Back to home pageCanada (Montréal) CAHIERS QUEBECOIS DE DEMOGRAPHIE AUTUMN 1991 - VOLUME 20, NUMBER 2 93.07.01 - French - Jean-Marie ROBINE, Denis BUCQUET et Karen RITCHIE, INSERM, Montpellier (France) Disability-free Life Expectancy, An Indicator of the Evolution of Health Conditions Over Time: 20 Years of Calculations (L'espérance de vie sans incapacité, un indicateur de l'évolution des conditions de santé au cours du temps: 20 ans de calcul) (p. 205- 235) In the absence of reliable data on the evolution of morbidity, three general theories have been proposed concerning changes over time in the health status of populations, concurrent with the fall in mortality: the pandemic of mental disorders, chronic diseases and disabilities; the compression of morbidity; and the theories of "equilibrium". These theories have all been described in terms of the relative evolution of life expectancy (LE) and of disability-free life expectancy (DFLE). Several series of disability-free life expectancies have already been calculated. Most of these were for the United States and were based on the National Health Interview Survey disability data. What lessons are to be drawn from these studies, covering a thirty-year period, concerning the changes over time in health conditions? (MORTALITY, MORBIDITY, LIFE EXPECTANCY, AGEING) 93.07.02 - French - Pierre MINAIRE, Service de rééducation et réadaptation fonctionnelles, et Groupement d'intérêt publique "Effets de l'exercice", Université Jean Monnet, 4203 Saint-Etienne 2 (France) Health Expectancy: Conceptual and Practical Contribution of the International Classification of Impairments, Disabilities and Handicaps (ICIDH) (Espérance de vie en santé: apport conceptuel et pratique de la classification internationale des déficiences, incapacités, handicaps (CIDIH)) (p. 237-251) Calculation of health expectancy is based on measurements of both mortality and disability. The notion of disability is linked to modern definitions of health, i.e., how persons or groups adapt to their environment. The International Classification of Impairments, Disabilities and Handicaps (ICIDH) provides a means to make an overall analysis of disabilities and handicaps, thus allowing us to envisage common definitions of health and disability to be used in developing instruments suitable for calculating disability-free life expectancy or health expectancy. It is essential that this development work be carried out on an international scale before going on to make comparisons between statistical data on health expectancy, since such comparisons will only be valid if the basic concepts and definitions used are the same. (MORTALITY, MORBIDITY, LIFE EXPECTANCY, PHYSICAL HANDICAP, MENTAL HANDICAP, AGEING) 93.07.03 - French - Karen RITCHIE, Chargée de recherche, Institute national de la santé et de la recherche nationale, Montpellier (France) The Calculation of Dementia-Free Life Expectancy: A Preliminary Examination of its Feasibility (La mesure de l'espérance de vie sans démence: étude préliminaire de faisabilité) (p. 253-268) Studies of healthy life expectancy have focused almost entirely on the prevalence of chronic physical diseases and disabilities with little consideration being given to either the desirability or feasibility of calculating life expectancy free of senile dementia, although prevalence rates for the latter are strongly related to age. The present paper suggests how such a calculation may be used and discusses the advances in case-finding procedures which have made cross-cultural comparisons possible. An attempt is also made to construct a theoretical dementia-free life expectancy curve on the basis of prevalence data from a number of countries. (MORTALITY, MORBIDITY, LIFE EXPECTANCY, MENTAL HANDICAP, PHYSICAL HANDICAP, AGEING) 93.07.04 - French - Richard G. ROGERS, Andrei ROGERS, Population Program, University of Colorado, Boulder, Colorado (U.S.A.), and Alain BELANGER, Division de la démographie, Statistique Canada, Ottawa, Ontario K1A 0T6 (Canada) Active, Dependent and Institutionalized Life Among the Elderly in the United States (Espérance de vie autonome, en perte d'autonomie et en institution parmi la population âgée des Etats-Unis) (p. 269-289) This article combines newly-released data from the Longitudinal Study of Aging with multistate life table methods to examine active life among the elderly in the United States. The authors focus on those elderly who are independent, dependent (defined by their activities of daily living), or institutionalized. They report on their transitions between these three states during the years 1986 and 1988 and provide the first empirical estimates of life expectancies and transitions for the U.S. institutionalized population. They find that the elderly are living longer and more active lives. (UNITED STATES, MORTALITY, MORBIDITY, LIFE EXPECTANCY, AGEING, AGED) 93.07.05 - French - Yasuhiko SAITO, Eileen M. CRIMMINS and Mark D. HAYWARD, Andrus Gerontology