Health Expectancies: UK experience

Task Force on Health Expectancies: 8th June 2006

Madhavi Bajekal

Background

• First UK report: “Health Expectancy and its Uses”, edited by Bone, M, Bebbington, A, Jagger C. (HMSO, 1995)

• Regular articles in Health Statistics Quarterly 2000 onwards (ONS publication)

– Research papers plus reports to update time series– Methodological developments – http://www.statistics.gov.uk/statbase/Product.asp?

vlnk=6725

• Product page on ONS website with latest figures– http://www.statistics.gov.uk/StatBase/Product.asp?vlnk

=12964&Pos=1&ColRank=2&Rank=240

Two types of health expectancy series calculated annually by ONS

HLE (Healthy Life Expectancy)• Over the last 12 months, would you say your health has on the whole been?

– Good– Fairly good

– Not good

DFLE (Disability-free Life Expectancy)• Do you have any long-standing illness, disability or infirmity? By long-standing I

mean anything that has troubled you over a period of time or that is likely to affect you over a period of time.

– Yes/No.• If ‘Yes’• a) What is the matter with you?• b) Does this illness or disability limit your activities in any way?

– Yes/No

Sources of Data

A t n a tio na l le ve l:p ro d uce d byG o ve rn m e nt

A c tu a ry 's De p a rtm e nt

A t su b na tio n a l le ve l:p ro d uce d by

O ffice fo rN a tio n a l S ta tis t ics

L ife T a b lesp re p a re d from p o pu la tion

e s tim ate s a n d d e a th re g istra tio ns

S e lf-p e rce ivedg e n e ra l h e a lth

L im itinglo n g -s ta n d ing

illn e ss

S u rvey d a ta o n h e a lthfro m B rit ish G e n e ra lH o u se h o ld S u rvey

What are health expectancies used for in the UK?

• Monitoring population health – Over time (survey data)– Geography (4 countries, sub-national (NUTS 1 & NUTS 4), area

typologies )

• Monitoring inequalities– By area deprivation (survey + Census)– Between social groups (LS)

• European comparisons– European Health Expectancy Monitoring Unit – EU-SILC (harmonisation of instruments)

• Forecasting future need for health and care

Policy: Health expectancies as indicators of progress

• DWP: Poverty and Social exclusion of elderly (HLE 65)

• ODPM: Sustainable development (HLE birth)

• DoH: Improving standards of care of older people (HLE 65)

UK Parliament: healthy ageing

• Parliamentary Office for Science & Technology (POST) produced summary of concept, key issues for MPs, 2006

• Report of Lords Science & Technology Committee, 2005-6. “Ageing: Scientific aspects”

– Recommendations: longitudinal survey of disability, objective measurement (performance tests), more research

• Pensions Commission: “Challenges and Choices”, 2004– Extend retirement age to 70 in future– SES variation in HLE

LE and DFLE for men at age 65 in Great Britain, 1981-2002 (HSQ 19, HSQ 29)

0

2

4

6

8

10

12

14

16

18

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1997

1999

2001

2001

2002

DFLE LE

5.4

7.0

LE and DFLE for women at age 65 in Great Britain, 1981-2002 (HSQ 19, HSQ 29)

0

5

10

15

20

25

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1997

1999

2001

2001

2002

DFLE LE

8.4 8.8

Trends : HLE and DFLE (HSQ 19, HSQ 29)

• LE and HLE increased for both sexes between 1981 and 2001

• Male LE increased at a greater rate than female LE

• HLE has not increased as fast as LE, gap widened since early 1990s

• The gender difference in the number of expected years without disability has stayed the same

Comparisons between countries in UK 2001 (HSQ 29)

Key findings

• Health expectancy in the UK in 2002 was the consistently highest in England

• Life expectancy was lowest in Scotland. Health expectancy in Scotland was lower than England, but higher than in Wales and NI.

• For males, just over half the gains in life expectancy between 1981 and 2002 have been in good health or without a disability.

• For women, more than 80% of the gains in life expectancy were in good health, and 60% without a disability.

