Decomposition of differences in health expectancy by cause

Abstract

Health expectancy is a widely used measure for monitoring trends in the health of a population and assessing differences in health among population groups. However, no decomposition method is available to examine the contribution made by causes of death and disability to differences in health expectancy among population groups or periods. We present a method for decomposing differences in health expectancy, based on the Sullivan method. This method is an extension of the decomposition method for life expectancy developed by Arriaga. We illustrate the method and its added value by decomposing male-female differences in health expectancy for the Netherlands.

This is a preview of subscription content, access via your institution.

References

  1. Arriaga, E.E. 1984. “Measuring and Explaining the Change in Life Expectancies.” Demography 21:83–96.

    Article  Google Scholar 

  2. —. 1989. “Changing Trends in Mortality Decline During the Last Decades.” Pp. 105–29 in Differential Mortality: Methodological Issues and Biosocial Factors, edited by L. Ruzicka, G. Wunsch, and P. Kane. Oxford, England: Clarendon Press.

    Google Scholar 

  3. Bah, S.M. 1998. “Assessing the Contribution of Age-Sex Differentials in Causes of Death Due to Infectious and Parasitic Diseases to the Trends in Age-Sex Differentials in Life Expectancy in Mauritius.” Social Biology 45(3-4):260–72.

    Google Scholar 

  4. Barendregt, J.J. 2002. “Incidence and Prevalence-Based SMPH: Making the Twain Meet.” Pp. 221–31 in Summary Measures of Population Health, edited by C.J.L. Murray, J.A. Salomon, C.D. Mathers, and A.D. Lopez. Geneva: World Health Organization.

    Google Scholar 

  5. Barendregt, J.J., L. Bonneux, and P.J. Van der Maas. 1994. “Health Expectancy: An Indicator for Change?” Journal of Epidemiology and Community Health 48:482–87.

    Article  Google Scholar 

  6. —. 1995. “Health Expectancy: An Indicator for Change?” (reply to a letter). Journal of Epidemiology and Community Health 49:330–31.

    Article  Google Scholar 

  7. —. 1997. “How Good Is Sullivan’s Method for Monitoring Changes in Population Health Expectancies?” (letter). Journal of Epidemiology and Community Health 51:578.

    Article  Google Scholar 

  8. Bebbington, A. and M. Bajekal. 2003. “Sub-National Variations Health Expectancy.” Pp. 127–47 in Determining Health Expectancies, edited by J.M. Robine, C. Jagger, C.D. Mathers, E.M. Crimmins, and R.M. Suzman. Chichester, England: John Wiley & Sons.

    Google Scholar 

  9. Bone, M. 1995. Health Expectancy and Its Use. London: Her Majesty’s Stationery Office.

    Google Scholar 

  10. Colvez, A. and M. Blanchet. 1983. “Potential Gains in Life Expectancy Free of Disability: A Tool for Health Planning.” International Journal of Epidemiology 12:224–29.

    Article  Google Scholar 

  11. Conti, S., G. Farchi, M. Masocco, V. Toccaceli, and M. Vichi. 1999. “The Impact of the Major Causes of Death on Life Expectancy in Italy.” International Journal of Epidemiology 8:905–10.

    Article  Google Scholar 

  12. Crimmins, E.M. 2002. “What Can We Expect From Summary Indicators of Population Health?” Pp. 213–19 in Summary Measures of Population Health, edited by C.J.L. Murray, J.A. Salomon, C.D. Mathers, and A.D. Lopez. Geneva: World Health Organization.

    Google Scholar 

  13. Crimmins, E.M. and E. Cambois. 2003. “Social Inequalities in Health Expectancies.” Pp. 111–25 in Determining Health Expectancies, edited by J.M. Robine, C. Jagger, C.D. Mathers, E.M. Crimmins, and R.M. Suzman. Chichester, England: John Wiley & Sons.

    Google Scholar 

  14. Crimmins, E.M., M.D. Hayward, and Y. Saito. 1996. “Differentials in Active Life Expectancy in the Older Population of the United States.” Journal of Gerontology B—Psychological Sciences and Social Sciences 51:S111-S120.