Center, University of Southern California, Los Angeles, California (U.S.A.) Stability of Estimates of Active Life Expectancy Using Two Methods of Life Table Construction (Stabilité des estimations de l'espérance de vie sans perte d'autonomie calculées au moyen de deux méthodes de construction de tables de survie) (p. 291-327) This paper addresses empirically the relative stability over two intervals of estimates of active life expectancy made using the prevalence rate and multistate methods of computing active life expectancy. Three waves of the U.S. Longitudinal Study of Aging, a representative sample of community dwelling elderly 70 years of age and over, are the data used in the analysis. The prevalence rate estimates are more stable than the multistate estimates because all incidence schedules are less stable than prevalence schedules. In addition, mortality schedules for the dependent population, a separate input to only the multistate model, appear particularly affected by instability, change in sample composition and sample attrition. (CANADA, MORTALITY, MORBIDITY, LIFE EXPECTANCY, AGEING) 93.07.06 - French - Michael C. WOLFSON, Etudes analytiques, Statistique Canada, Ottawa, Ontario K1A 0T6 (Canada) POHEM - A New Approach to the Estimation of Health Status Adjusted Life Expectancy (POHEM: une approche inédite pour l'estimation de l'espérance de vie corrigée en fonction de l'état de santé) (p. 329-366) This paper describes a general methodology for estimating life expectancy adjusted for variations in health status during the course of individuals' lifetimes - the population health model, POHEM. Measures such as "disability-free life expectancy" and the life table methodology on which these kinds of indices are based are considered. The restrictions embodied in such measures and their underlying methodologies can be conveniently avoided with the POHEM microsimulation approach. Prototypical outputs of POHEM are presented and it is argued that the POHEM methodology is not unduly complex. Many countries could use it to generate health status adjusted life expectancy indices, given already available data. Moreover, POHEM provides a framework for integrating a range of health data and for producing a family of important health indices. (MORTALITY, MORBIDITY, LIFE EXPECTANCY, HEALTH, AGEING) 93.07.07 - French - Russell WILKINS, Statistique Canada, Ottawa, Ontario K1A 0T6 (Canada) Disability-free Life Expectancy in Quebec and Canada, 1986 (L'espérance de vie en santé au Québec et au Canada en 1986) (p. 367-382) The authors calculated health expectancy by sex at birth and age 65 for Quebec and Canada, based on special tabulations of disability prevalence rates in the total population (including residents of institutions) estimated from the Health and Activity Limitation Survey (HALS) of 1986-87 and abridged life tables for 1985-87. For both sexes together, Quebec had the lowest life expectancy of Canada's five regions, but the highest disability- free life expectancy. Using their weights for each state of health, disability-adjusted life expectancy in Quebec was almost identical to that of Canada for both sexes together at birth and at age 65; it was relatively higher for Quebec women, and lower for Quebec men. Health expectancy results based on the Canada Health Survey (CHS) of 1978-79, though derived from a conceptually different measurement of disability, produced similar results in terms of the regional differences in Canada. However, the differences between the two surveys in the measurement of disability precluded any meaningful comparison of changes over time in the absolute values of the health expectancy results. (CANADA, MORTALITY, MORBIDITY, LIFE EXPECTANCY, PHYSICAL HANDICAP, MENTAL HANDICAP, AGEING) 93.07.08 - French - Pierre LAFONTAINE, Robert PAMPALON and Madeleine ROCHON, Ministère de la santé et des services sociaux, Direction générale de la planification et de l'évaluation, Service des études socio-sanitaires, Québec (Canada) Disability-free Life Expectancy in the Regions of Quebec in 1987 (L'espérance de vie sans incapacité selon les régions au Québec en 1987) (p. 383-404) The article deals with disability-free life expectancy in the thirteen public-health regions of Quebec (excluding the Kativik and James Bay regions). Mortality, institutionalization and disability data are presented, along with the precautions taken to ensure statistical accuracy, followed by analysis of various results. Inter-regional variations in DFLE are much greater than for LE and are mainly due to long-term disability. Figures are higher in the central regions, although it cannot be concluded that there is a strict correlation between regional variations in DFLE and LE. The notion of severity of disability provides some clarification of results. Various problems involved in regional analyses of this indicator are described, including the socio- economic situation and specific culture of each region and the effects of migration. The