Roberta Crialesi Health and Care Sector ISTAT

1. Life Expectancy and Disability • Free Life Expectancy in Italy • 2nd Meeting of the Task Force on Health Expectancies Roberta Crialesi Health and Care Sector ISTAT Luxembourg, 8th June 2006

2. Life Expectancy (LE) and Disability Free Life Expectancy (DFLE): background • Italian LE at birth is one of the highest in the World: 77.8 years for Men and 83.7 years for Women in 2004. • But not always a longer life means a better life. • DFLE helps to evaluate quality of life and provides useful information on areas needing interventions and on possible burden of care to health systems Disability Free Life Expectancy (DFLE) average number of years survivors are expected to live at various ages without disabilities Life Expectancy (LE) average number of years survivors are expected to live at various ages Luxembourg, 8th June 2006

3. DFLE at 65 as measure of health needs and burden for health systems Burden for health system • Useful to identify areas needing interventions because of high number of years with bad quality of life • It could be used as parameter to allocate resources in addition to others (population by age, mortality, etc.) Health needs • This indicator provides information on the quality of years to live • It provides indirect information on autonomy in activities of daily living • It provides information on the health status of elderly without being affected from the age structure of this population group Luxembourg, 8th June 2006

4. Methodology and Sources • The Sullivan method combines mortality data from population life tables and age specific prevalence of disability generally obtained from surveys (the years lived of the life table are multiplied by the proportion of persons who are not disabled/ proportion of persons who perceived their health as good). • Italian data is calculated using the National Health Interview Survey performed every 5 years by ISTAT. Last survey was performed in 2004/2005. The previous one was performed in 1999/2000. Luxembourg, 8th June 2006

5. Sources (1) • The survey on Health conditions and use of the health services is one of the main sources to describe the health status of the Italian population. It gives information about perceived health status, symptoms, chronic conditions, disability and health related behaviour, information which is not available from administrative data sources. • Data on disability have been collected since 1990. Data are available for 1990, 1994, 1999-2000. • The Italian HIS is carried out by Istat (Italian National Institute of Statistics) on a sample of households distributed on the whole country, using PAPI interviews; • The sampling design is on two stages, with stratification in the first stage based on demographic criteria (units are municipalities) in each region. In the second stage, a minimum number of households are randomly selected from registers of each municipality and every member of each household is interviewed. Luxembourg, 8th June 2006

6. Sources (2) Main warnings: • Questionnaire has been administered to persons aged 6 years and older. We know that the instrument is not suitable for young children (less than 16 years old). Some distortions could in fact derive from questions such as whether one is capable of taking a bath or getting dressed on one’s own, which are totally independent from whether there is a disability or not. • The survey leaves out people who live permanently in institutions (rest homes for the elderly, disabled persons or other types of collective forms of cohabitation). It is reasonable to suppose that this non surveyed population has characteristics, even regarding the presence of disabilities, that are completely different from those of the rest of the population who live in households: it should therefore not be ignored. This problem will be solved in the survey of the bodies in charge of social-assistance. Luxembourg, 8th June 2006

7. Definition of disability • Activity of Daily Living (ADL) scale: A set of questions is dedicated to different disability areas. The answer indicates different severity levels of disability (from a partial autonomy to a greater difficulty and to the inability of carrying out a function without the help of other people). • From this battery of questions it is possible to identify 4 types of disability: personal confinement (constraint to bed, on a chair or at home), disability in functional activities (difficulties in dressing up, washing, taking a bath, feeding), disability in the movements (difficulties in walking, in going up the stairs, in squatting, in lying down, in sitting down), sensorial disabilities (difficulties in hearing, seeing and speaking). • A person is defined as disabled when, excluding conditions of temporary limitation, he/she declares to be not able to perform, despite the sanitary equipments he or she may have (prosthesis, canes, glasses, etc.),at least one of the above mentioned functions. Luxembourg, 8th June 2006

8. Life Expectancy Indicators • LE at 65 increased over time relatively more than LE at birth in both sexes • DFLE at 65 increased in the same period more than LE at 65 for Male • Men gained relatively more months of life without disability than women • The proportion of years lived without disability within life expectancy has increased Luxembourg, 8th June 2006

9. Evolution of LE and DFLE at 65Italy, 1990, 1994, 2000 • Women advantage with respect to men is more evident in LE than in DFLE. • Men can expect to live a higher percentage of their life after 65 without disability than women. It means that the advantage of women in terms of the duration of life reduces when a dimension of quality of life is introduced. Women live longer, they have also a longer DFLE, but they have a higher share of total life to live with disability. Luxembourg, 8th June 2006

10. Disability prevalence Reduction of disability prevalence in ten years has been concentrate in the middle-aged people. Luxembourg, 8th June 2006

11. Disability free Life Expectancy • DFLE at 65 is higher in northern and central regions. • Puglia, Campania, Sicily have the smaller value of HLE both for male and female. • In 7 regions (Emilia Romagna, Toscana, Marche, Umbria, Molise, Basilicata, Calabria) male DFLE at 65 is higher than female.

