Unit of EPIDEMIOLOGY SCIENTIFIC INSTITUTE OF PUBLIC HEALTH HEALTH EXPECTANCY INDICATORS IN BELGIUM 4th Meeting of the Task Force on Health Expectancies

Unit of EPIDEMIOLOGY

SCIENTIFIC INSTITUTE OF PUBLIC HEALTH

HEALTH EXPECTANCY INDICATORS IN

BELGIUM

4th Meeting of the Task Force on Health Expectancies

Luxembourg, 4th June 2007

Herman Van Oyen

TF Health Expectancies, 06/2006 2

FIRST ESTIMATIONS

Belgian Science Policy Office (Dec 1991)Project: Disability-free life expectancy in the elderly. A method for well-being planning and decision-making

•Data availability? Only small/local studiesEurobarometer

•Indicators: Healthy life expectancy• Disability free Life expectancy• Dementia free life expectancy


Healthy life years, Eurobarometer, 1989-1990

Van Oyen H. et al. Tijdschrift Geneeskunde, 49:1169, 1993


Dementia free life expectancy, 1991Epidemiologic research on dementia, Antwerp, Belgium

Roelands M. et al. Eur J Pub Hlth 4: 33, 1994

0

2

4

6

8

10

12

14

16

18

65 70 75 80 85 65 70 75 80 85

LE

DemFLE

DemLE

AGE

FEMALESMALES


Healthy life years, Eurobarometer, 1989-1990Regional differences

Van Oyen H. et al. Soc Sci Med 43:1673, 1996

Age Flemish HLE

Walloon HLE

Difference in HLE

Z-score difference

Males 15 56.5

(55.5-57.6) 50.2

(48.4-51.9) 6.3 5.95

45 29.3 (28.8-30.2)

23.4 (21.6-25.1)

5.9 5.83

65 13.31 (12.2-14.4)

9.2 (7.4-11.0)

4.1 3.86

Females 15 61.3

(59.8-62.8) 58.1

(56.1-60.0) 3.2 2.56

45 33.3 (31.8-34.7)

30.7 (28.9-32.6)

2.6 2.12

65 16.0 (14.5-17.6)

14.3 (12.4-16.2)

1.7 1.44


CONCLUSION

Monitoring system

•Cross-sectional data series: Health survey 97-01-04-08Census 2001

•Longitudinal data : still no data


Mortality: 97, 01, 04

Life table: last interval 100-105 years

Health: Health Interview Survey 97, 01, 04

Face to Face

N: 10,000 – 13,000 each survey

Response rate: 60%

DATA


Screening: chronic morbidity

Do you suffer from one or more longstanding diseases, chronic conditions or handicaps?

YES — NO

HEALTH QUESTIONS DISABILITY


Are you restricted in your daily activities due to this (these) illness(es), chronic condition(s) or handicap(s)?

continuously severe disability

every now and then moderate disability

seldom or not / no disabilityno chronic disease

HEALTH QUESTIONS DISABILITY


Total Life Expectancy, Disability Free Life Expectancy and Life Expectancy with Disability at age 65, Belgium, 1997-2004

MALES Total Life Expectancy 15.53 16.24 16.79 DFLE 9.00 9.69 10.96 With Disability 6.53 6.55 5.83 Moderate 2.69 2.33 2.25 Severe 3.84 4.22 3.58 FEMALES Total Life Expectancy 19.80 20.23 20.66 DFLE 11.70 11.07 12.71 With Disability 8.10 9.16 7.95 Moderate 2.60 3.14 2.62 Severe 5.50 6.02 5.33


Disability free life expectancy (DFLE) and life expectancy with moderate (MDLE) and severe (SDLE) disability as % of the total life expectancy at age 65, 1997-2004, Belgium

MALES FEMALES 1997 2001 2004 1997 2001 2004 DFLE 58 60 65 59 55 62 DLE 42 40 35 41 45 38 MDLE 17 14 13 13 15 13 SDLE 25 26 22 28 30 25


Change in total life expectancy (LE), disability free LE (DFLE) and LE with moderate (MDLE) and severe (SDLE) disability at ages 65 and 80 by gender, 1997-2004, Belgium