    Google Scholar 

  15. Ettinger, W., Jr., L.P. Fried, T. Harris, L. Shemanski, R. Schulz, and J. Robbins. 1994. “Self-Reported Causes of Physical Disability in Older People: The Cardiovascular Health Study, CHS Collaborative Research Group.” Journal of the American Geriatric Society 42:1035–44.

    Google Scholar 

  16. Guccione, A.A., D.T. Felson, J.J. Anderson, J.M. Anthony, Y. Zhang, P.W. Wilson, M. Kelly-Hayes, P.A. Wolf, B.E. Kreger, and W.B. Kannel. 1994. “The Effects of Specific Medical Conditions on the Functional Limitations of Elders in the Framingham Study.” American Journal of Public Health 84:351–58.

    Article  Google Scholar 

  17. Hayward, M.D., E.M. Crimmins, and Y. Saito. 1998. “Cause of Death and Active Life Expectancy in the Older Population of the United States.” Journal of Aging and Health 10:192–213.

    Article  Google Scholar 

  18. Hayward, M.D. and M. Heron. 1999. “Racial Inequality in Active Life Among Adult Americans.” Demography 36:77–91.

    Article  Google Scholar 

  19. Heliovaara, M., A. Aromaa, T. Klaukka, P. Knekt, M. Joukamaa, and O. Impivaara. 1993. “Reliability and Validity of Interview Data on Chronic Diseases. The Mini-Finland Health Survey.” Journal of Clinical Epidemiolgy 46:181–91.

    Article  Google Scholar 

  20. Kochanek, K.D., J.D. Maurer, and H.M. Rosenberg. 1994. “Why Did Black Life Expectancy Decline From 1984 Through 1989 in the United States?” American Journal of Public Health 84:938–44.

    Article  Google Scholar 

  21. Leveille, S., L. Fried, and J.M. Guralnik. 2002. “Disabling Symptoms: What Do Older Women Report?” Journal of General Internal Medicine 17:766–73.

    Article  Google Scholar 

  22. Leveille, S., H. Resnick, and J. Balfour. 2000. “Gender Differences in Disability: Evidence and Underlying Reasons.” Aging (Milano) 12:106–12.

    Google Scholar 

  23. Manton, K.G. and E. Stallard. 1984. Recent Trends in Mortality Analysis. Orlando, FL: Academic Press.

    Google Scholar 

  24. —. 1991. “Cross-Sectional Estimates of Active Life Expectancy for the U.S. Elderly and Oldest-Old Populations.” Journal of Gerontology 46:S170-S182.

    Google Scholar 

  25. Martikainen, P., T. Valkonen, and T. Martelin. 2001. “Change in Male and Female Life Expectancy by Social Class: Decomposition by Age and Cause of Death in Finland 1971–95.” Journal of Epidemiology and Community Health 55:494–99.

    Article  Google Scholar 

  26. Mathers, C.D. 1999. “Gains in Health Expectancy From the Elimination of Diseases Among Older People.” Disability and Rehabilitation 21(5–6):211–21.

    Google Scholar 

  27. —. 2003. “Cause-Deleted Health Expectancies.” Pp. 149–82 in Determining Health Expectancies, edited by J.M. Robine, C. Jagger, C.D. Mathers, E.M. Crimmins, and R.M. Suzman. Chichester, England: John Wiley & Sons.

    Google Scholar 

  28. Mathers, C.D. and J.M. Robine. 1997. “How Good Is Sullivan’s Method for Monitoring Changes in Population Health Expectancies?” Journal of Epidemiology and Community Health 51:80–86.

    Article  Google Scholar 

  29. McWhinnie, J.R. 1981. “Disability Assessment in Population Surveys: Results of the O.E.C.D. Common Development Effort.” Reveu de Epidemiologie et Sante Publique 29:413–19.

