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Modeling and Forecasting Health Expectancy: Theoretical Framework and Application

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Demography

Abstract

Life expectancy continues to grow in most Western countries; however, a major remaining question is whether longer life expectancy will be associated with more or fewer life years spent with poor health. Therefore, complementing forecasts of life expectancy with forecasts of health expectancies is useful. To forecast health expectancy, an extension of the stochastic extrapolative models developed for forecasting total life expectancy could be applied, but instead of projecting total mortality and using regular life tables, one could project transition probabilities between health states simultaneously and use multistate life table methods. In this article, we present a theoretical framework for a multistate life table model in which the transition probabilities depend on age and calendar time. The goal of our study is to describe a model that projects transition probabilities by the Lee-Carter method, and to illustrate how it can be used to forecast future health expectancy with prediction intervals around the estimates. We applied the method to data on the Dutch population aged 55 and older, and projected transition probabilities until 2030 to obtain forecasts of life expectancy, disability-free life expectancy, and probability of compression of disability.

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Notes

  1. Online Resource 1 provides detailed descriptions of the quantities obtainable in an MSLT and information about how transition rates are converted into one-year transition probabilities.

References

  • Akushevich, I., Kravchenko, J. S., & Manton, K. G. (2007). Health-based population forecasting: Effects of smoking on mortality and fertility. Risk Analysis, 27, 467–482.

    Article  Google Scholar 

  • Barendregt, J. J., Baan, C. A., & Bonneux, L. (2000). An indirect estimate of the incidence of non-insulin-dependent diabetes mellitus. Epidemiology, 11, 274–279.

    Article  Google Scholar 

  • Barendregt, J. J., Bonneux, L., & Van der Maas, P. J. (1994). Health expectancy: An indicator for change? Technology Assessment Methods Project Team. Journal of Epidemiology and Community Health, 48, 482–487.

    Article  Google Scholar 

  • Bemelmans, W. J .E., Hoogenveen, R. T., Wendel-Vos, C. G. W., Verschuren, W. M. M., & Schuit, A. J. (2004). Inschatting effecten van gezondheidsbeleid gericht op bewegen. Scenario analyses in de totale bevolking [Estimating the effects of health policy directed to physical activity. Scenario analyses in the general population]. Bilthoven, The Netherlands: RIVM.

  • Bruggink, J. W., Garssen, J., Lodder, B., & Kardal, M. (2009). Trends in gezonde levensverwachting [Trends in health expectancy]. In Bevolkingstrend. Den Haag, The Netherlands: Centraal Bureau voor de Statistiek.

  • Cairns, A. J., Blake, D. P., & Dowd, K. (2006). A two-factor model for stochastic mortality with parameter uncertainty: Theory and calibration. Journal of Risk & Insurance, 73, 687–718.

    Article  Google Scholar 

  • Cairns, A. J., Blake, D. P., & Dowd, K. (2008). Modelling and management of mortality risk: A review. Scandinavian Actuarial Journal, 2–3, 79–113.

    Article  Google Scholar 

  • CBS. (2005). Permanent Onderzoek Leefsituatie - Reference. Den Haag/Heerlen, The Netherlands: Centraal Bureau voor de Statistiek (CBS).

  • Crimmins, E. M., Hayward, M. D., Hagedorn, A. H., Saito, Y., & Brouard, N. (2009). Change in disability-free life expectancy for Americans 70 years old and older. Demography, 46, 627–646.

    Article  Google Scholar 

  • Crimmins, E. M., Saito, Y., & Ingegneri, D. (1989). Changes in life expectancy and disability-free life expectancy in the United States. Population and Development Review, 15, 235–267.

    Article  Google Scholar 

  • Crimmins, E. M., Saito, Y., & Ingegneri, D. (1997). Trends in disability-free life expectancy in the United States, 1970–90. Population and Development Review, 23, 555–572.

    Article  Google Scholar 

  • De Waegenaere, A., Melenberg, B., & Stevens, R. (2010). Longevity risk. De Economist, 158, 151–192.

    Article  Google Scholar 

  • Deaton, A., & Paxson, C. (2004). Mortality, income, and income inequality over time in Britain and the United States. In D. A. Wise (Ed.), Perspectives on the economics of aging (pp. 247–285). Chicago, IL: The University of Chicago Press.

    Chapter  Google Scholar 

  • Dowd, K., Blake, D. P., & Cairns, A. J. G. (2010). Facing up to uncertain life expectancy: The longevity fan charts. Demography, 47, 67–78.

    Article  Google Scholar 

  • Draper, H. (2005). Asbak leger, schatkist voller [Ashtray emptier, treasury house fuller]. In CBS Webmagazine. Voorburg/Heerlen, The Netherlands: Statistics Netherlands.

