Disability-free life expectancy and life expectancy in good self-rated health in Chile: Gender differences and compression of morbidity between 2009 and 2016

Ethnic differences in disability-free life expectancy and disabled life expectancy in older adults in Chile

BACKGROUND

Although about 10% of the Latin American population is indigenous, ethnic differences in disability-free life expectancy (DFLE) and life expectancy with disability (DLE) are unknown.

OBJECTIVE

To estimate disability-free life expectancy and disabled life expectancy among Mapuche (the largest indigenous group) and non-indigenous older adults aged 60 years or more in Chile.

METHOD

Disability was measured following a methodology that combines limitations of daily living, cognitive impairment and dependence previously validated in Chile. Finally, the DFLE was estimated using Sullivan's method combining life tables by ethnicity and disability proportions from the EDES survey designed for the study of ethnic differentials in health and longevity in Chile.

RESULTS

Non-Indigenous people have a higher total and Disability-free life expectancy compared to Mapuche people at all ages. While at age 60 a Mapuche expects to live 18.9 years, of which 9.4 are disability-free, a non-Indigenous expects to live 26.4 years, of which 14 are disability-free. In addition, although the length of life with disability increases with age for both populations, Mapuche who survive to age 80 or 90 expect to live 84% and 91% of their remaining life with disability, higher proportions compared to non-indigenous people (62.9% and 75%, respectively).

CONCLUSIONS

This is the first study addressing inequities in DFLE between the Mapuche and non-Indigenous population, reflected in lower total life expectancy, lower DFLE and higher DLE in Mapuche compared to the non-Indigenous population. Our results underscore the need for increased capacity to monitor mortality risks among older people, considering ethnic differences.

Gender differences in life expectancy free of depressive symptoms in Chile between 2003 and 2016

The aim of the study was to analyze gender differences in life expectancy free of depressive symptoms among the adult population in Chile between 2003 and 2016. The Sullivan method was used to estimate the total and marginal life expectancy, based on prevalence data from the National Health Survey (2003, 2010 and 2016), and abridged life tables for the Chilean population. There was a compression of morbidity among middle-aged men during the first period and among younger and older women during the last one. Men at all ages could expect to live a higher proportion of their lives without depressive symptoms during the whole period. The gender gap in the proportion of life expectancy free of depressive symptoms reached 10 percent points or more, considering almost all ages and periods. Unemployment and lower education increased the probability of depressive symptoms, and these effects were more marked among women. Public policies should have a gender-sensitive approach to address the gap in depression and the disadvantage experienced by women in life expectancy free of depressive symptoms, considering those dimensions that intersect with gender, such as access to education, employment or income.

Disabled life expectancy among older Colombian men and women

Colombia's population is rapidly aging and older adults are living longer, however, we have limited information on the level of disability and number of years older Colombians spend with disability. We estimated age-and-gender specific ADL, IADL and mobility disability prevalence and disabled life expectancy (DLE) and to examined gender differences. Life tables came from the Colombian vital statistics and disability prevalence data came from the cross-sectional 2015 Colombia National Survey of Health, Well-being, and Aging. Disabled life expectancy (DLE) was calculated using Sullivan's method. About one-third to one-half of remaining years will be spent with IADL or mobility disability. The remaining years of life spent with ADL was relatively low at younger ages, but by age 85, about half of remaining life will be spent with disability. Compared to men, women had higher levels of disability and are estimated to spend more years with disability. Gender differences in ADL did not emerge until ages 70 and older. Older Colombians, in particularly women, are estimated to live a significant proportion of their life with disability, particularly IADL and mobility disability. High levels of disability are concerning because the country lacks adequate infrastructure and has limited options for long term care.

Transitions across states with and without difficulties in performing activities of daily living and death: a longitudinal comparison of ten European countries

Ageing has been related to the onset of disability and dependency in older adults. There is a need to better understand the disability and dependency trajectories of older adults and their relationship with socio-demographic characteristics and institutional or cultural context. This study analyses the role of age, sex, education and self-perceived health in disability, dependency and death transitions, addressing the heterogeneity across European countries and inconsistencies when using different measures of disability. Multi-state models were adjusted to evaluate the role of risk and protective factors in the transitions to disability, dependency and death. Difficulties in performing activities of daily living (ADLs) assess disability and dependency states. Data were from the Survey of Health, Ageing and Retirement in Europe conducted in 2004-2013, considering individuals aged 65 and older at baseline from Austria, Belgium, Denmark, France, Germany, Italy, the Netherlands, Spain, Sweden and Switzerland. The results showed that transitions to disability and dependency varied with age, sex, education and self-perceived health. The probability of transition to disability and dependency states increases until the age of 70 for all countries. However, there was heterogeneity in the disability and dependency trajectories with ageing between men and women. In most countries, women live with difficulties and may need help for longer than men. Care policies should consider sex differences to decrease the burden of care of informal caregivers, particularly in countries where care systems are absent or partially developed and a high level of family obligations to care needs exist.

