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Decomposition of changes in disease life expectancy. England 1991-2005

UPTAP Meeting. University of Leeds, 18-20 March 2008. Decomposition of changes in disease life expectancy. England 1991-2005. Domenica Rasulo ( User Fellow ). Background concepts – life expectancy.

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Decomposition of changes in disease life expectancy. England 1991-2005

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  1. UPTAP Meeting University of Leeds, 18-20 March 2008 Decomposition of changes in disease life expectancy. England 1991-2005 DomenicaRasulo (User Fellow)

  2. Background concepts – life expectancy Life expectancy represents the expected number of years to be lived and is computed by using death and population counts It does not indicate whether people live in good or bad health (e.g. the same number of years can be lived with or without diseases) Using measures of disease prevalence, the number of years to be lived can be partitioned in years into with and without diseases

  3. Partitioning life expectancy The number of years of life expectancy is generally partitioned in years with and without limiting illness: Life expectancy (LE) = LE illness + LE without illness

  4. Years of life with ‘limiting long term illness’ in England

  5. Years of life with ‘limiting long term illness’ in England (indexed values)

  6. Policy issues arising The burden on the health system might be underestimated if only ‘long term limiting illness’ is considered People may have a long term illness but not consider it ‘limiting’ but they still may: • take medicine on a daily basis • require hospitalisation • require hospital visits • Can we circumvent this by using a more general definition of illness? • Can we break the years in ill health down into different conditions e.g. in order to estimate economic cost? • People might have more than one disease so need to be able to deal with co-morbidity

  7. Different definitions of long term illness The life expectancy with different diseases can be analysed using the Health Survey for England (HSE). It includes questions on • ‘limiting’ long-term illness (from 1997) • long-term illness (from 1991) • specific diseases (from 1991) Using the HSE it is, therefore, possible to compute • life expectancy with limiting long-term illness • life expectancy with long-term illness • life expectancy with any disease

  8. Methodology The diseases affecting a change in life expectancy with disease can be identified using decomposition methods (e.g. Sullivan 1971, Nussleder& Looman 2004) Life expectancy with disease is computed by using mortality and disease data as follows LE with disease = total LE * disease prevalence Changes over time can be decomposed by separating mortality and disease effects

  9. Decomposition (Arriaga 1989, Nussleder& Looman 2004) Let us suppose that life expectancy with disease has changed between time t and time t+n The change is attributable to a change in the number of person-years with disease (Ldis) which can be decomposed as follows Where the difference between the Disdepends on the change of theprevalence ofeach cause of disease, and the difference between the LLifedepends on the change of each cause of death

  10. Previous work on decomposition The method was applied on Dutch data to explain the difference between the sexes in the period 1990-1994 (Nussleder & Looman 2004) The research indicated that the higher life expectancy with LLT illness among the women was mostly attributable to arthritis. This required the identification of exclusive diseases conditions (i.e. they could not have more than one disease)

  11. Objectives Decompose the differences over time and between the sexes in the life expectancy with disease by applying the Nussleder & Looman method (2004) Three types of life expectancy with disease • life expectancy with limiting long-term illness • life expectancy with long-term illness • life expectancy with any disease

  12. Data used ONS (death and population counts) Health Survey for England (disease prevalence) Analysis performed on the most complete data series available from ONS and the Health Survey for England: • 1991 - 2005 The Health Survey for England has included from 1991 people aged 16 and above: • All the analysis performed on people 16+

  13. Analysis of mortality data Code specific causes of death consistently through ICD IX and ICD X Compute period life tables for each sex consistently with GAD using 3 years data Aggregate specific causes of death in categories (e.g. neoplasm) Compute mortality rates for each category of cause of death by age band and sex

  14. Classification of causes of death

  15. Mortality rates by cause (Males)

  16. Mortality rates by cause (Females)

  17. Health Survey for England Measure the prevalence of different disease seriousness: • prevalence of diseases (from 1991) • prevalence of long-term illness (from 1991) • prevalence of limiting long-term illness (from 1997) Identify the diseases based on survey questions Compute exclusive disease categories for each year of survey for each person in the survey

  18. Information collected in different years (HSE 1991-2005)

  19. Disease categories analysed (A)

  20. Disease categories analysed (B)

  21. Prevalence of diseases by % males any disease LT illness LTLI

  22. Results: Life expectancy with disease(s), LT illness & LLT illness (Males)

  23. Results: Life expectancy with disease(s), LT illness & LLT illness (Females)

  24. Life Expectancy with disease(s)

  25. Life Expectancy with long-term illness

  26. Life Expectancy with limiting LT illness

  27. Emerging conclusions (Males, age 16) Between 1992 and 2004 the total life expectancy has increased by 3.1 years In the same period the life expectancy with any disease has increased by 5.2 years and the life expectancy with long-term illness by 6.1 years The life expectancy with limiting long-term illness has increased by 1.1 years between 1998 and 2004

  28. Emerging conclusions (Females, age 16) Between 1992 and 2004 the total life expectancy has increased by 2 years In the same period the life expectancy with any disease has increased by 2.7 years and the life expectancy with long-term illness by 5.4 years The life expectancy with limiting long-term illness has increased by 1.9 years between 1998 and 2004

  29. Emerging conclusions (Co-morbidity) Between 1992 and 2004, out of 100 men with any disease or a long-term illness 29 have a co-morbidity condition Out of 100 men with a limiting long-term illness, 40 have a co-morbidity condition Out of 100 women with any disease or a long-term illness, 32 have a co-morbidity condition Out of 100 women with a limiting long-term illness, 44 have a co-morbidity condition

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