Gender differences in disability-free life expectancy at old ages in Bangladesh

Differences between subjective and disability health expectancies across ages in older adults

Health expectancies (HEs) have become a key indicator for monitoring healthy aging. So far, they have mainly been calculated based on functional rather than subjective health measures. Yet, by integrating several dimensions (medical, social, and cultural), subjective health is also an important measure of an older person's health status. In this study, we first estimated HEs using self-rated health (SRH), by age and sex. Second, we compared these results to those obtained when using a disability measure. We used pooled data from three prospective population-based cohorts including adults aged 65 years and over, living in Southwestern France (N = 4468). SRH was assessed using a single question and disability was measured using the Lawton scale. Healthy/Unhealthy Life Expectancies (HLE/UHLE) and Disability/Disability-Free Life Expectancies (DLE/DFLE) were estimated using the Interpolated Markov Chain program (IMaCh), separately in men and women. Women lived longer than men, with similar HLE but longer UHLE at all ages. The proportion of HLE in total LE decreased with age for both sexes and for women, it became smaller than the proportion of UHLE from age 73 onward. In both sexes, while the DLE was shorter than the UHLE in the youngest, a reversal was observed with advancing age. This change occurred earlier in women. Our study supports that SRH and disability showed different aging patterns, with sex and age differences. From a public health perspective, SRH and disability indicators appeared not interchangeable as they uncovered complementary but different information on the needs of aging people.

Age and sex-specific disability-free life expectancy in urban and rural settings of Bangladesh

BACKGROUND

Disability-free life expectancy (DFLE) has been used to gain a better understanding of the population's quality of life.

OBJECTIVES

The authors aimed to estimate age and sex-specific disability-free life expectancy (DFLE) for urban and rural areas of Bangladesh, as well as to investigate the differences in DFLE between males and females of urban and rural areas.

METHODS

Data from the Bangladesh Sample Vital Statistics-2016 and the Bangladesh Household Income and Expenditure Survey (HIES)-2016 were used to calculate the disability-free life expectancy (DFLE) of urban and rural males and females in Bangladesh in 2016. The DFLE was calculated using the Sullivan method.

RESULTS

With only a few exceptions, rural areas have higher mortality and disability rates than urban areas. For both males and females, statistically significant differences in DFLE were reported between urban and rural areas between the ages of birth and 39 years. In comparison to rural males and females, urban males and females had a longer life expectancy (LE), a longer disability-free life expectancy, and a higher share of life without disability.

CONCLUSION

This study illuminates stark urban-rural disparities in LE and DFLE, especially among individuals aged < 1-39 years. Gender dynamics reveal longer life expectancy but shorter disability-free life expectancy for Bangladeshi women compared to men, emphasizing the need for targeted interventions to address these pronounced health inequalities.

The burden of diabetes and hypertension on healthy life expectancy in Bangladesh

Diabetes and hypertension are among the leading causes of death in Bangladesh. This study examined hypertension, diabetes, and either or both, free life expectancy, to measure the effect of the diseases on the overall health of individuals in Bangladesh with regional variations. We utilized data from Bangladesh Sample Vital Statistics 2018 for mortality and Bangladesh Demographic and Health Survey 2017-2018 for diabetes and hypertension. The Sullivan method was employed to estimate age-specific hypertension and diabetes-free life expectancy. Altogether, 10.3% of the people aged 18-19 years lived with either diabetes or hypertension. The hypertension-free life expectancy was 40.4 years, and the diabetes-free life expectancy was 53.2 years for those aged 15-19. Overall, individuals would expect to spend 38.7% of their lives with either of the diseases. Females suffered more from hypertension and males from diabetes. Still, females suffered more from the aggregate of both. Rural people had more diabetes and hypertension-free life expectancy than those of urban. Individuals of Mymensingh had the highest life expectancy free of both diseases compared to other divisions of Bangladesh. Diabetes and hypertension affect a considerable proportion of the life of the population in Bangladesh. Policy actions are needed to guide the prevention, diagnosis, and treatment of both diseases, specifically focusing on women and urban populations. Widespread health-enhancing actions need to be taken to diminish the effect of these two diseases in Bangladesh.

