Health-adjusted Life Expectancy Research Articles

Cost‐effectiveness of caesarean sections in a post‐conflict environment: a case study of Bunia, Democratic Republic of the Congo

This paper demonstrates the feasibility of health services research in an unstable environment during the transition from crisis to development and its importance for future planning. Effectiveness and the cost of caesarean sections (CSs) were investigated in Bunia, a town affected by conflict and insecurity, in the Democratic Republic of the Congo (DRC) in 2008. The CS rate was 9.7 per cent of expected deliveries. All CSs in the study sample were emergency procedures. A humanitarian non-governmental organisation (NGO) hospital, offering free services, performed 75 per cent of all CSs. The estimated provider cost for CS in 2008 at this hospital was USD 103,514 (that is, USD 144 per CS). With a cost of between USD 3.8 and 9.2 per year of health adjusted life expectancy (HALE) gained, CSs at the NGO hospital were very cost-effective. The estimates give an indication of funding requirements to maintain adequate access to CS after the departure of the humanitarian organisation.

HealthPaths—Using health trajectories to estimate and simulate the relative importance of determinants of health-adjusted life expectancy (HALE): a statistical analysis

BackgroundThere is broad agreement that a summary measure of population health such as health-adjusted life expectancy (HALE) is fundamental. While HALE is strongly correlated with income, multivariate analyses ascribing relative importance to a range of socioeconomic determinants are relatively rare. MethodsThis analysis combines very detailed statistical analysis of Statistics Canada's longitudinal National Population Health Survey (NPHS) with the HealthPaths dynamic microsimulation model. Microsimulation is used to synthesise a realistic base-case representative longitudinal population sample and then a series of carefully constructed counterfactual populations, each cutting a link in the “web of causality” estimated from the NPHS. Comparisons of the distributions of health-adjusted life lengths and summary HALE measures between counterfactuals and the base case are then used to estimate the quantitative importance of the determinants being analysed. Replicate simulations plus underlying replicate regressions further enable sophisticated measures of uncertainty in model results. FindingsThis analysis extends an earlier version that focused on four factors: obesity, smoking, education, and Antonovsky's Sense of Coherence (SoC). In that analysis, surprisingly, SoC had the largest potential impact, while education and smoking each accounted for about half as many years of (cause-deleted) HALE, and obesity accounted for relatively little. This analysis extends these results to encompass a broader range of factors, including household income, leisure and daily physical activity, employment, sense of mastery, family membership, and institutional residence. These additions change the rank order and magnitudes of the factors somewhat, reflecting omitted variable biases. The statistical analysis has had to confront a number of challenges with the main dataset, including inertia in health states, missing data, and errors in variables. InterpretationWidely observed socioeconomic gradients in health, when examined in greater detail, are the culmination of myriad co-evolving dynamic processes, where their interacting and joint effects, alone, are small. It is essential to employ an analytical framework that combines robust estimates of individual multivariate health status dynamics with health determinants dynamics in order to assess realistically the sources of health inequalities. FundingCanadian Foundation for Innovation.

Small-area health comparisons using health-adjusted life expectancies: A Bayesian random-effects approach

Health-adjusted life expectancy (HALE) is one of the most attractive summary measures of population health. It provides balanced attention to fatal as well as non-fatal health outcomes, is sensitive to the severity of morbidity within the population, and can be readily compared between areas with very different population age structures. HALE, however, cannot be calculated at the small-area level using traditional life table methodology. Hence we propose a Bayesian random-effects modeling approach that recognizes correlations and pools strength between sexes, age-groups, geographical areas, and health outcomes. This approach allows for the calculation of HALE for areas as small as 2000 person years at risk and with relatively modest health state survey sample sizes. The feasibility of the Bayesian approach is illustrated in a real-life example, which also shows how differences in areas' health performances can be adequately quantified. Such information can be invaluable for the appropriate targetting and subsequent evaluation of urban regeneration, neighborhood renewal, and community-based initiatives aimed at improving health and reducing health inequalities.

