PowerPointprsentation

1
Health expectancy in Denmark
Secular trends Social gradient Social
differences in the burden of diseases Impact of
selected risk factors
3rd Meeting of the Task Force on Health
Expectancies Luxembourg, 12 December 2006 Henrik
Brønnum-Hansen
2
Secular trends
3
Purpose   What could be told about the
development in Denmark as to the hypothesises

• Compression of morbidity

• Expansion of morbidity

• Dynamic equilibrium

?
4
Data sources
Health interview surveys carried out by the
National Institute of Public Health. Surveys in
1987, 1991, 1994, 2000 and 2005
New data!
Standard life tables from Statistics Denmark
for 19861987, 19901991, 19931994, 19992000
and 20042005
5
Methods
Health expectancy by Sullivans method Expected
lifetime in various health states

• Self-rated health

• Functional limitations

• Long-standing, limiting illness

6
Self-rated health
Interview question How do you rate your present
state of health in general?

• Answer categories
• Very good
• Good
• Fair
• Poor
• Very poor

Dichotomised

7
(No Transcript)
8
Functional limitations
A person was considered to have functional
limitations if he/she could do one or more of the
following, only with difficulty or not at all

• walk 400 m without resting,
• walk up or down a staircase from one floor to
  another without resting,
• carry 5 kg,
• read ordinary newspaper print,
• hear what is being said in a normal conversation
  between three or more persons,
• or
• speak with minor or major difficulty (assessed by
  the interviewer)

9
(No Transcript)
10
Long-standing, limiting illness
Interview question Do you suffer from any
long-standing illness, long-standing after-effect
of injury, any disability, or other long-standing
condition?
If yes a question were asked to clarify whether
the disease implied restrictions to daily life or
at work
11
(No Transcript)
12
Conclusions
Compression of morbidity is observed in Denmark
when health expectancy is measured by

• Self-rated health

• Functional limitations

• Long-standing, limiting illness

13
Social gradient
14
Purpose   To estimate social inequalities as to
expected lifetime without and with long-standing,
limiting illness
Social classification
Educational level
15
Data sources
The Danish Health Interview Survey 2000 (National
Institute of Public Health) Sex-, age- and
educational level-specific prevalence of
long-standing, limiting illness
Mortality, register linkage (Statistics
Denmark) Sex- and age-specific numbers of persons
at risk and the numbers of deaths during the
period 1995-1999 for each of three educational
groups
16
Educational level
Information about schooling, vocational training
and further education

Register information (Statistics
Denmark)
Questions in the health interview
survey (National Institute of Public Health)

• Three levels
• Low
• Medium
• High

17
Educational level
Low - persons with a max. of 10 years of
schooling and no more than semi-skilled training,
basic vocational training or business school
(first year)
Medium - persons with either a max. of 10 years
of schooling and further vocational or other
training or with post-secondary schooling but no
higher education
High - persons with any type of higher education
18
(No Transcript)
19
Social differences in the burden of diseases
20
Purpose   To quantify the health impact of
diseases with high prevalence or mortality, and
to evaluate social differences in the burden of
long-standing illness
21
(No Transcript)
22
Data sources
Mortality, register linkage (Statistics Denmark)
Sex- and age-specific
numbers of persons at risk and the numbers of
deaths from selected causes during the period
1995-1999 for each of three educational groups
Long-standing illness, the Danish Health
Interview Survey 2000 (National Institute of
Public Health)
Sex-, age- and educational level-specific
prevalence of long-standing, limiting illness
23
Long-standing illness
Interview question Do you suffer from any
long-standing illness, long-standing after-effect
of injury, any disability, or other long-standing
condition?