Trends in health expectancy at age 60 in Bangladesh from 1996 to 2016

BACKGROUND

Life expectancy (LE) is increasing all over the world, and relying on LE alone is no longer sufficient to identify whether a country is having a healthier population. Examining the increase in LE in relation to health - health expectancy estimation - is advised to ascertain the increase (or decrease) in LE without disability over time. This study examines the trends in health expectancy at age 60 in Bangladesh from 1996 to 2016.

METHODS

Mortality information from United Nations and World Health Organization and morbidity information from Bangladesh Bureau of Statistics were combined using the Sullivan method.

RESULTS

With an overall declining trend over the study period and a big drop in disability rates during 2012-2013, the disability rates were observed 1.6-1.7% in 2016. The declining trend in disability may have two-fold implications: (1) among the 98.3% older adults (≥60 years) with no severe/extreme disability, those were in jobs could have continued their work if there was no mandatory retirement at age 59, and (2) the 1.7% (translates into 0.2 million in 2020) older adults with severe/extreme disability require care assistance with their daily activities. The observed gain in disability-free life expectancy, the decrease in life expectancy with disability and its proportion allude to the compression of morbidity and healthier older adults over time.

CONCLUSION

In 2020, Bangladesh had 13.2 million (i.e., 8% of the total population) older adults, which is increasing day by day. The policy makers and government are suggested to prioritize the issues of older adults, particularly disability, care needs, retirement age, and health in the light of the current study's findings. Utilizing health expectancy research is suggested to understand the combined effect of disability and mortality for considering policy changes.

Modifications of Traditional Formulas to Estimate and Project Dependency Ratios and Their Implications in a Developing Country, Bangladesh

Traditional dependency ratios based on the United Nations’ old age definition (≥ 65 years) appear to be an inappropriate indicator for many developing countries, including Bangladesh. Bangladesh, with a retirement age of 59 in many sectors, defines old age as ≥ 60 years, whereas the United Nations documents 60–64 years as working age. This study offers two modifications to the traditional formulas of dependency ratios and compares the modified measures against the traditional measures from 1975 to 2100. Using data from the United Nations and the World Bank, (i) we moved the cut-off for ‘old age’ to 60 instead of 65 years, considering 15–59 years as ‘potentially working’, and (ii) we used the economically active population instead of the entire working-age population. Using our modified calculations, the growth rate of older adults (≥ 60 years) will be at its peak (4.6%) between 2020 and 2030 and continue to increase until 2085, though we will observe a negative population growth after 2055, and 2020–2040 appears to be the best time for reaping the highest demographic dividend. Compared to our modification, the traditional formula undercounted the older adults substantially, predicting a much lower demographic and financial burden. The modifications and associated estimates are important in advancing our understanding of dependency ratios in Bangladesh and have policy and practical implications in preventing the inaccurate representation of demographic and financial issues, and they are useful for planning for geriatric care, social safety nets, and healthy aging. The modified formulas may also be applicable in other countries which adopt ≥ 60 years as an old-age threshold.

Do the issues of religious minority and coastal climate crisis increase the burden of chronic illness in Bangladesh?

BACKGROUND

Chronic illness with disability and its out-of-pocket expenditure (OOPE) remains a big financial challenge in Bangladesh. The purpose of this study was to explore how religious minority problem and coastal climate crisis with other common risk factors determined chronic illness with a disability and its financial burden in Bangladesh. Existing policy responses, especially, social safety net programs and their governance were analyzed for suggesting better policy options that avoid distress financing.

METHODS

Binary logistic and multiple linear regression models were respectively used to identify the factors of disability, and high OOPE based on Bangladesh Household Income and Expenditure Survey 2016 data.

RESULTS

We found that disable people had relatively higher OOPE than their non-disabled counterparts and this OOPE further surges when the number of disabilities increases. In addition to the common factors, the novelty of our findings indicated that the religious minority problem as well as the coastal climate crisis have bearing on the disability burden in Bangladesh. The likelihood of having a chronic illness with a disability was 13.2% higher for the religious minorities compared to the majorities (Odds ratio (OR): 1.132, 95% confidence interval (CI): 1.033-1.241) and it was 21.6% higher for the people who lived in the exposed coast than those who lived in the non-exposed area (OR: 1.216, 95% CI: 1.107-1.335). With disabilities, people from the exposed coast incurred higher OOPE than those from the non-exposed areas. Although receiving assistance from social safety net programs (SSNPs) seemed to reduce their high OOPE and financial distress such as selling assets and being indebted, the distribution was not equitably and efficiently managed to confirm the process of inclusion leakage-free. On average, those who enrolled from the minority group and the exposed coast paid the relatively higher bribes.