Vascular Protection in People with Diabetes

Vascular Protection in People with Diabetes

Report summary – Health-Adjusted Life Expectancy in Canada: 2012 Report by the Public Health Agency of Canada

Report summary – Health-Adjusted Life Expectancy in Canada: 2012 Report by the Public Health Agency of Canada

Impacto de la violencia homicida en la esperanza de vida masculina de México

To determine the impact of homicide on male life expectancy in Mexico and its 32 states during the three-year periods 1998-2000 and 2008-2010 and the weight of the different age groups in years of life expectancy lost (YLEL) due to this cause. Based on official death and population data, abridged tables for male mortality in Mexico as a whole and its states were created for the three-year periods studied. Health-adjusted life expectancy and YLEL for men aged 15 to 75 were calculated by selected causes (homicide, diabetes mellitus, and traffic accidents) and age groups in each three-year period. In the years between the 1998-2000 and 2008-2010 periods, YLEL due to homicide increased both nationally and in 19 states. In four states, the YLEL in 2008-2010 exceeded two, with the state of Chihuahua standing out at 5.2 years. In 14 of the 18 states where health-adjusted life expectancy among men declined between the two three-year periods, the YLEL due to homicide increased. From 2008 to 2010, homicides were the leading cause of YLEL among men aged 20-44. YLEL due to homicide among those aged 15-44 increased between the two three-year periods. The increase in the rate of homicidal violence, especially among young people, is impeding an increase in male life expectancy in Mexico. In several states, such as Chihuahua and Durango, this violence appears to be the main reason for the decline in life expectancy among men aged 15 to 75.

The Canadian Index of Wellbeing: Key Findings From the Healthy Populations Domain

The Canadian Index of Wellbeing (CIW) is an ambitious undertaking that aims to measure and track Canadians' overall "wellbeing". The Healthy Populations, one of eight CIW domains, brings together both population health outcomes and important influences on health. Indicators from eight subdomains (personal wellbeing, life expectancy/mortality, physical health conditions, functional health, mental health, lifestyle and behaviour, health care, and public health) make up the Healthy Populations domain. Following a review of worldwide literature on health and wellbeing indicators, application of a prespecified set of selection criteria, and expert external validation, ten core indicators and six secondary indicators were selected. The data sources include several national population data systems (CCHS, NPHS) and databases kept at the Canadian Institute for Health Information. Indicators were examined for trends over time, and were stratified by age, sex, income and education. A single summary measure, health domain index, was calculated and reported annually from 1994 to 2008. Analysis of data over a 15-year time period found that Canadians are living longer, but with fewer years in optimal health. Diabetes rates have risen, along with obesity rates, while smoking rates are on the decline and regular physical activity is becoming more common. There were notable income and education gradients for virtually all indicators measured, and gender disparities evident for life expectancy, health-adjusted life expectancy, diabetes, and depression. A worrisome downward trend in health outcomes for Canada's youth (12-19 years) was observed. The overall health index score showed a modest rise of 6.6% from 1994 to 2008. The Healthy Populations domain, and its ongoing use and refinement, can be an important resource for understanding and monitoring the health of Canadians. Knowledge about the status of Canadians' wellbeing will benefit from the contextualization of these findings through evidence generated from the other CIW domains.

Impact of diabetes mellitus on life expectancy and health-adjusted life expectancy in Canada.

The objectives of this study were to estimate life expectancy (LE) and health-adjusted life expectancy (HALE) for Canadians with and without diabetes and to evaluate the impact of diabetes on population health using administrative and survey data.Mortality data from the Canadian Chronic Disease Surveillance System (2004 to 2006) and Health Utilities Index data from the Canadian Community Health Survey (2000 to 2005) were used. Life table analysis was applied to calculate LE, HALE, and their confidence intervals using the Chiang and the adapted Sullivan methods.LE and HALE were significantly lower among people with diabetes than for people without the disease. LE and HALE for females without diabetes were 85.0 and 73.3 years, respectively (males: 80.2 and 70.9 years). Diabetes was associated with a loss of LE and HALE of 6.0 years and 5.8 years, respectively, for females, and 5.0 years and 5.3 years, respectively, for males, living with diabetes at 55 years of age. The overall gains in LE and HALE after the hypothetical elimination of prevalent diagnosed diabetes cases in the population were 1.4 years and 1.2 years, respectively, for females, and 1.3 years for both LE and HALE for males.The results of the study confirm that diabetes is an important disease burden in Canada impacting the female and male populations differently. The methods can be used to calculate LE and HALE for other chronic conditions, providing useful information for public health researchers and policymakers.

O4-2.2 Healthpaths dynamics: using functional health trajectories to quantify impacts on Health-Adjusted Life Expectancy (HALE) in Canada

There is significant dispersion in health status in populations, as well as a strong correlation between health status and socio-economc status. However, there remains considerable uncertainty as to the quantitiative...

