Berlin, 12. November 2002 Cornelia Lange The EU structural indicator Healthy Life Years – preliminary calculations for Germany Cornelia Lange, Jutta Wirz, Thomas Ziese Robert Koch Institute

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 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 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; p (Schriftenreihe des Bundesinstituts für Bevölkerungsforschung, n°36) 2002 Klein, T., Unger, R. Aktive Lebenserwartung in Deutschland und in den USA. KohortenbezogeneAnalysen auf Basis des Sozio- ökonomischen Panel [Active life expectancy in Germany and in the United States. A cohort analysis based on the "German Socio- Economic Panel" (GSOEP) and the "Panel Study of Income Dynamics" (PSID)]. Zeitschrift für Gerontologie und Geriatrie 2002;35(6):

Dissemination of HLY on national level Integration in National Health Report: Health in Germany (2006)

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) Fühlen Sie sich seit mindestens sechs Monaten infolge eines Gesundheitsproblems in den gewöhnlichen Tätigkeiten beeinträchtigt? German version, Germany 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) 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: 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)

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)

Limitations, women

Limitations, men

Calculation DFLE (GSTel03 and GSTel05) (severe and moderate limitation) Sullivan Method Lifetable

Calculation DFLE (GSTel03 and GSTel05) (severe limitation) Sullivan Method Lifetable

Prevalences of disability

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 ( ) GSTel04 ( ) GSTel05 ( ) GSTel06 ( ) Life tables from the Federal Statistical Office Germany

Methods Calculation of Health expectancies by Sullivans 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 good health fair + bad + very bad bad health

Life expectancy men

Life expectancy women

Trends in life expectancy and life time, men 18-year-old men Self-rated good healthSelf-rated bad health

Trends in life expectancy and life time, women 18-year-old women Self-rated good healthSelf-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) Dynamic equilibrium – expansion of morbidity Compression of morbidity Calculations Eurostat/EHEMU; download

Conclusion (2) Compression of morbidity Dynamic equilibrium – compression of morbidity Calculations RKI (life expectancy in good health) 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