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Global patterns and trends in healthy life expectancy• Background• Summary of methods• Key findings• Interpretation, limit...
Healthy life expectancy     % Surviving 100  90  80  70  60  50  40  30  20  10    0        0              20             ...
Healthy life expectancy                                                                   Life expectancy =     % Survivin...
Healthy life expectancy                                                                         Life expectancy =     % Su...
Healthy life expectancy                                                                        Life expectancy =     % Sur...
Healthy life expectancy and compression of morbidity• By examining life expectancy, healthy life expectancy, and the    di...
Study objectives• Assess healthy life expectancy for 187 countries, in 1990 and    2010, using comparable methods, to:    ...
Global patterns and trends in healthy life expectancy• Background• Summary of methods• Key findings• Interpretation, limit...
Inputs for calculating healthy life expectancy in GBD        Age-specific mortality        Prevalence of nonfatal         ...
Inputs for calculating healthy life expectancy in GBD                                         • Life tables by sex, countr...
Inputs for calculating healthy life expectancy in GBD        Age-specific mortality                                       ...
Inputs for calculating healthy life expectancy in GBD        Age-specific mortality        Prevalence of nonfatal         ...
Computing healthy life expectancy• Information on prevalence of all disabling sequelae, and  disability weights attached t...
Global patterns and trends in healthy life expectancy• Background• Methods for measuring healthy life expectancy (HALE) in...
Global life expectancy and healthy life expectancy• In 2010, global life expectancy at birth was       For males: 67.5 (9...
Highest and lowest healthy life expectancy at birth, 2010Highest male healthy life expectancy                    Highest f...
Male healthy life expectancy at birth, 2010Salomon – Healthy life expectancy - 18
Female healthy life expectancy at birth, 2010Salomon – Healthy life expectancy - 19
Changes in healthy life expectancy at birth, 1990-2010Largest increases, males                          Largest increases,...
Compression or expansion of morbidity?   Life expectancy – healthy life expectancy = healthy years lost to disabilityMales...
Compression or expansion of morbidity?   Life expectancy – healthy life expectancy = healthy years lost to disabilityMales...
Compression or expansion of morbidity?   Life expectancy – healthy life expectancy = healthy years lost to disabilityMales...
Drivers of change in healthy life expectancySalomon – Healthy life expectancy - 24
Advances and limitations• Strengths of the approach used include       Systematic use of multiple data sources including ...
Summary and discussion• Healthy life expectancy has increased more slowly than life  expectancy over the last 20 years, wh...
Healthy life expectancy for 187 countries, 1990 - 2010
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Healthy life expectancy for 187 countries, 1990 - 2010

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Findings and implications of the Global Burden of Disease Study 2010

Royal Society, London, 14 December 2012

Joshua A Salomon
Harvard School of Public Health

Published in: Health & Medicine
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  • Difference between LE and HALE was 9.2 (males) and 11.5 (females)
  • Transcript of "Healthy life expectancy for 187 countries, 1990 - 2010"

