Monitoring socioeconomic differentials in HLY across

EHLEIS Technical report 2014_6.1 June 2014 Monitoring socioeconomic differentials in healthy life years across Europe. A brief overview of existing studies. Emmanuelle Cambois for the WP6 team The EHLEIS team comprises: Jean‐Marie Robine, INSERM U988 and U710, Montpellier, France, jean‐[email protected] Herman Van Oyen, Scientific Institute of Public Health, Brussels, Belgium, [email protected]‐ Šárka Daňková, Institute of Health Information and Statistics of the Czech Republic, Praha, Czech Republic, [email protected] Bernard Jeune, University of Southern Denmark, Institute of Public Health, Odense, Denmark, [email protected] Henrik Bronnum‐Hansen, University of Copenhagen, Denmark, Henrik.Bronnum‐[email protected] Ola Ekholm, National Institute of Public Health, Copenhagen, Denmark, [email protected] Barbara Hjalsted, Danish National Board of Health, Copenhagen, Denmark, [email protected] Mikkel Baadsgaard, Economic Council of the Labour Movement, Copenhagen, Denmark, [email protected] Emmanuelle Cambois, INED (Institut National d’Etudes Démographiques), Paris, France, [email protected] France Meslé, INED, (Institut National d’Etudes Démographiques), Paris, France, [email protected] Isabelle Mougenot, University of Montpellier II, Montpellier, France, [email protected] Gabriele Doblhammer, Rostock Center for Demographic Change, Germany, [email protected] Jürgen Thelen, Robert Koch Institute, Berlin, Germany, [email protected] Lars Kroll, Robert Koch Institute, Berlin, Germany, [email protected] Giorgos Ntouros, Hellenic Statistical Authority, Athens, Greece, [email protected] Viviana Egidi, University la Sapienza, Rome, Italy, [email protected] Wilma J. Nusselder, Erasmus Medical Center, Rotterdam, Netherlands, [email protected] Caspar Looman, Erasmus Medical Center, Rotterdam, Netherlands, [email protected] Hendriek Boshuizen, National Institute for Public Health and the Environment,Bilthoven, Netherlands, [email protected] Jan‐Willem Bruggink, Statistical Office (CBS), Heerlen, Netherlands, [email protected] Marten Lagergren, National Board of Health and Welfare (SoS/NBHW), Stockholm, Sweden, [email protected] Carol Jagger, Newcastle University, United‐Kingdom, [email protected] Chris White, Office of National Statistics, Newport, United‐Kingdom, [email protected] Tony Fouweather, Newcastle University, United‐Kingdom, [email protected] Nicolas Berger, Scientific Institute of Public Health, Brussels, Belgium, [email protected]‐ Stefaan Demarest, Scientific Institute of Public Health, Brussels, Belgium, [email protected]‐ Denise Walckiers, Scientific Institute of Public Health, Brussels, Belgium, [email protected]‐ Kaatje Bollaerts, Scientific Institute of Public Health, Brussels, Belgium, [email protected]‐ Leila Oumeddour, INED (Institut National d’Etudes Démographiques), Paris, France, [email protected] Isabelle Beluche, INSERM U710, Montpellier, France, [email protected] Christine Perrier, ICM, Montpellier, France, [email protected] Contact EHLEIS: Jean Marie ROBINE, INSERM Université Montpellier II / U710 ‐ MMDN Place Eugène Bataillon, bat 24 ‐ CC105 34095 Montpellier Cedex 05, France. Tel: +33 (0) 467 14 33 85 Fax: +33 (0) 467 14 92 95 Email: jean‐[email protected] Joint action EHLEIS co‐funded by DG SANCO (Agreement number 20102301)
While an increasing longevity has been experienced in most European countries, a
significant part of life expectancy is lived with diseases and disability. Large variations in
health expectancies are observed across Europe (Jagger, Gillies et al. 2008; Solé-Auró and
Crimmins 2013). While the objective of a two-year gain in healthy life years (HLY) by 2020
has been settled by the European Union (Lagiewka 2012), reducing differentials between
country is one of the possible mean to reach this objective (Jagger, McKee et al. 2013).
Knowing the large variations in health differentials within countries according to
socioeconomic status (SES), reducing health differentials is not only an important public
health concern at country levels but also a mean to increase healthy active aging in Europe
(Mackenbach, Stirbu et al. 2008; Marmot, Friel et al. 2008; Jagger, McKee et al. 2013;
Rechel, Grundy et al. 2013). This workpackage intended to overview the national and
international experiences in computing health expectancies by SES and highlight the fact that
requested data are not yet available to produce routinely HLY by SES at the level of the
European Union. In this note, we provide the references and general conclusion of the
existing studies.