CONCLUSIONS

To reduce burden, the government should strengthen and specify the existing SSNPs more for disable people, especially from the minority group and the exposed coast, and ensure the selection process more inclusive and leakage-free.

Women outweighed men at life expectancy in Bangladesh: does it mean a better quality of life?

Introduction

Men had a higher life expectancy than women until 2000 in Bangladesh. After 2000, statistics showed that women had a higher life expectancy than men. We aimed to address whether higher life expectancy is a gain or burden (Failures of Success) for older women.

Methods

We utilised data from Bangladesh Demographic and Health Survey-2011, Health and Morbidity Status Survey-2014, Population and Housing Census-2011, Household Income and Expenditure Survey-2010, and primary data. We calculated and estimated gender-specific different aspects of quality of life.

Findings

Findings showed that the mean age at marriage was 5.8 years lower for women, while life expectancy was three years higher than men; thus, women were expected to live for 8.8 years alone. Both disabilities and morbidities were higher among women than men; hence they had lower healthy life expectancy. About 53% of women could work daily activities while 8% higher for men. Only 2.4% of women earned while almost 58% for men. Depression and loneliness were also higher among women than men. The value of the active ageing index and quality of life were also lower for women than men.

Conclusion

This study overall found that there were the Failures of Success especially for older women in Bangladesh, as increasing life expectancies led them to extra years of chronic illness, economic insolvency, more anxiety and depression, and increasing misery. Therefore, sex and gender and their inherent differences should inform decision making to promote gender equity in health. The government and policymakers may intervene for quality of life, especially for women, through reducing gender stereotypes and increasing community engagement. Without considering the quality of life, healthy ageing cannot be ensured.

Are We Living Longer and Healthier?

Objective: To examine whether we live healthier as we live longer in Hong Kong, which has one of the highest life expectancies in the world. Methods: Sullivan's method was used to evaluate the chronic disease-free life expectancy (CDFLE), life expectancy in good self-perceived health (GPHLE), and impairment-free life expectancy (IFLE) among population aged 50 years and older in Hong Kong in 2007-2016. Results: In spite of the marked improvement in life expectancy in Hong Kong, the increase in GPHLE was much smaller, while CDFLE and IFLE even declined for both genders. The situation was more severe among older population. Discussion: People in Hong Kong live longer but with worsening health. The expansion of chronic diseases, self-perceived poor health, and impairments among older adults calls for more fiscal investments, government attention, and public health policies.

Disability-free life expectancy at old ages in Egypt

This study aimed to estimate among the older population in Egypt (aged 60 years and over): 1) disability prevalence rates, their levels of severity and the common types and 2) disability-free life expectancy (DFLE) by sex, age and disability type. Data were from the nationally representative 2016 Household Observatory Survey (HOS-2016), with 4658 persons aged 60+ constituting the study sample population. To identify individuals with disabilities, the HOS asked respondents a short set of questions on functional difficulties, as suggested by the United Nations Washington Group on Disability Statistics. The DFLE was estimated using the Sullivan method. Older (60+) women reported a higher prevalence of disability than older men. Women had longer DFLEs and longer disabled life expectancies (DLEs) than men but had lower proportions of DFLE to their total lifetime. The findings suggest that, at age 60, around 30% of life expectancy in Egypt can be expected to be with limitations in mobility and vision. Men, although they live for fewer years than women, can expect to have a greater proportion of their life expectancy free of disability. The findings of the study suggest that the contextual differences in how the process of ageing is experienced need to be considered by decision-makers when designing gender-responsive health policies.

Psychological distress and its association with socio-demographic factors in a rural district in Bangladesh: A cross-sectional study

Background

Psychological distress including depression and anxiety are among the most serious causes of morbidity and mortality in Bangladesh. There has been no study in the rural area to report the prevalence of and risk factors for psychological distress. The aim of this study was to estimate the prevalence of and risk factors for psychological distress in a rural district in Bangladesh.