Association of social factors and health conditions with capacity and performance

OBJECTIVE

Determine and measure the association of social factors and health conditions with worse capacity and performance levels.

METHODS

Dependent variables consisted of performance and capacity; independent variables comprised age, gender, level of education, personal income, and health conditions. Means (95%CI) of performance and capacity were presented according to the independent variables. Generalized linear models, using a mutual adjustment for all variables considered statistically significant (p < 0.05), measured the associations between each exposure and outcomes. Study population included 12,265 individuals.

RESULTS

Older women with lower education and income levels and with some health condition showed the worst performance and capacity.

CONCLUSION

Results showed that the capacity and performance levels of the Chilean population changed according to social demographic characteristics and health conditions.

Socio-spatial inequalities in healthy life expectancy in the elderly, Brazil, 2013 and 2019

The growth in longevity in Brazil has drawn attention to more useful population health measures to complement mortality. In this paper, we investigate socio-spatial differences in life expectancy and healthy life expectancy based on information from the Brazilian National Health Survey (PNS), 2013 and 2019. A three-stage cluster sampling with stratification of the primary sampling units and random selection in all stages was used in both PNS editions. Healthy life expectancy was estimated by Sullivan's method by sex, age, and Federated Units (UF). Severe limitations to at least one noncommunicable chronic disease (NCD) or poor self-rated health were used to define the unhealthy state. Inequality indicators and a Principal Component analysis were used to investigate socio-spatial inequalities. From 2013 to 2019, both life expectancy and healthy life expectancy increased. The analysis by UF show larger disparities in healthy life expectancy than in life expectancy, with healthy life expectancy at age 60 varying from 13.6 to 19.9 years, in 2013, and from 14.9 to 20.1, in 2019. Healthy life expectancy in the wealthiest quintile was 20% longer than for those living in the poorest quintile. Wide socio-spatial disparities were found with the worst indicators in the UF located in the North and Northeast regions, whether considering poverty concentration or health care utilization. The socio-spatial inequalities demonstrated the excess burden of poor health experienced by older adults living in the less developed UF. The development of strategies at subnational levels is essential not only to provide equal access to health care but also to reduce risk exposures and support prevention policies for adoption of health behaviors.

Forecasting Healthy Life Expectancy Among Chilean Community-Dwelling Older Adults With and Without Sarcopenia

BACKGROUND

Sarcopenia is an important risk factor for disability and dependency at old age. The prevalence of sarcopenia among the Chilean older population is high.

OBJECTIVE

To estimate life expectancy, healthy life expectancy and unhealthy life expectancy among sarcopenic and non-sarcopenic older adults from Santiago, Chile.

METHODS

A sample of 1,897 community-dwelling older adults aged 60 years or more, living in Santiago, was observed between 5-15 years. Disability was defined as the unhealthy state, assessed through self-reported difficulties in activities of daily living. Sarcopenia was determined via HTSMayor software. Total and marginal life expectancies were estimated using the Interpolated Markov Chain method "IMaCh".

RESULTS

At 60 years, estimated life expectancy for sarcopenic and non-sarcopenic older adults was similar (22.7 and 22.5 years, respectively). The proportion of years to be lived with disability was three times greater in sarcopenic adults, compared to non-sarcopenic people. This difference was observed up to 80 years. Non-sarcopenic women had a higher proportion of years to be lived with disabilities compared to non-sarcopenic men of the same age, but this proportion was higher among sarcopenic men, compared to sarcopenic women until 70 years of age.

DISCUSSION

People with sarcopenia expect to live a higher proportion of years with disabilities. Sarcopenic men until 70 years expected to live a higher proportion of years with disability, compared to sarcopenic women. Monitoring sarcopenia among older people may help to identify individuals with higher risk of disability onset. Future research should focus on disentangling the mechanisms explaining sex differences.

Depressive Symptomology, Identity and Religious Practices among Catholics and Evangelicals: Differences between the Mapuche and Non-Indigenous Chilean Population

Background: Chile is a highly religious country. Although a majority of the population describes itself as Catholic, there has been a substantial growth in Evangelism, especially among indigenous people. In this context, the aim of this study is to analyse the relationship between Catholic and Evangelical religiosity in terms of identity and practices and depressive symptoms in the Mapuche and non-indigenous Chilean population. Methods: The study was conducted using secondary data from the Longitudinal Intercultural Relations Study of 2017, estimating linear regressions to explain variations on the PHQ-9 scale between the adult Mapuche and non-indigenous Chilean population by first including the controls variables, followed by religious identification, churchgoing, and prayer. Results: Social support, good health, and age showed a negative association with PHQ-9 in both groups. Being a woman and not having a partner were only positively related with depression in the non-indigenous group. A negative association was found between Evangelical religious identity and depressive symptoms among the Mapuche population, while churchgoing was negatively associated and prayer was positively associated with depression in the non-indigenous group. Conclusions: The findings confirm that religiosity is a protective factor against depressive symptomology in the Chilean population. However, the analysis reveals significant ethnic differences.