    1. 1. Global patterns and trends in healthy life expectancy• Background• Summary of methods• Key findings• Interpretation, limitations, conclusionsSalomon – Healthy life expectancy - 2
    2. 2. Healthy life expectancy % Surviving 100 90 80 70 60 50 40 30 20 10 0 0 20 40 60 80 100 AgeSalomon – Healthy life expectancy - 3
    3. 3. Healthy life expectancy Life expectancy = % Surviving Area under survival curve 100 90 80 70 60 50 40 30 20 10 0 0 20 40 60 80 100 AgeSalomon – Healthy life expectancy - 4
    4. 4. Healthy life expectancy Life expectancy = % Surviving Weight 0 Area under survival curve 100 90 1 80 Healthy life expectancy 70 B‘Not (dichotomous) = 60 Area A only 50 healthy’ 40 30 A 20 ‘Healthy’ 10 0 0 20 40 60 80 100 AgeSalomon – Healthy life expectancy - 5
    5. 5. Healthy life expectancy Life expectancy = % Surviving Weight 0 Area under survival curve 100 90 80 Healthy life expectancy 70 B 1 (dichotomous) = 60 Area A only 50 40 30 A Healthy life expectancy 20 (continuous) = 10 Weighted area under 0 0 20 40 60 80 100 survival curve AgeSalomon – Healthy life expectancy - 6
    6. 6. Healthy life expectancy and compression of morbidity• By examining life expectancy, healthy life expectancy, and the difference between the two over time, we can evaluate competing hypotheses about relationships between changes in mortality and morbidity  Compression of morbidity: healthy life expectancy rises faster than life expectancy  Expansion of morbidity: life expectancy rises faster than healthy life expectancy• A number of studies have evaluated compression vs. expansion using health expectancy measures  e.g. Crimmins et al. 1997, Mathers et al. 1999, Robine et al. 1999, 2009; Crimmins and Beltrán-Sánchez 2010.Salomon – Healthy life expectancy - 7
    7. 7. Study objectives• Assess healthy life expectancy for 187 countries, in 1990 and 2010, using comparable methods, to:  Characterize current levels and patterns  Evaluate change over time  Consider evidence for compression or expansion of morbiditySalomon – Healthy life expectancy - 8
    8. 8. Global patterns and trends in healthy life expectancy• Background• Summary of methods• Key findings• Interpretation, limitations, conclusionsSalomon – Healthy life expectancy - 9
    9. 9. Inputs for calculating healthy life expectancy in GBD Age-specific mortality Prevalence of nonfatal outcomes Disability weightsSalomon – Healthy life expectancy - 10
    10. 10. Inputs for calculating healthy life expectancy in GBD • Life tables by sex, country, and year in GBD 2010 based on Age-specific mortality • Estimation of mortality between birth and age five (5q0) • Estimation of mortality between ages 15 and 60 (45q15) Prevalence of nonfatal • Model life tables to translate into full set outcomes of age-specific mortality rates Disability weightsSalomon – Healthy life expectancy - 11
    11. 11. Inputs for calculating healthy life expectancy in GBD Age-specific mortality • Prevalence of 1,160 disabling sequelae by age, sex, country, year based on: Prevalence of nonfatal • Systematic review of available data outcomes sources from published literature • Bayesian meta-regression approach to estimate prevalence across populations and over time Disability weightsSalomon – Healthy life expectancy - 12
    12. 12. Inputs for calculating healthy life expectancy in GBD Age-specific mortality Prevalence of nonfatal • 1,160 sequelae mapped into 220 unique outcomes health states, and disability weights estimated for each of these • Disability weights capture health loss on scale from 0 (no health loss) to 1 Disability weights (equivalent to death) • Estimates based on new survey data collected among 30,000 respondents from diverse settingsSalomon – Healthy life expectancy - 13
    13. 13. Computing healthy life expectancy• Information on prevalence of all disabling sequelae, and disability weights attached to these, integrated into a continuous index of average disability including comorbidity  Simulation used to capture exposure to multiple disabilities  Combined disability weight for an individual with multiple morbidities computed multiplicatively (assumes independence)  Individual results aggregated by age to yield ‘YLD rates’ which capture severity-weighted disability prevalence• Sullivan’s method used to incorporate YLD rates into life table  ‘Healthy years’ lived in an age interval estimated by multiplying years lived by (1 – YLD rate)  Life table recomputed for healthy life yearsSalomon – Healthy life expectancy - 14