article stresses the need for discernment in using this indicator. (CANADA, MORTALITY, MORBIDITY, LIFE EXPECTANCY, PHYSICAL HANDICAP, MENTAL HANDICAP, AGEING) 93.07.09 - French - Yvon BRUNELLE and Madeleine ROCHON, Ministère de la santé et des services sociaux, Direction générale de la planification et de l'évaluation, Service des études socio-sanitaires, Québec (Canada) Limits, Advantages and Use of DFLE in the Current Development of the Health Care System (Limites, avantages et utilisation des EVSI dans le contexte actuel de l'évolution des systèmes de soins) (p. 405-437) DLFE-type indicators correspond to a definition of functional health based on how individuals adapt to their environments. The health care system is always seeking new forms of equity and allocation, demands new indicators to describe variations in health, estimate and predict care and service requirements and, most importantly, justify choices in the volume, organization and distribution (rationing) of resources. The system does, however, have problems dealing with the contradictory results and nuances inherent in this type of indicator. It may be expected that, as with all health-related information, DFLE indicators will be used and interpreted in different ways, but that they will nevertheless influence expectations regarding the health care system and how it develops. (MORTALITY, MORBIDITY, LIFE EXPECTANCY, HEALTH, AGEING) 93.07.10 - French - Michel C. THURIAUX, Division de la surveillance épidémiologique et de l'appréciation de la situation sanitaire et de ses tendances, WHO, Geneva (Switzerland) Healthy Life Expectancy: An Index of Disability in the Community, Current Status and Usefulness for Health Policies (Espérance de de vie en santé: une mesure synthétique de l'incapacité dans la communauté, statut actuel et utilité pour les politiques de santé) (p. 439-450) Increasing lifespan and the improved control of acute diseases have underlined the importance of chronic disorders and their long-term impact on health. Member states in both the developing and the developed areas of the world are gathering data for the quantitative assessment of disability in the community. Internationally accepted instruments such as the International Classification of Impairments, Disabilities and Handicaps will facilitate standardised data collection and analysis, as well as the calculation of indicators, such as Healthy Life Expectancy, combining traditional survival measurements based on mortality with elements related to the quality of survival. The article lists the main conditions required for the calculation of this type of indicator, together with the main countries or areas where these conditions are likely to be met. (MORTALITY, MORBIDITY, LIFE EXPECTANCY, HEALTH, HEALTH POLICY, AGEING) 93.07.11 - French - Alain COLVEZ, INSERM, Recherches épidémiologiques sur le vieillissement et les incapacités, Hôpital Lapeyrronie, Montpellier (France) Point of View on the Future of Indicators of Health Expectancy (Un point de vue sur l'avenir des indicateurs d'espérance de vie en santé) (p. 451-466) The article expresses the author's point of view on the future of indicators of health expectancy from the standpoint of the public health practitioner. The discussion focuses on the possible ways to transfer knowledge and procedures from the research community to the health statistics field so that health expectancy can be used as a routine indicator of the health status of a population. According to the author, the concept of health expectancy must first be seen through the more limited concept of disability-free life expectancy. The article looks at the selection of aspects of disability, standardization of instruments, types of surveys, the role of major statistics organizations in introducing routine calculation. The last section looks briefly at possible research avenues to transfer the concept of health expectancy to the practical level. (MORTALITY, MORBIDITY, LIFE EXPECTANCY, HEALTH, AGEING) 93.07.12 - French - Alain BELANGER, Division de la Démographie, Statistique Canada, Ottawa, Ontario K1A 0T6 (Canada) Estimating Age-specific Mortality Rates by Health Status from the Longitudinal Study of Aging (Estimation de la mortalité selon l'âge et l'état de santé à partir d'une enquête longitudinale) (p. 467-481) A necessary step in the estimation of active life expectancy using the multistate model is the calculation of reliable age-specific observed death rates. This paper describes the method used to obtain age-specific mortality estimates from the Longitudinal Survey of Aging (LSOA). Our results point to important differences in the age-specific mortality rates according to the health status. The differences between dependent and independent life expectancies are of the same order as the well-documented sex differential in mortality. (UNITED STATES, MORTALITY, MORBIDITY, LIFE EXPECTANCY, HEALTH, AGEING)
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