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.

Direct Healthy Life Expectancy Estimates from Life Tables with a Sullivan Extension: The case of Brazil 2003

The Healthy Life Expectancy (HLE) in Brazil 2003 was estimated by Romero et al (2005) by using the Sullivan method and data from the World Health Survey carried out in Brazil in 2003. Here we use a Direct method to estimate the Healthy Life Years Lost (HLYL) and then the HLE. This is done after the analytic derivation of a more general model of survival-mortality and the estimation of a parameter bx related to the HLYL is followed by the formulation of a computer program providing results similar to those of the World Health Organization for the Healthy Life Expectancy (HALE) and the corresponding HLYL estimates. This program is an extension of classical life table including more columns to estimate the cumulative mortality, the average mortality, the person life years lost, and finally the HLYL parameter bx. Even more, a further extension of the Excel program based on the Sullivan method provides estimates of the Healthy Life Expectancy at every year of the lifespan.

Healthy life expectancy by frailty state in Europe from 2004 to 2015: findings from SHARE

Background As populations age, the possible consequences of increased frailty are a major concern for the health sector. Here, we investigate how life expectancy with and without frailty has changed during a 10–11-year-period across Europe. Methods The Sullivan method was used to investigate changes in life expectancy with and without frailty in 10 European countries. Frailty status (non-frail, pre-frail and frail) was determined by use of the Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI). Data on frailty prevalence was obtained from 21 698 individuals in wave 1 (2004–05) and 38 859 individuals in wave 6 (2015) of the SHARE. Information on mortality was obtained from the Eurostat Database. Results In 2015, women aged 70 spent 25.0% (95% CI: 24.0–26.1) of their remaining life expectancy in a frail state, and the number for men was 11.5% (95% CI: 10.7–12.3). Southern Europeans spent 24.2% (95% CI: 22.9–25.4) of their remaining life expectancy in a frail state and the numbers for Central Europeans and Northern Europeans were 17.0% (95% CI: 16.0–17.9) and 12.2% (95% CI: 10.9–13.5), respectively. From 2004–05 to 2015, life expectancy increased by 1.1 years (from 15.3 to 16.4 years) for 70-year-old Europeans. Similarly, non-frail life expectancy increased by 1.1 years (95% CI: 0.8–1.4), whereas no significant changes in life expectancy in frail states were observed. Conclusions This study suggests that Europeans today spend more years in a non-frail state than Europeans did 10–11 years ago. Our findings reflect a considerable inequality by gender and region.

Altersrente: Innovative Kennzahlen zur Beschreibung von Beginn und Dauer von Rente 2012–2018

Zusammenfassung Die Rentenpolitik in Deutschland hebt das gesetzliche Rentenalter an und beschränkt gleichzeitig Optionen, die Altersrente vorzuziehen. Die Berichterstattung über die „rentenaufschiebende“ Wirkung dieser Regeln verwendet jedoch ungeeignete Kennzahlen. Um den Mangel zu beheben nutzt der Artikel die Sullivan-Methode, die die Lebenserwartung im Alter 60 aufteilt in Jahre innerhalb bzw. außerhalb von Altersrente. Diese Kennzahlen zeigen, dass der durchschnittliche Rentenaufschub zwischen 2012 und 2018 stark war (9 Monate bei Männern, 6 Monate bei Frauen) und sogar den Gewinn an Lebenserwartung (5 Monate bei Männern, 4 Monate bei Frauen) überstieg. Schlussfolgerung: Der Umbau des Rentenzugangs zeigt messbare, rasche Folgen für die Bevölkerung, und die Öffentlichkeit und Politik sollten dies zur Kenntnis nehmen. Die Sullivan-Methode wird zur Fortschreibung empfohlen. Abstract: Old Age Pension: Innovative Figures to Describe the Start and Duration of Pensions 2012–2018 Germany’s pensions policy has increased the statutory retirement age and discouraged early pensions. However, the monitoring of the respective postponing effect is weakened by inappropriate indicators. To remedy this, the paper uses the Sullivan method to divide life expectancy at age 60 into years with and years without old age pension. The results show that the average from 2012 to 2018 was large (9 months in men, 6 months in women) and even exceeded life expectancy gains (5 months in men, 4 months in women). In conclusion, the pension reform has a measurable and rapid impact on the population, and the public and politicians need to be aware of this. The Sullivan method is recommended for regular updates.

