Life expectancy and healthy life expectancy in Scotland

Life expectancy and healthy life expectancy in Scotland

Alison Burlison, ISD ScotPHO team

Life expectancy (LE) and Healthy life expectancy (HLE)

• Definitions • Scotland data and changes over time• Methodology and pitfalls• Variations within Scotland• Scotland compared to other countries

Life expectancy (LE) at birth, for a given time period

• Is an estimate of the number of years a newborn baby would survive if they experienced the area’s age-specific mortality rates for that time period throughout their life.

• But the baby’s actual LE will vary - with future changes in death rates during their life - if they move to a different area.

Adding the ‘H’…

Healthy life expectancy (HLE) at birth• Is an estimate of the average number of years a newborn

baby would survive in a ‘healthy’ state if they experienced the particular area’s age-specific mortality rates and self-assessed health (SAH) for that time period throughout their life.

LE – HLE = Number of years in ‘not healthy’ health.

Can’t assume these are all at the end of life.

}‘Not

healthy’

health

Scotland MALES: LE and HLE at birth, 1980-2008

58

60

62

64

66

68

70

72

74

76

78

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

Year

LE

or

HL

E (

ye

ars

)

LEHLE (household survey SAH)95% CL

68.1

75.3

}

Scotland MALES: LE and HLE at birth, 1980-2008

58

60

62

64

66

68

70

72

74

76

78

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

Year

LE

or

HL

E (

ye

ars

)

LE

HLE (household survey SAH)

95% CL

Linear (HLE (householdsurvey SAH))Linear (LE)

68.1

75.3

~9% of life in ‘not healthy’

health

‘Not

healthy’

health

}‘Not

healthy’

health

Scotland FEMALES: LE and HLE at birth, 1980-2008

60

62

64

66

68

70

72

74

76

78

80

82

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

Year

LE

or

HL

E (y

ears

)

LE

HLE (household survey SAH)

95% CL

Linear (LE)

Linear (HLE (household surveySAH))

80.0

70.8

~12% of life in ‘not healthy’

health

HLE in Scotland

With time

LE HLE years in ‘not healthy’ health

(% life in ‘not healthy’ health unchanged)

Methodology

…and pitfalls

Deaths registrations

(GROS)

Population mid-year estimates(GROS)

Self-assessed health‘healthy’ versus ‘not healthy’

(surveys or Census)

Life tables for calculating period

LE and HLE

HLE calculations for Scotland

Self-assessed health (SAH)2011 Census and Scottish Household Survey from 2009 (EU definition):

‘How is your health in general? Would you say it was.....- very good- good

- fair- bad - very bad?’

2001 Censusand Scottish Household Survey until 2008:

‘Over the last 12 months would you say your health has on the whole been - good - fairly good

- not good?’

‘healthy’

‘not healthy’

Life table, with LE calculations based on Chiang (II) and HLE based on Sullivan method: Scotland, males, 2006

ISD/ONS

Age group x n a x pop deaths

M x

Age-specific

death rate

q x

Probability that individual entering age interval will

die in it

p x

Probability that individual entering age interval will survive it I X d x L x T x LE x

PX

Proportion with 'not healthy' health (1-P x )*L x TH x HLE x

<1 0 1 0.1 28,218 145 0.0051 0.0051 0.9949 1.0000 0.005 1.00 74.9 74.9 0.02 0.98 67.7 67.7

1-4 1 4 0.5 109,171 21 0.0002 0.0008 0.9992 0.9949 0.001 3.98 73.9 74.3 0.02 3.91 66.7 67.15-9 5 5 0.5 143,221 18 0.0001 0.0006 0.9994 0.9941 0.001 4.97 69.9 70.3 0.01 4.91 62.8 63.2

