Berlin, 12. November 2002Cornelia Lange

The EU structural indicatorHealthy Life Years – preliminary calculations for Germany

Cornelia Lange, Jutta Wirz, Thomas Ziese

Robert Koch Institute

Outline

Data sources in Germany appropriate to calculate HLYs; possibilities, limitations, and experiences

Problems concerning the translation/adaptation of the question on limitations (PH030)

Calculation of DFLE using Telephone Health Survey data

Conclusion

„Statistics on the causes of death“ in Germany

Specifics: Neither information about social status nor possibility of linkage to other datasources which contain this information (i.e. social statistics)

Variables: age, gender, commune of death; main cause of death, place of death (home / hospital); date of death; nationality (German / not German)

Life expectancy at birth in Germany

Data on Health(Health) Surveys on national level

Robert Koch Institute German National Health Interview and Examination Survey 1998

(HIS and HES)representative, age of respondents: 18-79, sample size: 7,124

Telephone Health Interview Surveys 2003, 2004, 2005, 2006 (HIS)representative, age of respondents: 18 plussample size: 5,000 - 8,000MEHM integrated

Deutsches Institut für Wirtschaftsforschung The German Socio-Economic Panel (annually)

representative, longitudinal study of private households, started in 1984, sample size: 12,000 housholds and 22,000 persons

Federal Statistical Office Microcensus (annually) : 1 % of households (370,000 househoulds, 820,000

persons). Every four years additional questions on health (1 % of households) From 2005 ongoing: EU-SILC (Survey on Income and Living Conditions)

Other datasources (1)

Nursing care statistics

2005 Deutschland

weiblich männlich

Pflegebedürftige absolut Pflegequote Pflegebedürftige absolut Pflegequote

Alle Altersgruppen 1,438 ,278 3.4 690 ,272 1.7

unter 75 Jahre 339,507 0.9 360 ,572 0.9

75 bis unter 85 Jahre 520,308 15.7 210,359 11 .1

85 bis unter 90 Jahre 269,199 39.7 64,542 26 .9

90 Jahre und älter 309,264 66.5 54,799 39 .2

Limitations: Underestimation of men needing nursing care Underestimation of young/middle-aged persons needing nursing care

HLY using Nursing Care Statistics

Bickel H (2001) Lebenserwartung und Pflegebedürftigkeit in Deutschland. Gesundheitswesen 63: 9-14

Other datasources (2)

Statistics of severely disabled persons with official certification (extentof disablity: over 50 %)

Limitation: Underestimation of women who are severely disabled

DFLE, Northrhine-Westfaliausing Statistics of severely disabled persons

Ref.: Arbeitsgemeinschaft der obersten Landesgesundheitsbehörden: Indikatorensatz für die Gesundheitsberichterstattung der Länder; Anhang 1: Statistische Methoden. 3. neu bearbeitete Fassung, Bielefeld 2003

Other publications

2005

Gärtner, K., Scholz, R. D. Lebenserwartung in Gesundheit [Healthy life expectancy] In: Gärtner, K., Grünheid, E., Luy, M., editors. Lebensstile, Lebensphasen, Lebensqualität: interdisziplinäre Analysen von Gesundheit und Sterblichkeit aus dem Lebenserwartungssurvey des BiB. Wiesbaden: VS Verlag für Sozialwissenschaften; 2005. p. 311-331. (Schriftenreihe des Bundesinstituts für Bevölkerungsforschung, n°36)

2002

Klein, T., Unger, R. Aktive Lebenserwartung in Deutschland und in den USA. KohortenbezogeneAnalysen auf Basis des Sozio-ökonomischen Panel [Active life expectancy in Germany and in the United States. A cohort analysis based on the "German Socio-Economic Panel" (GSOEP) and the "Panel Study of Income Dynamics" (PSID)]. Zeitschrift für Gerontologie und Geriatrie 2002;35(6):528-539

Dissemination of HLY on national level

Integration in National Health Report: Health in Germany (2006)

www.rki.de

PH030 – German translations

Verschiedene Fragenvarianten vorstellen;

Unterschiedliche Prävalenzen darstellen

policy makers are disappointed about the SILC results; low (decreasing) acceptability of the indicator HLY

SILC (1)

Fühlen Sie sich seit mindestens sechs Monaten infolge eines Gesundheitsproblems in den gewöhnlichen Tätigkeiten beeinträchtigt?

German version, Germany

German Version, Belgium

Sind Sie seit zumindest einem halben Jahr durch eine Behinderung oder eine sonstige gesundheitliche Beeinträchtigung bei der Verrichtung der alltäglichenArbeiten beeinträchtigt?

