Life Expectancy and Disability
Free Life Expectancy in Italy
2nd Meeting of the Task Force on Health
Expectancies
Roberta Crialesi
Health and Care Sector
ISTAT
Luxembourg, 8th June 2006
Life Expectancy (LE) and Disability Free Life
Expectancy (DFLE): background
•Italian LE at birth is one of the highest in the World: 77.8 years
for Men and 83.7 years for Women in 2004.
•But not always a longer life means a better life.
•DFLE helps to evaluate quality of life and provides useful
information on areas needing interventions and on possible
burden of care to health systems
Life Expectancy (LE)
average number of years
survivors are expected to
live at various ages
Luxembourg, 8th June 2006
Disability Free Life
Expectancy (DFLE)
average number of years
survivors are expected to
live at various ages without
disabilities
DFLE at 65 as measure of health needs
and burden for health systems
Health needs
• This indicator provides
information on the quality
of years to live
• It provides indirect
information on autonomy
in activities of daily living
• It provides information on
the health status of
elderly without being
affected from the age
structure of this
population group
Luxembourg, 8th June 2006
Burden for health
system
• Useful to identify areas
needing interventions
because of high number
of years with bad quality
of life
• It could be used as
parameter to allocate
resources in addition to
others (population by age,
mortality, etc.)
Methodology and Sources
•
The Sullivan method combines mortality data from population
life tables and age specific prevalence of disability generally
obtained from surveys (the years lived of the life table are
multiplied by the proportion of persons who are not disabled/
proportion of persons who perceived their health as good).
•
Italian data is calculated using the National Health Interview
Survey performed every 5 years by ISTAT. Last survey was
performed in 2004/2005. The previous one was performed in
1999/2000.
Luxembourg, 8th June 2006
Sources (1)
•
•
•
•
The survey on Health conditions and use of the health
services is one of the main sources to describe the health
status of the Italian population. It gives information about
perceived health status, symptoms, chronic conditions,
disability and health related behaviour, information which is not
available from administrative data sources.
Data on disability have been collected since 1990. Data are
available for 1990, 1994, 1999-2000.
The Italian HIS is carried out by Istat (Italian National Institute
of Statistics) on a sample of households distributed on the
whole country, using PAPI interviews;
The sampling design is on two stages, with stratification
in the first stage based on demographic criteria (units are
municipalities) in each region. In the second stage, a minimum
number of households are randomly selected from registers of
each municipality and every member of each household is
interviewed.
Luxembourg, 8th June 2006
Sources (2)
Main warnings:
• Questionnaire has been administered to persons aged 6
years and older. We know that the instrument is not suitable
for young children (less than 16 years old). Some distortions
could in fact derive from questions such as whether one is
capable of taking a bath or getting dressed on one’s own,
which are totally independent from whether there is a disability
or not.
• The survey leaves out people who live permanently in
institutions (rest homes for the elderly, disabled persons or
other types of collective forms of cohabitation). It is reasonable
to suppose that this non surveyed population has
characteristics, even regarding the presence of disabilities,
that are completely different from those of the rest of the
population who live in households: it should therefore not be
ignored. This problem will be solved in the survey of the
bodies in charge of social-assistance.
Luxembourg, 8th June 2006
Definition of disability
•
Activity of Daily Living (ADL) scale:
A set of questions is dedicated to different disability areas. The answer
indicates different severity levels of disability (from a partial autonomy to a
greater difficulty and to the inability of carrying out a function without the help of
other people).
•
From this battery of questions it is possible to identify 4 types of
disability: personal confinement (constraint to bed, on a chair or at
home), disability in functional activities (difficulties in dressing up,
washing, taking a bath, feeding), disability in the movements
(difficulties in walking, in going up the stairs, in squatting, in lying down,
in sitting down), sensorial disabilities (difficulties in hearing, seeing and
speaking).
•
A person is defined as disabled when, excluding conditions of temporary
limitation, he/she declares to be not able to perform, despite the sanitary
equipments he or she may have (prosthesis, canes, glasses, etc.), at
least one of the above mentioned functions.