12. Healthy Life Expectancy • HLE at 65 is higher in north-east • Umbria, Molise, Basilicata, Calabria have the smaller value of HLE both for male and female • In 5 regions (Valle d’Aosta, Emilia Romagna, Toscana, Abruzzo, Campania) male HLE at 65 is higher than female Luxembourg, 8th June 2006

13. Main conclusions Prudent optimism: Italians live longer and the n°. of years spent without disability are increasing Gender differences: women have a longer life but they also have a greater n. of years lived with disability (about 2 times) Clear geographical gradient: all the Southern Regions having DFLE lower than the national average. Luxembourg, 8th June 2006

14. In the future…… In a very short time it would be available data of the Health Interview Survey 2004-2005. The new survey would give us the possibility to have recent data on health and disability. The survey used the same questions used in the previous survey to measure disability, perceived health and chronic diseases, in this way it could be possible to analyse the data evolution over ten years (1994-2004). Luxembourg, 8th June 2006

15. References (1) • ISTAT, La qualità della sopravvivenza: salute e autonomia in “Rapporto Annuale – La situazione del Paese nel 2002”. Roma: Istat, 2003. • ISTAT, HEALTH FOR ALL – ITALY “Un sistema informativo territoriale su sanità e salute” (June 2005), http://www.istat.it/sanita/health/ (over 4.000 indicators are available, among these disability and health perceived free life expectancy are calculated for Italy and regional areas, by gender and age. Data comes from the Italian Health Interview Survey 1999-2000. Data only at national level are also available for year 1994). Luxembourg, 8th June 2006

16. References (2) • ISTAT – Statistical Information System on Disability – www.disabilitaincifre.it Luxembourg, 8th June 2006

17. References (3) • Crialesi R. “ Qualità della sopravvivenza” in “Salute e malattie” chapter of “Relazione sullo stato sanitario del Paese – 2000”, Ministero della Sanità (Ministry of Health), Direzione Generale Studi, Documentazione sanitaria e Comunicazione ai cittadini, Rome, 2001. • Burgio A. “Speranza di vita libera da disabiltà” in “Salute e disabiltà” chapter of “Rapporto osservasalute. Stato di salute e qualità dell’assistenza nelle regioni italiane”, Vita e Pensiero ed., Milan, December 2004 http://www.osservasalute.it/. Luxembourg, 8th June 2006

18. References (4) • Crialesi R., Frova L., Rocchi F., Verdecchia A. (1999), An integrated approach to measure the health status of the Italian population, Rivista di Statistica Ufficiale, Quaderni di ricerca, n.1, Istat, Franco Angeli ed., pagg. 9-22. • Frova L. (1995), “Longevity and quality of life: an appraisal of healthy-life expectancy” in IRP (a cura di), Contributions of Italian Scholars, European Population Conference, 4-8 September, IRPSS. • Egidi V., Frova L., Verdecchia A. (1997), Speranza di vita totale e speranza di vita in buona salute: un approccio statistico, in “La salute degli italiani”, Atti del Convegno, Rome 21-22 March 1995, IRPSS (a cura di), monografie 7/1997, pagg. 297-319. Luxembourg, 8th June 2006

19. References (5) • Burgio A., Marano C., Folino-Gallo P., “Geographic variations and gender differences in Life Expectancy in the Italian Regions. A challenge to health systems” Public Health Association, EUPHA, 10-12 November, Graz, Austria, Session: Social and ecological determinants of health. Abstract: http://www.eupha.org/html/2005_graz/3-3.doc. • Burgio A., Solipaca A. “Ripartizione del finanziamento sanitario contributo tecnico metodologico dell’Istat alla riflessione sui vantaggi e gli svantaggi dell’adozione di alcuni indicatori” not quoted document, 13 November 2002 (document prepared by Istat researchers for the Italian Minister of Health). Luxembourg, 8th June 2006