Unhealthy Life Years Research Articles

Cross-Sectional Association Between Life Expectancy and Unhealthy Life Years: Proof of Concept Tests of the CroHaM Hypothesis

The recently presented CroHaM hypothesis says (1) that longitudinal health domain-specific expansion and compression effects depend primarily on the health domains’ mortality risk and (2) that these effects exist equivalently in the cross-sectional context, affecting differences in healthy life years (HLY) between populations and subpopulations with different levels of life expectancy (LE). We test this hypothesis by analysing the association between LE and unhealthy life years (ULY) at age 50 for a large number of subpopulations. The analyses are carried out for three health domains which are differently related to mortality: poor self-perceived health and strong activity limitation with comparatively high mortality, and chronic morbidity with comparatively low risk of dying. Data on gender- and subpopulation-specific prevalence of these health conditions are taken from the Actual German Health Study 2012 (GEDA). LEs are estimated with the “Longitudinal Survival Method”, using data of the German Life Expectancy Survey. ULY are estimated with the “Sullivan Method”. Differences in ULY between each subpopulation and the total population and between women and men for each subpopulation are decomposed into the effects caused by differences in health (“health effect”) and mortality (“mortality effect”) with the “Nusselder/Looman Method”. The results confirm the CroHaM hypothesis: we find a positive relationship between LE and ULY only for chronic morbidity, whereas this relationship is negative for poor self-perceived health and strong activity limitation. However, when the mortality effect is controlled for, we find a negative relationship between LE and ULY for all three health domains. The practical relevance of these findings is discussed using the example of the so-called “gender paradox” in health and mortality. We conclude that the CroHaM hypothesis may describe an important determinant of life years spent with and without health impairment, and it may help to better understand and interpret trends and differentials in HLY or ULY based on cross-sectional data. * This article belongs to a special issue on “Levels and Trends of Health Expectancy: Understanding its Measurement and Estimation Sensitivity”.

The Trend of Healthcare Needs among Elders and Its Association with Healthcare Access and Quality in Low-Income Countries: An Exploration of the Global Burden of Disease Study 2019.

To investigate the trend of healthcare needs among elders in low-income countries (LICs) and how changes in healthcare access and quality (HAQ) have correlated with these changes from 1990 to 2019, this study used estimates from the global burden of disease (GBD) 2019 study, including prevalence, years of life lost (YLLs), years lived with disability (YLDs), life expectancy (LE), health-adjusted life expectancy (HALE) and the HAQ index for years 1990 and 2019. We found increases in numbers of YLLs, YLDs, and prevalent cases due to NCDs, and the rate of increase was higher for all indicators of non-communicable diseases (NCDs) when compared with communicable, maternal, neonatal and nutritional diseases among elders. We also observed increases in LE and HALE among all countries. However, this was also challenged by increases in unhealthy life years (ULYs) and their constant percentage of LE. The HAQ index of LICs was also found to be low, although it had increased during the period. A reduction in the burden of acute diseases explains the increase in LE, but increases in ULYs and the NCD burden were also observed. LICs need to improve their HAQ to counter the growing threat of longer but less healthy lives.

Analysis of recent changes in chronic disease-free life expectancy in Algeria.

No official estimates have been published regarding healthy life expectancy in Algeria, and chronic disease-free life expectancy in particular, despite their importance for assessing public health policy effectiveness and predicting social security expenditure. To estimate chronic disease-free life expectancy in Algeria and analyse its changes in recent years, and to determine how morbidity has changed according to age, time, and gender, compared with mortality, following expansion of morbidity, compression of morbidity, or morbidity-mortality balance. We used Sullivan's method to estimate chronic disease-free life expectancy in Algeria using data provided from the Multiple Indicator Cluster Surveys and national life tables published by the Office for National Statistics for 2006, 2012-2013, and 2018-2019. The changes in healthy/unhealthy years compared with life expectancy were analysed. Although Algerian women live an average 1-2 years longer than men, their chronic disease-free life expectancy is 5 years shorter. The gain in life expectancy between 2006 and 2018-2019 was accompanied by a decline in chronic disease-free life expectancy from 62.36 and 57.27 years to 61.13 and 55.64 years for men and women, respectively. Algerians in 2018-2019 lived longer but not healthier than in 2006, and the number of unhealthy life years increased compared with life expectancy. Thus, public health programmes need to be more efficient to increase healthy years faster, or at least at the same pace as life expectancy.