Methods

A total of 2425 adults (1249 women) aged 18–90 years were selected from the Narail upazilla using multi-level cluster random sampling for a cross-sectional study. Psychological distress was assessed using the Kessler 10 items questionnaire. Participants’ socio-demographic status, life style factors and health conditions were also collected. Odds ratios and 95% confidence intervals for binary outcomes and mean changes for continuous outcomes of psychological distress score were computed. Logistic regression and generalized linear model techniques were used for analytical purpose.

Results

The overall prevalence of psychological distress was 52.5%. This proportion included 22.7% people rated as having mild psychological distress, 20.8% moderate and 9.0% severe. The prevalence of moderate (24.7% vs. 17.5%, p<0.001) and severe (16.2% vs. 2.5%, p<0.001) psychological distress was significantly higher in older adults of age 60–90 years than that in younger adults of age 18–59 years. The prevalence of severe psychological distress was higher in females than males and the difference increased with age (vs. (females vs males: 1.9% vs. 1.1% at age of <30 years, 12.2% vs. 10.1% at age between 60–69 years, and 45.5% vs. 25.4% at age of 80 years or older). After multivariate adjustment, compared to degree or equivalent level of education, no education (odds ratio (OR), 1.71, 95% confidence interval (CI), 1.03–2.82) was associated with higher prevalence of any psychological distress in the total sample. Compared to married, psychological distress among widowed older adults was almost five times higher prevalence (OR, 4.89, 95% CI, 2.51–9.55). Socio-economic status showed a U-shaped relationship with the prevalence of psychological distress; being very poor or wealthy was associated with higher prevalence of psychological distress compared to those of moderate socio-economic status. People living in pourashava (semi-urban areas) reported significantly higher prevalence of psychological distress compared to people living in typical rural unions.

Conclusions

In this rural Bangladeshi community, the prevalence of psychological distress was high, especially among older women. Factors including lower level of education, inability to work, and living in semi-urban areas were associated with higher prevalence of psychological distress. Public health programmes should target people in high risk groups to reduce their psychological distress in Bangladesh.

Perceptions of Successful Aging among Older Adults in Bangladesh: An Exploratory Study

To analyze older adults' definitions of successful aging in Bangladesh. The purposively selected study sample comprised twelve participants who were aged over 60. Interviews using in-depth semi-structured questionnaires were conducted based on participants' chosen mode, either face-to-face, or by phone. Findings of this study support that successful aging is multidimensional - that is - for Bangladeshis successful aging encompasses dimensions such as adaptation to an aging body, financial security, family and intergenerational care, and social participation. Older adults' emphases on all these dimensions were qualitatively different from those relevant in western societies. Bangladeshis see disease and disability as a normal part of aging and do not emphasize freedom from disease or longevity as much as North Americans and the US-focused successful aging discourses do. Family care is a key component of successful aging in Bangladesh. While in western models functional independence has been emphasized, for Bangladeshi older adults' adaptations to changing body, co-residing with children, being financially, physically, and emotionally dependent on family and receiving their care are viewed as normal and appropriate. Cross-cultural comparisons in this study suggest that what it means and entails to age well differ across cultures. This study highlights the need among health professionals to understand Bangladeshi culture, with its specific beliefs and values, as it relates to the views of aging well.

Variation in the Gender Gap in Inactive and Active Life Expectancy by the Definition of Inactivity Among Older Adults

OBJECTIVE

To assess variation in gender gap (female-male) in inactive life expectancy (IALE) and active life expectancy (ALE) by definition of inactivity.

METHOD

Inactivity, among older Singaporeans, was defined as follows: Scenario 1-health-related difficulty in activities of daily living (ADLs); Scenario 2-health-related difficulty in ADLs/instrumental ADLs (IADLs); Scenario 3-health-related difficulty in ADLs/IADLs or non-health-related non-performance of IADLs. Multistate life tables computed IALE and ALE at age 60, testing three hypotheses: In all scenarios, life expectancy, absolute and relative IALE, and absolute ALE are higher for females (Hypothesis 1 [H1]); gender gap in absolute and relative IALE expands, and in absolute ALE, it contracts in Scenario 2 versus 1 (Hypothesis 2 [H2]); gender gap in absolute and relative IALE decreases, and in absolute ALE, it increases in Scenario 3 versus 2 (Hypothesis 3 [H3]).

RESULTS

H1 was supported in Scenarios 1 and 3 but not Scenario 2. Both H2 and H3 were supported.

DISCUSSION

Definition of inactivity influences gender gap in IALE and ALE.