Austrian version

SILC (2)

For at least the last 6 month to what extent have you been limited because of a health problem in activitiespeople usually do? Would you say you have been: Severely limited/ limited but not severely/ not limited?

English version

English GermanFor at least 6 month ß Seit mindestens sechs Monaten

ß Seit zumindest einem halben J ahrß In den letzten sechs Monaten

(„within the last 6 month“)Health problem ß Gesundheitsproblem

ß Gesundheitliche Gründeß Behinderung („disability, handicap“)ß Beeinträchtigung („impairment“)

Activities, people usually do ß Tägliche Aktivitäten („activities of dailylife“)

ß Gewöhnliche Tätigkeitenß Verrichtung der alltäglichen Arbeit

(„performance of daily work“)

Telephone Health Surveys (GSTel03)

2003: Waren Sie in den letzten 6 Monaten oder länger bei Dingen, die man üblicherweise so tut, aus gesundheitlichen Gründen eingeschränkt? (Ja, stark eingeschränkt; ja, eingeschränkt;

nein, nicht eingeschränkt)

Ja, stark eingeschränkt

Ja, eingeschränkt

Nein, nicht eingeschränkt

Männer Gesamt 9.0 23.1 67.8 18-24 5.0 19.1 75.5 25-49 6.7 18.7 74.5 50-64 11.8 26.4 61.9 >= 65 13.8 33.2 52.4 Frauen Gesamt 9.6 26.3 64.0 18-24 3.7 20.0 76.2 25-49 6.9 20.6 72.4 50-64 10.8 29.2 59.8 >= 65 15.7 36.1 48.1

Telephone Health Surveys (GSTel05)

2005: In welchem Ausmaß sind Sie durch Krankheit in der Ausübung Ihrer alltäglichen Tätigkeiten dauerhaft eingeschränkt? Wir meinen damit seit mindestens einem halben Jahr. (Erheblich eingeschränkt; eingeschränkt aber nicht erheblich; nicht eingeschränkt)

Erheblich eingeschränkt

Eingeschränkt, aber nicht erheblich

Nein, nicht eingeschränkt

Männer Gesamt 8.7 16.5 74.4 18-24 2.7 10.4 86.3 25-49 3.2 11.7 85.0 50-64 12.0 18.1 69.0 >= 65 21.8 29.8 47.8 Frauen Gesamt 9.7 20.6 69.4 18-24 0 13.0 87.0 25-49 5.0 12.6 81.8 50-64 11.7 23.4 64.7 >= 65 19.3 34.3 46.4

Limitations, women

9,6

26,3

64

9,7

20,6

69,4

0

10

20

30

40

50

60

70

80

stark/erheblicheingeschränkt

eingeschränkt nicht eingeschränkt

Percent

GSTel03

GSTel05

Limitations, men

9

23,1

67,8

8,7

16,5

74,4

0

10

20

30

40

50

60

70

80

stark/erheblicheingeschränkt

eingeschränkt nicht eingeschränkt

Percent

GSTel03

GSTel05

Calculation DFLE (GSTel03 and GSTel05) (severe and moderate limitation)

0

10

20

30

40

50

60

70

80

90

100

GSTel03 (w) GSTel05 (w) Eurostat 2003(w)

GSTel03 (m) GSTel05 (m) Eurostat 2003(m)

Years 68,6 % 73,4% 71,6 % 80,0%

Women Men

,

79,6 % 86,1%

Sullivan Method

Lifetable 2002-2004

Calculation DFLE (GSTel03 and GSTel05) (severe limitation)

0

10

20

30

40

50

60

70

80

90

100

GSTel03 (w) GSTel05 (w) Eurostat 2003(w)

GSTel03 (m) GSTel05 (m) Eurostat 2003(m)

Years

Women Men

79,6 %91,6 % 92,3 % 92,7 % 92,5 % 86,1 %

Sullivan Method

Lifetable 2002-2004

Prevalences of disability

Datasource Age group Prevalence of disability / severe limitation

Men Women Microzensus 2005 (disabled)

All agegroups

11.5 % 9.5 %

German SILC 2005 (MEHM) 16 plus 7.9 % 8.8 % Statistics of severely disabled persons with official certification 2005

All agegroups

8.7 % 7.7 %

German Socio-Economic Panel 2005 (severly disabled)

18 plus 11.3 % 9.0 %

Austria: SILC 2004 (MEHM) 16 plus 8.4 % 8.9 % GSTel 03 (MEHM) 18 plus 9.0 % 9.6 % GSTel04 (MEHM) 18 plus 7.5 % 9.2 % GSTel05 (MEHM) 18 plus 8.7 % 9.7 %

Suggestion for calculation HLY

HLY should be depicted in two ways:

(1) Years lived in good health versus years lived with limitations (severe and not severe limitations). This is the usual manner to depict the indicator.

