EQUILIBRIUM TREND IN HEALTH AND MORTALITY COMPRESSION :
THE SPANISH CASE
Rosa GÓMEZ REDONDO(1), Ricard GÉNOVA(2) and Elena ROBLES(1)
(1) Department of Sociology III, UNED, Spain.
(2) Public Health Institute, Public Health Directorate, Comunidad de Madrid, Spain.
18th REVES CONFERENCE, 2006
Amsterdam, The Nederland, 29-31 May, 2006
INTRODUCTION
Spanish population exhibits one of the highest life expectancies in the world,
although its mortality transition took place later
than in many other European countries.
During the last 30 years of the XXth century (1970-2001), the more important
socio-demographic processes are the following:
Ageing of the population and a high longevity
Feminization of the elderly followed by a stabilization of the
difference by gender in the life expectancy
Spain is currently within the last period of the
Health-Epidemiological Transition, and it is experiencing a slow
but continuous decline of mortality until the present time
In this work we would like to present new data to contribute to the knowledge about
How to integrate the Disability Transition in the fourth phase of the Age of
Delayed Degenerative Diseases, following the theoretical objective presented
recently by Robine and Michel (2004).
Sources : Official National Sources
Our study shows indicators for Healthy and Disability-free Life
from official sources at the national level for the Spanish population.
Anyway, as the only source that allows us the study of the evolution
of the disability-free live expectancy for Spanish population is the European
Community Household Panel (ECHP), we have obtained the prevalence
of disability from this source for the period 1995-2003.
Deaths (nDx), mode, median and life expectancy at birth in Spain.
Total population. Years 1900 and 2003.
25000
median=82,89
e(0)=79,58
Deaths
20000
mode=86,68
1900
15000
2003
10000
5000
median=32,57
Adult
mode=71 55
e(0)=34,76
0
0
20
40
Age
60
80
The compression of mortality at older ages is evident in the theoretical death series
at the beginning of the XXth and XXIth Centuries and across specific indexes of longevity.
Transition from a curve with a bimodal distribution at 1900 to the compression of the death,
that we can see in the proximity of the life expectancy, modal age and median in 2003.
100
Spain. Survivors by age. 1900 – 2003.
100.000
90.000
1990
80.000
70.000
Survivors
2003
1970
1910 1940
1920
60.000
1930
1950
1900
50.000
MEN
40.000
30.000
20.000
10.000
0
0
5
10
15 20
25 30
35
40 45
50 55
60 65
70
75 80
85 90
95 100 105
100.000
90.000
80.000
1970
1950
70.000
Survivors
2003
1990
60.000
1910
1920
50.000
1940
1930
WOMEN
1900
40.000
30.000
20.000
10.000
0
0
5
10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100 105
Age
The rectangularization of the survivors curve is clear.
The mortality structures of men and women are very different.
Women has evolved faster in the epidemiological transition.
The movement of deaths towards progressively older ages
has not a fixed limit until present times.
During the last three years, there is a certain stabilization of the mortality,
but the historic experience shows that the compression is not absolute.
HEALTHY LIFE EXPECTANCY
Long life does not mean quality of life during the lived years.
HLEP, healthy life expectancy (perceived), (1986-2003) by
5 National Health Surveys, ENS (Encuesta Nacional de Salud).
In 2003 the men at 65 years old expect to live 16.80 years,
while women expect 20.72. But if the question is the health condition
during these years, the numbers are reduced to around 7.5 for men
and less of 7.0 for women enjoying good health conditions.
In relative terms, this represents a 44% of total Life Expectancy for men,
and even more in women that only live in a good health condition
32% out of those years.
LE and HLEP at 65 years in Spain by sex. Years 1987 and 2003.
MEN 1987
WOMEN 1987
HLEP65
MEN 2003
LE65
WOMEN 2003
0
5
10
15
20
25
Years of life
The evolution of healthy life expectancy perceived between the Health Surveys 1987 and 2003,
show that the HLEP has increased both for men and women during the whole period.
Ratio of Healthy Life Expectancy Perceived /
Life Expectancy (%)
2003
YEAR
1997
Women 65
1995
Men 65
1993
1987
0
10
20
30
40
50
% HLEP / LE
The different surveys show a number of years of healthy life very similar for men and women,
but due to the larger longevity of women the ratio between HLE and LE is lower in women.