Disability-Free Life Expectancy among People Over 60 Years Old by Sex, Urban and Rural Areas in Jiangxi Province, China

OBJECTIVE

To estimate and compare age trends and the disability-free life expectancy (DFLE) of the population over 60 years old in 2018 in Jiangxi Province, China, by sex and urban-rural areas.

METHODS

The model life table was employed to estimate the age-specific mortality rate by sex and urban-rural areas, based on the Summary of Health Statistics of Jiangxi Province in 2018 and the Sixth National Health Service survey of Jiangxi Province. DFLE and its ratio to life expectancy (LE) were obtained by the Sullivan method.

RESULTS

In 2018, the DFLE among people over 60 is 17.157 years for men and is 19.055 years for women, accounting for 89.7% and 86.5% of their LE respectively. The DFLE/LE of men is higher than that of women at all ages. LE and DFLE are higher for the population in urban areas than in rural areas. For women, DFLE/LE is higher in urban areas than in rural areas (except at ages 75 and 80). Urban men have a higher DFLE/LE than rural men (except at age 85). The difference in DFLE between men and women over 60 years is 1.898 years, of which 2.260 years are attributable to the mortality rate, and 0.362 years are due to the disability-free prevalence. In addition, the difference in DFLE between urban-rural elderly over 60 years old is mostly attributed to the mortality rate by gender (male: 0.902/1.637; female: 0.893/1.454), but the impact of the disability-free rate cannot be ignored either (male: 0.735/1.637; female: 0.561/1.454).

CONCLUSIONS

The increase in DFLE is accompanied by the increase in LE, but with increased age, DFLE/LE gradually decreases. With advancing age, the effect of disability on elderly people becomes more severe. The government administration must implement some preventive actions to improve health awareness and the life quality of the elderly. Rural elderly; rural women in particular, need to be paid more attention and acquire more health care.

Socioeconomic inequalities in life expectancy and disability-free life expectancy among Chilean older adults: evidence from a longitudinal study

BACKGROUND

Chile has one of the longest life expectancies of Latin America. The country is characterised by an important macroeconomic growth and persisting socioeconomic inequalities. This study analyses socioeconomic differences in life expectancy (LE) and disability-free life expectancy (DFLE) among Chilean older people.

METHODS

The sample of the Social Protection Survey, a longitudinal study, was analysed. Five waves, from 2004 to 2016, were considered. The indicator was disability, defined as having difficulties to perform at least one basic activity of daily living. Type of health insurance was used to determine socioeconomic position (SEP). Total LE and DFLE were estimated with multistate life table models.

RESULTS

At age 60, men in the higher SEP could expect to live 3.7 years longer (22.2; 95% CI 19.6-24.8) compared to men of the same age in the medium SEP (18.4; 95% CI 17.4-19.4), and 4.9 years longer than men of the same age in the lower SEP (17.3; 95% CI 16.4-18.2). They also had a DFLE (19.4; 95% CI 17.1-21.7) 4 (15.4; 95% CI 14.6-16.1) and 5.2 (14.2; 95% CI 13.4-14.9) years longer, compared to the same groups. Women aged 60 years in the higher SEP had a LE (27.2; 95% CI 23.7-30.8) 4.6 (22.7; 95% CI 21.9-23.5) and 5.6 (21.6; 20.6-22.6) years longer, compared to women in the medium and the lower SEP. The difference in DFLE, for the same age and groups was 4.9 and 6.1 years, respectively (high: 21.4; 95% CI 19.5-23.3; medium: 16.5; 95% CI 15.8-17.1; low: 15.3; 95% CI 14.6-16.0). Socioeconomic differences in LE and DFLE were observed among both sexes until advanced age.

DISCUSSION

Socioeconomic inequalities in LE and DFLE were found among Chilean older men and women. Older people in the highest SEP live longer and healthier lives.

CONCLUSION

A reform to the Chilean health system should be considered, in order to guarantee timely access to care and benefits for older people who are not in the wealthiest group.

Are We Living Longer and Healthier?

Objective: To examine whether we live healthier as we live longer in Hong Kong, which has one of the highest life expectancies in the world. Methods: Sullivan's method was used to evaluate the chronic disease-free life expectancy (CDFLE), life expectancy in good self-perceived health (GPHLE), and impairment-free life expectancy (IFLE) among population aged 50 years and older in Hong Kong in 2007-2016. Results: In spite of the marked improvement in life expectancy in Hong Kong, the increase in GPHLE was much smaller, while CDFLE and IFLE even declined for both genders. The situation was more severe among older population. Discussion: People in Hong Kong live longer but with worsening health. The expansion of chronic diseases, self-perceived poor health, and impairments among older adults calls for more fiscal investments, government attention, and public health policies.