the eu structural indicator healthy life years – preliminary calculations for germany
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The EU structural indicator Healthy Life Years – preliminary calculations for Germany Cornelia Lange, Jutta Wirz, Thomas Ziese Robert Koch Institute. Outline. Data sources in Germany appropriate to calculate HLYs; possibilities, limitations, and experiences - PowerPoint PPT PresentationTRANSCRIPT
Berlin, 12. November 2002Cornelia Lange
The EU structural indicatorHealthy Life Years – preliminary calculations for Germany
Cornelia Lange, Jutta Wirz, Thomas Ziese
Robert Koch Institute
Outline
Data sources in Germany appropriate to calculate HLYs; possibilities, limitations, and experiences
Problems concerning the translation/adaptation of the question on limitations (PH030)
Calculation of DFLE using Telephone Health Survey data
Conclusion
„Statistics on the causes of death“ in Germany
Specifics: Neither information about social status nor possibility of linkage to other datasources which contain this information (i.e. social statistics)
Variables: age, gender, commune of death; main cause of death, place of death (home / hospital); date of death; nationality (German / not German)
Life expectancy at birth in Germany
Data on Health(Health) Surveys on national level
Robert Koch Institute German National Health Interview and Examination Survey 1998
(HIS and HES)representative, age of respondents: 18-79, sample size: 7,124
Telephone Health Interview Surveys 2003, 2004, 2005, 2006 (HIS)representative, age of respondents: 18 plussample size: 5,000 - 8,000MEHM integrated
Deutsches Institut für Wirtschaftsforschung The German Socio-Economic Panel (annually)
representative, longitudinal study of private households, started in 1984, sample size: 12,000 housholds and 22,000 persons
Federal Statistical Office Microcensus (annually) : 1 % of households (370,000 househoulds, 820,000
persons). Every four years additional questions on health (1 % of households) From 2005 ongoing: EU-SILC (Survey on Income and Living Conditions)
Other datasources (1)
Nursing care statistics
2005 Deutschland
weiblich männlich
Pflegebedürftige absolut Pflegequote Pflegebedürftige absolut Pflegequote
Alle Altersgruppen 1,438 ,278 3.4 690 ,272 1.7
unter 75 Jahre 339,507 0.9 360 ,572 0.9
75 bis unter 85 Jahre 520,308 15.7 210,359 11 .1
85 bis unter 90 Jahre 269,199 39.7 64,542 26 .9
90 Jahre und älter 309,264 66.5 54,799 39 .2
Limitations: Underestimation of men needing nursing care Underestimation of young/middle-aged persons needing nursing care
HLY using Nursing Care Statistics
Bickel H (2001) Lebenserwartung und Pflegebedürftigkeit in Deutschland. Gesundheitswesen 63: 9-14
Other datasources (2)
Statistics of severely disabled persons with official certification (extentof disablity: over 50 %)
Limitation: Underestimation of women who are severely disabled
DFLE, Northrhine-Westfaliausing Statistics of severely disabled persons
Ref.: Arbeitsgemeinschaft der obersten Landesgesundheitsbehörden: Indikatorensatz für die Gesundheitsberichterstattung der Länder; Anhang 1: Statistische Methoden. 3. neu bearbeitete Fassung, Bielefeld 2003
Other publications
2005
Gärtner, K., Scholz, R. D. Lebenserwartung in Gesundheit [Healthy life expectancy] In: Gärtner, K., Grünheid, E., Luy, M., editors. Lebensstile, Lebensphasen, Lebensqualität: interdisziplinäre Analysen von Gesundheit und Sterblichkeit aus dem Lebenserwartungssurvey des BiB. Wiesbaden: VS Verlag für Sozialwissenschaften; 2005. p. 311-331. (Schriftenreihe des Bundesinstituts für Bevölkerungsforschung, n°36)
2002
Klein, T., Unger, R. Aktive Lebenserwartung in Deutschland und in den USA. KohortenbezogeneAnalysen auf Basis des Sozio-ökonomischen Panel [Active life expectancy in Germany and in the United States. A cohort analysis based on the "German Socio-Economic Panel" (GSOEP) and the "Panel Study of Income Dynamics" (PSID)]. Zeitschrift für Gerontologie und Geriatrie 2002;35(6):528-539
Dissemination of HLY on national level
Integration in National Health Report: Health in Germany (2006)
www.rki.de
PH030 – German translations
Verschiedene Fragenvarianten vorstellen;
Unterschiedliche Prävalenzen darstellen
policy makers are disappointed about the SILC results; low (decreasing) acceptability of the indicator HLY
SILC (1)
Fühlen Sie sich seit mindestens sechs Monaten infolge eines Gesundheitsproblems in den gewöhnlichen Tätigkeiten beeinträchtigt?