Luxembourg, 8th June 2006
Life Expectancy Indicators
Life expectancy 0
Life expectancy 1
Life expectancy 15
Life expectancy 45
Life expectancy 65
Life expectancy 75
Healthy life expectancy 0
Healthy life expectancy 15
Healthy life expectancy 45
Healthy life expectancy 65
Healthy life expectancy 75
Disability free life expectancy 15
Disability free life expectancy 45
Disability free life expectancy 65
Disability free life expectancy 75
•
•
•
•
1994
Male
Female
74,09
80,57
73,72
80,12
59,95
66,32
31,78
37,13
15,35
19,13
9,28
11,47
50,20
47,50
37,10
34,20
12,70
11,00
3,30
3,20
1,40
1,50
57,30
61,10
29,20
32,00
12,70
14,20
6,60
6,90
2000
% Variation
Male
Female
Male Female
76,54
82,51
3,31
2,41
75,94
81,89
3,01
2,21
62,11
68,03
3,60
2,58
33,57
38,73
5,63
4,31
16,50
20,50
7,49
7,16
9,91
12,53
6,79
9,24
50,03
46,57 -0,34
-1,96
36,74
33,03 -0,97
-3,42
12,96
10,91
2,05
-0,82
3,64
3,24 10,30
1,25
1,58
1,50 12,86
0,00
58,83
62,26
2,67
1,90
30,53
33,18
4,55
3,69
13,66
15,20
7,56
7,04
7,30
7,66 10,61
11,01
LE at 65 increased over time relatively more than LE at
birth in both sexes
DFLE at 65 increased in the same period more than LE at
65 for Male
Men gained relatively more months of life without disability
than women
The proportion of years lived without disability within life
expectancy has increased
Luxembourg, 8th June 2006
Evolution of LE and DFLE at 65
Italy, 1990, 1994, 2000
Male
Life expectancy 65
Disability free life expectancy 65
Female
Life expectancy 65
Disability free life expectancy 65
1990
years
%
14,78
2,78
12,00
100,00 15,35
2,65
81,19 12,70
1990
18,46
4,36
14,10
1994
years
%
100,00
82,74
1994
100,00 19,13
4,93
76,38 14,20
2000
years
%
16,50
2,84
13,66
100,00
82,79
Trends
years 1990-2000 years 1994-2000
1,72
0,06
1,66
1,15
0,19
0,96
2000
100,00
74,23
20,50
5,30
15,20
Trends
years 1990-2000 years 1994-2000
100,00
2,04
1,37
0,94
0,37
74,15
1,10
1,00
• Women advantage with respect to men is more evident in LE
than in DFLE.
• Men can expect to live a higher percentage of their life after 65
without disability than women. It means that the advantage of
women in terms of the duration of life reduces when a dimension
of quality of life is introduced. Women live longer, they have also
a longer DFLE, but they have a higher share of total life to live
with disability.
Luxembourg, 8th June 2006
Disability prevalence
Popolazione con disabilità - Femmine
Popolazione con disabilità - Maschi
60,0
45,0
40,0
50,0
30,0
1990
25,0
1994
20,0
2000
15,0
10,0
Valori percentuali
Valori percentuali
35,0
40,0
1990
30,0
1994
2000
20,0
10,0
5,0
0,0
0,0
6-14
15-24
25-44 45-54 55-59 60-64 65-69
70-74 75-79
6-14
80 e
più
15-24
25-44 45-54 55-59
60-64 65-69 70-74
75-79
80 e
più
Classe d'età
Classe d'età
Popolazione con disabilità - Maschi e Femmine
60,0
Valori percentuali
50,0
40,0
1990
30,0
1994
2000
20,0
10,0
0,0
6-14 15-24 25-44 45-54 55-59 60-64 65-69 70-74 75-79
Classe d'età
Luxembourg, 8th June 2006
80 e
più
Reduction of disability
prevalence in ten years
has been concentrate in
the middle-aged people.
Disability free Life Expectancy
Speranza di vita libera da disabilità 65 F
Speranza di vita libera da disabilità 65 M
ITALIA
15.2
2000
ITALIA
13.66
2000
Superiore
Superiore
4-a
4-a
3-a
3-a
2-a
2-a
Inferiore
Inferiore
No dati
Min = 12.07
No dati
Min = 12.73
• DFLE at 65 is higher in northern and central regions.
• Puglia, Campania, Sicily have the smaller value of HLE
both for male and female.
• In 7 regions (Emilia Romagna, Toscana, Marche, Umbria,
Molise, Basilicata, Calabria) male DFLE at 65 is higher
than female.