10-14 10 5 0.5 157,404 21 0.0001 0.0007 0.9993 0.9935 0.001 4.97 65.0 65.4 0.01 4.91 57.9 58.315-19 15 5 0.5 168,880 112 0.0007 0.0033 0.9967 0.9928 0.003 4.96 60.0 60.4 0.01 4.91 53.0 53.420-24 20 5 0.5 171,019 206 0.0012 0.0060 0.9940 0.9895 0.006 4.93 55.0 55.6 0.03 4.80 48.1 48.625-29 25 5 0.5 156,422 189 0.0012 0.0060 0.9940 0.9836 0.006 4.90 50.1 50.9 0.06 4.59 43.3 44.030-34 30 5 0.5 153,686 272 0.0018 0.0088 0.9912 0.9777 0.009 4.87 45.2 46.2 0.07 4.53 38.7 39.635-39 35 5 0.5 185,147 398 0.0021 0.0107 0.9893 0.9691 0.010 4.82 40.3 41.6 0.08 4.42 34.2 35.340-44 40 5 0.5 194,867 540 0.0028 0.0138 0.9862 0.9587 0.013 4.76 35.5 37.0 0.09 4.35 29.7 31.045-49 45 5 0.5 183,306 710 0.0039 0.0192 0.9808 0.9455 0.018 4.68 30.8 32.5 0.11 4.16 25.4 26.950-54 50 5 0.5 164,736 987 0.0060 0.0295 0.9705 0.9274 0.027 4.57 26.1 28.1 0.13 3.95 21.2 22.955-59 55 5 0.5 169,377 1,506 0.0089 0.0435 0.9565 0.9000 0.039 4.40 21.5 23.9 0.17 3.64 17.3 19.260-64 60 5 0.5 135,028 2,061 0.0153 0.0735 0.9265 0.8609 0.063 4.15 17.1 19.9 0.20 3.31 13.6 15.865-69 65 5 0.5 113,650 2,615 0.0230 0.1088 0.8912 0.7976 0.087 3.77 13.0 16.2 0.16 3.18 10.3 12.9

70-74 70 5 0.5 94,702 3,351 0.0354 0.1625 0.8375 0.7108 0.116 3.27 9.2 12.9 0.16 2.73 7.2 10.175-79 75 5 0.5 69,739 4,100 0.0588 0.2563 0.7437 0.5953 0.153 2.59 5.9 9.9 0.22 2.04 4.4 7.4

80-85 80 5 0.5 43,643 4,253 0.0974 0.3918 0.6082 0.4427 0.173 1.78 3.3 7.5 0.25 1.33 2.4 5.485+ 85 5 0.5 27,191 4,746 0.1745 1.0000 0.0000 0.2693 0.269 1.54 1.5 5.7 0.32 1.05 1.1 3.9

2,469,407 26,251

Pitfalls in HLE calculations (1)

Death registrations residents of Scotland who die in Scotland non-residents who die in Scotland residents of Scotland who die outwith Scotland.

For sub-Scotland analyses, we impute area of residence for non-residents dying here, to compensate for the loss of residents dying outwith Scotland.

Pitfalls (2)Robustness and availability of SAH data

Census The most robust available estimates of SAH and HLE in 2001 No comparable time trends HLE calculations for geographies down to NHS boards and CHPs

Scottish Household Survey HLE trends for Scotland NOT robust for HLE for NHS boards and CHPs Only for ages 16+, so need to “patch” it For females - slightly worse SAH and lower HLE than Census Disruption in time trends due to question change.

Scotland MALES: LE and HLE at birth, 1980-2009

58

60

62

64

66

68

70

72

74

76

78

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

Year

LE

or

HL

E (

ye

ars

)

LEHLE (household survey SAH)95% CL

68.1

60.0

76.0

Scotland FEMALES: LE and HLE at birth, 1980-2009

60

62

64

66

68

70

72

74

76

78

80

82

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

Year

LE

or

HL

E (

ye

ars

)

LE

HLE (household survey SAH)

95% CL

80.6

62.2

70.8

Pitfalls (3)

Perils of small areas and populations

* Smallest geography where we have calculated HLE = Orkney CHP/NHS board (5-year male pop ~48,000).

* For smaller areas – HLE not calculated. – LE only presented for:

5-year populations 5,000 5-year deaths 40.

* Smaller population wider CI for LE at birth.

