1. Decomposition Tools for Health Expectancy Wilma Nusselder Department of Public Health Erasmus MC Rotterdam, The Netherlands w.nusselder@erasmusmc.nl Task Force on Health Expectancy, Luxembourg, June 8, 2006

2. Health expectancy (HE) in the EU Step 1: HE to describe population health: EHEMU database New questions: Is this low or high relative to other MS? Is this low or high relative to other sex/subpopulation? Is this low or high as compared to 10 years ago? Step 2: to compare HE between MS, within MS, over time EHEMU database New questions: Is difference due to higher mortality or higher disability? Which age groups are responsible for this difference? Which causes of death and disability are responsible for this difference? Step 3: to explain differences in HE between MS, within MS, over time Decomposition tools

3. Health expectancy (HE) in the EU Step 1: HE to describe population health: EHEMU database New questions: Is this low or high relative to other MS? Is this low or high relative to other sex/subpopulation? Is this low or high as compared to 10 years ago? Step 2: to compare HE between MS, within MS, over time EHEMU database New questions: Is difference due to higher mortality or higher disability? Which age groups are responsible for this difference? Which causes of death and disability are responsible for this difference? Step 3: to explain differences in HE between MS, within MS, over time Decomposition tools

4. Health expectancy (HE) in the EU Step 1: HE to describe population health: EHEMU database New questions: Is this low or high relative to other MS? Is this low or high relative to other sex/subpopulation? Is this low or high as compared to five years ago? Step 2: to compare HE between MS, within MS, over time EHEMU database New questions: Is difference due to higher mortality or higher disability? Which age groups are responsible responsible for this difference? Step 3: to explain differences in HE between for this difference? Which causes of death and disability are MS, within MS, over time Decomposition tools

5. Health expectancy (HE) in the EU Step 1: HE to describe population health: EHEMU database New questions: Is this low or high relative to other MS? Is this low or high relative to other sex/subpopulation? Is this low or high as compared to five years ago? Step 2: to compare HE between MS, within MS, over time EHEMU database New questions: Is difference due to higher mortality or higher disability? Which age groups are responsible for this difference? Which causes of death and disability are responsible for this difference? Step 3: to explain differences in HE between MS, within MS, over time Decomposition tools

6. Health expectancy (HE) in the EU Step 1: HE to describe population health: EHEMU database New questions: Is this low or high relative to other MS? Is this low or high relative to other sex/subpopulation? Is this low or high as compared to five years ago? Step 2: to compare HE between MS, within MS, over time EHEMU database New questions: Is difference due to higher mortality or higher disability? Which age groups are responsible for this difference? Which causes of death and disability are responsible for this difference? Step 3: to explain differences in HE between MS, within MS, over time Decomposition tools

7. Health expectancy (HE) in the EU Step 1: HE to describe population health: EHEMU database New questions: Is this low or high relative to other MS? Is this low or high relative to other sex/subpopulation? Is this low or high as compared to five years ago? Step 2: to compare HE between MS, within MS, over time EHEMU database New questions: Is difference due to higher mortality or higher disability? Which age groups are responsible for this difference? Which causes of death and disability are responsible for this difference? Step 3: to explain differences in H between MS, within MS, over time Decomposition tools

8. Health expectancy (HE) in the EU Step 1: HE to describe population health: EHEMU database New questions: Is this low or high relative to other MS? Is this low or high relative to other sex/subpopulation? Is this low or high as compared to five years ago? Step 2: to compare HE between MS, within MS, over time EHEMU database New questions: Is difference due to higher mortality or higher disability? Which age groups are responsible for this difference? Which causes of death and disability are responsible for this difference? Step 3: to explain differences in HE between MS, within MS, over time Decomposition tools

9. Health expectancy (HE) in the EU Step 1: HE to describe population health: EHEMU database New questions: Is this low or high relative to other MS? Is this low or high relative to other sex/subpopulation? Is this low or high as compared to five years ago? Step 2: to compare HE between MS, within MS, over time EHEMU database New questions: Is difference due to higher mortality or higher disability? Which age groups are responsible for this difference? Which causes of death and disability are responsible for this difference? Step 3: to explain differences in HE between MS, within MS, over time Decomposition tools