Disability Experience and Measurement

Top themes of international research on disability in the past three decades are discussed: disability dynamics, buffers and barriers for disability, disability trends, and disability among very old persons. Each theme is highlighted by research examples. Turning to measurement, I discuss traditional measures of disability, new longer and shorter ones, and composites like disability-free life expectancy, noting their merits. Contemporary models of disability are presented, ranging from visual images to formal theories. The article ends on how scientists can facilitate movement of disability science into health care practice and policy.

Gender differences in functional disability and self-care among seniors in Bangladesh

BACKGROUND

Disability among older adults is a public health concern. To date there are no in-depth and comprehensive analyses on older adults' disabilities in Bangladesh. This study investigated gender differences in the prevalence of disability and the socio-demographic factors associated with disability among older adults in Bangladesh.

METHODS

This research used a sample of 4176 elderly males and females aged 60 years and over from a nationally representative data set- Bangladesh's 2010 Household Income and Expenditure Survey. The study used both household level and individual level data and applied a wealth index, which was constructed based on household assets using principal component analysis. The Washington Group's short set of questions on disability were used to measure disability. Chi-square tests and ordinal logistic regression models were fit.

RESULTS

Forty-two percent of older had some form of functional disability, including 5% of elderly with severe/extreme functional disability. Seven percent of older adults had a self-care disability, including 3% of elderly with a severe/extreme form of self-care disability. Elderly females suffered from all the studied disabilities, including functional and self-care disabilities in higher percentages, and had higher odds ratios of having both functional disability and self-care disability compared to elderly males. The study also identified some significant factors affecting functional disability and self-care disability, namely age, having a chronic condition, wealth status and place of residence, including divisional differences.

CONCLUSIONS

Programs aimed at reducing functional disability among seniors, particularly elderly females, should be granted the highest priority in Bangladesh.

Urban-rural differences in disability-free life expectancy in Bangladesh using the 2010 HIES data

Background

Research on health expectancy has been carried out in Bangladesh but none of it has examined the differences in Disability-Free Life Expectancy (DFLE) between urban and rural setting in context of rapid urbanization of Bangladesh in past decades.

Objectives

The present study aims to estimate DFLE for people of all ages living in urban and rural areas in Bangladesh, and to examine the differences in DFLE between these two areas.

Methods

Data from the Sample Vital Registration System 2010 and the Bangladesh Household Income and Expenditure Survey (HIES) 2010 were used in this study. The Sullivan method was applied to estimate DFLE in Bangladesh.

Results

Higher rates of mortality and disability were observed in rural areas compared to urban areas with few exceptions. Statistically significant differences in DFLE were revealed from birth to age 15 years for both sexes between urban and rural areas. Urban males had a longer life expectancy (LE), longer DFLE and shorter LE with disability both in number and proportion when compared to rural males. Rural females at age 20+ years had a longer LE than urban females but urban females had a longer DFLE and a shorter LE with disability in both number and proportion at all ages than did rural females.

Conclusion

This study demonstrates that there were clear inequalities in LE, DFLE and LE with disability between rural and urban areas of Bangladesh along with age-specific differences as well. These findings may serve as useful and benchmark for intervention and policy implications for reducing the gap in health outcomes.

Burden of chronic illness and associated disabilities in Bangladesh: Evidence from the Household Income and Expenditure Survey

OBJECTIVE

The purpose of this study was to investigate the distribution of chronic illness and associated disability, out-of-pocket payment (OOPP), and other related factors using survey data from Bangladesh.

METHODS

This study analyzed Bangladesh Household Income and Expenditure Survey data that include socio-economic and demographic data, such as consumption, expenditures, and assets, along with information regarding chronic illness and disability. Multiple linear regression models were used to identify factors significantly associated with OOPP. Furthermore, a binary Logistic regression model was employed to assess the association of the explanatory variables with disability status.

RESULTS

A higher prevalence of chronic illness was found for those with chronic gastritis (18.70%), and 41.92% of the population had at least one side disability. The average OOPP healthcare expenditure for chronic illness was estimated to be US$7.59. Higher OOPP was found among the upper 2 wealth quintiles. Overall OOPP health expenditure was significantly higher among individuals with an associated disability (P < 0.001). The likelihood of having an associated disability was higher among those individuals with a lower education level (OR = 2.36, 95% CI: 1.95-4.06), those who not earning an income (OR = 2.85, 95% CI: 2.53-3.21), those who did not seek care (OR = 1.73, 95% CI: 1.57-1.90), those who sought care from a pharmacy (OR = 8.91, 95% CI: 7.38-10.74), and those in the lowest wealth quintile (OR = 7.21, 95% CI: 6.41-8.12).

