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Life expectancy and healthy life expectancy in Scotland
Alison Burlison, ISD ScotPHO team
Life expectancy (LE) and Healthy life expectancy (HLE)
• Definitions • Scotland data and changes over time• Methodology and pitfalls• Variations within Scotland• Scotland compared to other countries
Life expectancy (LE) at birth, for a given time period
• Is an estimate of the number of years a newborn baby would survive if they experienced the area’s age-specific mortality rates for that time period throughout their life.
• But the baby’s actual LE will vary - with future changes in death rates during their life - if they move to a different area.
Adding the ‘H’…
Healthy life expectancy (HLE) at birth• Is an estimate of the average number of years a newborn
baby would survive in a ‘healthy’ state if they experienced the particular area’s age-specific mortality rates and self-assessed health (SAH) for that time period throughout their life.
LE – HLE = Number of years in ‘not healthy’ health.
Can’t assume these are all at the end of life.
}‘Not
healthy’
health
Scotland MALES: LE and HLE at birth, 1980-2008
58
60
62
64
66
68
70
72
74
76
78
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Year
LE
or
HL
E (
ye
ars
)
LEHLE (household survey SAH)95% CL
68.1
75.3
}
Scotland MALES: LE and HLE at birth, 1980-2008
58
60
62
64
66
68
70
72
74
76
78
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Year
LE
or
HL
E (
ye
ars
)
LE
HLE (household survey SAH)
95% CL
Linear (HLE (householdsurvey SAH))Linear (LE)
68.1
75.3
~9% of life in ‘not healthy’
health
‘Not
healthy’
health
}‘Not
healthy’
health
Scotland FEMALES: LE and HLE at birth, 1980-2008
60
62
64
66
68
70
72
74
76
78
80
82
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Year
LE
or
HL
E (y
ears
)
LE
HLE (household survey SAH)
95% CL
Linear (LE)
Linear (HLE (household surveySAH))
80.0
70.8
~12% of life in ‘not healthy’
health
HLE in Scotland
With time
LE HLE years in ‘not healthy’ health
(% life in ‘not healthy’ health unchanged)
Methodology
…and pitfalls
Deaths registrations
(GROS)
Population mid-year estimates(GROS)
Self-assessed health‘healthy’ versus ‘not healthy’
(surveys or Census)
Life tables for calculating period
LE and HLE
HLE calculations for Scotland
Self-assessed health (SAH)2011 Census and Scottish Household Survey from 2009 (EU definition):
‘How is your health in general? Would you say it was.....- very good- good
- fair- bad - very bad?’
2001 Censusand Scottish Household Survey until 2008:
‘Over the last 12 months would you say your health has on the whole been - good - fairly good
- not good?’
‘healthy’
‘not healthy’
Life table, with LE calculations based on Chiang (II) and HLE based on Sullivan method: Scotland, males, 2006
ISD/ONS
Age group x n a x pop deaths
M x
Age-specific
death rate
q x
Probability that individual entering age interval will
die in it
p x
Probability that individual entering age interval will survive it I X d x L x T x LE x
PX
Proportion with 'not healthy' health (1-P x )*L x TH x HLE x
<1 0 1 0.1 28,218 145 0.0051 0.0051 0.9949 1.0000 0.005 1.00 74.9 74.9 0.02 0.98 67.7 67.7