    Google Scholar 

  30. Merrill, S.S., T.E. Seeman, S.V. Kasl, and L.F. Berkman. 1997. “Gender Differences in the Comparison of Self-Reported Disability and Performance Measures.” Journal of Gerontology A— Biological Sciences and Medical Sciences 52(1):M19-M26.

    Google Scholar 

  31. Murray, C.J. and A.D. Lopez. 1997. “Regional Patterns of Disability-Free Life Expectancy and Disability-Adjusted Life Expectancy: Global Burden of Disease Study.” Lancet 349(9062):1347–52.

    Article  Google Scholar 

  32. Nusselder, W.J., K. van der Velden, J.L. van Sonsbeek, M.E. Lenior, and G.A. van den Bos. 1996. “The Elimination of Selected Chronic Diseases in a Population: The Compression and Expansion of Morbidity.” American Journal of Public Health 86:187–94.

    Article  Google Scholar 

  33. Oman, D., D. Reed, and A. Ferrara. 1999. “Do Elderly Women Have More Physical Disability Than Men Do?” American Journal of Epidemiology 150:834–42.

    Google Scholar 

  34. Perenboom, R., L. Herten, H. Boshuizen, and H. Van de Water. 1997. “Trends in de gezonde levensverwachting in Nederland 1983–1994, met een verdeling naar ernst van ongezondheid” [Trends in health expectancy in the Netherlands 1980–1994, by level of ill health]. Pp. 53–77 in Volksgezondheid Toekomst Verkenningen III: Gezondheid en Levensverwachting Gewogen, edited by P. Van der Maas and P. Kramers. Maarsen: Elsevier/De Tijdstroom.

    Google Scholar 

  35. Pollard, J.H. 1988. “On the Decomposition of Changes in Expectation of Life and Differentials in Life Expectancy.” Demography 25:265–76.

    Article  Google Scholar 

  36. Pressat, R. 1985. “Contributions des Ecarts de Mortalité par âge à la Différence des Vies Moyennes” [The significance of variations in mortality by age on differences in life expectancy]. Population 40(4–5):766–70.

    Article  Google Scholar 

  37. Robine, J., P. Mormiche, and C. Sermet. 1998. “Examination of the Causes and Mechanisms of the Increase in Disability-Free Life Expectancy.” Journal of Aging and Health 10:171–91.

    Article  Google Scholar 

  38. Robine, J.M., C. Jagger, C.D. Mathers, E.M. Crimmins, and R.M. Suzman. 2003. Determining Health Expectancies. Chichester, England: John Wiley & Sons.

    Google Scholar 

  39. Robine, J.M., J.P. Michel, and L.G. Branch. 1992. “Measurement and Utilization of Healthy Life Expectancy: Conceptual Issues.” Bulletin of the World Health Organisation 70:791–800.

    Google Scholar 

  40. Robine, J.M. and K. Ritchie. 1991. “Healthy Life Expectancy: Evaluation of Global Indicator of Change in Population Health.” British Medical Journal 302(6774):457–60.

    Article  Google Scholar 

  41. Robine, J.M., I. Romieu, and E. Cambois. 1999. “Health Expectancy and Assessment of Populations’ Health Status.” Bulletin of the World Health Organization 77:181–85.

    Google Scholar 

  42. Robine, J.M., I. Romieu, and J.M. Michel. 2003. “Trends in Health Expectancies.” Pp. 75–101 in Determining Health Expectancies, edited by J.M. Robine, C. Jagger, C.D. Mathers, E.M. Crimmins, and R.M. Suzman. Chichester, England: John Wiley & Sons.

    Google Scholar 

  43. Schrijvers, C.T., K. Stronks, D.H. van de Mheen, J.W. Coebergh, and J.P. Mackenbach. 1994. “Validation of Cancer Prevalence Data From a Postal Survey by Comparison With Cancer Registry Records.” American Journal of Epidemiology 139:408–14.

    Google Scholar 

  44. Shkolnikov, V.M., T. Valkonen, A. Begun, and E.M. Andreev. 1991. “Measuring Inter-Group Inequalities in Length of Life.” Genus 52(3–4):33–62.

