Disability-free life expectancies
What is disability-free life expectancy?
Disability-free life expectancy is measured by a combination of mortality and disability indicators in order to take account of the "quality" of the years of life. Indicators of healthy life expectancy combine mortality and health data. They indicate the average number of years of life spent in good health and in poor health within total life expectancy, given the mortality and health conditions of the moment. There are as many indicators of healthy life expectancy as there are indicators of health (perceived good health, without chronic diseases, without disability, without dependency).
INED has been involved in this research since it first developed in France through methodological work, such as that developed by N. Brouard, and the production and analysis of French estimates. E. Cambois and J. Robine are also involved in European projects and the researchers also contribute to international projects, particularly through our activities within the REVES International Network on Health Expectancy and the Disability Process (INED hosts the network’s website). As well as producing indicators, our research work seeks to analyse the trends and disparities between countries and within the same country and to identify the conditions and factors involved in these trends.
The most recent estimates and projects underway
The estimates calculated by E. Cambois, A. Sieurin and J. Robine show that in 2008, life expectancy at age 65 was 18 years for men and almost 23 years for women. Years of life with functional limitations account for more than 70% of life expectancy at age 65 (13 years for men and 17 years for women). But functional limitations do not always mean activity restrictions, which only affect half of the years of life after 65 (9 years for men and 13 years for women), with dependency (difficulty with personal care) accounting for 15% to 20% of these years of life (3 years for men and 5 years for women).
This research has highlighted a less favourable trend in disability-free life expectancy in recent years than in previous decades. In particular, it reveals a widening gap between men and women and a less favourable trend for the 50-65 age group than for older people. These results have been widely quoted in the national debate on dependency.
This analytical research will be pursued in the years ahead as
part of a project on gender inequality. It will seek explanations
for the latest results by seeking factors contributing to the
differences between the sexes. Methods for breaking down
disability-free life expectancy by disease and cause of death will
be developed with W. Nusselder, who developed the tool at Erasmus
University in the Netherlands. Various items will be monitored: the
role of diseases and health-related behaviours that affect men and
women differently; the role of economic and social status; the role
of the different social status and social roles assigned to men and
women (family-work balance, care, etc.). Several INED researchers
are involved (C. Bonnet, M. Khlat, F. Meslé and A.
A new European project was launched in 2011. E. Cambois and J.
Robine will now continue their European research on "Healthy Life
Years" through a European Union Joint Action, involving partner
countries, and administered by L. Oumeddour.
Manual workers are doubly penalized in terms of disability-free life expectancy
In addition to gender inequality with regard to disability-free life expectancy, there are sharp social inequalities, which persist at old ages. Research using the 2003 health survey revealed that manual workers had not only a shorter total life expectancy than managers, but that they spent more years on average with disabilities and in dependency: we describe this as the "double disadvantage" of manual workers.
A more recent study confirms this observation and shows that inequalities affect not only retirement: incapacity begins well before 65, and inequality by occupation is also very pronounced before retirement age.
Within the framework of a new European project, new estimates
will be developed for France in a study of European comparability
of "Healthy life years" by social categories.
Extension of life with and without activity restrictions
With American colleagues, N. Brouard showed an increase in dependent life expectancy in the last years of life in the United States. This study, based on longitudinal data (not available for France), shows the importance of estimating not only the prevalence of disability and dependency, but also the incidence (the risk of becoming dependent) and the probability of recovering some capacity.
This research uses IMaCh estimates of the probabilities of
transition between different states of health. IMaCh is a software
program developed by N. Brouard and widely used by researchers in
Cambois, E., C. Laborde, I. Romieu, and J.-M. Robine. 2011. Occupational inequalities in health expectancies in France in the early 2000s: Unequal chances of reaching and living retirement in good health. Demographic Research 25: 407-36
Crimmins Eileen M, Hayward Mark D, Hagedorn Aaron, Saito Yasuhiko, Brouard Nicolas. 2009. Change in disability-free life expectancy for Americans 70-years-old and older. Demography, 46 (3), p. 627-46.
Jagger Carol , Gillies Claire, Moscone Fransisco , Cambois Emmanuelle , Van Oyen Herman, Nusselder Wilma , Robine Jean-Marie , EHLEIS team. 2008. Inequalities in Healthy life years in the 25 countries of the European Union in 2005: a cross-national meta-regression analysis. Lancet, 9656 (372), p. 2124-2131. (with Erratum in same issue)
Cambois Emmanuelle, Clavel Aurore, Robine Jean-Marie, Romieu Isabelle. 2008. Trends in Disability-Free Life Expectancy at Age 65 in France: Consistent and Diverging Patterns According to the Underlying Disability Measure. European Journal of Ageing, (5), p. 287-298.
Lièvre A, N Brouard, C Heathcote, The estimation of health
expectancies from cross-longitudinal surveys. Math. Pop. Studies
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Cambois E, JM Robine, M. Hayward, Social inequalities in
disability-free life expectancy in the French male population
(1980-1991). Demography, 2001. 38(4): p. 513-524