Trends in health expectancies in Europe: Link to the ... Van Oyen.pdf · Health expectancy...

Trends in health expectancies in Europe:

Link to the retirement age

La Pénibilité au Travail: une Notion Centrale en Prévention 12/5/2017

Prof Dr H. Van Oyen

Increase in life expectancy

Source: Christensen, Doblhammer, Rau, and Vaupel,

Lancet, Vol. 374, 2009

Trends in life expectancy at birth 1840-2007 Demographic transition

Epidemiologic transition Second important shifts in the patterning of ageing and dying

Epidemiologic transition : Shift in mortality pattern: infectious => man-made diseases

Source: Christensen, Doblhammer, Rau, and Vaupel, Lancet, Vol. 374, 2009

Trends in life expectancy at birth: Age S50 by birthcohort

Source: Stat Belgium

Trends in life expectancy at birth, Belgium

Trends in life expectancy at ages 50 and 65, Belgium

10

15

20

25

30

35

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

M_50

M_65

F_50

F_65

+3.74

+2.28

+2.13

+3.21

Source: Christensen, Doblhammer, Rau, and Vaupel, Lancet, Vol. 374, 2009

Trends in life expectancy at birth: mortality rate at older ages

Source: Christensen, Doblhammer, Rau, and Vaupel, Lancet, Vol. 374, 2009

Trends in life expectancy at birth: age specific contribution

Trends in life expectancy at age 65

Men Women

Ageing of populations: demographic and epidemiologic transitions

• Long live • Low fertility • Low immigration • Shift in morbidity and mortality pattern KEY QUESTIONS:

1. Are the increases in LE accompanied by concurrent postponement of ill-health morbidity disability : functional limitations participation restrictions 2. Link retirement age with increasing longevity

Retirement age and increasing duration of live

SUMMARY MEASURE OF POPULATION HEALTH HEALTH EXPECTANCY

14

SUMMARY MEASURE OF POPULATION HEALTH

Combines information on • mortality and • non-fatal health outcomes to represent the health of a population into a single index Types: • Quality adjusted Life Years (QALY): medical intervention • Disability adjusted Life Years (DALY): health gap • Health expectancy (HE)

In 1989…

• REVES: The International network on health expectancies and the disablement process

• One of its main objectives was (and is still) to monitor change over time in population health, and especially to monitor the compression of morbidity/disability hypothesis

1980’s Health theories

• The compression of morbidity: According to Fries, life expectancy was close to its maximum in the 1980s. Medical and especially health behaviors progress will reduce the number of bad years to a small part of the life expectancy (Fries, 1980).

• The expansion of morbidity: On the opposite side, according

to Gruenberg and Kramer, the same medical progress will increase the survival of frail elderly people such as those with dementia (Gruenberg, 1977; Kramer, 1980).

• The dynamic equilibrium: Between these two extreme

futures, Manton proposed a dynamic equilibrium in which increased survival is offset by better control of chronic diseases, keeping the proportion of life lived in good health more or less constant (Manton, 1982).

18

Model of health transitions

Compression of morbidity: the number of years lived increases slower than the number of healthy years lives (Fries)

Expansion of morbidity: the number of years lived increases more than the number of healthy years lives (Gruenberg: Failure of success)

Dynamic equilibrium: there is more ill-health, but the severity levels are going down

Sullivan, 1971 Sullivan D.F. A single index of mortality and morbidity. Health Services Reports 1971;86:347-354. • Prevalence based Multistate life tables • Incidence based: transitions probabilities

between health states.

20

Health expectancy indicators

Divide life expectancy into life spent in different states of health, from say good to bad health (different levels of severity). It is at age x, the average number of years persons live in a health state Add a dimension of quality to the quantity of life lived. It is related to the initial WHO-Europe target (1980-1990ties) « add health to life » WHO-Health21 targets:

healthy ageing as reflected in increases in life expectancy, disability-free life expectancy, and the proportion of older people who are healthy and at home

Are health expectancies increasing faster than total life expectancy?