    14. 14. Global patterns and trends in healthy life expectancy• Background• Methods for measuring healthy life expectancy (HALE) in the Global Burden of Disease 2010• Key findings• Interpretation, limitations, conclusionsSalomon – Healthy life expectancy - 15
    15. 15. Global life expectancy and healthy life expectancy• In 2010, global life expectancy at birth was  For males: 67.5 (95% uncertainty interval 66.9 to 68.1)  For females: 73.3 (72.8 to 73.8)• In 2010, global healthy life expectancy was  For males: 58.3 (56.7 to 59.8)  For females: 61.8 (60.1 to 63.4)• Between 1990 and 2010, life expectancy at birth increased  For males, by 4.7 (3.9 to 5.4) years  For females, by 5.1 (4.5 to 5.8 years)• Between 1990 and 2010, HALE at birth increased  For males, by 3.9 (3.3 to 4.5) years  For females, by 4.0 (3.5 to 4.5 years)Salomon – Healthy life expectancy - 16
    16. 16. Highest and lowest healthy life expectancy at birth, 2010Highest male healthy life expectancy Highest female healthy life expectancy Japan Japan Singapore South Korea Switzerland Spain Spain Singapore Italy TaiwanLowest male healthy life expectancy Lowest female healthy life expectancy Mozambique Mozambique Swaziland Swaziland Central… Lesotho Lesotho Central… Haiti Haiti 0 20 40 60 80 0 20 40 60 80Salomon – Healthy life expectancy - 17
    17. 17. Male healthy life expectancy at birth, 2010Salomon – Healthy life expectancy - 18
    18. 18. Female healthy life expectancy at birth, 2010Salomon – Healthy life expectancy - 19
    19. 19. Changes in healthy life expectancy at birth, 1990-2010Largest increases, males Largest increases, females Ethiopia Rwanda Angola Maldives Rwanda Ethiopia Niger Angola Maldives BhutanLargest decreases, males Largest decreases, females South Africa South Africa Zimbabwe Zimbabwe Swaziland Haiti Lesotho Swaziland Haiti Lesotho -20 0 20 -20 0 20Salomon – Healthy life expectancy - 20
    20. 20. Compression or expansion of morbidity? Life expectancy – healthy life expectancy = healthy years lost to disabilityMales Females 1. Across countries, higher life expectancy is associated with more healthy years lost to disability in 1990 Salomon – Healthy life expectancy - 21
    21. 21. Compression or expansion of morbidity? Life expectancy – healthy life expectancy = healthy years lost to disabilityMales Females 1. Across countries, higher life expectancy is associated with more healthy years lost to disability in 1990 and in 2010 Salomon – Healthy life expectancy - 22
    22. 22. Compression or expansion of morbidity? Life expectancy – healthy life expectancy = healthy years lost to disabilityMales Females 2. Over time (1990 to 2010), increases in life expectancy are associated with increases in healthy years lost to disability Salomon – Healthy life expectancy - 23
    23. 23. Drivers of change in healthy life expectancySalomon – Healthy life expectancy - 24
    24. 24. Advances and limitations• Strengths of the approach used include  Systematic use of multiple data sources including biomarkers and functional measurements where appropriate and available  Comparable methods applied to two time points  Accounting for independent comorbidity• Limitations of the approach include  Lack of vital registration data in many countries, and limited basis for estimating adult mortality  Limitations in available information on prevalence over time for some conditions, and Bayesian estimation approach may underestimate variability where evidence on regional differences is weak  Estimates of disability weights depend on validity of descriptions, and no allowance for changing disability weights over time may miss some effects of interventionSalomon – Healthy life expectancy - 25
    25. 25. Summary and discussion• Healthy life expectancy has increased more slowly than life expectancy over the last 20 years, which means:  Gains in survivorship have added healthy years but also unhealthy ones  The world’s population loses more healthy years to disability today than 20 years ago  This increase has profound implications for healthcare needs and costs• Most gains in healthy life expectancy since 1990 have been attributable to reductions in child and adult mortality• Major drivers of nonfatal losses of healthy life include mental and behavioral disorders and musculoskeletal disorders, which have not seen major improvements globally over last 20 years• More attention needed on reducing prevalence and impact of major causes of disabilitySalomon – Healthy life expectancy - 26
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