Trends of Healthy Life Expectancy of the Elderly in China in 1994–2015: Revisiting From the Perspective of Morbidity Transition

Research on healthy life expectancy (HLE) in China has been fueled by a spate of new data sources and studies, yet no consensus is reached on the pattern of HLE changes and the underlying mechanism. This study examined the change of HLE in China over 20 years with long term national data. Health status, measured by activities of daily living, is combined with mortality to calculate the disability-free life expectancy by the Sullivan method. The results show that the HLE rose slower than life expectancy (LE) in 1994–2004, indicating morbidity expansion. However, in 2010–2015, the proportion of HLE to LE increased, manifesting morbidity compression. A counterfactual analysis further shows that health improvement has been increasingly important in increasing HLE in 2010–2015, despite the dominance of mortality decline. The findings suggest that morbidity can transition between compression, expansion and dynamic equilibrium over a long period due to different combinations of mortality and health improvements. Given the limited data in this study, whether and how morbidity transitions unfold in the future remains open and requires further research.

Trends in Partial Disability-Free Life Expectancy between the Ages of 45 and 70 in Canada, 2000–2014

To better evaluate the benefits of a possible increase in the normal retirement age, this article proposes to examine recent trends in the health status of Canadians between 45 and 70 years of age. Using the Sullivan method, trends from 2000 to 2014 in partial disability-free life expectancy (PDFLE) between the ages of 45 and 70 years are computed. Disability is estimated using attributes of the Health Utility Index correlated with the capacity to work, and is looked at by level of severity. Data from the Canadian Community Health Survey were used to estimate the prevalence of disability. Results reveal a slight increase in partial life expectancy between the ages of 45 and 70, and a larger number of those years spent in poor health since the beginning of the 2000s. Hence, this study brings no evidence in support of the postponement of the normal retirement age if this policy were solely based on gains in life expectancy.

Increasing inequalities in disability-free life expectancy among older adults in Sweden 2002–2014

Background: In an aging society with increasing old age life expectancy, it has become increasingly important to monitor the health development in the population. This paper combines information on mortality and disability and explores educational inequalities in disability-free life expectancy in the aging population in Sweden, and to what extent these inequalities have increased or decreased over time. Methods: A random sample of the Swedish population aged 77 years and above ( n=2895) provided information about disability in the population in the years 2002, 2004, 2011 and 2014. The prevalence of disability was assessed by five items of personal activities of daily living and incorporated in period life tables for the corresponding years, using the Sullivan method. The analyses were stratified by sex and educational attainment. Estimates at ages 77 and 85 years are presented. Results: Disability-free life expectancy at age 77 years increased more than total life expectancy for all except men with lower education. Women with higher education had a 2.7-year increase and women with lower education a 1.6-year increase. The corresponding numbers for men were 2.0 and 0.8 years. The educational gap in disability-free life expectancy increased by 1.2 years at age 77 years for both men and women. Conclusions: While most of the increase in life expectancy was years free from disability, men with lower education had an increase of years with disability. The educational differences prevailed and increased over the period as the gains in disability-free life expectancy were smaller among those with lower education.

Transitions of disability, disability-free life expectancy and health insurance among adults aged 50 and older in Mexico: a multistate life table analysis

ObjectivesTo analyse the transitions of disability onset and recovery, estimate life expectancy (LE) with and without disability and explore the relation between insurance and disability patterns in the population aged 50+ in Mexico.DesignMultistate life table analysis of data from a longitudinal cohort survey.SettingData came from the Mexican Health and Aging Study, a longitudinal and representative survey of older adults in Mexico.Participants10 651 individuals aged 50+ interviewed in 2012 and 2015, including those who died between waves.Primary and secondary outcome measuresDisability is measured using the activities of daily living (ADL) scale. Transition rates between disability free, ADL disabled and death were employed to estimate total life expectancy (TLE) and disability-free life expectancy (DFLE).Results46% of the individuals who reported an ADL limitation in 2012 recover from disability by 2015. TLE at age 60 for people without ADL limitations is 30 years (95% CI 28.9 to 31), out of which 4.7 years (95% CI 4.1 to 5.4) are lived with ADL limitations, while TLE at age 60 in the initially disabled is 18.7 years (95% CI 17.3 to 20), with 9.4 years (95% CI 8.4 to 10.3) lived with disability. DFLE at age 60 in people with social security is 24.2 years (95% CI 23.3 to 25.2), in people with public insurance is 24.6 years (95% CI 23.7 to 25.4) and in uninsured people is 26.9 years (95% CI 25.9 to 27.9).ConclusionsIn Mexico, a substantial proportion of ADL disabled individuals recover from disability. Nevertheless, initially disabled individuals have a considerably lower DFLE regardless of age when compared with initially active individuals. There appeared to be no differences in terms of disability and LEs between the individuals with social security and public insurance.

