The EU structural indicator
Healthy Life Years – preliminary
calculations for Germany
Cornelia Lange, Jutta Wirz, Thomas Ziese
Robert Koch Institute
Berlin, 12. November 2002
Cornelia Lange
Outline
 Data sources in Germany appropriate to calculate HLYs;
possibilities, limitations, and experiences
 Problems concerning the translation/adaptation of the question
on limitations (PH030)
 Calculation of DFLE using Telephone Health Survey data
 Conclusion
„Statistics on the causes of death“ in Germany
 Specifics: Neither information about social status nor
possibility of linkage to other datasources which contain this
information (i.e. social statistics)
 Variables:
age,
gender,
commune of death;
main cause of death,
place of death (home / hospital);
date of death;
nationality (German / not German)
Life expectancy at birth in Germany
Data on Health
(Health) Surveys on national level
Robert Koch Institute
 German National Health Interview and Examination Survey 1998
(HIS and HES)
representative, age of respondents: 18-79, sample size: 7,124
 Telephone Health Interview Surveys 2003, 2004, 2005, 2006 (HIS)
representative, age of respondents: 18 plus
sample size: 5,000 - 8,000
MEHM integrated
Deutsches Institut für Wirtschaftsforschung
 The German Socio-Economic Panel (annually)
representative, longitudinal study of private households, started in 1984,
sample size: 12,000 housholds and 22,000 persons
Federal Statistical Office
 Microcensus (annually) : 1 % of households (370,000 househoulds, 820,000
persons). Every four years additional questions on health (1 % of households)
 From 2005 ongoing: EU-SILC (Survey on Income and Living Conditions)
Other datasources (1)
Nursing care statistics
2005
Deutschland
weiblich
männlich
Pflegebedürftige absolut
Pflegequote
Pflegebedürftige absolut
Pflegequote
1,438,278
3.4
690,272
1.7
unter 75 Jahre
339,507
0.9
360,572
0.9
75 bis unter 85 Jahre
520,308
15.7
210,359
11.1
85 bis unter 90 Jahre
269,199
39.7
64,542
26.9
90 Jahre und älter
309,264
66.5
54,799
39.2
Alle Altersgruppen
Limitations: Underestimation of men needing nursing care
Underestimation of young/middle-aged persons needing nursing care
HLY using Nursing Care Statistics
Bickel H (2001) Lebenserwartung und Pflegebedürftigkeit in Deutschland. Gesundheitswesen 63: 9-14
Other datasources (2)
Statistics of severely disabled persons with official certification (extent
of disablity: over 50 %)
Limitation: Underestimation of women who are severely disabled
DFLE, Northrhine-Westfalia
using Statistics of severely disabled persons
Ref.:
Arbeitsgemeinschaft der obersten Landesgesundheitsbehörden: Indikatorensatz
für die Gesundheitsberichterstattung der Länder; Anhang 1: Statistische
Methoden. 3. neu bearbeitete Fassung, Bielefeld 2003
Other publications
2005
Gärtner, K., Scholz, R. D. Lebenserwartung in Gesundheit [Healthy life
expectancy] In: Gärtner, K., Grünheid, E., Luy, M., editors.
Lebensstile, Lebensphasen, Lebensqualität: interdisziplinäre Analysen
von Gesundheit und Sterblichkeit aus dem Lebenserwartungssurvey
des BiB. Wiesbaden: VS Verlag für Sozialwissenschaften; 2005. p.
311-331. (Schriftenreihe des Bundesinstituts für
Bevölkerungsforschung, n°36)
2002
Klein, T., Unger, R. Aktive Lebenserwartung in Deutschland und in
den USA. KohortenbezogeneAnalysen auf Basis des Sozioökonomischen Panel [Active life expectancy in Germany and in
the United States. A cohort analysis based on the "German SocioEconomic Panel" (GSOEP) and the "Panel Study of Income
Dynamics" (PSID)]. Zeitschrift für Gerontologie und Geriatrie
2002;35(6):528-539
Dissemination of HLY on national level
Integration in National Health Report: Health in Germany (2006)
www.rki.de
PH030 – German translations
Verschiedene Fragenvarianten vorstellen;
Unterschiedliche Prävalenzen darstellen
policy makers are disappointed about the SILC results; low (decreasing)
acceptability of the indicator HLY
SILC (1)
German
version,
Germany
Fühlen Sie sich seit mindestens sechs Monaten infolge eines
Gesundheitsproblems in den gewöhnlichen Tätigkeiten
beeinträchtigt?
German
Version,
Belgium
Sind Sie seit zumindest einem halben Jahr durch eine
Behinderung oder eine sonstige gesundheitliche
Beeinträchtigung bei der Verrichtung der alltäglichen
Arbeiten beeinträchtigt?
