Les espérances de vie sans incapacité en France
Abstract
Background. In 2008, the life expectancy (LE) of men and women was 78 years and 84 years, respectively. With the increase in LE, it has become of crucial importance for public health and care planning to know whether the years gained are years of good or poor health. It has also become a social and economic issue due to the growing expectation for social participation of the elderly. How many years are lived in good functional health? What can be said about recent trends? To answer these questions, this study presents the new estimates of disability-free life expectancies (DFLE) in France.
Method. To produce the new estimates, we used various disability indicators found in 5 national and European health surveys conducted in France circa 2008. Disability indicators cover different disability dimensions, relating to both functional limitations (physical, sensory and cognitive/mental) and activity restrictions. We added these new estimates to those computed previously, which were based on the same surveys or on different sources. The Sullivan method is used to compute the DFLE at ages 50 and 65. We also computed partial DFLE in the 50-65 age group in order to assess premature mortality and disability risks, which can jeopardize social participation, especially on the labour market.
Results. Almost half of the LE50 for men, and 40% for women, are years of good functional health. The years lived with disability are mostly years of physical and sensory functional limitations which do not impact daily activities. Indeed, 60% of LE50 of both men and women are perceived as years free of activity limitations. Women live longer with functional limitations and activity restrictions than men, notably for chore activities (25% of women's LE50 vs 13% for men). These differences are already marked at ages 50-60. Indeed, although disabilities are more frequent at later ages, they occur well before age 65, suggesting a critical period of life in terms of health and functioning at these ages. Finally, the results suggest that trends in LE without activity restrictions are less favourable than in earlier decades, especially in the 50-65 age group. Furthermore, we found a clear contrast in trends between the sexes: a decrease in LE without chore activity restrictions for women, and a decrease in LE without personal care activity restrictions for men. The proportion of life lived without functional limitation is also decreasing slightly, as in the past.
Discussion. While trends must be analysed with caution due to breaks in the time series, the overall picture appears, for the first time, to be gender-specific. These results also suggest that it is important not only to focus on the elderly, but also to study functional health at much earlier ages due to the occurrence of functional problems before age 65, especially in the late working ages. The results finally suggest that various dimensions of disability should be studied in order to better anticipate future needs. The comparison of past and more recent trends reveals stagnation in DFLE in recent years. This pattern, which is less favourable for women, could be explained by the improved survival of people with chronic diseases and functional limitations. It could also be explained by an increased perception of altered functional health or by an actual deterioration. In the female population, this pattern concerns generations of women who were more numerous in the labour force and who are now in their late working ages or entering retirement. Do these trends reflect changes in perceptions or worsening functional health among persons in their 50s? In-depth analysis of the social and health context is required in order to better document this new situation in France.
Also available:
Cambois E, Blachier-Sieurin A, Robine J-M. 2012. Aging and health in France: an unexpected expansion of disability in mid-adulthood over recent years. European journal of public health.