The experience of Denmark with global disability questions in surveys Ola Ekholm & Henrik Brønnum-Hansen, National Institute of Public Health, University of Southern Denmark

Task Force on Health Expectancies 2 December 2008Page 2 Life expectancy (LE) and healthy life years (HLYs) at 50 years of age among men for all EU countries Jagger et al. (2008) LE at 50 years of age (years)

Task Force on Health Expectancies 2 December 2008Page 3 Life expectancy (LE) and healthy life years (HLYs) at 50 years of age among women for all EU countries Jagger et al. (2008) LE at 50 years of age (years)

Task Force on Health Expectancies 2 December 2008Page 4 Clippings from Danish and Swedish media November 17, 2008

Task Force on Health Expectancies 2 December 2008Page 5 The MEHM is adopted as an essential part of the European Health Survey System and consists of three general disability/health items: Self-rated health Longstanding illness Activity limitations The MEHM is included in the Survey on Income and Living Conditions (SILC) The minimum European Health Module (MEHM)

Task Force on Health Expectancies 2 December 2008Page 6 To present the disagreement between MEHM and the questions used in the Danish-SILC Can the differences influence e.g. HLY estimates? Data from the Danish SILC-2006 and the Danish Health Interview Survey in 2005 was used to investigate the influence Purpose

Task Force on Health Expectancies 2 December 2008Page 7 SILC - Denmark Is carried out under EU legalisation The reference population is private households residing in Denmark 1 January 2006 and members of these households SILC has a rotating panel design In total, SILC-2006 consists of 9,492 sampled persons/ households (16 years or older) selected from the Central Population Register Number of respondents: 5,711 households (60%) Data were collected via telephone interview and postal questionnaires by Statistics Denmark

Task Force on Health Expectancies 2 December 2008Page 8 The Danish Health Interview Surveys The Danish National Institute of Public Health, University of Southern Denmark has carried out national representative health interview surveys since 1987 The purpose of the surveys is to describe the status and trends in health and morbidity in the adult population (16 years or older) and in the factors that influence health status The survey in 2005 was based on a random sample of 21,832 Danish citizens. The response rate was 67% Data were collected via face-to-face interview at the respondents’ home

Task Force on Health Expectancies 2 December 2008Page 9 General Health SILC: How is your health in general? Is it very good, good, neither good or bad, bad or very bad? No problems with this question in the Danish SILC

Task Force on Health Expectancies 2 December 2008Page 10 Long-standing illness SILC/EHIS Do you have any longstanding illness or [longstanding] health problem? [By longstanding I mean illnesses or health problems which have lasted, or Are expected to last, for 6 months or more] Yes No SILC-Denmark (unofficial translation) Do you have any chronic or mental illness or any chronic disability? Problems that do not cause burden in the daily life should also be included. Yes No

Task Force on Health Expectancies 2 December 2008Page 11 Activity limiation SILC/EHIS: For at least the past 6 months, to what extent have you been limited because of a health problem in activities people usually do? Yes, strongly limited Yes, limited No, not limited SILC-Denmark (unofficial translation): Have you been hampered in your daily activities by this chronic problem or by other health- related problems for longer time-periods within the past 6 months? Yes No

Task Force on Health Expectancies 2 December 2008Page 12 Statistical analysis The Sullivan method was used to calculate life expectancies and HLYs at 50 years of age by sex for each MEHM indicator in SILC and the Danish Health Interview Survey 2005, respectively

Task Force on Health Expectancies 2 December 2008Page 13 General health SILC-DK: How is your health in general? Is it… very good good neither good or bad bad very bad? HIS: In general, would you say your health is: Really good Good good Fair Poor Very poor

Task Force on Health Expectancies 2 December 2008Page 14 HLYs at 50 years of age in SILC-2006 and the Danish Health Interview Survey Very/really good or good self-rated health.

Task Force on Health Expectancies 2 December 2008Page 15 Long-standing illness SILC-DK: Do you have any chronic or mental illness or any chronic disability? Problems that do not cause burden in the daily life should also be included. Yes No HIS: Do you have any long-standing disease, disorder or illness, long-standing effects of injury, any functional impairment or any other long-standing health problem? (any that has lasted 6 months or more) Yes No

Task Force on Health Expectancies 2 December 2008Page 16 HLYs at 50 years of age in SILC-2006 and the Danish Health Interview Survey Without any long-standing illness.

Task Force on Health Expectancies 2 December 2008Page 17 Activity limitation SILC-DK: Have you been hampered in your daily activities by this chronic problem or by other health- related problems for longer time-periods within the past 6 months? Yes; No HIS I: Do you have any long-standing disease, disorder or illness, long-standing effects of injury, any functional impairment or any other long-standing health problem? Yes; No If yes: Does the disease, disorder or illness limit you in your work or usual activities? Yes, very much; Yes, a little; No

Task Force on Health Expectancies 2 December 2008Page 18 Activity limitation (cont.) HIS II: During the past 2 weeks, has any disease, disorder, illness or injury made it difficult or impossible for you to carry out your usual daily activities? (such as work outside the home or domestic work or leisure activities) Yes; No If yes: Have these difficulties or limitations been long term? Long term here means that the difficulties or limitations have lasted or are expected to last 6 months or more. Yes; No

Task Force on Health Expectancies 2 December 2008Page 19 HLYs at 50 years of age in SILC-2006 and the Danish Health Interview Survey Without activity limitation.

Task Force on Health Expectancies 2 December 2008Page 20 Conclusion (and some good news) Our results indicates that the wording of the question influence the HLY estimates The results for Denmark should be interpreted with caution The questions have been corrected in SILC-2008