Austrian
version
SILC (2)
English
For at least 6 month
Health problem
Activities, people usually do
German
 Seit m indestens sechs Monaten
 Seit zumindest einem halben Jahr
 In den letzten sechs Monaten
(ãwithin the last 6 m onthÒ)
 Gesundheitsproblem
 Gesundheitliche GrŸnde
 Behinderung (ãdisabili ty, handicapÒ)
 BeeintrŠchtigung (ãimpairm entÒ)
 TŠgliche AktivitŠten (ãactivities of daily
lifeÒ)
 Gewšhnliche T Štigkeiten
 Verri chtung der alltŠglichen Arbeit
(ãperform ance of daily workÒ)
For at least the last 6 month to what extent have you been
limited because of a health problem in activities
people usually do? Would you say you have been: Severely
limited/ limited but not severely/ not limited?
English
version
Telephone Health Surveys (GSTel03)
2003:
Männer
Frauen
Waren Sie in den letzten 6 Monaten oder länger bei Dingen, die
man üblicherweise so tut, aus gesundheitlichen Gründen
eingeschränkt? (Ja, stark eingeschränkt; ja, eingeschränkt;
nein, nicht eingeschränkt)
Gesamt
18-24
25-49
50-64
>= 65
Gesamt
18-24
25-49
50-64
>= 65
Ja, stark
eingeschränkt
9.0
5.0
6.7
11.8
13.8
9.6
3.7
6.9
10.8
15.7
Ja,
eingeschränkt
23.1
19.1
18.7
26.4
33.2
26.3
20.0
20.6
29.2
36.1
Nein, nicht
eingeschränkt
67.8
75.5
74.5
61.9
52.4
64.0
76.2
72.4
59.8
48.1
Telephone Health Surveys (GSTel05)
2005:
In welchem Ausmaß sind Sie durch Krankheit in der Ausübung
Ihrer alltäglichen Tätigkeiten dauerhaft eingeschränkt? Wir meinen
damit seit mindestens einem halben Jahr. (Erheblich
eingeschränkt; eingeschränkt aber nicht erheblich; nicht
eingeschränkt)
Erheblich
eingeschränkt
Männer
Frauen
Gesamt
18-24
25-49
50-64
>= 65
Gesamt
18-24
25-49
50-64
>= 65
8.7
2.7
3.2
12.0
21.8
9.7
0
5.0
11.7
19.3
Eingeschränkt,
aber nicht
erheblich
16.5
10.4
11.7
18.1
29.8
20.6
13.0
12.6
23.4
34.3
Nein, nicht
eingeschränkt
74.4
86.3
85.0
69.0
47.8
69.4
87.0
81.8
64.7
46.4
Limitations, women
80
69,4
70
64
60
Percent
50
GSTel03
GSTel05
40
30
26,3
20,6
20
10
9,6
9,7
0
stark/erheblich
eingeschränkt
eingeschränkt
nicht eingeschränkt
Limitations, men
80
74,4
67,8
70
60
Percent
50
GSTel03
GSTel05
40
30
23,1
20
10
16,5
9
8,7
0
stark/erheblich
eingeschränkt
eingeschränkt
nicht eingeschränkt
Calculation DFLE (GSTel03 and GSTel05)
(severe and moderate limitation)
100
Women
Sullivan Method
Men
90
Lifetable
2002-2004
80
70
Years
60
50
68,6 %
73,4%
79,6 %
71,6 %
80,0%
GSTel03 (m)
GSTel05 (m)
86,1%
,
40
30
20
10
0
GSTel03 (w)
GSTel05 (w)
Eurostat 2003
(w)
Eurostat 2003
(m)
Calculation DFLE (GSTel03 and GSTel05)
(severe limitation)
100
Women
Sullivan Method
Men
90
Lifetable
2002-2004
80
70
Years
60
50
91,6 %
92,3 %
79,6 %
92,7 %
GSTel03 (w)
GSTel05 (w)
Eurostat 2003
(w)
GSTel03 (m)
92,5 %
86,1 %
40
30
20
10
0
GSTel05 (m)
Eurostat 2003
(m)
Prevalences of disability
Datasource
Age group
Microzensus 2005
(disabled)
German SILC 2005 (MEHM)
Statistics of severely disabled persons with
official certification 2005
German Socio-Economic Panel 2005
(severly disabled)
Austria: SILC 2004 (MEHM)
GSTel 03 (MEHM)
GSTel04 (MEHM)
GSTel05 (MEHM)
All
agegroups
16 plus
All
agegroups
18 plus
16 plus
18 plus
18 plus
18 plus
Prevalence of disability /
severe limitation
Men
Women
11.5 %
9.5 %
7.9 %
8.7 %
8.8 %
7.7 %
11.3 %
9.0 %
8.4 %
9.0 %
7.5 %
8.7 %
8.9 %
9.6 %
9.2 %
9.7 %
Suggestion for calculation HLY
HLY should be depicted in two ways:
(1) Years lived in good health versus years lived with limitations
(severe and not severe limitations). This is the usual manner to
depict the indicator.