Gender Gap in Unhealthy Life Expectancy: The Role of Education Among Adults Aged 45.

Objectives: This paper examines the gender gap in unhealthy life expectancy across education levels and age in Spain to understand the extent to which the gender paradox exists over education and across ages. Methods: Death registrations and vital status were taken from the Spanish Statistical Office, while the three health measures (chronic conditions, bad-self rated health and cognitive impairment) from the 2019 European Health Interview Survey. We used Sullivan’s method to compute unhealthy life expectancy by education level. We computed the gender and the education ratios of the proportion of unhealthy life years in each health measure by education and age. Results: At almost all ages and all education levels, women significantly lived longer but in poorer health than men. Marked gender differences are seen across most age-groups, particularly among the low educated. We detected greater health inequalities by education level for women (confirming the gender paradox) and a health gradient due to aging and across the health measures charting the disablement process. Conclusion: The new education distribution might improve the unhealthy life expectancy and might reduce the gender gap in the number of years spent in poor health.

The contribution of social participation to differences in life expectancy and healthy years among the older population: A comparison between Chile, Costa Rica and Spain.

We study the health trajectories of the population aged over 60, comparing between one European and two Latin American countries (Spain, Chile and Costa Rica) which have similar longevity patterns. Our focus is on functional limitation and mortality risks, considering differences by gender, education and social participation. Data come from national panel surveys (EPS, CRELES, SHARE). Multistate modelling is used to estimate transition probabilities between two health states: healthy to unhealthy, unhealthy to healthy as well as the transition to death from healthy or unhealthy states, to estimate the duration of stay in a specific state (computing healthy and unhealthy life expectancies) and the effect of the selected covariates. Results show that older Costa Ricans have the smallest gender gap in life expectancy but women have a lower healthy life expectancy compared to those in Chile and Spain. Participation in social activities leads to higher healthy life expectancy among the elderly in Costa Rica and Spain, whilst there were no relevant educational differences observed in longevity in the analysed countries. To conclude: despite the different patterns observed in health transitions and survival across the three countries, social participation is associated with greater health and longevity among people of old age, with little effect coming from educational attainment. Public policies should therefore be aimed at reducing unhealthy life years and dependency at advanced ages by promoting more engagement in social activities, especially among vulnerable groups who are more likely to experience impairment from a younger age.

Trends in life expectancy and healthy life years at birth and age 65 in the UK, 2008-2016, and other countries of the EU28: An observational cross-sectional study.

BackgroundAs society ages, promoting the health of the extra years of life is of paramount importance for health, social care and pension provision. Increases in life expectancy in the UK and elsewhere have slowed in recent years, but the reasons for this are unclear. No formal comparison of trends in healthy life years between the UK and the other countries of the EU28 in recent times has been published. These countries are geographically proximate, and share many social, cultural and demographic properties, making them interesting and useful comparators, especially as the UK prepared to leave the European Union in 2020.MethodsWe calculated sex-specific healthy life years (HLY), unhealthy life years (ULY), mild and severe ULY at birth and age 65 using life tables and age-specific prevalence of activity limitation amongst the EU28 between 2008 and 2016 from EuroHex. Trends in life expectancy, HLY, ULY and proportion of life spent healthy (HLY%) were compared. We then decomposed HLY temporal changes into relative effects of changes in healthy life and mortality, by age group.FindingsLife expectancy at birth, and age 65, in the UK were increasing rapidly in 2008 but slowed around 2011. Germany, Portugal and France showed evidence of a similar slowing. HLY at birth in the UK decreased, whereas it increased in most EU28 countries. The UK experienced a period of absolute expansion of unhealthy life in both sexes. The reduction in HLY at birth in the UK was mainly attributable to increases in unhealthy life in younger age groups.InterpretationThe UK's performance relative to the other countries of the EU28 was poor after 2011, combining static life expectancy and reductions in healthy life years. These trends suggest that the UK government's Ageing Society Grand Challenge (to increase the healthy life expectancy by five years by 2035) will be difficult to attain.FundingNational Institute for Health Research (NIHR) Policy Research Programme conducted through the NIHR Older People and Frailty Policy Research Unit, PR-PRU-1217-21502. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Mixed evidence for the compression of morbidity hypothesis for smoking elimination-a systematic literature review.