Trends in health expectancies: a systematic review of international evidence

ObjectivesA clear understanding of whether increases in longevity are spent in good health is necessary to support ageing, health and care-related policy.DesignWe conducted a systematic review to update and summarise evidence on trends in health expectancies, in Organisation for Economic Co-operation and Development (OECD) high-income countries.Data sourcesFour electronic databases (MEDLINE, 1946–19 September 2019; Embase 1980–2019 week 38; Scopus 1966–22 September 2019, Health Management Information Consortium, 1979–September 2019), and the UK Office for National Statistics website (November 2019).Eligibility criteriaEnglish language studies published from 2016 that reported trends in healthy, active and/or disability-free life expectancy in an OECD high-income country.Data extraction and synthesisRecords were screened independently by two researchers. Study quality was assessed using published criteria designed to identify sources of bias in studies reporting trends, and evidence summarised by narrative synthesis.FindingsTwenty-eight publications from 11 countries were included, covering periods from 6 to 40 years, between 1970 and 2017. In most countries, gains in healthy and disability-free life expectancy do not match the growth in total life expectancy. Exceptions were demonstrated for women in Sweden, where there were greater gains in disability-free years than life expectancy. Gains in healthy and disability-free life expectancy were greater for men than women in most countries except the USA (age 85), Japan (birth), Korea (age 65) and Sweden (age 77).ConclusionAn expansion of disability in later life is evident in a number of high-income countries, with implications for the sustainability of health and care systems. The recent COVID-19 pandemic may also impact health expectancies in the longer term.

Trends in disability-free life expectancy at age 50 years in Australia between 2001 and 2011 by social disadvantage

BackgroundThe aims of this study were (1) to estimate 10-year trends in disability-free life expectancy (DFLE) by area-level social disadvantage and (2) to examine how incidence, recovery and mortality transitions contributed to these trends.MethodsData were drawn from the nationally representative Household Income and Labour Dynamics in Australia survey. Two cohorts (baseline age 50+ years) were followed up for 7 years, from 2001 to 2007 and from 2011 to 2017, respectively. Social disadvantage was indicated by the Socio-Economic Indexes for Areas (SEIFA). Two DFLEs based on a Global Activity Limitation Indicator (GALI) and difficulties with activities of daily living (ADLs) measured by the 36-Item Short Form Survey physical function subscale were estimated by cohort, sex and SEIFA tertile using multistate models.ResultsPersons residing in the low-advantage tertile had more years lived with GALI and ADL disability than those in high-advantage tertiles. Across the two cohorts, dynamic equilibrium for GALI disability was observed among men in mid-advantage and high-advantage tertiles, but expansion of GALI disability occurred in the low-advantage tertile. There was expansion of GALI disability for all women irrespective of their SEIFA tertile. Compression of ADL disability was observed for all men and for women in the high-advantage tertile. Compared to the 2001 cohort, disability incidence was lower for the 2011 cohort of men within mid-advantage and high-advantage tertiles, whereas recovery and disability-related mortality were lower for the 2011 cohort of women within the mid-advantage tertile.ConclusionOverall, compression of morbidity was more common in high-advantage areas, whereas expansion of morbidity was characteristic of low-advantage areas. Trends also varied by sex and disability severity.