German version, Germany
German Version, Belgium
Sind Sie seit zumindest einem halben Jahr durch eine Behinderung oder eine sonstige gesundheitliche Beeinträchtigung bei der Verrichtung der alltäglichenArbeiten beeinträchtigt?
Austrian version
SILC (2)
For at least the last 6 month to what extent have you been limited because of a health problem in activitiespeople usually do? Would you say you have been: Severely limited/ limited but not severely/ not limited?
English version
English GermanFor at least 6 month ß Seit mindestens sechs Monaten
ß Seit zumindest einem halben J ahrß In den letzten sechs Monaten
(„within the last 6 month“)Health problem ß Gesundheitsproblem
ß Gesundheitliche Gründeß Behinderung („disability, handicap“)ß Beeinträchtigung („impairment“)
Activities, people usually do ß Tägliche Aktivitäten („activities of dailylife“)
ß Gewöhnliche Tätigkeitenß Verrichtung der alltäglichen Arbeit
(„performance of daily work“)
Telephone Health Surveys (GSTel03)
2003: Waren Sie in den letzten 6 Monaten oder länger bei Dingen, die man üblicherweise so tut, aus gesundheitlichen Gründen eingeschränkt? (Ja, stark eingeschränkt; ja, eingeschränkt;
nein, nicht eingeschränkt)
Ja, stark eingeschränkt
Ja, eingeschränkt
Nein, nicht eingeschränkt
Männer Gesamt 9.0 23.1 67.8 18-24 5.0 19.1 75.5 25-49 6.7 18.7 74.5 50-64 11.8 26.4 61.9 >= 65 13.8 33.2 52.4 Frauen Gesamt 9.6 26.3 64.0 18-24 3.7 20.0 76.2 25-49 6.9 20.6 72.4 50-64 10.8 29.2 59.8 >= 65 15.7 36.1 48.1
Telephone Health Surveys (GSTel05)
2005: In welchem Ausmaß sind Sie durch Krankheit in der Ausübung Ihrer alltäglichen Tätigkeiten dauerhaft eingeschränkt? Wir meinen damit seit mindestens einem halben Jahr. (Erheblich eingeschränkt; eingeschränkt aber nicht erheblich; nicht eingeschränkt)
Erheblich eingeschränkt
Eingeschränkt, aber nicht erheblich
Nein, nicht eingeschränkt
Männer Gesamt 8.7 16.5 74.4 18-24 2.7 10.4 86.3 25-49 3.2 11.7 85.0 50-64 12.0 18.1 69.0 >= 65 21.8 29.8 47.8 Frauen Gesamt 9.7 20.6 69.4 18-24 0 13.0 87.0 25-49 5.0 12.6 81.8 50-64 11.7 23.4 64.7 >= 65 19.3 34.3 46.4
Limitations, women
9,6
26,3
64
9,7
20,6
69,4
0
10
20
30
40
50
60
70
80
stark/erheblicheingeschränkt
eingeschränkt nicht eingeschränkt
Percent
GSTel03
GSTel05
Limitations, men
9
23,1
67,8
8,7
16,5
74,4
0
10
20
30
40
50
60
70
80
stark/erheblicheingeschränkt
eingeschränkt nicht eingeschränkt
Percent
GSTel03
GSTel05
Calculation DFLE (GSTel03 and GSTel05) (severe and moderate limitation)
0
10
20
30
40
50
60
70
80
90
100
GSTel03 (w) GSTel05 (w) Eurostat 2003(w)
GSTel03 (m) GSTel05 (m) Eurostat 2003(m)
Years 68,6 % 73,4% 71,6 % 80,0%
Women Men
,
79,6 % 86,1%
Sullivan Method
Lifetable 2002-2004
Calculation DFLE (GSTel03 and GSTel05) (severe limitation)
0
10
20
30
40
50
60
70
80
90
100
GSTel03 (w) GSTel05 (w) Eurostat 2003(w)
GSTel03 (m) GSTel05 (m) Eurostat 2003(m)
Years
Women Men
79,6 %91,6 % 92,3 % 92,7 % 92,5 % 86,1 %
Sullivan Method
Lifetable 2002-2004
Prevalences of disability
Datasource Age group Prevalence of disability / severe limitation
Men Women Microzensus 2005 (disabled)
All agegroups
11.5 % 9.5 %
German SILC 2005 (MEHM) 16 plus 7.9 % 8.8 % Statistics of severely disabled persons with official certification 2005
All agegroups
8.7 % 7.7 %
German Socio-Economic Panel 2005 (severly disabled)
18 plus 11.3 % 9.0 %
Austria: SILC 2004 (MEHM) 16 plus 8.4 % 8.9 % GSTel 03 (MEHM) 18 plus 9.0 % 9.6 % GSTel04 (MEHM) 18 plus 7.5 % 9.2 % GSTel05 (MEHM) 18 plus 8.7 % 9.7 %
Suggestion for calculation HLY
HLY should be depicted in two ways:
(1) Years lived in good health versus years lived with limitations (severe and not severe limitations). This is the usual manner to depict the indicator.
