Differences in healthy life expectancy for the US population by sex, race/ethnicity and geographic region: 2008.

BACKGROUND: Healthy life expectancy (HLE) varies among demographic segments of the US population and by geography. To quantify that variation, we estimated the national and regional HLE for the US population by sex, race/ethnicity and geographic region in 2008. METHODS: National HLEs were calculated using the published 2008 life table and the self-reported health status data from the National Health Interview Survey (NHIS). Regional HLEs were calculated using the combined 2007-09 mortality, population and NHIS health status data. RESULTS: In 2008, HLE in the USA varied significantly by sex, race/ethnicity and geographical regions. At 25 years of age, HLE for females was 47.3 years and ∼2.9 years greater than that for males at 44.4 years. HLE for non-Hispanic white adults was 2.6 years greater than that for Hispanic adults and 7.8 years greater than that for non-Hispanic black adults. By region, the Northeast had the longest HLE and the South had the shortest. CONCLUSIONS: The HLE estimates in this report can be used to monitor trends in the health of populations, compare estimates across populations and identify health inequalities that require attention.

Expected years of life free of chronic condition-induced activity limitations - United States, 1999-2008.

Over the 20th century, the U.S. population has witnessed major changes in fatal and nonfatal health outcomes. Mortality has declined, and life expectancy has increased continuously; chronic conditions have replaced acute diseases as leading causes of both illness and death. During 1900-2008, average life expectancy at birth for the total U.S. population increased from 47.3 years in 1900 to 78.1 years in 2008, a gain of 30.8 years. In addition, an increasing proportion of the U.S. population is aged >65 years. According to the U.S. Census Bureau estimates, at the beginning of the 20th century, the U.S. population aged >65 years constituted only 4.1 percent of the total population; by 2008, the percentage of the total U.S. population aged >65 years was 12.8%. However, declines in mortality are not necessarily associated with declines in morbidity or the consequences of chronic conditions on life activities. The possibility that longer life might be accompanied by poor health makes it essential to develop measures that account for both mortality and morbidity at the same time. Hence, over the past 40 years, a new set of health measures (e.g., "healthy life expectancies") have been developed that account for both mortality and life spent free of the consequences of ill health. One of these newly developed set of measures (called "active life expectancy") is the average number of years expected to be lived without activity limitations.

Life Expectancy Free of Chronic Condition-induced Activity Limitations Among White and Black Americans, 2000-2006.

Objective-Life expectancy without activity limitations or active life expectancy is one of the health expectancy measures that is used to summarize population health. The measure differentiates the remaining years of life that are expected to be spent with activity limitations from expected years of life without activity limitations. The objective of this study was to estimate life expectancy with and without activity limitations for the white and black populations of the United States in the years 2000-2006, focusing on expected years free of chronic condition-induced activity limitations. Methods-Life expectancies for the total as well as the white and black populations for the years 2000-2006 were calculated separately using abridged single decrement life tables. Expected years of life with and without chronic condition-induced activity limitations were calculated using Sullivan's method. The statistical analysis is based on data from the U.S. Census Bureau and the National Center for Health Statistics. Results-Results of the study show that during the 7-year period, expected years free of chronic condition-induced activity limitations increased for the total population as well as the white and black populations of both sexes. For the total population, all males and all females, years free of chronic condition-induced activity limitations increased significantly at all ages except at 85 and over. Expected years free of chronic condition-induced activity limitations increased at age 75 and under for the white population and at age 65 and under for the black population.

Retrospective information on health status and its application for population health measures.

Healthy life expectancies are almost always calculated by using health data from cross-sectional surveys. This type of calculation is done partly because data from longitudinal surveys are not always available, and when they are available, they are collected at intervals that are longer than one year. In such cases, collecting health information retrospectively for the years skipped by the survey is useful. The main purpose of this paper is to show how retrospective health information can be used to estimate life expectancies in different health states. Healthy life expectancies are estimated with and without using data on retrospective health information, and the corresponding estimates are compared. The two sets of estimates are similar. We conclude that retrospectively assessed health information based on a one-year recall period can be used to estimate years of life in various health states and that estimates based on such information will closely approximate estimates based on concurrent health information.

Estimating healthy life expectancies using longitudinal survey data: methods and techniques in population health measures.

Objective-Summary measures of population health are statistics that combine mortality and morbidity to represent overall population health in a single index. Such measures include healthy life expectancy, also called disability-free life expectancy and active life expectancy. Healthy life expectancy can be calculated using cross-sectional or longitudinal survey data. This report presents a comprehensive discussion of a method for calculating healthy life expectancy using data from longitudinal surveys. Methods-Healthy life expectancies are calculated using the multistate life table model. Expected life in various states of health is estimated using data from the Second Longitudinal Study of Aging and the Medicare Current Beneficiary Survey to illustrate the calculation of the statistics and the discussion of data and methodology related issues. Results-The study shows that estimating summary measures of population health using longitudinal survey data provides the opportunity of using incidence rather than prevalence rates. Health measures estimated based on incidence reflect the most recent health status of the population. Models that use longitudinal survey data measure transitions from good to poor health as well as poor to good health. That is, the models account for recovery from morbidity or illness. Longitudinal survey data canalsobeusedtocalculate healthy or active life expectancies by initial health states.

Achieving national health objectives: the impact on life expectancy and on healthy life expectancy.

Our study quantifies the impact of achieving specific Healthy People 2010 targets and of eliminating racial/ethnic health disparities on summary measures of health. We used life table methods to calculate gains in life expectancy and healthy life expectancy that would result from achievement of Healthy People 2010 objectives or of current mortality rates in the Asian/Pacific Islander (API) population. Attainment of Healthy People 2010 mortality targets would increase life expectancy by 2.8 years, and reduction of population wide mortality rates to current API rates would add 4.1 years. Healthy life expectancy would increase by 5.8 years if Healthy People 2010 mortality and assumed morbidity targets were attained and by 8.1 years if API mortality and activity limitation rates were attained. Achievement of specific Healthy People 2010 targets would produce significant increases in longevity and health, and elimination of racial/ethnic health disparities could result in even larger gains.