  • Fries, J. F. (1980). Aging, natural death, and the compression of morbidity. New England Journal of Medicine, 303, 130–135.

    Article  Google Scholar 

  • Garssen, J. (2006). Will life expectancy continue to increase or level off? Weighing the arguments of optimists and pessimists. Voorburg/Heerlen, The Netherlands: Statistics Netherlands.

    Google Scholar 

  • Girosi, F., & King, G. (2008). Demographic forecasting. Princeton, NJ: Princeton University Press.

    Google Scholar 

  • Guo, G. (1993). Event-history analysis for left-truncated data. Sociological Methodology, 23, 217–243.

    Article  Google Scholar 

  • Hardy, S. E., & Gill, T. M. (2004). Recovery from disability among community-dwelling older persons. Journal of the American Medical Association, 291, 1596–1602.

    Article  Google Scholar 

  • Hyndman, R. J., & Shahid Ullah, M. (2007). Robust forecasting of mortality and fertility rates: A functional data approach. Computational Statistics & Data Analysis, 51, 4942–4956.

    Article  Google Scholar 

  • Jagger, C., Gillies, C., Cambois, E., van Oyen, H., Nusselder, W. J., & Robine, J.-M. (2009). Trends in disability-free life expectancy at age 65 in the European Union 1995–2001: A comparison of 13 EU countries. Montpellier, France: European Health Expectancy Monitoring Unit.

    Google Scholar 

  • Korn, E. L., Graubard, B. I., & Midthune, D. (1997). Time-to-event analysis of longitudinal follow-up of a survey: Choice of the time-scale. American Journal of Epidemiology, 145, 72–80.

    Article  Google Scholar 

  • Lee, R. D., & Carter, L. R. (1992). Modeling and forecasting U.S. mortality. Journal of the American Statistical Association, 87, 659–671.

    Google Scholar 

  • Li, N., & Lee, R. (2005). Coherent mortality forecasts for a group of populations: An extension of the Lee-Carter method. Demography, 42, 575–594.

    Article  Google Scholar 

  • Lodder, B., & Kardal, M. (2009). Reparatie methodebreuken tijdreeksen gezondheid [Methods to adjust for breaks in time series of health status]. Den Haag/Heerlen, The Netherlands: Statistics Netherlands.

  • Lutz, W., & Goujon, A. (2001). The world’s changing human capital stock: Multi-state population projections by educational attainment. Population and Development Review, 27, 323–339.

    Article  Google Scholar 

  • Lutz, W., Sanderson, W., & Scherbov, S. (1997). Doubling of world population unlikely. Nature, 387, 803–805.

    Article  Google Scholar 

  • MacMinn, R., Brockett, P., & Blake, D. (2006). Longevity risk and capital markets. Journal of Risk & Insurance, 73, 551–557.

    Article  Google Scholar 

  • Manton, K. G. (1982). Changing concepts of morbidity and mortality in the elderly population. Milbank Memorial Fund Quarterly: Health and Society, 60, 183–244.

    Article  Google Scholar 

  • Manton, K. G., Gu, X., & Lamb, V. L. (2006). Long-term trends in life expectancy and active life expectancy in the United States. Population and Development Review, 32, 81–105.

    Article  Google Scholar 

  • Manton, K. G., Lamb, V. L., & Gu, X.-L. (2007). Medicare cost effects of recent U.S. disability trends in the elderly. Journal of Aging and Health, 19, 359–381.

    Article  Google Scholar 

  • Manton, K. G., Singer, B. H., & Suzman, R. (1993). Forecasting the health of elderly populations. New York: Springer-Verlag.

    Book  Google Scholar 

  • Manton, K. G., Stallard, E., & Singer, B. (1992). Projecting the future size and health status of the US elderly population. International Journal of Forecasting, 8, 433–458.

    Article  Google Scholar 

  • McWhinnie, J. R. (1981). Disability assessment in population surveys: Results of the O.E.C.D. common development effort. Revue d'Epidémioogie et de Santé Publique, 29, 413–419.

  • Mokdad, A. H., Ford, E. S., Bowman, B. A., Dietz, W. H., Vinicor, F., Bales, V. S., & Marks, J. S. (2003). Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. Journal of the American Medical Association, 289, 76–79.

    Google Scholar 

  • Nusselder, W. J. (2003). Compression of morbidity. In J.-M. Robine, C. Jagger, C. D. Mathers, E. M. Crimmins, & R. M. Suzman (Eds.), Determining health expectancies. Chichester, UK: John Wiley & Sons, Ltd.

  • OECD. (2009). Pensions at a glance 2009: Retirement-income systems in OECD countries. Paris, France: OECD.

  • Olshansky, S. J., Rudberg, M. A., Carnes, B. A., Cassel, C. K., & Brody, J. A. (1991). Trading off longer life for worsening health. Journal of Aging and Health, 3, 194–216.