(2) Years lived in good or moderate health versus years lived with severe limitations. This approach seems to produce results more comparable between the Member States. Presumably the underlying concept of severe limitation is more consistent and more robust against different translations or cultural adaptations.
Preliminary calculations – time trends
Data sources:
Health Interview Surveys (CATI) carried out by the Robert Koch Institute
GSTel03 (2002-2003)
GSTel04 (2003-2004)
GSTel05 (2004-2005)
GSTel06 (2005-2006)
Life tables from the Federal Statistical Office Germany
2000-2002
2001-2003
2002-2004
2003-2005
Methods
Calculation of Health expectancies by Sullivan‘s method
Self-rated health
Q: Wie ist ihr Gesundheitszustand im Allgemeinen? [How is your state of health in general?] Ist er sehr gut, gut, mittelmäßig, schlecht oder sehr schlecht? [Is it very good, good, fair, bad or very bad].
Very good + good good health
fair + bad + very bad bad health
Life expectancy men
Life expectancy in good health - Men
0
10
20
30
40
50
60
70
0 4 8 12 16 20 24 28 32 36 40 44 48 52 56 60 64 68 72 76 80 84 88 92 96 100Age
Years
Lifetable 2000-2002 - GSTel03 LIfetable 2001-2003 - GSTel04
Lifetable 2002-2004 - GSTel05 Lifetable 2003-2005 - GSTel06
Life expectancy women
Life expectancy in good health - Women
0
10
20
30
40
50
60
70
0 4 8 12 16 20 24 28 32 36 40 44 48 52 56 60 64 68 72 76 80 84 88 92 96 100Age
Years
Lifetable 2000-2002 - GSTel03 Lifetable 2001-2003 - GSTel04
Lifetable 2002-2004 - GSTel05 Lifetable 2003-2005 - GSTel06
Trends in life expectancy and life time, men
0,00
10,00
20,00
30,00
40,00
50,00
60,00
70,00
2002-2003 2003-2004 2004-2005 2005-2006
Lifetime (years)
73.9 % 73.7 % 74.0 % 77.7 %
18-year-old men
Self-rated good health Self-rated bad health
Trends in life expectancy and life time, women
0,00
10,00
20,00
30,00
40,00
50,00
60,00
70,00
2002-2003 2003-2004 2004-2005 2005-2006
Lifetime (years)
67.8 % 69.3 % 69.6 % 72.9 %
18-year-old women
Self-rated good health Self-rated bad health
Are we living longer, healthier lives?
Major question: Will increases in life expectancy be associated with a greater or lesser proportion of the future population spending their years living with disability?
Compression of morbidity Expansion of morbidity Dynamic equilibrium (status quo)
Conclusion (1)
Men 1995 1996 1997 1998 1999 2000 2001 2002 2003
LE 73.3 73.6 74.0 74.5 74.7 75.0 75.6 75.4 75.5
DFLE 60.0 60.8 61.9 62.1 62.3 63.2 64.1 64.4 65.0
%DFLE/LE 81.8 82.6 83.7 83.4 83.4 84.3 84.8 85.5 86.1
Dynamic equilibrium – expansion of morbidity
Compression of morbidity
Women 1995 1996 1997 1998 1999 2000 2001 2002 2003
LE 79.7 79.9 80.3 80.6 80.7 81.0 81.3 81.2 81.3
DFLE 64.3 64.5 64.3 64.3 64.3 64.6 64.5 64.5 64.7
%DFLE/LE 80.6 80.7 80.0 79.8 79.6 79.8 79.3 79.5 79.6
Calculations Eurostat/EHEMU; download 1.6.2007
Conclusion (2)
Men 2002 -2003 2003 -2004 2004 -2005 2005 -2006
LE 75,38 75,59 75,89 76,21
DFLE 59,60 59,77 59,97 62,60
%DFLE/LE 79.1 79.1 79.0 82.1
Women 2002 -2003 2003 -2004 2004 -2005 2005 -2006
LE 81,22 81,34 81,55 81,78
DFLE 59,87 60,86 61,19 63,62
%DFLE/LE 73.7 74.8 75.0 77.8
Compression of morbidity
Dynamic equilibrium – compression of morbidity
Calculations RKI (life expectancy in good health)
Results somewhat controversial to calculations using GSOEP Data
Conclusion (3)
Use of HLY indicator not very common in Germany
Cooperation between Demography, Public Health and other research
disciplines should be improved
Problems referring to the translation / cultural adaptation of PH030 not
yet been solved
Suggestion to calculate HLY without strong / severe limation
Also PH010 or index of PH010-PH030 should be used for calculation
of time trends