Males: LE and DFLE at birth by deprivation deciles, England, 1996-99 (HSQ 25)

63 62 61 61 60 58 57 55 54 51

14 15 15 15 16 17 17 18 1921

303540

45505560

65707580

1 2 3 4 5 6 7 8 9 10

Affluent <------Deprivation deciles ------>Deprived

Year

s of

life

LE-DFLE

DFLE

Females: LE and DFLE at birth by deprivation deciles, England, 1996-99 (HSQ 25)

65 63 64 62 61 59 59 58 57 55

17 18 17 19 19 21 21 21 22 24

303540455055606570758085

1 2 3 4 5 6 7 8 9 10

Affluent <------Deprivation deciles ------>Deprived

Year

s of

life

LE-DFLE

DFLE

ONS latest research: Trends in mild, moderate and severe disability-free life expectancy

• Mild DFLE based on self reported no limiting longstanding illness

• Moderate DFLE based on inability to perform Instrumental Activities of Daily Living (IADLs e.g. shopping, preparing meals and cleaning windows) without human assistance

• Severe DFLE based on inability to perform Activities of Daily Living (ADLs e.g. bathing, feeding and getting in and out of bed) without human assistance.

• NB: Findings of this research are tentative and must not be reported or circulated without authors permission

Overview of analysis

• Gender differences: overall difference by sex using 2001 estimates as example

• Trends between 1981 and 2001 (estimated using data for five time points - 1980, 1985, 1994, 1998, 2001).

Gender Differences at age 65 in years without disability. 2001, Great Britain (NB: findings not to be quoted or circulated without authors permission)

Years Men Women

Life Expectancy 15.9 19.0

Mild DFLE 9.2 10.6

Moderate DFLE 12.6 12.8

Severe DFLE 14.7 16.3

Trends (1a) _Males @65: Number of expected years in each health state. 1980-2001, GB (NB: findings not to be quoted or circulated without authors permission)

7.5 7.8 8.3 8.7 9.2

2.5 2.33.1

3.4 3.31.6 1.8

1.81.8

2.1

1.3 1.51.3

1.31.3

0

2

4

6

8

10

12

14

16

1980 1985 1994 1998 2001

Severedisability

Moderatedisability

Milddisability

Healthy

Trends (1b) _ Males @65: Proportion of expected life in each health state. 1980-2001, GB (NB: findings not to be quoted or circulated without authors permission)

58.1 58.2 57.2 57.2 57.9

19.4 17.2 21.4 22.4 20.8

12.4 13.4 12.4 11.8 13.2

10.1 11.2 9 8.6 8.2

0%

20%

40%

60%

80%

100%

1980 1985 1994 1998 2001

Severedisability

Moderatedisability

Milddisability

Healthy

Trends (2a) _Females @65: Number of expected years in each health state. 1980-2001, GB (NB: findings not to be quoted or circulated without authors permission)

8.4 9.1 9.9 9.6 10.6

3.1 2.3 1.9 2.42.2

2.9 3.6 3.6 3.83.6

2.5 2.22.8 2.7

2.7

0

2

4

6

8

10

12

14

16

18

20

1980 1985 1994 1998 2001

Severedisability

Moderatedisability

Milddisability

Healthy

Trends (2b) _ Females @65: Proportion of expected life in each health state. 1980-2001, GB (NB: findings not to be quoted or circulated without authors permission)

49.7 52.9 54.4 51.9 55.5

18.3 13.4 10.4 13 11.5

17.2 20.9 19.8 20.5 18.8

14.8 12.8 15.4 14.6 14.1

0%

20%

40%

60%

80%

100%

1980 1985 1994 1998 2001

Severedisability

Moderatedisability

Milddisability

Healthy

Preliminary conclusions: (NB: findings not to be quoted or circulated without authors permission)

• Gender Differences:– Men can expect to spend a larger proportion of their remaining life

free from disability compared to women.

– Men can also expect to spend a higher proportion of remaining life with a mild disability, whereas women spend more time with a moderate or severe disability

• Trends: are not the same for men and women. – The amount of time spent healthy for women has increased since

1980, supporting the theory of compression of morbidity

– For men, the magnitude of the change less marked: proportion of life with mild disability has increased and severe disability decreased, supporting the theory of dynamic equilibrium.

Limitations

• Uneven time points• Not enough time points to see a definite trend• Need to check consistency of finding with other survey

sources (e.g. Health Survey for England)• Response rate for the GHS is falling

• Assumptions had to be made about the health of those in long-stay care homes

• Severe disability definition fairly objective, but moderate/ mild disability definitions more likely to vary with social factors, cultural norms and environmental factors.

Future work plan ONS

• Understanding change in LE / HLE – Decomposition methods (eg. Arriga, Nusselder)

• Over time - by age, gender, cause

• Between groups/areas - by age, gender cause

– Pseudo-cohort analysis (GHS 1971 onwards)– Joint project with academics (UCL), industry (life insurance

provider), and ONS to look at contribution of determinants of increase in LE from 1970s (eg medical, lifestyle, socio-economic)

• Methodological developments– Review of self-assessed health measures– Multi-category response weights – eg. health-adjusted LE– Multi-state life tables (mortality-linked panel data)