It is important to note the stabilization of the trend towards a more healthy life for the period covered
by our data. There are also frequent oscillations from one survey to the other. The trend is, thus, ill defined.
The observed situation in differential longevity by gender is paradoxically inverted
when referring to inequality in health.
Increment (%) of LE and HLEP at 65 years in Spain by sex.
1987-1995 and 1995-2003
1
ME N
EN
WO M
-8
-6
-4
-2
95
- 1995
1 987
HLEP65
LE65
1
ME N
EN
WO M
9
987- 1
0
995- 2
03
- 2003
1 995
0
2
% Increment
4
6
8
10
12
The rhythm of the increment of life (LE) in populations over 65 years
as compared to that followed by the rhythm increment of health (HLEP) shows
that there was a small decrement in the first part of the period for men (1987/1995),
followed by a notable recovery in the second part (1995/2003).
For women, the results are different: their decrease in health in 2003
might be recovered in the next survey as it happened previously with men.
DISABILITY-FREE LIFE EXPECTANCY
Disability is a growing fact along the human life cycle.
DFLE, disability-free life expectancy from the Encuesta de Discapacidad y Minusvalia,
in 1999 by INE (Instituto Nacional de Estadística).
From the specific national sources we have only access to a single description at
the end of the XXth century because, unfortunately,
the survey of 1999 can not be compared with a previous survey (1986)
due to methodological reasons.
Ratio of Disability-free Life Expectancy /
Life expectancy (%), 1999.
DFLE
Men 65
Women 65
DFLE (s)
0
20
40
60
80
100
% DFLE / LE
Impairment, Disabilities and Handicaps are common for both genders, but the DFLE represent a 70%
of the men life and only the 61% for the women.
In the cases of severe disability the corresponding DFLE(s) is slightly higher,
around 2 years more than disability-free, both for men and women.
This is due to a double effect: Differential women disability and differential men mortality.
Both factors contribute to a feminization of disability.
More years to live but a lower health level for women than for men.
Whatever the type of disability preventing any activity, this ratio DFLE / LE according to gender is maintained.
Evolution of the ratio (%) of Disability-free Life Expectancy /
Life Expectancy at 65 + in Spain. 1995 to 2003
2003
2002
2001
Years
2000
WOMEN
1999
MEN
1998
1997
1996
1995
0%
10%
20%
30%
40%
50%
60%
70%
80%
% HLEP/LE
Evolution during the last decade of the quality of life lived by the older population based on the data from the
Household Panel (ECHP). The DFLE at 65+ years old increased one year of life during the period, with similar gains in the LE.
The evolution of the ratio DFLE/LE could suggest a slight increment upon arrival at 65 years old. Nevertheless, due to the
oscillations from one year to the other, it is risky to conclude an increment trend for this ratio during these years.
The main conclusion would be a trend to equilibrium.
DISCUSSION
After the advancements in health and longevity during the period, the self-perceived
health has a trend towards stability at the present time.
From the middle 1980’s healthy life expectancy for Spaniards has increased slightly
considering the period as a whole. Nevertheless the period has not been homogeneous,
and during the last few years we have observed frequent oscillations at advanced ages.
The evolution of the DFLE/LE presents an equilibrium trend with a clear feminization of
disabled population. In a recent EHEMU report, Carol Jager (2005) pointed out that Spain
is among the group of European countries that follows a stability trend in the life spent
disability-free.
If we consider disability (DFLE) as an indicator of the severity of morbidity,
and the HLEP as an indicator of the health, the above referred oscillations
in both indicators could reflect the interplay between the advances in mortality
and the control of morbidity.
This scenario makes it possible a stabilization of morbility and disability,
with periods of losses in health conditions within a defined context. Consequently,
we could conclude that Spanish population is in a period characterized
by a dynamic equilibrium (Manton, 1982).
The extent of this stability period will depend upon the group of changes of different nature
that would eventually upgrade in the Spanish society
towards climbing an additional step to reach a new stage in the disability transition.
……..THANK YOU FOR YOUR ATTENTION
nDx
YEAR 2004
5000
median=83,39
4500
mode=86,92
4000
e(0)=80,18
2004-Total
Deaths
3500
2004-Women
3000
2004-Men
2500
2000
1500
1000
500
0
0
10
20
30
40
50
60
Age
70
80
90
100
110