The Minimal European Health Module (MEHM)

3 concepts:

• Self perceived health

• Long standing or chronic health problems

• Functional health / disability

3 global questions >>> The world smallest health survey

In EU-SILC since 2004/2005

23

Minimal European Health module To measure health expectancies accross Europe:

General Perceived Health : Self assessed health (SAH): How is your health in general? Is it… very good/ good / fair/ bad/ very bad

0

5

10

15

20

25

30

verybad

bad fair good verygood

verybad

bad fair good verygood

verybad

bad fair good verygood

verybad

bad fair good verygood

verybad

bad fair good verygood

no formal education primary lower secundary higher secundary tertiary

Relative Risk for mortality by highest educational level and SAH in men 60-79, 2001 Census Belgium with mortality follow-up

No formal educ Tertiary educ Primary educ Lower sec educ Higher sec educ

Deboosere P, Neels K, Van Oyen H

0

10

20

30

40

50

60

very good

Relative Risk for mortality by highest educational level and SAH men 25-39

0

20

40

60

80

100

120

very good

Relative Risk for mortality by highest educational level and SAH women 25-39

0

5

10

15

20

25

30

35

very good

Relative Risk for mortality by highest educational level and SAH men 40-59

0

10

20

30

40

50

60

70

very good

Relative Risk for mortality by highest educational level and SAH women 40-59

0

5

10

15

20

25

30

very good

Relative Risk for mortality by highest educational level and SAH men 60-79

0

5

10

15

20

25

30

very good

Relative Risk for mortality by highest educational level and SAH women 60-79

0

1

2

3

4

5

6

7

8

9

10

very good

Relative Risk for mortality by highest educational level and SAH men 80-99

0

1

2

3

4

5

6

7

8

9

10

very good

Relative Risk for mortality by highest educational level and SAH women 80-99

26

Minimal European Health module To measure health expectancies accross Europe:

General Perceived Health : Self assessed health (SAH): How is your health in general? Is it… very good/ good / fair/ bad/ very bad

Chronic Health Problems

Do you have any longstanding illness or longstanding health problem? [longstanding = which have lasted, or are expected to last, for 6 months or more]. Yes / No

Functional health / disability

Macular degeneration

Alteration of central vision

Difficulty to see details

Cannot not drive

Need help for daily shopping Do not go and visit

friend

Iimpairment Disease Disability Disadvantage

Environmental factors and individual resources(physical, intellectual, social, behavioral…)Environmental factors and individual resources(physical, intellectual, social, behavioral…)

The disablement process (Wood, 1975, WHO, 1980, Verbrugge et al., 1994)

Disability in ICF: function (disability) & participation (disadvantage)

Functional Limitations

Sensory, physical, cognitive

Activity restrictions

Disability

Potentially disabling diseases

Impairments

Operationalization of the model in surveys?

Nagi, OECD questions

and the 4 Q of the UN

Washington group short set

ADLs, IADLs, setting (work,

…) Single Global

measure: GALI

List of main diseases or general question on chronic morbidity

29

Minimal European Health module To measure health expectancies accross Europe:

General Perceived Health : Self assessed health (SAH): How is your health in general? Is it… very good/ good / fair/ bad/ very bad

Chronic Health Problems

Do you have any longstanding illness or longstanding health problem? [longstanding = which have lasted, or are expected to last, for 6 months or more]. Yes / No

Functional heath / disability : Global Activity Limitation (GALI)

For at least the past 6 months, to what extent have you been limited because of a health problem in activities people usually do? Would you say you have been … severely limited/ limited but not severely/ not limited at all

Prevalence of participation restriction (GALI), 2012-2014

SILC mean 2012-2014

GALI & Health care expenditure (FUP :12 mths)

HIS 2008, BELGIUM Van der Heyden, BMC Public Health, 2015, 15:267

GALI and mortality (FUP :10 years), HIS 2001

Berger, Archives if Public Health, 2015, 73:25

Health expectancies in Europe

•Life expectancy in good perceived health

How is your health in general? Is it… Very good + Good •Life expectancy without chronic disease

Do you have any chronic illness or condition? No

•Life expectancy without activity limitation: healthy life years (HLY) For at least the past 6 months, to what extent have you been limited

because of a health problem in activities people usually do? Not limited at all

Health Expectancies at age 65 in BELGIUM 2014

http://www.eurohex.eu/index.php?option=countryreports

HLY at age 50 in EU Member States

Jagger C. Lancet 2008; 372: 2124–31

Policy needs on Healthy Life Years (HLY) and Global Activity Limitation Indicator (GALI) in the EU

Policy needs HLY/ GALI in Europe

• Overall strategic policies

• Lisbon strategy (2000-2010): development plan for the economy of the European Union.

Under the strategy, a stronger economy would create employment in the EU, alongside inclusive social and environmental policies, which would themselves drive economic growth even further

• HLY: structural indicator at age 50 years to be measured every year

Policy needs HLY/ GALI in Europe

• Overall strategic policies

• Europe 2020 – Innovation Union • Active and Healthy Ageing through innovation

Target: increase the HLY at birth on EU average by 2 years by 2020

See: Lagiewka K. European Innovation Partnership on Active and Healthy Ageing: what have been the policy drivers and determinants to set a headline target of 2 additional Healthy Life Years at birth at EU average by 2020? Arch Public Health 2012;70:23. Jagger C, et al. Mind the gap-reaching the European target of a 2-year increase in healthy life years in the next decade. Eur J Publ Health 2013 Mar 13;23(5):829-33.

