HEALTH EXPECTANCIES IN SPAIN

(1986-2002)

Juan L. Gutiérrez Fisac

Instituto de Información SanitariaMinisterio de Sanidad y ConsumoSpain

• First calculations: DFLE, at the begninig of the 90’

• Survey on disability, impairments and handicaps (National Institute of Statistics, 1986)

• Results were pubished at both:

• Institutional report (Health Indicators)

• Medical journal (Medicina Clinica)

HEALTH EXPECTANCIES IN SPAIN

Range (Higher-lower) = 3.2 5.8 7.7 3.8 5.6 5.9 3.2 15.1 16.1

Linear regression models of DFLE (*) at birth and at 65 years of age.

SE Standardized p R2

DFLE at birth

Education -0.038 0.015 -0.373 0.011 0.415

Unemployment rate

-0.113 0.053 -0.310 0.039

Smoking -0.178 0.096 -0.243 0.070

DFLE at 65

Education -0.035 0.010 -0.457 0.001 0.280

Smoking -0.206 0.069 -0.375 0.005

Gutiérrez-Fisac JL, Gispert R, Solá J. Factors explaining the geographical differences in Disability Free Life Expectancy in Spain. J Epidemiol Community Health 2000; 54:451-455.

• In 1999, The National Institute of Statistics carried out a second disability survey, but unfortunately the definition of disability was different than in the 1986 survey, and we can not study trends in DFLE.

• We started to calculate Life Expectancy in good perceived health, information available in the National health interview surveys carried out periodically in Spain since the end of the 80’s

LIFE EXPECTANCY IN GOOD PERCEIVED HEALTH

Life tables: National Institute of Statistics

Self perceived health: National Health Interview Survey

Very good, good

vs

fair, bad, very bad

52,6 53,9 54,6 55,1

24,623,32323,8

30

50

70

90

1986 1991 1995 2002

76.976.4

77.9 79.7

Life expectancy (LE), life expectancy in good perceived health (LEGH) and number of years lived in bad health (YBH) at birth in Spain, 1986-2002

LEGH YBH

54 54,5 54,7 56,3

18,8 19,6 2019,2

30

50

70

90

1986 1991 1995 2002

51,4 53,3 54,6 53,6

28,3 27,2 27 29,1

30

50

70

90

1986 1991 1995 2002

Men Women

73.2 73.3 74.3 76.3

Life expectancy (LE), life expectancy in good perceived health (LEGH) and number of years lived in bad health (YBH) at birth in men and women in Spain, 1986-2002

81.680.579.683.0

LEGH YBH

69,1370,0970,09

68,82

73,7973,6274,3573,77

64,5766,21 66,91

64,94

55

75

1986 1991 1995 2002

Total Men Women

Percentage of years lived in good perceived health at birth. Spain, 1986-2002.

Absolute and relative change in LE and LE in good perceived health (LEGH) at birth in men and women.

Spain, 1986-2002.

1986 - 2002 1995 - 2002

Absolute change

Relative change (%)

Absolute change

Relative change (%)

TOTALLE

LEGH3.3

2.5

4.3

4.8

1.8

0.5

2.3

0.9

MENLE

LEGH3.1

2.3

4.2

4.3

2.0

1.6

2.7

2.9

WOMENLE

LEGH3.4

2.5

4.3

4.9

1.4

-0.7

1.7

-1.3

Absolute change = Difference (2002 – 1986; 2002 – 1995).

Relative change = Ratio (in %) (2002/1986; 2002/1995)

6,4 6,9 7,5 7,4

8,5 8,6 9,58,6

0

10

20

30

1986 1991 1995 2002

5,8 7,1 7,8 6,6

12,6 12,1 12,2 14,2

0

10

20

30

1986 1991 1995 2002

Men Women

15 15.416.1

16.9

Life expectancy (LE), life expectancy in good perceived health (LEGH) and numbers of years lived in bad health (YBH) at 65 years in men and women in Spain, 1986-2002

20.019.218.4

20.8

LEGH YBH

LIFE EXPECTANCY IN GOOD PERCEIVED HEALTH AT BIRTH IN 2002

PERCENTAGE OF YEARS LIVED IN GOOD PERCEIVED HEALTH AT BIRTH IN 2002

< 51 51.0 – 51.6 51.7 – 55.6 55.7 – 59.5 > 59.5

(Range = 15 years)

< 62.7 62.7 – 65.5 65.6 – 69.6 69.7 – 74.3 > 74.3

(Range = 17 %)

Educational differences in LEGH

• Number of deaths of people older than 24 years by sex, age and educational level in 1993: council deaths registers of Madrid and Barcelona

• Population Census Data 1991

• Self-perceived health status from the National Health Interview Survey 1993

• Educational level:– Lower: Up to 11 years of school

– Higher: 12 and more years of school

Life expectancy and life expectancy in good perceived health at 25 years of age by educational level in men and women in Madrid

and Barcelona, 1993.

LIFE EXPECTANCY LIFE EXPECTANCY IN GOOD PERCEIVED HEALTH

Educational level Educational level

Lower Higher Difference Higher-lower

Lower Higher Difference Higher-lower

Madrid

Men

Women

49.0

59.7

52.7

62.3

3.7

2.6

31.6

31.9

39.1

37.5

7.5

5.6

Barcelona

Men

Women

51.2

61.7

53.6

62.2

2.4

0.5

33.3

34.2

42.8

47.5

9.5

13.4

Martinez-Sanchez et al. Educational differences in health expectancy in Madrid and barcelona. Health Policy 2001; 55: 227-231.

17,4 17,9

27,8 27,5

14,6

24,8

13,6

10,7

0

10

20

30

40

Madrid Barcelona Madrid Barcelona

Life expectancy in bad health at 25 years old by educational level in Madrid and Barcelona.

Lower education Higher education

Men

Women

Life expectancy and life expectancy in good perceived health at 65 years of age by educational level in men and women in Madrid

and Barcelona, 1993.

LIFE EXPECTANCY LIFE EXPECTANCY IN GOOD PERCEIVED HEALTH

Educational level Educational level

Lower Higher Difference Higher-lower

Lower Higher Difference Higher-lower

Madrid

Men

Women

16.3

22.7

17.4

24.6

1.2

1.9

5.9

9.5

9.4

12.5

3.6

3.0

Barcelona

Men

Women

17.8

24.1

18.0

24.6

0.1

0.5

8.4

10.3

11.1

16.8

2.7

6.5

Martinez-Sanchez et al. Educational differences in health expectancy in Madrid and barcelona. Health Policy 2001; 55: 227-231.

CONCLUSIONS

• Time trends

– LE and LEGH at birth and at 65 years of age have been increasing since 1986 both in men and women. But a decreased in LEGH has been observed in women for the 1995-2002 period.

• Gender differences

– The percentage of years lived in good perceived health at birth is higher in men than in women. Moreover, while in men this percentage has remained stable from 1986, in women it has decreased in the last years.

CONCLUSIONS

• Geographical differences

– There are geographical differences in LEGH in Spain, with a North-South and East-West gradient that might be explained mainly by socioeconomic factors

• Social differences

– Differences by education are greater in LEGH than in LE