Impact of increased use of adjuvant chemotherapy in non-small cell lung cancer: A population and economic assessment.

e16630 Background: Lung cancer confers a substantial burden on patients and healthcare systems. Among patients with resectable non-small cell lung cancer (NSCLC), adjuvant chemotherapy (AC) has improved survival, but uptake has been incomplete. To determine the impact of increased use of AC, microsimulations were undertaken using the Cancer Risk Management (CRM) model developed by Statistics Canada and the Canadian Partnership Against Cancer. Methods: The CRM model uses inputs from Canadian demographics, risk factors, direct healthcare costs, and clinical practice data to assess incremental life expectancy (LE), health-adjusted life expectancy (HALE), and cost from the perspective of the Canadian healthcare system. Sensitivity analysis examined rates of use of AC over a range of 0-100% in 10% increments. The baseline regimen tested was 4 cycles of cisplatin and vinorelbine (PV) assuming a 50% uptake with a hazard ratio (HR) of 0.68 for overall mortality. Sensitivity analysis with HR=0.74 was performed. Alternate regimens included cisplatin and etoposide (given for 3 or 4 cycles (PE3, PE4) and assessing a HR range of 0.95 to 0.68), gemcitabine with cisplatin (PG) or carboplatin (CG) (HR=0.68) and baseline PV plus bevacizumab q3 weeks to 1 year (EPB). Results: In the PV baseline scenario, LE was 76.2 years, HALE was 66.2 years and the lifetime cost per patient was $32,290. Adjuvant chemotherapy remained cost-effective under the sensitivity analysis (HR=0.74). Each 10% increase in the use of AC resulted in an average increase of 3.7 months in LE and 2.7 months in HALE, and a lifetime cost savings of up to $360 per patient. Compared with baseline PV, the PE regimen was not cost-effective, with the exception of PE3 assuming HR = 0.68. PG and CG were less cost-effective than PV, at an additional lifetime cost of $589 and $1023 per patient, respectively. The EPB scenario would be cost-effective at $100,000 per QALY compared to baseline PV if the survival HR=0.55. Conclusions: The CRM model suggests greater use of PV AC in NSCLC would improve LE and net healthcare costs, with other drug pairs being less cost-effective. The HR required for bevacizumab to be cost-effective will be difficult to achieve in current trials.

The Valuation of the Increase in Quality of Life and Health-Adjusted Life Expectancy as a Result of Colorectal Cancer Screening in Future Decades; A Population-Based Study

The Valuation of the Increase in Quality of Life and Health-Adjusted Life Expectancy as a Result of Colorectal Cancer Screening in Future Decades; A Population-Based Study

Health-Adjusted Life Expectancy among Canadian Adults with and without Hypertension.

Hypertension can lead to cardiovascular diseases and other chronic conditions. While the impact of hypertension on premature death and life expectancy has been published, the impact on health-adjusted life expectancy has not, and constitutes the research objective of this study. Health-adjusted life expectancy (HALE) is the number of expected years of life equivalent to years lived in full health. Data were obtained from the Canadian Chronic Disease Surveillance System (mortality data 2004–2006) and the Canadian Community Health Survey (Health Utilities Index data 2000–2005) for people with and without hypertension. Life table analysis was applied to calculate life expectancy and health-adjusted life expectancy and their confidence intervals. Our results show that for Canadians 20 years of age, without hypertension, life expectancy is 65.4 years and 61.0 years, for females and males, respectively. HALE is 55.0 years and 52.8 years for the two sexes at age 20; and 24.7 years and 22.9 years at age 55. For Canadians with hypertension, HALE is only 48.9 years and 47.1 years for the two sexes at age 20; and 22.7 years and 20.2 years at age 55. Hypertension is associated with a significant loss in health-adjusted life expectancy compared to life expectancy.

Self-rated health as a tool for estimating health-adjusted life expectancy among patients newly diagnosed with localized prostate cancer: a preliminary study

Localized prostate cancer (LPC) patients are faced with numerous treatment options, including observation or watchful waiting. The choice of treatment largely depends on their baseline health-adjusted life expectancy (HALE). By consensus, physicians recommend treatment if the patient's HALE is ten or more years. However, the estimation of HALE is difficult. Although subjective by nature, self-rated health (SRH) is a robust predictor of mortality. We studied the usefulness of SRH in estimating HALE in patients who are considering treatment for LPC. A total of 144 LPC patients from a large urology private practice in Norfolk, Virginia, were surveyed before they had chosen a treatment option. HALE determined by SRH correlated well with objective health measures and was higher than age-based life expectancy by an average of 2years. The observed difference in life expectancy due to SRH adjustment was higher among patients with a better socioeconomic and health profile. SRH is an easy-to-use indicator of HALE in LPC patients. A table for HALE estimation by age and SRH is provided for men aged 70-80years. Additional research with larger samples and prospective study designs are needed before the SRH method can be used in primary care and urology settings.