BackgroundThere is debate around the composition of life years gained from smoking elimination. The aim of this study was to conduct a systematic review of the literature to synthesize existing evidence on the effect of smoking status on health expectancy and to examine whether smoking elimination leads to compression of morbidity.MethodsFive databases were systematically searched for peer-reviewed articles. Studies that presented quantitative estimates of health expectancy for smokers and non-/never-smokers were eligible for inclusion. Studies were searched, selected and reviewed by two reviewers who extracted the relevant data and assessed the risk of bias of the included articles independently.ResultsThe search identified 2491 unique records, whereof 20 articles were eligible for inclusion (including 26 cohorts). The indicators used to measure health included disability/activity limitations (n=9), health-related quality of life (EQ-5D) (n=2), weighted disabilities (n=1), self-rated health (n=9), chronic diseases (n=6), cardiovascular diseases (n=4) and cognitive impairment (n=1). Available evidence showed consistently that non-/never-smokers experience more healthy life years throughout their lives than smokers. Findings were inconsistent on the effect of smoking on the absolute number of unhealthy life years. Findings concerning the time proportionally spent unhealthy were less heterogeneous: nearly all included articles reported that non-/never-smokers experience relatively less unhealthy life years (e.g. relative compression of morbidity).ConclusionsSupport for the relative compression of morbidity due to smoking elimination was evident. Further research is needed into the absolute compression of morbidity hypothesis since current evidence is mixed, and methodology of studies needs to be harmonized.

Potential impact of reduced tobacco use on life and health expectancies in Belgium

ObjectivesWe investigated the potential impact of reduced tobacco use scenarios on total life expectancy and health expectancies, i.e., healthy life years and unhealthy life years.MethodsData from the Belgian Health Interview Survey 2013 were used to estimate smoking and disability prevalence. Disability was based on the Global Activity Limitation Indicator. We used DYNAMO-HIA to quantify the impacts of risk factor changes and to compare the “business-as-usual” with alternative scenarios.ResultsThe “business-as-usual” scenario estimated that in 2028 the 15-year-old men/women would live additional 50/52 years without disability and 14/17 years with disability. The “smoking-free population” scenario added 3.4/2.8 healthy life years and reduced unhealthy life years by 0.79/1.9. Scenarios combining the prevention of smoking initiation with smoking cessation programs are the most effective, yielding the largest increase in healthy life years (1.9/1.7) and the largest decrease in unhealthy life years (− 0.80/− 1.47).ConclusionsHealth impact assessment tools provide different scenarios for evidence-informed public health actions. New anti-smoking strategies or stricter enforcement of existing policies potentially gain more healthy life years and reduce unhealthy life years in Belgium.

Women's excess unhealthy life years: disentangling the unhealthy life years gap.

BackgroundCompared to men, women live longer but have more years with disability. We assessed the contribution of gender differences in mortality and disability, total and by cause, to women’s excess unhealthy life years (ULYs).MethodsWe used mortality data for France 2008 from Eurostat, causes of death from the CépiDc-INSERM-database; and disability and chronic conditions data from the French Disability Health Survey 2008–09. ULYs were calculated by the Sullivan method. The contributions of mortality and disability differences to gender differences in ULY were based on decomposition analyses.ResultsLife expectancy of French women aged 50 was 36.3 years of which 19.0 were ULYs; life expectancy of men was 30.4 years of which 14.2 were ULYs. Of the 4.8 excess ULYs in women, 4.0 years were due to lower mortality. Of these 4.0 ULYs, 1.8 ULY originated from women’s lower mortality from cancer, 0.8 ULY from heart disease and 0.3 ULY from accidents. The remaining 0.8 excess ULY in women were from higher disability prevalence, including higher disability from musculoskeletal diseases (+1.8 ULY) and anxiety-depression (+0.6 ULY) partly offset by lower disability from heart diseases (−0.8 ULY) and accidents (−0.3 ULY).ConclusionLower mortality and higher disability prevalence contributed to women’s longer life expectancy with disability. Women’s higher disability prevalence due to non-fatal disabling conditions was partly offset by lower disability from heart disease and accidents. Conditions differentially impact gender differences in ULY, depending on whether they are mainly life-threatening or disabling. The conclusions confirm the health-survival paradox.