    Article  Google Scholar 

  • Perenboom, R. J. M., Van Herten, L. M., Boshuizen, H. C., & Van Den Bos, G. A. M. (2004). Trends in disability-free life expectancy. Disability and Rehabilitation, 26, 377–386.

    Article  Google Scholar 

  • Picavet, H. S., & Hoeymans, N. (2002). Physical disability in The Netherlands: Prevalence, risk groups and time trends. Public Health, 116, 231–237.

    Google Scholar 

  • Reitsma, J. B., Kardaun, J. W., Gevers, E., de Bruin, A., van der Wal, J., & Bonsel, G. J. (2003). Possibilities for anonymous follow-up studies of patients in Dutch national medical registrations using the Municipal Population Register: A pilot study. Nederlands Tijdschrift voor geneeskunde, 147, 2286–2290.

    Google Scholar 

  • Robine, J. M., & Jagger, C. (2003). Creating a coherent set of indicators to monitor health across Europe: The Euro-REVES 2 project. European Journal of Public Health, 13(Suppl. 3), 6–14.

    Google Scholar 

  • Robine, J. M., Jagger, C., Mathers, C. D., Crimmins, E. M., & Suzman, R. M. (2003). Determining health expectancies. Chichester, UK: John Wiley & Sons, Ltd.

  • Rogers, A., Rogers, R. G., & Belanger, A. (1990). Longer life but worse health? Measurement and dynamics. Gerontologist, 30, 640–649.

    Article  Google Scholar 

  • Rogers, R. G., Rogers, A., & Belanger, A. (1989). Active life among the elderly in the United States: Multistate life-table estimates and population projections. The Milbank Quarterly, 67, 370–411.

    Article  Google Scholar 

  • Singer, B. H., & Manton, K. G. (1998). The effects of health changes on projections of health service needs for the elderly population of the United States. Procedings of National Academy of Sciences, 95, 15618–15622.

    Article  Google Scholar 

  • Stam, S., & Knoops, K. (2009). Lange tijdreeksen gezonde levensverwachting. Beschikbaarheid van enqûetedata gezondheidsindicatoren [Long time series data of life expectancy. Availability of survey data on health status indicators]. Den Haag/Heerlen, The Netherlands: Statistics Netherlands.

  • Sullivan, D. F. (1971). A single index of mortality and morbidity. HSMHA Health Reports, 86, 347–354.

    Article  Google Scholar 

  • Tabeau, E., Berg Jeths, A., Hoogenveen, R., & Hollander, G. (2002). A review of epidemiological approaches to forecasting mortality and morbidity. In E. Tabeau, A. Berg Jeths, & C. Heathcote (Eds.), in Forecasting mortality in developed countries (pp. 33–56). Amsterdam, The Netherlands: Springer.

  • Van De Water, H. P. A., Boshuizen, H. C., & Perenboom, R. J. M. (1996). Health expectancy in the Netherlands 1983–1990. European Journal of Public Health, 6, 21–28.

    Article  Google Scholar 

  • Van Kreijl, C.F., & Knaap, A.G.A.C. (2004). Ons eten gemeten. Gsezonde voeding en veilig voedsel in Nederland [Our meal measured. Healthy diet and safe food in the Netherlands]. Houten, The Netherlands: RIVM.

  • Willekens, F. L. (2005). Biographic forecasting: Bridging the micro–macro gap in population forecasting. New Zealand Population Review, 31, 77–124.

    Google Scholar 

  • Yi, Z., Land, K. C., Wang, Z., & Gu, D. (2010). Household and population projections at sub-national levels: An extended cohort-component approach (MPIDR Working Paper No. 2010–028). Rostock, Germany: Max Planck Institute for Demographic Research.

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Authors and Affiliations

  1. Department of Public Health, Erasmus Medical Center, P.O. Box 2040, Rotterdam, 3000, The Netherlands

    Istvan M. Majer

  2. Tilburg School of Economics and Management, Tilburg University, Tilburg, The Netherlands

    Ralph Stevens

  3. Erasmus Medical Center, Rotterdam, The Netherlands

    Wilma J. Nusselder & Johan P. Mackenbach

  4. Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands

    Pieter H. M. van Baal

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  1. Istvan M. Majer
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  2. Ralph Stevens
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  3. Wilma J. Nusselder
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  4. Johan P. Mackenbach
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  5. Pieter H. M. van Baal
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Correspondence to Istvan M. Majer.

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Majer, I.M., Stevens, R., Nusselder, W.J. et al. Modeling and Forecasting Health Expectancy: Theoretical Framework and Application. Demography 50, 673–697 (2013). https://doi.org/10.1007/s13524-012-0156-2

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