (a supplementary index to the Human Development Index) is taken as a starting point, to address the issue of health and overall well-being. But this is found wanting, and suggestions are made as to how its conceptual and empirical properties could be improved. Meanwhile we conclude that a prima facie case has been made that the current distribution of health in most countries does not give men a "fair innings", but the broader question about general well-being remains unresolved.

Health expectancy in Denmark, 1987–2000

BACKGROUND

While life expectancy quantifies average length of life, health expectancy represents the average lifetime in different health states and offers the possibility to evaluate quality of life with respect to health. The purpose of the study was to estimate changes in health expectancy in Denmark from 1987 to 2000 and to assess theories about the relation between increased total lifetime and lifetime in various health states.

METHODS

Data on health status derived from the Danish Health Interview Surveys carried out in 1987, 1991, 1994 and 2000 were combined with life-table data. Expected lifetime in selfrated good health, life expectancy without longstanding illness and disabilityfree life expectancy were estimated by Sullivan's method.

RESULTS

In 1987, the life expectancy of a 65-year-old man was 14.1 years, 8.9 years of which were expected to be disabilityfree. In 2000, life expectancy had increased to 15.0 years, 11.3 years of which were disabilityfree. Thus, life expectancy had increased by 0.9 years, whereas disabilityfree life expectancy had increased by 2.4 years. Among 65-year-old women, life expectancy had increased by 0.2 years and disabilityfree life expectancy by 1.1 years. Expected lifetime in selfrated good health had also improved, but the trend in life expectancy without longstanding illness went in the opposite direction, and expected lifetime with longstanding illness had increased.

CONCLUSION

The recent rise in life expectancy in Denmark after many years of stagnation appears to be accompanied by generally improved health status among the elderly, but health expectancy trends depend on the health indicator chosen.

KEY POINTS

Health expectancy expresses average lifetime in various states of health. The study examines changes in expected lifetime in selfrated good health, lifetime without longstanding illness and lifetime without longterm disability. Among 65-year-olds the percentage of disabilityfree life expectancy increased from 63.4% to 74.9% for men and from 55.6% to 61.0% for women between 1987 and 2000. Health status among elderly Danes has apparently improved, but secular trends in health expectancy depend on the choice of health indicator.

Coping with aging: international challenges

This DataWatch discusses trends in functional health status among the elderly in several countries. Life expectancy at an advanced age has increased, and there is some evidence of lower prevalence of severe disability and a trend toward deinstitutionalization. These changes may result in fewer severely disabled persons, but the impact is less clear from the perspective of public finances, because of the increased need for formal home care and the relative subsidization of institutions. The implications for health care need further research but also may point to increased expenditures.