Disability free Life Expectancy

Disability free Life Expectancy

Carol JaggerUniversity of Leicester

EHEMU Team

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


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? ‘


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


1995 1996 1997 1998 1999 2000 2001 2002 2003

55

60

65

70

75


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


• 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.



What about life expectancy and

disability free life expectancy at older

ages?


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


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



LE

DFLE


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




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




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


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


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’


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


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’


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)


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


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).


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


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

Disability free Life Expectancy

Documents