• If yes questions were asked to clarify
• the nature of the disease(s) (up to four
  diseases)
• whether the disease implied restrictions to daily
  life or at work

24
Methods
Construction of life tables by sex and
educational level

• Disease elimination
• Construction of cause-deleted life tables
  (specific demographic technique)
• Elimination of specific diseases from prevalence
  of long-standing, limiting illness

• Health expectancy, Sullivans method
• Expected lifetime with and without long-standing,
  limiting illness
• Observed
• Hypothetical after disease elimination

25
(No Transcript)
26
(No Transcript)
27
Difference in expected lifetime (between age 30
and 75) with and without long-standing, limiting
illness between people with high and low
educational level
Difference in partial life expectancy 3.1
years
Difference in partial life expectancy 1.6
years
28
Gain in partial life expectancy and changes in
expected lifetime with and without long-standing,
limiting illness due to elimination of cancer at
age 30
29
Gain in partial life expectancy and changes in
expected lifetime with and without long-standing,
limiting illness due to elimination of diseases
of the circulatory system at age 30
30
Gain in partial life expectancy and changes in
expected lifetime with and without long-standing,
limiting illness due to elimination of diseases
of the musculoskeletal system at age 30
social gradient
31
Gain in partial life expectancy and changes in
expected lifetime with and without long-standing,
limiting illness due to elimination of mental and
behavioural disorders at age 30
social gradient
32
Gain in partial life expectancy and changes in
expected lifetime with and without long-standing,
limiting illness due to elimination of diseases
of the nervous system at age 30
social gradient opposite direction!
?
?
33
Conclusions

• Persons with a low educational level were more
  likely to have long-standing, limiting illness
  than those with a high educational level.

• The gain in partial life expectancy to be
  expected by eliminating certain diseases
  decreased with educational level.

• The gain in partial life expectancy that could be
  expected to derive from elimination of cancer
  decreases with educational level, but also added
  lifetime with long-standing illness decreases
  with educational level. A similar phenomenon was
  seen for cardiovascular diseases if they were
  eliminated, women with a low educational level
  would gain lifetime years, but the reduction in
  lifetime with long-standing illness would be
  greatest for women with a high educational level.

• We found a social gradient in the burden of all
  major diseases with low fatality, except for
  diseases of the nervous system for women.

34
Impact ofselected risk factors
35
Risk factors

• Smoking
• Never smoker
• Ex-smoker
• Moderate smoker 1-14 gram of tobacco per day
• Heavy smoker ? 15 gram of tobacco per day

• Alcohol consumption
• Moderate consumption 1-14 units of alcohol per
  week for women
• 1-21 units of alcohol per week for men
• High consumption more than 14 units of alcohol
  per week for women
• more than 21 units of alcohol per week for men

• Physical inactivity (during leisure time)
• Active At least light physical activity 4 hours
  per week
• Inactive Sedentary (except for disabled
  individuals)

• Overweight
• Normal weight 18.5 BMI lt 25.0
• Overweight 25.0 BMI lt 30.0
• Obese 30.0 BMI

BMI Body Mass Index Underweight (BMI lt 18.5)
excluded
36
Data sources

• Death rates by sex and age from the Cause of
  Death Register

• As to smoking Lung cancer death rates and
  relative risks from the second prospective Cancer
  Prevention Study
• (CPS-II) of the American Cancer Society

• Relative risks for death estimated from the
  Danish National Cohort Study (DANCOS) the Danish
  Health Interview Surveys in 1987, 1991, 1994 and
  2000 linked to the Danish Civil Registration
  System and other national registers

• Prevalence of long-standing, limiting illness by
  sex, age and risk factor level established from
  the Danish Health Interview Survey 2000

37
Methods
Construction of life tables by sex and risk
factor level P0 sex and age specific prevalence
of unexposed Pi prevalence for risk factor
exposure level i RRi relative risk (RR0 1) Then
sex and age specific death rate, is given by D
? Pi RRi D0 and D0 death rate of unexposed
can be calculated Sex and age specific death
rates for unexposed, D0, are multiplied with the
relative risk, RRi to estimate sex and age
specific death rates for risk factor level
i Finally, risk factor level specific life tables
are constructed For smoking an indirect method
(Peto and colleagues) was used.
38
Methods
Survey data Prevalence of long-standing,
limiting illness by sex and risk factor level
Sullivans method to estimate expected lifetime
without longstanding, limiting illness
39
Results
Risk factors and expected lifetime without
longstanding, limiting illness
40
Summary Life expectancy
41
Summary Health expectancy
42
(No Transcript)
43
Summary Health expectancy
44
Summary Health expectancy
45
Thank you!