10. Health expectancy (HE) in the EU Step 1: HE to describe population health: EHEMU database New questions: Is this low or high relative to other MS? Is this low or high relative to other sex/subpopulation? Is this low or high as compared to five years ago? Step 2: to compare HE between MS, within MS, over time EHEMU database New questions: Is difference due to higher mortality or higher disability? Which age groups are responsible for this difference? Which causes of death and disability are responsible for this difference? Step 3: to explain differences in HE between MS, within MS, over time Decomposition tools Contribution of mortality vs. disability, age groups and causes to HE differences

11. Decomposition tools Decomposition (or partition techniques) are widely used in mortality research to decompose differences in life expectancy (LE) By age: additive contribution of age groups By cause: additive contribution of causes of death For HE derived with the Sullivan method decomposition tools have recently been developed (Nusselder & Looman, 2004; ******) By type: additive contribution of mortality and disability By age: additive contribution of age groups By cause: additive contribution of causes of death and causes of disability

12. Decomposition tools Decomposition (or partition techniques) are widely used in mortality research to decompose differences in life expectancy (LE) -By age: additive contribution of age groups -By cause: additive contribution of causes of death Decomposition tools have recently been developed (Nusselder & Looman, 2004; Andreev et al, 2003) to decompose differences in health expectancy (HE) -By type: additive contribution of mortality and disability -By age: additive contribution of age groups -By cause: additive contribution of causes of death and causes of disability

13. Date needed for decomposition of HE Decomposition by kind of effect & age: Mortality rates by age and sex Disability prevalence by age and sex Decomposition by cause: Mortality rates by age, sex and cause of death Disability prevalence by age, sex and cause of disability = Not generally available: can be derived from individual-level survey data on age, sex, disability and chronic diseases

14. Two illustrations 1.Gender gap in years with disability in the Netherlands 2.SES disparities in DFLE in Belgium 3.Other possible applications: 1.Differences in HE over time 2.Differences in HE between MS

15. 1. Decomposition of gender gap in HE (a) Why is number of years with disability higher among women?

16. 1. Decomposition of gender gap in HE (b) Source : Nusselder & Looman, 2004.

17. 1. Decomposition of gender gap in HE (c) Difference in years with disability: men 8.4 vs. women 14.8 yrs Source : Nusselder & Looman, 2004.

18. 2. Decomposition of SES disparity in DFLE (a) Source : Nusselder et al, 2005.

19. 2.Decomposition of SES disparity in DFLE (b) Source : Nusselder et al, 2005.

20. 2. Decomposition of SES disparity by cause, men Mort.Disab.Total Total difference in DFLE1.56.58.0 Due to Cancer0.40.20.6 Heartdisease/stroke0.41.21.5 asthma/COPD0.21.01.2 Diabetes mellitus0.0-0.3-0.2 Back complaints0.02.1 Arthritis0.01.3 Other diseases0.51.92.4 Background0.0-0.9 Source : Nusselder et al, 2005.

21. 2. Decomposition of SES disparity by cause, men Source : Nusselder et al, 2005.

22. 2. Decomposition of SES disparity by cause, women Source : Nusselder et al, 2005.

23. 2. Decomposition of SES disparity by cause, women Source : Nusselder et al, 2005.

24. Added value of decomposition tools Provides more insight into differences in health Mortality vs. disability Mortality -> which age -> which cause of death Disability -> which age -> which chronic disease * prevalence of disease * disabling impact of disease Provides parsimonious summary of contribution of specific diseases to health differences Takes into account that contribution of disease depends on huge amount of factors (e.g., differences in prevalence, disabling impact, age distribution, mortality from the disease, age distribution of mortality from the disease, mortality from other causes)

25. Conclusion Decomposition of HE is feasible Decomposition of HE is useful to explain differences in HE between MS, within MS and over time More work is needed to make tool widely applicable: Publicly available program to decompose differences in HE Publicly available program to obtain cause-specific disability information

26. Thank you for your attention