Comparing population health in the United States and Canada.

BackgroundThe objective of the paper is to compare population health in the United States (US) and Canada. Although the two countries are very similar in many ways, there are potentially important differences in the levels of social and economic inequality and the organization and financing of and access to health care in the two countries.MethodsData are from the Joint Canada/United States Survey of Health 2002/03. The Health Utilities Index Mark 3 (HUI3) was used to measure overall health-related quality of life (HRQL). Mean HUI3 scores were compared, adjusting for major determinants of health, including body mass index, smoking, education, gender, race, and income. In addition, estimates of life expectancy were compared. Finally, mean HUI3 scores by age and gender and Canadian and US life tables were used to estimate health-adjusted life expectancy (HALE).ResultsLife expectancy in Canada is higher than in the US. For those < 40 years, there were no differences in HRQL between the US and Canada. For the 40+ group, HRQL appears to be higher in Canada. The results comparing the white-only population in both countries were very similar. For a 19-year-old, HALE was 52.0 years in Canada and 49.3 in the US.ConclusionsThe population of Canada appears to be substantially healthier than the US population with respect to life expectancy, HRQL, and HALE. Factors that account for the difference may include access to health care over the full life span (universal health insurance) and lower levels of social and economic inequality, especially among the elderly.

Diabetes and its impact on health-related quality of life: a life table analysis

To investigate the health burden of diabetes and determine its impact on health-related quality of life (HRQOL) in a population with a high prevalence of chronic conditions. A representative sample of the Canadian province of Newfoundland and Labrador (NL) was used to estimate prevalence of diabetes and mean health utility index (HUI), a utility-based measure of HRQOL. Diabetes-deleted life expectancy (LE) and health-adjusted life expectancy (HALE) were derived to measure HRQOL. Diabetic individuals comprised 6.8% of the sample and accounted for 14% of total deaths from 2001 to 2005. Life Expectancy at age 15 was 61.3 years for men and 66.7 years for women, of which 53.0 and 57.0 years, respectively, were spent with perfect health (86.4 and 85.5%). Eliminating diabetes would extend both the overall LE and HALE for men by 1.3 and 1.4 years, and women by 2.0 and 1.7 years, respectively. People with diabetes had a significantly lower HRQOL than people without diabetes (mean HUI: 0.78 vs. 0.88, P < 0.01). The burden of illness from diabetes in NL is considerable. Using cause-eliminated LE and HALE provides a robust approach for assessing HRQOL that may have important implications for diabetes surveillance, prevention, and management strategies.

The health loss from ischemic stroke and intracerebral hemorrhage: evidence from the North East Melbourne Stroke Incidence Study (NEMESIS)

BackgroundPeople suffering different types of stroke have differing demographic characteristics and survival. However, current estimates of disease burden are based on the same underlying assumptions irrespective of stroke type. We hypothesized that average Quality Adjusted Life Years (QALYs) lost from stroke would be different for ischemic stroke and intracerebral hemorrhage (ICH).MethodsWe used 1 and 5-year data collected from patients with first-ever stroke participating in the North East Melbourne Stroke Incidence Study (NEMESIS). We calculated case fatality rates, health-adjusted life expectancy, and quality-of-life (QoL) weights specific to each age and gender category. Lifetime 'health loss' for first-ever ischemic stroke and ICH surviving 28-days for the 2004 Australian population cohort was then estimated. Multivariable uncertainty analyses and sensitivity analyses (SA) were used to assess the impact of varying input parameters e.g. case fatality and QoL weights.ResultsPaired QoL data at 1 and 5 years were available for 237 NEMESIS participants. Extrapolating NEMESIS rates, 31,539 first-ever strokes were expected for Australia in 2004. Average discounted (3%) QALYs lost per first-ever stroke were estimated to be 5.09 (SD 0.20; SA 5.49) for ischemic stroke (n = 27,660) and 6.17 (SD 0.26; SA 6.45) for ICH (n = 4,291; p < 0.001). QALYs lost also differed according to gender for both subtypes (ischemic stroke: males 4.69 SD 0.38, females 5.51 SD 0.46; ICH: males 5.82 SD 0.67, females 6.50 SD 0.40).DiscussionPeople with ICH incurred greater loss of health over a lifetime than people with ischemic stroke. This is explained by greater stroke related case fatality at a younger age, but longer life expectancy with disability after the first 12 months for people with ICH. Thus, studies of disease burden in stroke should account for these differences between subtype and gender. Otherwise, in countries where ICH is more common, health loss for stroke may be underestimated. Similar to other studies of this type, the generalisability of the results may be limited. Sensitivity and uncertainty analyses were used to provide a plausible range of variation for Australia. In countries with demographic and life expectancy characteristics comparable to Australia, our QoL weights may be reasonably applicable.