-1.00

-0.50

0.00

0.50

1.00

1.50

2.00

2.50

LE

DFLE

MDLE

SDLE

Males Females

80 65 8065


SUMMARY-TRENDHIS 1997-2004


SES-INEQUALITIESFollow-up census for mortality (1991-1996)Health survey (1997)

0.00

10.00

20.00

30.00

40.00

50.00

LOWHIGH

Partial LE and DFLE between ages 25-74 by relative level of education, Belgim 1991-1996/1997

M_LEF_LE

M_DFLEF_DFLE

Bossuyt N. et al. Public Health 118:3, 2004


DIFFERENTIAL INEQUALITY IN DFLE BY REGION between ages 25-74

VAN OYEN H. et al. Soz-Präventivmed 50:301, 2005

Flemish Region Walloon Region

Level of Education LE Inequity in LE

LE Inequity in LE

Difference in inequity

in LE between the Regions

Men Bottom 44.86

(44.84 – 44.89) 1.62

(1.57 - 1.66) 42.77

(42.73 – 42.80) 2.15

(2.09 - 2.21) 0.53

(0.43 – 0.64) Top

46.48 (46.46 – 46.50)

44.92 (44.89 - 44.94)

All 45.77 (45.75 – 45.79)

43.88 (43.86 – 43.91)

Women Bottom 46.86

(46.84 – 46.88) 1.04

(1.01 – 1.07) 45.44

(45.42 - 45.46) 1.46

(1.41 - 1.50) 0.42

(0.34 – 0.49) Top

47.90 (47.89 – 47.91)

46.90 (46.88 - 46.91)

All 47.42 (47.41 – 47.43)

46.16 (46.15 – 46.18)


DECOMPOSITION OF SES-DIFFERENCES IN DFLE

NUSSELDER W. et al. AJPH:95, 2035, 2005

LE-30 (years) LED-30 (years) DFLE-30 (years) Total Total Mortality Disability Total Men 3.6 -4.4 1.5 6.5 8.0 Cancer 1.0 0.3 0.4 0.2 0.6 Heart disease/stroke 0.9 -0.6 0.4 1.2 1.5 Asthma/COPD 0.5 -0.6 0.2 1.0 1.2 Diabetes mellitus 0.1 0.3 0.0 -0.3 -0.2 Back complaints 0.0 -2.1 0.0 2.1 2.1 Arthritis 0.0 -1.3 0.0 1.3 1.3 Other diseases 1.1 -1.3 0.5 1.9 2.4 Background 0.0 0.9 0.0 -0.9 -0.9 Women 2.6 -3.3 0.6 5.3 5.9 Cancer 0.3 -0.2 0.1 0.4 0.5 Heart disease/stroke 1.2 -0.4 0.2 1.4 1.6 Asthma/COPD 0.2 -1.3 0.0 1.5 1.5 Diabetes mellitus 0.1 -0.6 0.0 0.7 0.7 Back complaints 0.0 0.2 0.0 -0.2 -0.2 Arthritis 0.0 -2.2 0.0 2.2 2.2 Other diseases 0.8 0.4 0.2 0.2 0.3 Background 0.0 0.8 0.0 -0.8 -0.8


HEALTH EXPECTANCIES BASED ON CENSUS DATA (among males)

0 20 40 60 80

Vlaams BrabantAntwerpen

LimburgWest-Vlaanderen Brabant WalloonOost-Vlaanderen

BrusselsLiège

LuxembourgNamur

Hainaut



BrusselsLiège

LuxembourgNamur

Hainaut



BrusselsLiège

LuxembourgNamur

Hainaut

Su

bje

ctiv

e H

ea

lthC

hro

nic

mo

rbid

ityD

isa

bili

ty

Good

Bad

Severe


PLANS FOR THE FUTURE

Evolution in SES-differences over time

Decomposition of regional differences

Estimation of health expectancies by life style factors


USE OF THE INDICATOR WITHIN BELGIUM

Ministry of Social Affairs

Federal Planning Office

Health Insurance Agency


Documents

Unit of EPIDEMIOLOGY SCIENTIFIC INSTITUTE OF PUBLIC HEALTH HEALTH EXPECTANCY INDICATORS IN BELGIUM 4th Meeting of the Task Force on Health Expectancies