(2) Years lived in good or moderate health versus years lived with
severe limitations. This approach seems to produce results more
comparable between the Member States. Presumably the
underlying concept of severe limitation is more consistent and
more robust against different translations or cultural adaptations.
Preliminary calculations – time trends
Data sources:
Health Interview Surveys (CATI) carried out by the Robert Koch Institute
GSTel03 (2002-2003)
GSTel04 (2003-2004)
GSTel05 (2004-2005)
GSTel06 (2005-2006)
Life tables from the Federal Statistical Office Germany
2000-2002
2001-2003
2002-2004
2003-2005
Methods
Calculation of Health expectancies by Sullivan‘s method
 Self-rated health
Q: Wie ist ihr Gesundheitszustand im Allgemeinen? [How is your state of
health in general?] Ist er sehr gut, gut, mittelmäßig, schlecht oder sehr
schlecht? [Is it very good, good, fair, bad or very bad].
Very good + good
fair + bad + very bad


good health
bad health
Life expectancy men
Life expectancy in good health - Men
70
60
40
30
20
10
Age
Lifetable 2000-2002 - GSTel03
Lifetable 2002-2004 - GSTel05
LIfetable 2001-2003 - GSTel04
Lifetable 2003-2005 - GSTel06
10
0
96
92
88
84
80
76
72
68
64
60
56
52
48
44
40
36
32
28
24
20
16
12
8
4
0
0
Years
50
Life expectancy women
Life expectancy in good health - Women
70
60
40
30
20
10
Age
Lifetable 2000-2002 - GSTel03
Lifetable 2002-2004 - GSTel05
Lifetable 2001-2003 - GSTel04
Lifetable 2003-2005 - GSTel06
10
0
96
92
88
84
80
76
72
68
64
60
56
52
48
44
40
36
32
28
24
20
16
12
8
4
0
0
Years
50
Trends in life expectancy and life time, men
18-year-old men
70,00
60,00
Lifetime (years)
50,00
40,00
73.9 %
73.7 %
74.0 %
77.7 %
2002-2003
2003-2004
2004-2005
2005-2006
30,00
20,00
10,00
0,00
Self-rated good health
Self-rated bad health
Trends in life expectancy and life time, women
18-year-old women
70,00
60,00
Lifetime (years)
50,00
40,00
67.8 %
69.3 %
69.6 %
72.9 %
2002-2003
2003-2004
2004-2005
2005-2006
30,00
20,00
10,00
0,00
Self-rated good health
Self-rated bad health
Are we living longer, healthier lives?
Major question: Will increases in life expectancy be
associated with a greater or lesser proportion of the future
population spending their years living with disability?
 Compression of morbidity
 Expansion of morbidity
 Dynamic equilibrium (status quo)
Conclusion (1)
Calculations Eurostat/EHEMU; download 1.6.2007
Women
LE
DFLE
%DFLE/LE
1995
79.7
64.3
80.6
1996
79.9
64.5
80.7
1997
80.3
64.3
80.0
1998
80.6
64.3
79.8
1999
80.7
64.3
79.6
2000
81.0
64.6
79.8
2001
81.3
64.5
79.3
2002
81.2
64.5
79.5
2003
81.3
64.7
79.6
 Dynamic equilibrium – expansion of morbidity
Men
LE
DFLE
%DFLE/LE
1995
73.3
60.0
81.8
1996
73.6
60.8
82.6
 Compression of morbidity
1997
74.0
61.9
83.7
1998
74.5
62.1
83.4
1999
74.7
62.3
83.4
2000
75.0
63.2
84.3
2001
75.6
64.1
84.8
2002
75.4
64.4
85.5
2003
75.5
65.0
86.1
Conclusion (2)
Calculations RKI (life expectancy in good health)
Women
2002-2003
2003-2004
2004-2005
2005-2006
LE
81,22
81,34
81,55
81,78
DFLE
59,87
60,86
61,19
63,62
73.7
74.8
75.0
77.8
2002-2003
2003-2004
2004-2005
2005-2006
LE
75,38
75,59
75,89
76,21
DFLE
59,60
59,77
59,97
62,60
79.1
79.1
79.0
82.1
%DFLE/LE
 Compression of morbidity
Men
%DFLE/LE
 Dynamic equilibrium – compression of morbidity
Results somewhat controversial to calculations using GSOEP Data
Conclusion (3)
 Use of HLY indicator not very common in Germany
 Cooperation between Demography, Public Health and other research
disciplines should be improved
 Problems referring to the translation / cultural adaptation of PH030 not
yet been solved
 Suggestion to calculate HLY without strong / severe limation
 Also PH010 or index of PH010-PH030 should be used for calculation
of time trends

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