    Google Scholar 

  45. —. 2001. “Measuring Inter-Group Inequalities in Length of Life.” Genus 57(3–4):33–62.

    Google Scholar 

  46. Statistics Netherlands. 1994. Gezondheidsenquête 1990–1994 [Health interview survey 1990–1994] (computerfile). ′s-Gravenhage, The Netherlands: Statistics Netherlands.

    Google Scholar 

  47. —. 1995. Overlevingstafels 1994 en 1990–1994 [Life tables 1994 and 1990–1994]. ′s-Gravenhage, The Netherlands: Statistics Netherlands.

    Google Scholar 

  48. —. Annually. “Overledenen naar doodsoorzaak, leeftijd en geslacht in het jaar 19..” [Number of deaths by cause of death, age and sex in the year 19..]. `s-Gravenhage, The Netherlands: Statistics Netherlands.

    Google Scholar 

  49. Sullivan, D.F. 1971a. “Disability Components for an Index of Health.” Washington, DC: U.S. Government Printing Office.

    Google Scholar 

  50. —. 1971b. “A Single Index of Mortality and Morbidity.” HSMHA Health Reports 86:347–54.

    Article  Google Scholar 

  51. Trovato, F. and N.M. Lalu. 1998. “Contribution of Cause-Specific Mortality to Changing Sex Differences in Life Expectancy: Seven Nations Case Study.” Social Biology 45(1–2):1–20.

    Google Scholar 

  52. Valkonen, T., A.P. Sihvonen, and E. Lahelma. 1997. “Health Expectancy by Level of Education in Finland.” Social Science and Medicine 44:801–808.

    Article  Google Scholar 

  53. Van de Water, H.P., H.C. Boshuizen, R.J. Perenboom, C.D. Mathers, and J.M. Robine. 1995. “Health Expectancy: An Indicator for Change?” Journal of Epidemiology and Community Health 49:330–31.

    Article  Google Scholar 

  54. Velkova, A., J.H. Wolleswinkel-van den Bosch, and J.P. Mackenbach. 1997. “The East-West Life Expectancy Gap: Differences in Mortality From Conditions Amenable to Medical Intervention.” International Journal of Epidemiology 26(1):75–84.

    Article  Google Scholar 

  55. Verbrugge, L.M. 1989. “The Twain Meet: Empirical Explanations of Sex Differences in Health and Mortality.” Journal of Aging and Social Behaviour 30:282–304.

    Article  Google Scholar 

  56. World Health Organization. 1977. International Classification of Diseases, 9th revision (ICD-9). Geneva, Switzerland: World Health Organization.

    Google Scholar 

Download references

Author information

Affiliations

Authors

Additional information

This investigation was supported by a grant from the European Community, Community Action on Health Monitoring Within the Framework for Action in the Field of Public Health (1997 to 2001) (DG SANCO, Convention n oSI2.290643 [2000 CVG3-506]) Euro-REVES: Setting Up a Coherent Set of Health Indicators for the European Union. The authors are grateful to Euro-REVES Group: V. Buratta, E. Cambois, V. Coutton, M. Crawford, V. Egidi, R. Gispert, C. Jagger, R. Perenboom, N. Rasmussen, K. Ritchie, J.M. Robine, D. Sanderson, J. van den Berg, L. van Herten, H. van Oyen, and I. Romieu. We are indebted to Rom Perenboom from TNO-PG for providing data on people living in institutions; Colin Mathers and Vladimir Shkolnikov for their useful comments on the decomposition method; and Anton Kunst, Anna Peeters, Jan Barendregt, Johan Mackenbach, and two anonymous referees for their useful comments on an earlier version of this article.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Nusselder, W.J., Looman, C.W.N. Decomposition of differences in health expectancy by cause. Demography 41, 315–334 (2004). https://doi.org/10.1353/dem.2004.0017

Download citation

Keywords

  • Chronic Obstructive Pulmonary Disease
  • Life Expectancy
  • Mortality Effect
  • Background Risk
  • Health Expectancy