Disability free life expectancies in Francein recent years

Emmanuelle Cambois Aurore ClavelJean-Marie Robine

Task force on health expectancies12 september 2006

Disability free life expectancy in France at birth, 1981 and 1991

Men Women

1981

1991 Trends

1981 1991 Trends

Total Life Expectancy

70,4

72,9 + 2,5 78,6 81,1 + 2,5

DFLE (any severity) 60,8

63,8 + 3,0 65,9 68,5 + 2,5

LE with Severe disab

1,5 1,2 - 0,3 2,3 2,3 --

LE with Moderate disab

8,1 7,9 -0,2 10,4 10,3 -0,1

Disability-free life expectancy in France

• Two estimations based on the national household health surveys (1980 & 1991)

• Favorable trends over the 90’s

Disability-free life expectancy in France in 2002

• New opportunity with the 2002 survey ! The same single Q

• but new survey design…

- Household based interview to individual interview

- Disability question moved just after the household description being now the first health question + deals with “be disabled”while it was at the very end of the survey in previous editions

Does someone in the household being disabled or simply having some difficulties or being hampered in daily life ? (do not consider accute handicaps or difficulties…)

1 Yes 2 No

• New calculations and analysis of the 2002 disability question

• Other disability indicators in the health survey HIS Long term activity limitation (Single Q) Sensory and physical functional limitations Self-care activity restrictions

• Other data sources (household surveys) around year 2000

French disability survey (DS), 1999:• Sensory and physical functional limitations• Self care activity restrictions

Survey on social protection and health consumption (HCS), 2002

• mobility difficulty (severe + moderate)• Self care activity restriction (difficulty to wash face and hands)

European household panel, ECPH, 2001• being hampered in daily life due to disease or disability (Single

Q)

• Chronological series HIS / HCS / ECPH

Disability-free life expectancy in France in 2002

Men Women

Total life expectancy 56,6 63,7

Life expectancy without :

- Personal care activity restrictions54,0

(96%)58,8

(92%)

- Hampered in daily life due to disease or disability

50,5 (89%)

55,1 (87%)

- Long term activity limitations47,7

(84%)50,9

(80%)

- Sensory and physical functional limitations41,2

(73%)42,4

(67%)

DFLE at age 20 in the HIS, 2002-2003

• Various disability dimensions: from 96% to 73% for males / 92% to 67% for females

• Functional limitations are less compressed at the end of life

• Male/female differences in %DFLE more stressed with moderate

disability

Men Women

Total life expectancy 17,1 21,5

Life expectancy without :

- Personal care activity restrictions14,8

(87%)17,1

(80%)

- Hampered in daily life due to disease or disability

13,5 (79%)

16,1 (75%)

- Long term activity limitations11,7

(69%)13,1

(61%)

- Sensory and physical functional limitations 6,8 (40%) 6,9 (32%)

DFLE at age 65 in the HIS, 2002-2003

0

10

20

30

40

50

60

70

DFLE estimates at age 20, around year 2000

senso & physFL

Self care ARLimitations with single

Q

Sev

ere

mo

bili

tyH

CS

02

Sel

f ca

re (

was

h)

HC

S 0

2

Sel

f ca

reH

ID 9

9

mo

bili

tyH

CS

02

Dis

able

dH

IS 0

3

Act

ivit

y lim

itH

IS 0

3

Ham

per

edE

CP

H 0

1

Fu

nct

lim

itH

IS 0

3

Fu

nct

lim

itH

ID 9

9

Sel

f ca

reH

IS 0

3

Hommes

Femmes

Trends in DFLE at age 20

• Massive increase with the HIS single Q "disabled"

• Almost no years gained with ECHP

• Steeper increase for severe disability indicators

• HIS single Q at the level of FL…in 2003 at the level of severe AR

Men

20

25

30

35

40

45

50

55

60

65

1975 1980 1985 1990 1995 2000 2005

Women

20

25

30

35

40

45

50

55

60

65 HISHCS

HIDECHP

E s p é r a n c e d e v i e s a n s i n c a p a c i t é à 6 5 a n s ( F e m m e s )