Evidencing the gap between health expectancy and life expectancy for ethnic groups in Scotland.

Background Recent evidence has shown that ethnic minorities live longer than the majority population in Scotland. This mortality advantage in ethnic minorities is not unique to Scotland. However, whether morbidity patterns by ethnicity align with mortality patterns by ethnicity is unknown. Thus, this study explores ethnic differences in health expectancies (HE) in Scotland and contrasts HE with life expectancy (LE) findings. Methods The Scottish Health and Ethnicity Linkage study anonymously links the Scottish Census 2001 for 4.6 million people to mortality records. The Scottish Census 2001 collected two measures of self-assessed health, self-declared ethnicity, age, and sex. Utilising the life tables used to calculate life expectancy by ethnicity and sex in Scotland, the Sullivan method was employed to calculate two measures of health expectancy (healthy life expectancy and disability-free life expectancy) by ethnicity and sex. 95% confidence intervals were calculated to detect significant differences compared to the majority White Scottish population, taken as reference. Results Longer health expectancies were found in males and females of Other White British, Other White, and Chinese origins as well as in Indian males compared to White Scottish populations. Any Mixed Background and Pakistani populations had the shortest healthy life expectancies. Patterns of health expectancy by ethnicity mostly aligned with patterns of life expectancy by ethnicity with the clear exception of the Pakistani population who showed among the longest life expectancies with the shortest health expectancies. Contrasting HE with LE findings, the number of years in an unhealthy state was greater in females than in males for each ethnic group. In relation to ethnicity, Pakistani and Indian populations had the highest number of years in an unhealthy state in Scotland. Pakistani females showed the strong-est disadvantage in this respect. Conclusion Pakistani populations had the shortest health expectancies contrasting with the longest life expectancies in Scotland. Future research should aim to understand why such a discrepancy occurs while policy makers ensure that fair and adapt-ed care is provided to offer better quality of life for the most vulnerable.

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.

Survival and Years of Good Life in Finland in the very long run

In this paper we apply the recently developed wellbeing indicator ‘Years of Good Life’ (YoGL) to Finland, which has the world’s longest annual demographic time series starting in 1722. We combine this with scenarios up to 2100 as developed under the SSP (Shared Socioeconomic Pathways) framework. YoGL is based primarily on the trend in life expectancy but it also considers age-specific proportions of persons above critical levels of quality of life indicators (using the Sullivan method). Since estimating these indicators for historical populations is a major challenge, the paper uses a wide array of sources to come up with a first crude estimation of how quality of life has changed in Finland over the centuries.

Life expectancy with and without cognitive impairment among Chilean older adults: results of the National Survey of Health (2003, 2009 and 2016)

Background Chile has one of the highest life expectancies within Latin American. This is the first study to determine health expectancies in older populations in Chile, considering cognitive status as a health indicator. Methods We estimated prevalence of cognitive decline among people aged 60 years and over based on the Mini-mental State Examination and the Pfeffer Functional Activities Questionnaire, with data from the National Survey of Health (2003, 2009, 2016). Life expectancy free of cognitive impairment was calculated using the Sullivan method. Results At age 60, life expectancy free of cognitive impairment was more than 3 years longer for women, compared to men of the same age. Life expectancy free from cognitive impairment was higher for both men and women aged 60 in 2016 when compared to 2003 (2.1 and 2 years higher, respectively). Conclusions Longer life expectancy in women was accompanied by more years free of cognitive impairment. Men expected to live a similar proportion of years free of cognitive impairment, compared to women. Common and standardised assessments of health status of older people should be adopted in Latin American studies, to allow for time-trend analyses and international comparisons.