(2) Years lived in good or moderate health versus years lived with severe limitations. This approach seems to produce results more comparable between the Member States. Presumably the underlying concept of severe limitation is more consistent and more robust against different translations or cultural adaptations.

Preliminary calculations – time trends

Data sources:

Health Interview Surveys (CATI) carried out by the Robert Koch Institute

GSTel03 (2002-2003)

GSTel04 (2003-2004)

GSTel05 (2004-2005)

GSTel06 (2005-2006)

Life tables from the Federal Statistical Office Germany

2000-2002

2001-2003

2002-2004

2003-2005

Methods

Calculation of Health expectancies by Sullivan‘s method

Self-rated health

Q: Wie ist ihr Gesundheitszustand im Allgemeinen? [How is your state of health in general?] Ist er sehr gut, gut, mittelmäßig, schlecht oder sehr schlecht? [Is it very good, good, fair, bad or very bad].

Very good + good good health

fair + bad + very bad bad health

Life expectancy men

Life expectancy in good health - Men

0

10

20

30

40

50

60

70

0 4 8 12 16 20 24 28 32 36 40 44 48 52 56 60 64 68 72 76 80 84 88 92 96 100Age

Years

Lifetable 2000-2002 - GSTel03 LIfetable 2001-2003 - GSTel04

Lifetable 2002-2004 - GSTel05 Lifetable 2003-2005 - GSTel06

Life expectancy women

Life expectancy in good health - Women

0

10

20

30

40

50

60

70

0 4 8 12 16 20 24 28 32 36 40 44 48 52 56 60 64 68 72 76 80 84 88 92 96 100Age

Years

Lifetable 2000-2002 - GSTel03 Lifetable 2001-2003 - GSTel04

Lifetable 2002-2004 - GSTel05 Lifetable 2003-2005 - GSTel06

Trends in life expectancy and life time, men

0,00

10,00

20,00

30,00

40,00

50,00

60,00

70,00

2002-2003 2003-2004 2004-2005 2005-2006

Lifetime (years)

73.9 % 73.7 % 74.0 % 77.7 %

18-year-old men

Self-rated good health Self-rated bad health

Trends in life expectancy and life time, women

0,00

10,00

20,00

30,00

40,00

50,00

60,00

70,00

2002-2003 2003-2004 2004-2005 2005-2006

Lifetime (years)

67.8 % 69.3 % 69.6 % 72.9 %

18-year-old women

Self-rated good health Self-rated bad health

Are we living longer, healthier lives?

Major question: Will increases in life expectancy be associated with a greater or lesser proportion of the future population spending their years living with disability?

Compression of morbidity Expansion of morbidity Dynamic equilibrium (status quo)

Conclusion (1)

Men 1995 1996 1997 1998 1999 2000 2001 2002 2003

LE 73.3 73.6 74.0 74.5 74.7 75.0 75.6 75.4 75.5

DFLE 60.0 60.8 61.9 62.1 62.3 63.2 64.1 64.4 65.0

%DFLE/LE 81.8 82.6 83.7 83.4 83.4 84.3 84.8 85.5 86.1

Dynamic equilibrium – expansion of morbidity

Compression of morbidity

Women 1995 1996 1997 1998 1999 2000 2001 2002 2003

LE 79.7 79.9 80.3 80.6 80.7 81.0 81.3 81.2 81.3

DFLE 64.3 64.5 64.3 64.3 64.3 64.6 64.5 64.5 64.7

%DFLE/LE 80.6 80.7 80.0 79.8 79.6 79.8 79.3 79.5 79.6

Calculations Eurostat/EHEMU; download 1.6.2007

Conclusion (2)

Men 2002 -2003 2003 -2004 2004 -2005 2005 -2006

LE 75,38 75,59 75,89 76,21

DFLE 59,60 59,77 59,97 62,60

%DFLE/LE 79.1 79.1 79.0 82.1

Women 2002 -2003 2003 -2004 2004 -2005 2005 -2006

LE 81,22 81,34 81,55 81,78

DFLE 59,87 60,86 61,19 63,62

%DFLE/LE 73.7 74.8 75.0 77.8

Compression of morbidity

Dynamic equilibrium – compression of morbidity

Calculations RKI (life expectancy in good health)

Results somewhat controversial to calculations using GSOEP Data

Conclusion (3)

Use of HLY indicator not very common in Germany

Cooperation between Demography, Public Health and other research

disciplines should be improved

Problems referring to the translation / cultural adaptation of PH030 not

yet been solved

Suggestion to calculate HLY without strong / severe limation

Also PH010 or index of PH010-PH030 should be used for calculation

of time trends