Disability free Life Expectancy Carol Jagger University of Leicester EHEMU Team European Population Day: Ageing IUSSP Tours 2005

Purpose To explore compression or expansion of disability and gender differences through cross-national comparisons of disability-free life expectancy (DFLE) at birth and age 65 among 14 EU countries between 1995 and 2003 In preparation for new EU structural indicator Healthy Life Years

European Population Day: Ageing IUSSP Tours 2005 Data and methods Estimation of DFLE and 95% CI, using Sullivan method age specific probability of death: Eurostat life tables age specific disability prevalence: European Community Household Panel question ‘Are you hampered in your daily activities by any physical or mental health problem, illness or disability? ‘

European Population Day: Ageing IUSSP Tours 2005 LE Men Women Distribution of LE and DFLE at birth EU(14),

European Population Day: Ageing IUSSP Tours 2005 Distribution of LE and DFLE at birth EU(14), LE Men Women DFLE

European Population Day: Ageing IUSSP Tours 2005 By 2003 LE at birth in the EU14 ranged from 74.2 (Portugal) to 78 (Sweden) years for men and 80.1 (Denmark) to 83.2 years (France) for women, following a steady increase from Compared to LE, trends in DFLE were more variable although gender differences were smaller Between the gain in total years for men exceeded the gain in years free of disability In women there was only a slight improvement, on average, in life expectancy with a similar gain in disability-free life years. Distribution of LE and DFLE at birth EU(14),

European Population Day: Ageing IUSSP Tours 2005 What about life expectancy and disability free life expectancy at older ages?

European Population Day: Ageing IUSSP Tours 2005 Trends in LE and DFLE at age 65 in EU (14), Men

European Population Day: Ageing IUSSP Tours 2005 Trends in LE and DFLE at age 65 in EU (14), Women

European Population Day: Ageing IUSSP Tours 2005 Trends in proportion of life spent disability-free at age 65 = gain of 5% += loss of 5% += gain or loss of less than 5% Men

European Population Day: Ageing IUSSP Tours 2005 Trends in proportion of life spent disability-free at age 65 = gain of 5% += loss of 5% += gain or loss of less than 5% Women

European Population Day: Ageing IUSSP Tours 2005 Trends in the proportion of life spent disability-free at age 65 Men  Austria, Belgium, Finland, Germany Italy, Spain -France, Greece, Ireland, Netherlands, Portugal  Denmark, Sweden, UK Women  Italy,Sweden -Austria, Belgium, Denmark, Finland, France, Spain, UK  Germany, Greece, Ireland, Netherlands, Portugal

European Population Day: Ageing IUSSP Tours 2005 Trends in LE and DFLE using the ECHP 1)Life expectancy: Small variation in LE between these 14 MS Increase between )Disability Free Life Expectancy and %DFLE/LE Large variation in DFLE between these 14 MS Diverging trends over : reduction / stagnation / increase in the proportion of life with reported disability at age 65 while LE increases Gender differences in trends

European Population Day: Ageing IUSSP Tours 2005 Real or artefact? May be artefact due to Data problems Sampling Omission of institutionalised population Not harmonised disability question Cultural differences in reporting of disability Confounding factors – socio-economic But trends less sensitive to these If real what is ‘cause’

European Population Day: Ageing IUSSP Tours 2005 Data and Methods Problems in both mortality and ECHP data 1) Data base Probable data errors Replacement with other sources Missing 2) Interruption of data collection No data for 2002 and 2003 Solutions 1) Data base Linear imputation of age specific probabilities (death and disability) Shift of the prevalence trend to the ECHP level Imputation of data according to observed trends 2) Interruption of data collection Linear extrapolation of the disability prevalence

European Population Day: Ageing IUSSP Tours 2005 Real or artefact? May be artefact due to Data problems Sampling Omission of institutionalised population Not harmonised disability question Cultural differences in reporting of disability Confounding factors – socio-economic But trends less sensitive to these If real what is ‘cause’

European Population Day: Ageing IUSSP Tours 2005 Disease>Impairment>Functional limitation>Disability (Nagi, 1965,1976, 1991) Models of the disablement process Disease>Impairment>Functional limitation>Activity Restriction>Handicap (Wood, 1975) Disease>Impairment>Disability>Handicap (ICIDH, 1980)

European Population Day: Ageing IUSSP Tours 2005 Gain in TLE and DFLE without prevalent disease (MRC CFAS) MEN age 65

European Population Day: Ageing IUSSP Tours 2005 Prevalence of all dementias by study Source: Lobo et al. (2000)  = Finland;  = Sweden;  = Denmark;  = Rotterdam; – = UK (MRC-ALPHA);  = UK (Melton Mowbray);  = France; + = Italy; = Spain (Zaragoza Study); = Spain (Pamplona Study); x = Spain (ZARADEMP).

European Population Day: Ageing IUSSP Tours 2005 Age-specific incidence of first stroke per men* *standardised to European population

European Population Day: Ageing IUSSP Tours 2005 Conclusions Population aging has a different impact in the 14 Member States in Europe: –different levels of reported disability (larger dispersion than LE) –variation in the magnitude of the gender difference –different trends over time Need to further document cross-national differences in self-reported disability with regard to: –improved harmonisation of the instruments –using different levels of severity –documenting differences in reporting –documenting differences in selection in the panel

Disability free Life Expectancy Carol Jagger University of Leicester EHEMU Team France-Europe Day IUSSP Tours 2005