Healthy Life Expectancy
Speranza di vita buona salute 65 M
Speranza di vita buona salute 65 F
ITALIA
3.64
ITALIA
3.24
2000
2000
Superiore
Superiore
4-a
4-a
3-a
3-a
2-a
2-a
Inferiore
Inferiore
No dati
Min = 1.51
No dati
Min = 1.86
• HLE at 65 is higher in north-east
• Umbria, Molise, Basilicata, Calabria have the smaller
value of HLE both for male and female
• In 5 regions (Valle d’Aosta, Emilia Romagna, Toscana,
Abruzzo, Campania) male HLE at 65 is higher than female
Luxembourg, 8th June 2006
Main conclusions
Prudent optimism: Italians live longer and the n°. of
years spent without disability are increasing
Gender differences: women have a longer life but
they also have a greater n. of years lived with
disability (about 2 times)
Clear geographical gradient: all the Southern
Regions having DFLE lower than the national
average.
Luxembourg, 8th June 2006
In the future……
In a very short time it would be available data of
the Health Interview Survey 2004-2005. The
new survey would give us the possibility to have
recent data on health and disability. The survey
used the same questions used in the previous
survey to measure disability, perceived health
and chronic diseases, in this way it could be
possible to analyse the data evolution over ten
years (1994-2004).
Luxembourg, 8th June 2006
References (1)
•
ISTAT, La qualità della sopravvivenza: salute e autonomia in
“Rapporto Annuale – La situazione del Paese nel 2002”.
Roma: Istat, 2003.
•
ISTAT, HEALTH FOR ALL – ITALY “Un sistema informativo
territoriale
su
sanità
e
salute”
(June
2005),
http://www.istat.it/sanita/health/
(over 4.000 indicators are available, among these disability
and health perceived free life expectancy are calculated for
Italy and regional areas, by gender and age. Data comes from
the Italian Health Interview Survey 1999-2000. Data only at
national level are also available for year 1994).
Luxembourg, 8th June 2006
References (2)
•
ISTAT – Statistical Information System on Disability –
www.disabilitaincifre.it
Luxembourg, 8th June 2006
References (3)
•
Crialesi R. “ Qualità della sopravvivenza” in “Salute e malattie”
chapter of “Relazione sullo stato sanitario del Paese – 2000”,
Ministero della Sanità (Ministry of Health), Direzione Generale
Studi, Documentazione sanitaria e Comunicazione ai cittadini,
Rome, 2001.
•
Burgio A. “Speranza di vita libera da disabiltà” in “Salute e
disabiltà” chapter of “Rapporto osservasalute. Stato di salute e
qualità dell’assistenza nelle regioni italiane”, Vita e Pensiero
ed., Milan, December 2004 http://www.osservasalute.it/.
Luxembourg, 8th June 2006
References (4)
•
Crialesi R., Frova L., Rocchi F., Verdecchia A. (1999), An
integrated approach to measure the health status of the Italian
population, Rivista di Statistica Ufficiale, Quaderni di ricerca,
n.1, Istat, Franco Angeli ed., pagg. 9-22.
•
Frova L. (1995), “Longevity and quality of life: an appraisal of
healthy-life expectancy” in IRP (a cura di), Contributions of
Italian Scholars, European Population Conference, 4-8
September, IRPSS.
•
Egidi V., Frova L., Verdecchia A. (1997), Speranza di vita
totale e speranza di vita in buona salute: un approccio
statistico, in “La salute degli italiani”, Atti del Convegno, Rome
21-22 March 1995, IRPSS (a cura di), monografie 7/1997,
pagg. 297-319.
Luxembourg, 8th June 2006
References (5)
•
Burgio A., Marano C., Folino-Gallo P., “Geographic variations
and gender differences in Life Expectancy in the Italian
Regions. A challenge to health systems” Public Health
Association, EUPHA, 10-12 November, Graz, Austria,
Session: Social and ecological determinants of health.
Abstract: http://www.eupha.org/html/2005_graz/3-3.doc.
•
Burgio A., Solipaca A. “Ripartizione del finanziamento sanitario
contributo tecnico metodologico dell’Istat alla riflessione sui
vantaggi e gli svantaggi dell’adozione di alcuni indicatori” not
quoted document, 13 November 2002 (document prepared by
Istat researchers for the Italian Minister of Health).
Luxembourg, 8th June 2006