CONCLUSIONS

The high OOPP illustrates the necessity of financial risk protection for the population at low socio-economic status. Therefore, we recommend that the government strengthen the healthcare system with appropriate support directed to the rural and elderly populations.

Factors Associated with Disability in Rural Bangladesh: Bangladesh Population-Based Diabetes and Eye Study (BPDES)

BACKGROUND

To assess factors associated with disability in a rural district of Bangladesh.

METHODS

Using a population-based systematic sampling technique, data were collected from 3104 adults aged ≥ 30 years from the Banshgram union of Narail district. Data collected included an interviewer administered questionnaire to report physical disabilities including impairment that prevents engagement with paid work, visual, hearing, and mobility as well as mental disabilities. Socio-demographic and anthropometric factors including educational attainment and body mass index, as well as clinical factors such as blood pressure, and fasting blood glucose were also collected. Binary and multinomial logistic regression techniques were used to explore the association of various socio-demographic and clinical factors with disability.

RESULTS

The mean (SD), minimum and maximum ages of the participants were 51 (12), 30 and 89 years. Of total participants, 65% were female. The prevalence of disability varied from 29.1% for visual impairment (highest) to 16.5% for hearing, 14.7% for movement difficulties and 1.6% (lowest) for any other disability that prevented engagement with paid work. Overall, the prevalence of a single disability was 28.6% and that of two or more disabilities was 14.7%. Older age, gender (female), lower socio-economic status (SES), and hypertension were associated with a higher prevalence of most of the disability components. The prevalence of hearing problems (24.5% vs. 13.3%, p<0.001) and movement difficulties (24.9% vs. 13.0%, p<0.001) was significantly higher among lower-income participants than their higher-income counterparts after controlling for age. Prevalence of visual impairment (54.6% vs. 9.2%, p<0.001), hearing (32.2% vs. 6.7%, p<0.001) and movement difficulties (29.2% vs. 5.5%, p<0.001) were significantly higher in people of aged 60 years or older than those aged 30-34 years. After multivariate adjustment, the prevalence of single disability (prevalence risk ratio [PRR] 1.25, 95% CI: 1.09-1.42, p<0.001), and multiple disabilities (PRR 1.41, 95% CI 1.14-1.73, p<0.001) was higher among females than males. The prevalence of single disability and multiple disabilities was respectively 21% (PRR 1.21, 95% CI: 1.02-1.42, p<0.001) and 88% (PRR 1.88, 95% CI: 1.38-2.54, p<0.001) higher among participants with low educational attainment (primary level or less) than those with at least a secondary level of education.

CONCLUSIONS

In rural Bangladesh, the prevalence of disability is high. Public health programs should target those of low SES, older age, and female participants and aim to provide necessary supports in order to bridge disability-related inequities.

Inequality in disability-free life expectancies among older men and women in six countries with developing economies

Background

It is unclear whether the increase in life expectancy (LE) globally is coupled with a postponement of morbidity and disability. Evidence on trends and determinants of disability-free life expectancies (DFLEs) are available in high-income countries but less in low and middle-income countries (LMICs). This study examines the levels of and inequalities in LE, disability and DFLE between men and women across different age groups aged 50 years and over in six countries with developing economies.

Methods

This study utilised the cross-sectional data (n=32 724) from the WHO Study on global AGEing and adult health (SAGE) in China, Ghana, India, Mexico, the Russian Federation and South Africa in 2007–2010. Disability was measured with the activity of daily living (ADL) instrument. The DFLE was estimated using the Sullivan method based on the standard period life table and ADL-disability proportions.

Results

The disability prevalence ranged from 13% in China to 54% in India. The prevalence of disability was highest and occurred at younger age in both sexes in India. Women were more disadvantaged with higher prevalence of disability across all age groups, and the situation was worst among older women in Mexico and the Russian Federation. Though women had higher LE, their proportion of remaining LE free from disability was lower than men.