DISPARITIES IN HEALTHY LIFE EXPECTANCY: THE ROLE OF PLACE, PERSON AND TIME

A key concern for most countries is whether the added years of the longer lives now experienced are healthy and good quality years. Population health indicators such as healthy life expectancy, or the European indicator Healthy Life Years (HLY), that combine information on mortality and morbidity, are growing in importance, as they provide evidence to answer such concerns. Countries are also increasingly utilising these indicators to indicate and monitor the extent to which longer healthier lives are being enjoyed by all sections of the population, as defined by personal characteristics (education, socio-economic status) or place of residence. In this session we present new research on healthy life expectancy disparities within four countries (US, UK, Mexico, France) and explore the underlying drivers that can point towards solutions to reduce future disparities. The first presentation documents rural-urban differences in cognitive life expectancies at age 50 for Mexico and how personal characteristics (gender, education) contribute. The second presentation moves to regional variation in healthy and unhealthy life years across the 100 counties (departments) in France and examines, through meta-regression, the extent to which this variation is associated with disparities in local socio-economic context and long term care provision. In the third presentation US state differences in HLE are examined in light of state differences in socioeconomic and policy contexts. The final presentation focuses on person and time by looking to the future and examining the different ways in which dependency-free in England will evolve over the coming 20 years for men and women.

Gender differences in Healthy life years and years with activity limitations in France: the contribution of chronic diseases

Monitoring life expectancy and Healthy Life Years (HLY) clearly shows that a large number of years are spent with activity limitations (unhealthy life years, ULY) and that there is a persistent gender gap in the number of ULY, in favor of men. We illustrate how the public health relevancy of this information can be further increased by looking at the the contribution of chronic diseases to gender …

Scoping review report: obesity in older adults

Obesity is associated with an increased risk for early death, heart disease and stroke, disability and several other comorbidities. Although there is concern about the potential burden on health-care services with the aging demographic and the increasing trend of obesity prevalence in older adults, evidence on which to base management strategies is conflicting for various reasons. The analytic framework for this review is based on a scoping review methodology, and was conducted to examine what is known about the diagnosis, treatment and management of obesity in older adults. A total of 492 relevant research articles were identified using PubMed, Scirus, EBSCO, Clinicaltrials.gov, Cochrane Reviews and Google Scholar. The findings of this review indicate that the current WHO (World Health Organization)-recommended body mass index, waist circumference and waist-to-hip ratio obesity thresholds for the general adult population may not be appropriate for older adults. Alternatively, weight change or physical fitness may be more useful measures of mortality and health risk in obese older adults. Furthermore, although obesity in older adults is associated with several disorders that increase functional disability, epidemiological evidence suggests that obesity is protective against mortality in seniors. Consequently, the trend toward increasing prevalence of obesity in older adults will lead to an increase in unhealthy life years and health-care costs. The findings from this review also suggest that treatment strategies for obese older adults should focus on maintaining body weight and improving physical fitness and function rather than weight loss, and that a combination of aerobic and resistance exercise appears to be the most effective strategy. In conclusion, this review demonstrates the need for more research to clarify the definition of obesity in older adults, to establish criteria for evaluating when to treat older adults for obesity, and to develop effective treatment strategies focused on functional outcomes in obese older adults.

Gender differences in health of EU10 and EU15 populations: the double burden of EU10 men

This study compares gender differences in Healthy Life Years (HLY) and unhealthy life years (ULY) between the original (EU15) and new member states (EU10). Based on the number of deaths, population and prevalence of activity limitations from the Statistics of Living and Income Conditions Survey (SILC) survey, we calculated HLY and ULY for the EU10 and EU15 in 2006 with the Sullivan method. We used decomposition analysis to assess the contributions of mortality and disability and age to gender differences in HLY and ULY. HLY at age 15 for women in the EU10 were 3.1 years more than those for men at the same age, whereas HLY did not differ by gender in the EU15. In both populations ULY at age 15 for women exceeded those for men by 5.5 years. Decomposition showed that EU10 women had more HLY because higher disability in women only partially offset (−0.8 years) the effect of lower mortality (+3.9 years). In the EU15 women’s higher disability prevalence almost completely offset women’s lower mortality. The 5.3 fewer ULY in EU10 men than in EU10 women mainly reflected higher male mortality (4.5 years), while the fewer ULY in EU15 men than in EU15 women reflected both higher male mortality (2.9 years) and higher female disability (2.6 years). The absence of a clear gender gap in HLY in the EU15 thus masked important gender differences in mortality and disability. The similar size of the gender gap in ULY in the EU-10 and EU-15 masked the more unfavourable health situation of EU10 men, in particular the much stronger and younger mortality disadvantage in combination with the virtually absent disability advantage below age 65 in men.