Using mortality follow-up of surveys to estimate social inequalities in healthy life years

Rana Charafeddine,Nicolas Berger,Herman Van Oyen,Stefaan Demarest

doi:10.1186/1478-7954-12-13

Rana Charafeddine, Nicolas Berger + Show 2 more

Open Access

https://doi.org/10.1186/1478-7954-12-13

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Abstract

BackgroundThe estimation of healthy life years (HLY) by socio-economic status (SES) requires two types of data: the prevalence of activity limitation by SES generally extracted from surveys and mortality rates by SES generally derived from a linkage between the SES information in population databases (census, register) and mortality records. In some situations, no population-wide databases are available to produce mortality rates by SES, and therefore some alternatives must be explored. This paper assesses the validity of calculating HLY by SES using mortality rates derived from a linkage between surveys and mortality records.MethodsTwo surveys were chosen to explore the validity of the proposed approach: The Belgian Health Interview Survey (HIS) and the Belgian Survey on Income and Living Conditions (SILC). The mortality follow-up of these surveys were used to calculate HLY by educational level at age 25. These HLY were compared with HLY estimates calculated using the mortality follow-up of the 2001 census. The validity of this approach was evaluated against two criteria. First, the HLY calculated using the census and those calculated using the surveys must not be significantly different. Second, survey-based HLY must show significant social inequalities since such inequalities have been consistently reported with census-based HLY.ResultsBoth criteria were met. First, for each educational category, no statistically significant difference was found when comparing census-based and survey-based HLY estimates. For instance, men in the lowest educational category have shown a HLY of 34 years according to the HIS, and while this figure was 35.5 years according to the census, this difference was not statistically significant. Second, the survey-based HLY have shown a significant social gradient. For instance, men in the highest educational category are expected to live 9.5 more HLY than their counterparts in the lowest educational category based on the HIS estimates, compared with 7.3 HLY based on the census estimates.ConclusionsThis article suggests that using the mortality follow-up of a nationally representative cross-sectional survey is a valid approach to monitor social inequalities in HLY in the absence of population-wide data.

Highlights

The estimation of healthy life years (HLY) by socio-economic status (SES) requires two types of data: the prevalence of activity limitation by SES generally extracted from surveys and mortality rates by SES generally derived from a linkage between the SES information in population databases and mortality records
Efforts have been dedicated at the European level to ensure comparability of the HLY estimations across European Union (EU) Member States and to establish a sustainable monitoring system
These efforts are aimed mainly at ensuring the monitoring of HLY at the population level, but currently there are increasing requests to estimate this indicator by population subgroups, notably socio-economic groups [3]

Summary

Introduction

The estimation of healthy life years (HLY) by socio-economic status (SES) requires two types of data: the prevalence of activity limitation by SES generally extracted from surveys and mortality rates by SES generally derived from a linkage between the SES information in population databases (census, register) and mortality records. Efforts have been dedicated at the European level to ensure comparability of the HLY estimations across EU Member States and to establish a sustainable monitoring system These efforts are aimed mainly at ensuring the monitoring of HLY at the population level, but currently there are increasing requests to estimate this indicator by population subgroups, notably socio-economic groups [3]. Analyzing the evolution of these inequalities over time, the authors concluded that the educational gradient has increased in the country between 1997 and 2004 This highlights the importance of monitoring these indicators at the population level, and by socioeconomic groups

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Conclusion