The cross-sectional average length of healthy life (HCAL): a measure that summarizes the history of cohort health and mortality

Markus Sauerberg,Michel Guillot,Marc Luy

doi:10.1186/s12963-020-00220-5

Abstract

BackgroundHealthy life years have superseded life expectancy (LE) as the most important indicator for population health. The most common approach to separate the total number of life years into those spent in good and poor health is the Sullivan method which incorporates the health dimension to the classic period life table, thus transforming the LE indicator into the health expectancy (HE) indicator. However, life years derived from a period life table and health prevalence derived from survey data are based on different conceptual frameworks.MethodWe modify the Sullivan method by combining the health prevalence data with the conceptually better fitting cross-sectional average length of life (CAL). We refer to this alternative HE indicator as the “cross-sectional average length of healthy life” (HCAL). We compare results from this alternative indicator with the conventional Sullivan approach for nine European countries. The analyses are based on EU-SILC data in three empirical applications, including the absolute and relative level of healthy life years, changes between 2008 and 2014, and the extent of the gender gap.ResultsHCAL and conventional HE differ in each of these empirical applications. In general, HCAL provides larger gains in healthy life years in recent years, but at the same time greater declines in the proportion of healthy life years. Regarding the gender gap, HCAL provides a more favourable picture for women compared to conventional HE. Nonetheless, the extent of these differences between the indicators is only of minor extent.ConclusionsAlbeit the differences between HE and HCAL are small, we found some empirical examples in which the two indicators led to different conclusions. It is important to note, however, that the measurement of health and the data quality are much more important for the healthy life years indicator than the choice of the variant of the Sullivan method. Nonetheless, we suggest to use HCAL in addition to HE whenever possible because it widens the spectrum of empirical analyses and serves for verification of results based on the highly sensitive HE indicator.

Highlights

Healthy life years have superseded life expectancy (LE) as the most important indicator for population health
Cross-sectional average length of healthy life (HCAL) provides a more favourable picture for women compared to conventional health expectancy (HE)
Albeit the differences between HE and HCAL are small, we found some empirical examples in which the two indicators led to different conclusions

Summary

Introduction

Healthy life years have superseded life expectancy (LE) as the most important indicator for population health. In the application of the Sullivan method, it is frequently overlooked that life years derived from a period life table and health prevalence derived from survey data are based on different conceptual frameworks Whereas the former reflects the life span of a hypothetical population constructed on the basis of current age-specific death rates, the latter reflects the actual health condition of real individuals [9, 10]. To overcome this conceptual mismatch between health and mortality information, it was suggested to base the Sullivan method on the “Cross-Sectional Average Length of Life” (CAL) instead of conventional period LE [11,12,13]. Our central research question is to what extent the underlying mortality indicator, i.e. LE vs. CAL, affects the resulting estimates for healthy life years, i.e. HE vs. HCAL

Methods

Results

Conclusion