Policy needs HLY/ GALI in Europe

• Overall strategic policies European Pillar of Social Rights (April 26/2017) • => towards better working and living conditions in Europe

• Equal opportunities and access to labour market • Fair working conditions • Social protection and inclusion

• HLY at age 65 is one of the indicators

See: http://europa.eu/rapid/press-release_IP-17-1007_en.htm https://ec.europa.eu/commission/priorities/deeper-and-fairer-economic-and-monetary-union/european-pillar-social-rights_en https://composite-indicators.jrc.ec.europa.eu/social-scoreboard/ http://ec.europa.eu/eurostat/web/european-pillar-of-social-rights/indicators/main-tables

Policy needs HLY/ GALI in Europe HLY/GALI in other policies / policy documents • Social protection:

• HLY by social position • HLY for evaluation of investment in health systems • GALI into Labour Force survey: NUTS2 LEVEL

• Justice:

• Right of people with disability

• Finance: • Evaluation of future health care cost

Monitoring HLY changes over time

Compression of disability?

SILC, Eurostat; www.eurohex.eu

HLY at age 65

Expansion of disability?

SILC, Eurostat; www.eurohex.eu

HLY at age 65

Dynamic equilibrium?

SILC, Eurostat; www.eurohex.eu

HLY at age 65

LE and HLY at age 50,Belgium, 2001-2013

LE : STAT-Belgium, GALI: HIS WIV-ISP

MEN FEMALES

Proportion of remaining life with or without participation restrictions at age 50, Belgium, 2001-2013

LE : STAT-Belgium, GALI: HIS WIV-ISP

MEN FEMALES

LE and HLY at age 65,Belgium, 2001-2013

LE : STAT-Belgium, GALI: HIS WIV-ISP

MEN FEMALES

Proportion of remaining life with or without participation restrictions at age 65, Belgium, 2001-2013

LE : STAT-Belgium, GALI: HIS WIV-ISP

MEN FEMALES

HIS, 1997-2013

Trend in HLY at age 50, HIS2001-2013

AGE GENDER region LE HLY ULE ULY_M ULY 50 MALE FL 2.1 2.5 -0.4 -0.3 -0.1

BR 2.0 1.2 0.8 0.8 0.0

WAL 1.8 2.2 -0.4 -0.3 -0.1

BELGIUM 2.1 2.3 -0.2 -0.2 0.0

FEMALE FL 1.2 2.3 -1.1 -1.1 0.0

BR 1.1 0.7 0.3 1.5 -1.2

WAL 1.2 2.6 -1.4 -0.7 -0.7

BELGIUM 1.2 2.3 -1.1 -0.8 -0.3

Trend in HLY at age 65 among males in selected EU countries, SILC 2004-2014

Trend in %HLY at age 65 among males in selected EU countries, SILC 2005-2014

Trend in HLY at age 65 among females in selected EU countries, SILC 2004-2014

Trend in %HLY at age 65 among females in selected EU countries, SILC 2005-2014

Health expectancy and inequity in Belgium

Life expectancy, Healthy Life Years by educational attainment at age 50

SILC 2004, 5 years follow-up

MEN FEMALES

HLY at age 50 by occupation in men, France, 2003

Without activity limitation (HLY) With activity limitation

Men at age 50

Cambois E; Demographic Research, 25: 407-436, 2011

Occ

upat

ion

25.8

23.7

23.7

23.7

21.7

19.7

5.6

6.4

6.9

7.2

6.5

6.9

7.7

14.6

0 5 10 15 20 25 30 35

Expected years

Inactive

Clerks

Self-empl.

Farmers

Manual Wk.

Interm occup.

High. Qualif.

HLY at age 50 by occupation in women, France, 2003

Without activity limitation (HLY) With activity limitation

Women at age 50

Cambois E; Demographic Research, 25: 407-436, 2011

Occ

upat

ion

27.4

24.8

23.6

24.3

24.5

22.5

21.6

8.7

10.3

11.6

11.0

10.3

11.5

10.8

0 5 10 15 20 25 30 35 40

Expected years

Inactive

Clerks

Self-empl.

Farmers

Manual Wk.

Interm occup.

High. Qualif.

Conclusion

Ageing of populations • Increasing life expectancy asks for composite

measures such health expectancy: • Need to combine health/ill-health and mortality

• In Belgium there is some evidence for compression

• There is a substantial (and not decreasing) inequity

• Discussion on retirement age cannot be done only

using mortality/ life expectancy information