Conclusions

There are inequalities in the levels of disability and DFLE among men and women in different age groups among people aged over 50 years in these six countries. Countermeasures to decrease intercountry and gender gaps in DFLE, including improvements in health promotion and healthcare distribution, with a gender equity focus, are needed.

A Systematic Literature Review of Studies Analyzing Inequalities in Health Expectancy among the Older Population

Aim

To collect, organize and appraise evidence of socioeconomic and demographic inequalities in health and mortality among the older population using a summary measure of population health: Health Expectancy.

Methods

A systematic literature review was conducted. Literature published in English before November 2014 was searched via two possible sources: three electronic databases (Web of Science, Medline and Embase), and references in selected articles. The search was developed combining terms referring to outcome, exposure and participants, consisting in health expectancy, socioeconomic and demographic groups, and older population, respectively.

Results

Of 256 references identified, 90 met the inclusion criteria. Six references were added after searching reference lists of included articles. Thirty-three studies were focused only on gender-based inequalities; the remaining sixty-three considered gender along with other exposures. Findings were organized according to two leading perspectives: the type of inequalities considered and the health indicators chosen to measure health expectancy. Evidence of gender-based differentials and a socioeconomic gradient were found in all studies. A remarkable heterogeneity in the choice of health indicators used to compute health expectancy emerged as well as a non-uniform way of defining same health conditions.

Conclusions

Health expectancy is a useful and convenient measure to monitor and assess the quality of ageing and compare different groups and populations. This review showed a general agreement of results obtained in different studies with regard to the existence of inequalities associated with several factors, such as gender, education, behaviors, and race. However, the lack of a standardized definition of health expectancy limits its comparability across studies. The need of conceiving health expectancy as a comparable and repeatable measure was highlighted as fundamental to make it an informative instrument for policy makers.

Healthy life expectancy and the correlates of self-rated health in Bangladesh in 1996 and 2002

Background

Life expectancy (LE) at birth has increased steadily in Bangladesh since its independence. When people live longer, quality of life becomes a central issue. This study examines whether healthy life expectancy (HLE) at ages 15, 25, 35, and 45 is keeping pace with LE at those ages between 1996 and 2002. It also seeks to investigate the correlates of self-rated health (SRH) in 1996 and 2002.

Methods

We used data from the World Values Survey conducted in 1996 and 2002 among individuals 15 years and older. The Sullivan method was used to compute HLE. Socio-demographic differences and their association with different states of health were examined by chi-square and Pearson’s correlation tests. Multiple linear regression models were fitted to examine the correlates of SRH.

Results

The results show that perceived health improved between 1996 and 2002. For males, statistically significant increases in the expected number of years lived in good SRH were found. Proportionally, in 2002, both males and females at ages 15, 25, 35 and 45 expected more life years in good health and fewer life years in fair and poor health than did their counterparts in 1996. Comparatively, males expected fewer life years spent in good health but a much larger proportion of expected life in good health than did females. Finally, in multivariate analyses, life satisfaction was the only factor found to be significantly and positively associated with SRH for males and females in both years, although in both years the association was much more pronounced for females than for males.

Conclusion

This study documented changes in HLE during 1996-2002. Women outlive men, but they have a lower quality of life and are more likely to live a greater part of their remaining life in poor SRH. Life satisfaction as well as other significant factors associated with SRH should be promoted, with special attention given to women, to improve healthy life expectancy and the quality of life of the Bangladeshi people.

Inequality in disability in Bangladesh

Objective

To investigate inequality in disability in Bangladesh.

Methods

The study used both household level and individual level data from a large nationally representative data set, Bangladesh’s Household Income and Expenditure Survey - 2010. Principal component analysis was used to construct a wealth index based on household assets from household level data. Then, using data from 49,809 individuals aged 5 years and over, chi-square tests and logistic regression were performed to test the association between wealth level and disability.

Findings

Women and older people are significantly more likely to report having disabilities than men and younger people. For middle and rich families, respectively, there is a 14 percent lower likelihood of reporting disabilities than for poor families. Changes in the probability of having disabilities are linear with increasing wealth. In addition, the study identifies some significant factors affecting disability, namely, age, sex, education, marital status, and place of residence including divisional differences.

Conclusion

In Bangladesh, worse health among the poor argues for policies prioritizing this group while at the same time giving special attention to women and the elderly.