0

5

1 0

1 5

2 0

2 5

3 0

3 5

1 9 7 5 1 9 8 0 1 9 8 5 1 9 9 0 1 9 9 5 2 0 0 0 2 0 0 5

A n n é e s d ' e n q u ê t e

Anné

es d'

espé

rance

de vi

e san

s inc

apac

ité

E S P S : s a n s d i f f i c u l t é s s é v è r e s à s e d é p l a c e r

E S P S : s a n s d i f f i c u l t é s à f a i r e s a t o i l e t t e

E S P S : s a n s d i f f i c u l t é s à s e d é p l a c e r , t o u s n i v e a u x c o n f o n d u s

E S S M : s a n s h a n d i c a p o u g ê n e s d a n s l a v i e q u o t i d i e n n e

P E M : s a n s g ê n e s l i é e s à u n e m a l a d i e o u u n h a n d i c a p

H I D : s a n s r e s t r i c t i o n d ' a c t i v i t é p o u r l e s s o i n s p e r s o n n e l s

H I D : s a n s l i m i t a t i o n s f o n c t i o n n e l l e s

E S S M : s a n s r e s t r i c t i o n d ' a c t i v i t é p o u r l e s s o i n s p e r s o n n e l s

E S S M : s a n s l i m i t a t i o n s d ' a c t i v i t é d e l o n g t e r m e

E S S M : s a n s h a n d i c a p o u g ê n e s d a n s l a v i e q u o t i d i e n n e

E s p é r a n c e d e v i e s a n s i n c a p a c i t é à 6 5 a n s ( H o m m e s )

0

5

1 0

1 5

2 0

2 5

3 0

3 5

1 9 7 5 1 9 8 0 1 9 8 5 1 9 9 0 1 9 9 5 2 0 0 0 2 0 0 5

A n n é e s d ' e n q u ê t e

Anné

es d'

espé

rance

de vi

e san

s inc

apac

ité

E S P S : s a n s d i f f i c u l t é s s é v è r e s à s e d é p l a c e r

E S P S : s a n s d i f f i c u l t é s à f a i r e s a t o i l e t t e

E S P S : s a n s d i f f i c u l t é s à s e d é p l a c e r , t o u s n i v e a u x c o n f o n d u s

E S S M : s a n s h a n d i c a p o u g ê n e s d a n s l a v i e q u o t i d i e n n e

P E M : s a n s g ê n e s l i é e s à u n e m a l a d i e o u u n h a n d i c a p

H I D : s a n s r e s t r i c t i o n d ' a c t i v i t é p o u r l e s s o i n s p e r s o n n e l s

H I D : s a n s l i m i t a t i o n s f o n c t i o n n e l l e s

E S S M : s a n s r e s t r i c t i o n d ' a c t i v i t é p o u r l e s s o i n s p e r s o n n e l s

E S S M : s a n s l i m i t a t i o n s d ' a c t i v i t é d e l o n g t e r m e

E S S M : s a n s h a n d i c a p o u g ê n e s d a n s l a v i e q u o t i d i e n n e

Trends in DFLE at age 65

no differences between men and women reported by severely restricted persons, who have benefits…

rapid decrease: not congruent with international trends / previous decade change in the relationship with AR and FL (more specific, less sensible) impact of moving the Q and changing survey design

Limitations due to data

• Uncertainty with observed trends esp. for HIS… over-setimated!

Conclusions

• Usual patterns:differences men/women, FL more common and more spread over life

• Increasing DFLE, especially for the most severe indicators… but probably over-estimated

• Trends depend on the dimension under consideration the nature of disability (FL, AR, both…) the way to mesure it (survey design, Q wording…)

• But closeness of conclusions for similar dimensions

• Need for diversity to get a better picture

• Need for several chronological series to monitor overall trends

0%

5%

10%

15%

20%

25%

30%

35%

40%

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85

Women

Men

Taux d'incapacité à long terme des hommes

0%

20%

40%

60%

80%

0 10 20 30 40 50 60 70 80 90

Enquête santé 1980-81

Enquête santé 1991-92

Enquête santé 2002-03

Taux d'incapacité à long terme des femmes

0%

20%

40%

60%

80%

0 10 20 30 40 50 60 70 80 90

Enquête santé 1980-81

Enquête santé 1991-92

Enquête santé 2002-03

20+ 65 +

Men 5,6% 15,5%

Women 6,1% 16,5%

All together 5,9% 16,1%

Disability in the health survey 2002-2003 in France