Experiences in computation of health expectancies by socioeconomic status
Studies worldwide consistently show for the 1990s a double advantage for higher
socioeconomic groups in term of longer and healthy lives compared to lower socioeconomic
groups (Crimmins and Cambois 2003). They have a higher LE than men, whatever the
occupational situation, but this does not confer an advantage in terms of HE. At national
levels, most study use the level of education as socioeconomic criteria (Bossuyt, Gadeyne et
al. 2004; Bronnum-Hansen, Andersen et al. 2004; Minicuci and Noale 2005; Pérès, Jagger et
al. 2005; Van Oyen, Bossuyt et al. 2005; Matthews, Jagger et al. 2006; Bronnum-Hansen and
Baadsgaard 2008; Lievre, Alley et al. 2008; Matthews, Jagger et al. 2009; Van Oyen,
Charafeddine et al. 2011). Meanwhile some refer to occupational classes which bring a
interesting point of view in the debate concerning the age at retirement, occupation being a
relevant criterion to distribute the population (Bronnum-Hansen 2000; Melzer, McWilliams et
al. 2000; Cambois, Robine et al. 2001; White and Edgar 2010; Cambois, Laborde et al. 2011).
Since the beginning of this programme, new studies have been launched bringing new
estimates. For the UK, estimations and methodological issues were discussed in the
framework of a master dissertation (Evans 2012). In Denmark, based on estimates on life
expectancy by SES (Bronnum-Hansen and Baadsgaard 2012), estimates have been produced
using SHARE and EU-SILC data to present new estimates and discuss methodological issues.
Calculations using EU-SILC have been included in the last JA:EHLEIS country report as
supplementary page (see included notes). Belgium is also in the process of collecting accurate
data from national statistics to produce new estimates (Charafeddine R, Berger N et al. 2014).
For UK, the office of statistics is currently repeating the estimates by social class with the
same data and methods than the previous study of White and Edgar.
All studies both showed large differentials between the qualified and unskilled occupations or
between high and low educated. Women display large occupational differentials in HE
despite the small differences in LE. The magnitude of the HE's gap differs according to the
health measure under consideration, confirming the relevance of covering several health
dimensions. In some of these studies, such as in the French ones, partial health expectancies
are computed in order to highlight premature mortality and disability inequalities. In this age
group, women and men spend an equivalent period of time with some functional health
problems that jeopardize work and social participation in late working ages to the same extent
for both men and women. Finally, when several SES categories are considered, these studies
confirm that a gradient exist all along the social classes, expressing the varying and the
cumulated health risks over the life span, work and life experiences.
Direct comparison of these studies is limited, even within a country, due to differences in data
sources, disability/health indicators and period of observation (Cambois, Robine et al. 2007).
These differences are also due, to the size of the SES groups, and the level of detail in the
distribution and to the measurement of various disability dimensions. Meanwhile, European
research programs worked on harmonization of mortality data for some countries providing
opportunity to produce comparable estimations of health expectancy by SES. Majer and
colleagues used the European European Community Household Panel data to compute total
and partial disability free life expectancies. The study shows variation across the 10 countries
under consideration in the differentials DFLE; the gradient changes when considering the 5065 year old age group and the 65+ (Majer, Nusselder et al. 2010). More recently, another
study presented HLY by educational level for 8 EU countries using EU-SILC and modeling
mortality data (Maki, Martikainen et al. 2013). This study concentrates on partial HLY in the
50-79 age groups and also shows large variation in the educational gaps between countries.
Again, direct comparison between the results obtained in these two European studies is not
possible due to different data sources and disability indicators.
These studies both highlight the relevance of computing and discussing health expectancy
estimates by socioeconomic status and the caveats for computing routine and comparable
estimates at the EU level. We recommend the objective of stratifying the HLY estimates
yearly to be postponed, waiting for more accurate data on mortality by SES to be routinely
The objective of the WP6 was therefore to prolong the ongoing national initiatives to assess
SES differentials in HLY and in the meantime, to analyse the EU-SILC data on activity
limitation by SES across the European Union and discuss the obtained estimates.
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Co‐funded by 10 Member States, the European Commission, DG SANCO and two French institutions: DREES and CNSA. Contact EHLEIS: Jean Marie ROBINE, INSERM Université Montpellier II / U710 ‐ MMDN Place Eugène Bataillon, bat 24 ‐ CC105 34095 Montpellier Cedex 05, France. Tel: +33 (0) 467 14 33 85 Fax: +33 (0) 467 14 92 95 Email: jean‐[email protected]