Disability free Life Expectancy
description
Transcript of Disability free Life Expectancy
Disability free Life Expectancy
Carol JaggerUniversity of Leicester
EHEMU Team
European Population Day: Ageing IUSSP Tours 2005
European Population Day: Ageing IUSSP Tours 2005
Purpose
• To explore compression or expansion of disability and gender differences through cross-national comparisons of disability-free life expectancy (DFLE) at birth and age 65 among 14 EU countries between 1995 and 2003
• In preparation for new EU structural indicator Healthy Life Years
European Population Day: Ageing IUSSP Tours 2005
Data and methods
Estimation of DFLE and 95% CI, using Sullivan method
• age specific probability of death: Eurostat life tables
• age specific disability prevalence: European Community Household Panel 1995-2001 question ‘Are you hampered in your daily activities by any physical or mental health problem, illness or disability? ‘
European Population Day: Ageing IUSSP Tours 2005
1995 1996 1997 1998 1999 2000 2001 2002 2003
70
75
80
85
1995 1996 1997 1998 1999 2000 2001 2002 2003
70
75
80
85
LE
Men Women
Distribution of LE and DFLE at birth EU(14), 1995-2003
European Population Day: Ageing IUSSP Tours 2005
1995 1996 1997 1998 1999 2000 2001 2002 2003
55
60
65
70
75
Distribution of LE and DFLE at birth EU(14), 1995-2003
1995 1996 1997 1998 1999 2000 2001 2002 2003
70
75
80
85
1995 1996 1997 1998 1999 2000 2001 2002 2003
70
75
80
85
LE
Men Women
DFLE
1995 1996 1997 1998 1999 2000 2001 2002 2003
55
60
65
70
75
European Population Day: Ageing IUSSP Tours 2005
• By 2003 LE at birth in the EU14 ranged from 74.2 (Portugal) to 78 (Sweden) years for men and 80.1 (Denmark) to 83.2 years (France) for women, following a steady increase from 1995.
• Compared to LE, trends in DFLE were more variable although gender differences were smaller
• Between 1995-2003 the gain in total years for men exceeded the gain in years free of disability
• In women there was only a slight improvement, on average, in life expectancy with a similar gain in disability-free life years.
Distribution of LE and DFLE at birth EU(14), 1995-2003
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What about life expectancy and
disability free life expectancy at older
ages?
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Trends in LE and DFLE at age 65 in EU (14), 1995-2003
Men
4
6
8
10
12
14
16
18
20
22
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Exp
ecte
d y
ears
of
life
Austria Belgium Denmark Finland France Germany Greece
Ireland Italy Netherland Portugal Spain Sweden United Kingdom
LE
DFLE
European Population Day: Ageing IUSSP Tours 2005
Trends in LE and DFLE at age 65 in EU (14), 1995-2003
Women
4
6
8
10
12
14
16
18
20
22
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Ex
pe
cte
d y
ea
rs o
f lif
e
Austria Belgium Denmark Finland France Germany Greece
Ireland Italy Netherland Portugal Spain Sweden United Kingdom
LE
DFLE
European Population Day: Ageing IUSSP Tours 2005
Trends in proportion of life spent disability-free at age 65
= gain of 5% +
= loss of 5% +
= gain or loss of less than 5%
Men
30
35
40
45
50
55
60
65
70
75
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Year
Pro
po
rtio
n o
f L
E s
pen
t d
isab
ility
-fre
e at
ag
e 65
Austria Belgium Denmark Finland France Germany Greece
Ireland Italy Netherland Portugal Spain Sweden United Kingdom
European Population Day: Ageing IUSSP Tours 2005
Trends in proportion of life spent disability-free at age 65
= gain of 5% +
= loss of 5% += gain or loss of less than 5%
Women
30
35
40
45
50
55
60
65
70
75
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Year
Pro
po
rtio
n o
f L
E s
pen
t d
isab
ility
-fre
e at
ag
e 65
Austria Belgium Denmark Finland France Germany Greece
Ireland Italy Netherland Portugal Spain Sweden United Kingdom
European Population Day: Ageing IUSSP Tours 2005
Trends in the proportion of life spent disability-free at age 65
Men Austria, Belgium,
Finland, Germany Italy, Spain
- France, Greece, Ireland, Netherlands, Portugal
Denmark, Sweden, UK
Women Italy,Sweden
- Austria, Belgium, Denmark, Finland, France, Spain, UK
Germany, Greece, Ireland, Netherlands, Portugal
European Population Day: Ageing IUSSP Tours 2005
Trends in LE and DFLE using the ECHP
1) Life expectancy:• Small variation in LE between these 14 MS• Increase between 1995-2003
2) Disability Free Life Expectancy and %DFLE/LE• Large variation in DFLE between these 14 MS• Diverging trends over 1995-2003: reduction /
stagnation / increase in the proportion of life with reported disability at age 65 while LE increases
• Gender differences in trends
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Real or artefact?May be artefact due to• Data problems• Sampling• Omission of institutionalised population• Not harmonised disability question• Cultural differences in reporting of disability• Confounding factors – socio-economic
But trends less sensitive to these
If real what is ‘cause’
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Data and Methods
Problems in both mortality and ECHP data
1) Data base• Probable data errors• Replacement with other sources• Missing
2) Interruption of data collection• No data for 2002 and 2003
Solutions
1) Data base• Linear imputation of age specific
probabilities (death and disability)
• Shift of the prevalence trend to the ECHP level
• Imputation of data according to observed trends
2) Interruption of data collection • Linear extrapolation of the
disability prevalence
European Population Day: Ageing IUSSP Tours 2005
Real or artefact?May be artefact due to• Data problems• Sampling• Omission of institutionalised population• Not harmonised disability question• Cultural differences in reporting of disability• Confounding factors – socio-economic
But trends less sensitive to these
If real what is ‘cause’
European Population Day: Ageing IUSSP Tours 2005
Disease>Impairment>Functional limitation>Disability
(Nagi, 1965,1976, 1991)
Models of the disablement process
Disease>Impairment>Functional limitation>Activity Restriction>Handicap
(Wood, 1975)
Disease>Impairment>Disability>Handicap
(ICIDH, 1980)
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Gain in TLE and DFLE without prevalent disease (MRC CFAS) MEN age 65
-2.0 0.0 2.0 4.0 6.0 8.0
coronary heart disease
stroke
cognitive impairment
diabetes
peripheral vascular disease
chronic obstructive airways
arthritis
vision
hearing
Years gained without disease
tle dfle
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Prevalence of all dementias by studySource: Lobo et al. (2000)
= Finland; = Sweden; = Denmark; = Rotterdam; –= UK (MRC-ALPHA); = UK (Melton Mowbray); = France; + = Italy; = Spain (Zaragoza Study); � = Spain (Pamplona Study); x = Spain (ZARADEMP).
European Population Day: Ageing IUSSP Tours 2005
Age-specific incidence of first stroke per 100000 men*
115
120
125
130
135
140
145
150
155
160
Germany France UK
*standardised to European population
European Population Day: Ageing IUSSP Tours 2005
Conclusions
Population aging has a different impact in the 14 Member States in Europe:
– different levels of reported disability (larger dispersion than LE)
– variation in the magnitude of the gender difference– different trends over time
Need to further document cross-national differences in self-reported disability with regard to:
– improved harmonisation of the instruments– using different levels of severity – documenting differences in reporting– documenting differences in selection in the panel
Disability free Life Expectancy
Carol JaggerUniversity of Leicester
EHEMU Team
France-Europe Day IUSSP Tours 2005