ABSTRACT
Abstract Background Health expectancy indicators aim at capturing the quality dimension of total life expectancy.; however, the underlying approach, definition of health, and information source differ considerably among the indicators available. Objective (1) Review the main concepts and approaches used to estimate health expectancy focusing on two widely used European health indicators: Health-Adjusted Life Expectancy (HALE) and Healthy Life Years (HLY); (2) identify underlying differences between the results yielded by these two indicators. Method Statistical differences between the HALE and HLY indicators by sex at ages 50, 60, and 70 were tested using pairwise and global Student´s t-tests and z-scores based on standard deviation. Data for 29 European countries were collected from the European Health Expectancy Monitoring Unit (EHEMU) information system and the World Health Organization (WHO) Global Burden of Disease Study 2016 (GBD 2016). Results The HALE indicator estimates were smoother across European countries compared with those of the HLY indicator, present a narrower sex gap in morbidity, higher z-scores compared with the average distribution across Europe, and results less sensitive to cross-national variations. Conclusion The HALE estimates indicate that morbidity is more compressed for both sexes, whereas the HLY estimates suggest that morbidity is more compressed for males but more expanded for females. These contrasting results demonstrate that health expectancy indicators should be interpreted with caution.
Resumo Introdução Os indicadores de expectativa de vida saudável visam capturar uma dimensão de qualidade na expectativa de vida total. No entanto, os pressupostos, a definição de saúde e a fonte de informação diferem consideravelmente entre os indicadores. Objetivo (1) Revisar os principais conceitos e abordagens para estimar as expectativas de saúde com foco em dois indicadores de saúde usados no caso europeu (HALE e HLY); e (2) Identificar diferenças subjacentes nos resultados gerados por esses dois indicadores. Método As diferenças estatísticas entre HALE e HLY por sexo nas idades de 50, 60 e 70 são testadas através dos testes t de Student emparelhados e globais e escores z com base no desvio padrão. Os dados são de 29 países europeus do Sistema Europeu de Informação da Unidade de Monitoramento de Expectativas de Saúde (EHEMU) e do estudo OMS-GBD para o ano de 2016. Resultados As estimativas da HALE possuem menor variabilidade entre os países europeus do que a HLY, apresentam uma diferença de morbidade menor por sexo, apresentam escores-z mais altos em comparação com a distribuição média europeia e têm resultados menos sensíveis às variações entre países. Conclusão As estimativas da HALE indicam que a morbidade é mais comprimida para ambos os sexos, enquanto a HLY sugere que a morbidade para os homens é mais comprimida e para mulheres mais expandida. Esses resultados contrastantes implicam que se deve ter cuidado com os indicadores de expectativa de vida saudável e sua interpretação.
ABSTRACT
Objective To analyze the health life expectancy (HALE) of the residents aged 15 years and above in Zhejiang Province and to evaluate the health level among adults. Methods The study was based the mortality data collected from Zhejiang Chronic Disease Surveillance Information and Management System, and the mortality rates were from the Under-Reporting Survey and the sample data in Zhejiang from the 5th National Health Service Survey in 2013. A Sullivan' s method was used to calculate the HALE. Results The life expectancy and self-evaluated HALE were 63.62 years, 55.80 years, respectively, and the difference was 7.82 years (61.49 years VS 55.13 years in males and 66.10 years VS 56.57 years in females) . The self-evaluated HALE 55.89 years in urban and 55.54 years in rural residents aged 15 years and above. The proportion of self-evaluated HALE in the total life expectancy was 87.70%, and it decreased with age, and the proportion has dropped to 67.31% in ≥65 age group. Life expectancy without chronic morbidity was 46.68 years (46.35 years in males and 47.01 years in females; 44.03 years in urban and 47.15 years in rural areas) among residents aged 15 years and above, and the proportion of self-evaluated HALE without chronic morbidity in the total life expectancy without chronic morbidity was 73.37%. Conclusion In general the proportion of self-evaluated HALE in the total life expectancy was small , and males had a greater proportion than female, and adults in rural areas had a greater proportion than that in urban areas. We should consider NCDS management for the elderly residents and to improve the life quality among the elderly residents.
ABSTRACT
We report 13 chromophobe renal cell carcinomas (10.8%) observed among 120 renal cell carcinomas in adults. The average age was 53 (range: 34-72) years old, and 6 were males and 7 females. The mean tumor size was 10 (range: 5-17) cm, mean nuclear grade 2.4, and mean Robson's stage was 1.9. There were two distinct histologic variants; typical variant (n=9) and eosinophilic variant (n=4). Both of them showed typical light microscopic features and positive reaction with Hale's colloidal iron and carbonic anhydrase II, a marker protein of intercalated cells of renal collecting ducts. A strong positive immunoreactivity for epithelial membrane antigen was noted in the cytoplasm in 12 of 13 tumors. Numerous microvesicles, 180~440 nm in diameter, were identified ultrastructurally. DNA aneuploidy was found in 3 out of 10 cases. Neither local recurrence nor metastasis have been identified during the following period of 4~144 (mean 48) months.