Predicting life expectancy in prostate cancer patients

Due to its long natural history, prostate cancer illustrates best the need for tools that adequately predict life expectancy. We reviewed the actual tools available for clinicians involved in therapeutic decisions in newly diagnosed prostate cancer and examined their accuracy to provide individual life expectancy. Life tables, comorbidity indices, and multivariate prognostic models can assist clinicians for life expectancy predictions. However, the accuracy of life tables (60.9%) and comorbidity indices (accuracy unknown) may be as weak as clinician-derived life expectancy predictions (69%). Actually, statistical models provide the highest accuracy (69-84.3%). To date, Walz et al. developed the most accurate model (84.3%), predicting the risk of death of nonprostate cancer-related causes within 10 years of definitive therapy. Clinicians need the most accurate estimates of life expectancy in situations in which there is uncertainty regarding the need for aggressive local therapy. As the accuracy of clinician-derived life expectancy prediction is relatively modest, clinicians may benefit from assisted life expectancy prediction by life tables and statistical tools in their daily clinical practice. This would enhance the accuracy of the life expectancy predictions of individual candidates to definitive therapy for prostate cancer. Actually, nomograms provide the most accurate health-adjusted life expectancy prognostication.

Cause-excluded health adjusted life expectancy: a new indicator in measuring the burden of diseases

Based on the integration of concept and methods of cause-eliminated life expectancy (CELE), health-adjusted life expectancy (HALE) and disability-adjusted life year (DALY), a new index named cause-excluded health adjusted life expectancy (CEHALE) was developed in this study to evaluate the health impact(both fetal and non-fetal) of single disease. In order to include the impact of both premature death and health problems among those who are alive, the concept of suppositional death was introduced to calculate CEHALE. Cause-excluded health adjusted life expectancy developed in this study, should be not only easy to understand in concept, but also has theoretical support and be not affected by age structure, and be more suitable to use in comparison among different diseases and different population. Moreover, the new index is easy to calculate. So, CEHALE should be an ideal index to evaluate the impact of disease to population health.

Health-adjusted life expectancy of the British population

In this article, changes in the quality of health-adjusted life expectancy of the British population between 1991 and 1998 are analysed. It is found that at all given age levels, life expectancy increased during this period. Life expectancy at birth increased by 1 year for women and by 1.5 years for men. It is further found that the prevalence of health problems and handicaps increased during the 1990s. For all age categories, the self-assessment of the health status showed that the quality of health also declined on average. We concluded that the quality-adjusted life expectancy between 1991 and 1998 showed a decrease rather than an increase.

Expectations of benefit in survival in patients choosing treatment for localized prostate cancer

6549 Background: Three-fourths of screen-detected localized prostate cancer (LPC) has a Gleason score of <7. Untreated, such cancer has been projected to result in only 1% mortality over 15 years. However, despite serious risk of treatment side-effects, 94% of patients in the U.S. choose treatment for LPC. We surveyed, to our knowledge for the first time, how much longer survival patients expect by choosing treatment. Methods: 160 patients were studied before treatment for LPC. Their health-adjusted life expectancy (HALE) exceeded 10 years except for 2 patients. They were asked about their perceived reduction in survival (PRS) due to the cancer, and perceived benefit in survival (PBS) due to treatment for the cancer. Baseline HALE was calculated based on age and co-morbidities. Results: Mean age of patients was 61 years. Mean Gleason score of cancer was 6.5. Patients were mostly healthy, educated, and had higher than average health literacy and family incomes. 66% patients had HALE of >20 years; of them, over half believed they would live less than 10 years without treatment (PRS). Similarly, 106 patients expected to live over 20 years with treatment, but 45% of them believed they would live less than 10 years without treatment (PBS). PRS and PBS were higher in patients with higher HALE, cancer grade, anxiety, and depression, but were unrelated to race or scores of co-morbidities, functional capacity, generic health-related quality of life, social support, education, health literacy, family income, and satisfaction with life, health, and education given by physicians in treatment choices. Conclusions: Choice of treatment for LPC was associated with unrealistic pessimism regarding survival without treatment, and unrealistic optimism regarding benefit in survival due to treatment. No significant financial relationships to disclose.