>75,000: <2 year 95% CI 30,000: ~ 3 year 95% CI 5,000: ~ 7.5 year 95% CI

Variations within Scotland

• NHS boards

• Intermediate zones

• Deprivation deciles

• Urban rural classification

LE and HLE at birth, by NHS board area in Scotland, MALES, 5-year period 1999-2003

75.7

70.8

70.4

62.260

62

64

66

68

70

72

74

76

78

80

Bo

rde

rs

Ork

ne

y

Du

mfr

ies

&G

allo

wa

y

Gra

mp

ian

Sh

etl

an

d

Fif

e

Lo

thia

n

Hig

hla

nd

Ta

ys

ide

Fo

rth

Va

lley

SC

OT

LA

ND

Ay

rsh

ire

& A

rra

n

La

na

rks

hir

e

We

ste

rn Is

les

Gre

ate

r G

las

go

w&

Cly

de

NHS board

LE

or

HL

E (

ye

ars

)

LE

HLE (2001 Census SAH)

Intermediate zones in Scotland

(average M+F population ~4,000)

HLE not calculated

LE only presented for M or F where: 5-year populations 5,000

5-year deaths 40.

Scotland male LE at birth, by intermediate zone, 2003-07

Barnton/Cammo area

Males 85.5 years (82.4-88.5)

Females 90.4 years (88.6-92.2)

Edinburgh: LE at birth, 2003-2007

Greendykes/Niddrie Mains area

Males 61.1 years (57.3-65.0)

Females 73.7 years (69.5-78.0)

Scottish Government

• High-level target to increase HLE in Scotland 2007-2017

National indicator to increase HLE at birth in the most deprived

areas

• Long-term Monitoring of Health Inequalities HLE a key indicator

Deprivation and healthy life expectancy in Scotland: males, 2005-2006

81

68

77

57

50

55

60

65

70

75

80

85

10 (leastdeprived)

9 8 7 6 5 4 3 2 1 (mostdeprived)

Deprivation decile (income-employment index)

Yea

rs

Life expectancy at birth

Healthy life expectancy at birth

LE and HLE at birth, by 2001 urban rural classification,Scotland: MALES, 1999-2003

69.9 69.6 68.2 67.7 66.1 64.0

5.4 5.7 5.9 6.5 7.1 7.9

0

10

20

30

40

50

60

70

80

90

6 Remoterural

5 Accessiblerural

4 Remotesmall towns

3 Accessiblesmall towns

2 Otherurban areas

1 Largeurban areas

Ye

ars

Expected period in'not healthy' health(LE - HLE)

HLE (2001 CensusSAH)

7 % of life in 'not healthy' health 8 %

8 % 9 % 10 % 11 %

HLE in Scotland

With increasing deprivation (and urbanisation)

LE HLE years or % life in ‘not healthy’ health

65

70

75

80

85

1970 1980 1990 2000 2010

United KingdomEU

Life expectancy at birth, in years, female

GUESS!• Scotland• Denmark• France• Germany• Ireland (Eire)• Portugal

65

70

75

80

85

1970 1980 1990 2000 2010

United KingdomEU Scotland

Life expectancy at birth, in years, female

65

70

75

80

85

1970 1980 1990 2000 2010

DenmarkFranceGermanyIrelandPortugalUnited KingdomEU Scotland

Life expectancy at birth, in years, female

65

70

75

80

85

1970 1980 1990 2000 2010

United KingdomEU

Life expectancy at birth, in years, male

GUESS!• Scotland• Denmark• France• Germany• Ireland (Eire)• Portugal

65

70

75

80

85

1970 1980 1990 2000 2010

United KingdomEU Scotland

Life expectancy at birth, in years, male

65

70

75

80

85

1970 1980 1990 2000 2010

DenmarkFranceGermanyIrelandPortugalUnited KingdomEU Scotland

Life expectancy at birth, in years, male

55

60

65

70

75

80

1970 1980 1990 2000 2010

RomaniaRussian FederationUkraineUnited KingdomScotland

Life expectancy at birth, in years, male

HLE in Scotland

Internationally

Scotland lower LE than most Western European

countries, and apparently lower disability-freelife expectancy (DFLE) at birth than many.

Comparable health data required.

HLE in Scotland

1. With time…LE HLE years in ‘not healthy’ health (% life in ‘not healthy’ health unchanged)

2. With increasing deprivation (and urbanisation)…LE HLE years or % of life in ‘not healthy’ health

3. Internationally…Scot lower LE than most W European countries (and apparently lower DFLE at birth than many).

www.scotpho.org.uk

Healthy life expectancy

Health for All