1-4 1 4 0.5 109,171 21 0.0002 0.0008 0.9992 0.9949 0.001 3.98 73.9 74.3 0.02 3.91 66.7 67.15-9 5 5 0.5 143,221 18 0.0001 0.0006 0.9994 0.9941 0.001 4.97 69.9 70.3 0.01 4.91 62.8 63.2
10-14 10 5 0.5 157,404 21 0.0001 0.0007 0.9993 0.9935 0.001 4.97 65.0 65.4 0.01 4.91 57.9 58.315-19 15 5 0.5 168,880 112 0.0007 0.0033 0.9967 0.9928 0.003 4.96 60.0 60.4 0.01 4.91 53.0 53.420-24 20 5 0.5 171,019 206 0.0012 0.0060 0.9940 0.9895 0.006 4.93 55.0 55.6 0.03 4.80 48.1 48.625-29 25 5 0.5 156,422 189 0.0012 0.0060 0.9940 0.9836 0.006 4.90 50.1 50.9 0.06 4.59 43.3 44.030-34 30 5 0.5 153,686 272 0.0018 0.0088 0.9912 0.9777 0.009 4.87 45.2 46.2 0.07 4.53 38.7 39.635-39 35 5 0.5 185,147 398 0.0021 0.0107 0.9893 0.9691 0.010 4.82 40.3 41.6 0.08 4.42 34.2 35.340-44 40 5 0.5 194,867 540 0.0028 0.0138 0.9862 0.9587 0.013 4.76 35.5 37.0 0.09 4.35 29.7 31.045-49 45 5 0.5 183,306 710 0.0039 0.0192 0.9808 0.9455 0.018 4.68 30.8 32.5 0.11 4.16 25.4 26.950-54 50 5 0.5 164,736 987 0.0060 0.0295 0.9705 0.9274 0.027 4.57 26.1 28.1 0.13 3.95 21.2 22.955-59 55 5 0.5 169,377 1,506 0.0089 0.0435 0.9565 0.9000 0.039 4.40 21.5 23.9 0.17 3.64 17.3 19.260-64 60 5 0.5 135,028 2,061 0.0153 0.0735 0.9265 0.8609 0.063 4.15 17.1 19.9 0.20 3.31 13.6 15.865-69 65 5 0.5 113,650 2,615 0.0230 0.1088 0.8912 0.7976 0.087 3.77 13.0 16.2 0.16 3.18 10.3 12.9
70-74 70 5 0.5 94,702 3,351 0.0354 0.1625 0.8375 0.7108 0.116 3.27 9.2 12.9 0.16 2.73 7.2 10.175-79 75 5 0.5 69,739 4,100 0.0588 0.2563 0.7437 0.5953 0.153 2.59 5.9 9.9 0.22 2.04 4.4 7.4
80-85 80 5 0.5 43,643 4,253 0.0974 0.3918 0.6082 0.4427 0.173 1.78 3.3 7.5 0.25 1.33 2.4 5.485+ 85 5 0.5 27,191 4,746 0.1745 1.0000 0.0000 0.2693 0.269 1.54 1.5 5.7 0.32 1.05 1.1 3.9
2,469,407 26,251
Pitfalls in HLE calculations (1)
Death registrations residents of Scotland who die in Scotland non-residents who die in Scotland residents of Scotland who die outwith Scotland.
For sub-Scotland analyses, we impute area of residence for non-residents dying here, to compensate for the loss of residents dying outwith Scotland.
Pitfalls (2)Robustness and availability of SAH data
Census The most robust available estimates of SAH and HLE in 2001 No comparable time trends HLE calculations for geographies down to NHS boards and CHPs
Scottish Household Survey HLE trends for Scotland NOT robust for HLE for NHS boards and CHPs Only for ages 16+, so need to “patch” it For females - slightly worse SAH and lower HLE than Census Disruption in time trends due to question change.
Scotland MALES: LE and HLE at birth, 1980-2009
58
60
62
64
66
68
70
72
74
76
78
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Year
LE
or
HL
E (
ye
ars
)
LEHLE (household survey SAH)95% CL
68.1
60.0
76.0
Scotland FEMALES: LE and HLE at birth, 1980-2009
60
62
64
66
68
70
72
74
76
78
80
82
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Year
LE
or
HL
E (
ye
ars
)
LE
HLE (household survey SAH)
95% CL
80.6
62.2
70.8
Pitfalls (3)
Perils of small areas and populations
* Smallest geography where we have calculated HLE = Orkney CHP/NHS board (5-year male pop ~48,000).
* For smaller areas – HLE not calculated. – LE only presented for:
5-year populations 5,000 5-year deaths 40.
* Smaller population wider CI for LE at birth.
>75,000: <2 year 95% CI 30,000: ~ 3 year 95% CI 5,000: ~ 7.5 year 95% CI
Variations within Scotland
• NHS boards
• Intermediate zones
• Deprivation deciles
• Urban rural classification
LE and HLE at birth, by NHS board area in Scotland, MALES, 5-year period 1999-2003
75.7
70.8
70.4
62.260
62
64
66
68
70
72
74
76
78
80
Bo
rde
rs
Ork
ne
y
Du
mfr
ies
&G
allo
wa
y
Gra
mp
ian
Sh
etl
an
d
Fif
e
Lo
thia
n
Hig
hla
nd
Ta
ys
ide
Fo
rth
Va
lley
SC
OT
LA
ND
Ay
rsh
ire
& A
rra
n
La
na
rks
hir
e
We
ste
rn Is
les
Gre
ate
r G
las
go
w&
Cly
de
NHS board
LE
or
HL
E (
ye
ars
)
LE
HLE (2001 Census SAH)
Intermediate zones in Scotland
(average M+F population ~4,000)
HLE not calculated
LE only presented for M or F where: 5-year populations 5,000
5-year deaths 40.
Scotland male LE at birth, by intermediate zone, 2003-07
Barnton/Cammo area
Males 85.5 years (82.4-88.5)
Females 90.4 years (88.6-92.2)
Edinburgh: LE at birth, 2003-2007
Greendykes/Niddrie Mains area
Males 61.1 years (57.3-65.0)
Females 73.7 years (69.5-78.0)
Scottish Government
• High-level target to increase HLE in Scotland 2007-2017
National indicator to increase HLE at birth in the most deprived
areas
• Long-term Monitoring of Health Inequalities HLE a key indicator
Deprivation and healthy life expectancy in Scotland: males, 2005-2006
81
68
77
57
50
55
60
65
70
75
80
85
10 (leastdeprived)
9 8 7 6 5 4 3 2 1 (mostdeprived)
Deprivation decile (income-employment index)
Yea
rs
Life expectancy at birth
Healthy life expectancy at birth
LE and HLE at birth, by 2001 urban rural classification,Scotland: MALES, 1999-2003
69.9 69.6 68.2 67.7 66.1 64.0
5.4 5.7 5.9 6.5 7.1 7.9
0
10
20
30
40
50
60
70
80
90
6 Remoterural
5 Accessiblerural
4 Remotesmall towns
3 Accessiblesmall towns
2 Otherurban areas
1 Largeurban areas
Ye
ars
Expected period in'not healthy' health(LE - HLE)
HLE (2001 CensusSAH)
7 % of life in 'not healthy' health 8 %
8 % 9 % 10 % 11 %
HLE in Scotland
With increasing deprivation (and urbanisation)
LE HLE years or % life in ‘not healthy’ health
65
70
75
80
85
1970 1980 1990 2000 2010
United KingdomEU
Life expectancy at birth, in years, female
GUESS!• Scotland• Denmark• France• Germany• Ireland (Eire)• Portugal
65
70
75
80
85
1970 1980 1990 2000 2010
United KingdomEU Scotland
Life expectancy at birth, in years, female
65
70
75
80
85
1970 1980 1990 2000 2010
DenmarkFranceGermanyIrelandPortugalUnited KingdomEU Scotland
Life expectancy at birth, in years, female
65
70
75
80
85
1970 1980 1990 2000 2010
United KingdomEU
Life expectancy at birth, in years, male
GUESS!• Scotland• Denmark• France• Germany• Ireland (Eire)• Portugal
65
70
75
80
85
1970 1980 1990 2000 2010
United KingdomEU Scotland
Life expectancy at birth, in years, male
65
70
75
80
85
1970 1980 1990 2000 2010
DenmarkFranceGermanyIrelandPortugalUnited KingdomEU Scotland
Life expectancy at birth, in years, male
55
60
65
70
75
80
1970 1980 1990 2000 2010
RomaniaRussian FederationUkraineUnited KingdomScotland
Life expectancy at birth, in years, male
HLE in Scotland
Internationally
Scotland lower LE than most Western European
countries, and apparently lower disability-freelife expectancy (DFLE) at birth than many.
Comparable health data required.
HLE in Scotland
1. With time…LE HLE years in ‘not healthy’ health (% life in ‘not healthy’ health unchanged)
2. With increasing deprivation (and urbanisation)…LE HLE years or % of life in ‘not healthy’ health
3. Internationally…Scot lower LE than most W European countries (and apparently lower DFLE at birth than many).
www.scotpho.org.uk
Healthy life expectancy
Health for All