Trends in cancer-free working life expectancy based on health insurance data from Germany-Is the increase as strong as in working life expectancy?

BACKGROUND: Against the backdrop of population ageing, governments are facing the need to raise the statutory retirement age. In this context, the question arises whether these extra years added to working life would be spent in good health. As cancer represents a main contributor to premature retirement this study focuses on time trends and educational inequalities in cancer-free working life expectancy (WLE). METHODS: The analyses are based on the data of a large German health insurer covering annually about 2 million individuals. Cancer-free WLE is calculated based on multistate life tables and reported for three periods: 2006-2008, 2011-2013, and 2016-2018. Educational inequalities in 2011-2013 were assessed by two educational levels (8 to 11 years and 12 to 13 years of schooling). RESULTS: While labour force participation increased, cancer incidence rates decreased over time. Cancer-free WLE at age 18 increased by 2.5 years in men and 6.3 years in women (age 50: 1.3 years in men, 2.4 years in women) between the first and third period while increases in WLE after a cancer diagnosis remained limited. Furthermore, educational inequalities are substantial, with lower groups having lower cancer-free WLE. The proportion of cancer-free WLE in total WLE remained constant in women and younger men, while it decreased in men at higher working age. CONCLUSION: The increase in WLE is accompanied by an increase in cancer-free WLE. However, the subgroups considered have not benefitted equally from this positive development. Among men at higher working age, WLE increased at a faster pace than cancer-free WLE. Particular attention should be paid to individuals with lower education and older men, as the general level and time trends in cancer-free WLE are less favourable.

The effect of sample attrition in the EU Statistics on Income and Living Conditions on the estimates of Eurostat's Healthy Life Years.

Eurostat's official Healthy Life Years (HLY) estimates are based on European Union Statistics on Income and Living Conditions (EU-SILC) cross-sectional data. As EU-SILC has a rotational sample design, the largest part of the samples are longitudinal, health-related attrition constituting a potential source of bias of these estimates. Bland-Altman plots assessing the agreement between pairs of HLY based on total and new rotational, representative samples demonstrated no significant, systematic attrition-related bias. However, the wide limits of agreement indicate considerable uncertainty, larger than accounted for in the confidence intervals of HLY estimates.

Alcohol-related mortality in four European countries: A multiple-cause-of-death study.

INTRODUCTION: The impact of conditions that partly or indirectly contribute to drinking-related mortality is usually underestimated. We investigate all alcohol-related multiple (underlying and contributory) causes of death and compare mortality distributions in countries with different levels and patterns of drinking. METHOD: Analysis of population-level mortality data for persons aged 20 and over in Austria, Czechia, Poland and Spain. Age-standardised death rates and standardised ratios of multiple to underlying cause were calculated for alcohol-related causes of death. RESULTS: Multiple-cause mortality ranged from 20 to 58 deaths per 100,000 for men and from 5 to 16 per 100,000 for women. Liver diseases were the most common underlying and multiple causes, but mental and behavioural disorders were the second or third, depending on country and sex, most prevalent multiple mentions. Two distinct age patterns of alcohol-related mortality were observed: in Czechia and Poland an inverted-U distribution with a peak at the age of 60-64, in Austria and Spain a distribution increasing with age and then levelling off for older age groups. DISCUSSION AND CONCLUSION: The importance of alcohol-related conditions that indirectly impact mortality can be re-assessed with the use of contributory mentions. The multiple-cause-of-death approach provides convergent results for countries characterised by similar patterns of alcohol consumption. Multiple-cause mortality was almost double the level of mortality with alcohol as the underlying cause, except in Poland. Mental and behavioural disorders were mostly certified as contributory to other, non-alcohol-related underlying causes of death.

Well-Being Adjusted Health Expectancy: A New Summary Measure of Population Health.

We propose a new summary measure of population health (SMPH), the well-being-adjusted health expectancy (WAHE). WAHE belongs to a subgroup of health-adjusted life expectancy indicators and gives the number of life years equivalent to full health. WAHE combines health and mortality information into a single indicator with weights that quantify the reduction in well-being associated with decreased health. WAHE's advantage over other SMPHs lies in its ability to differentiate between the consequences of health limitations at various levels of severity and its transparent, simple valuation function. Following the guidelines of a Committee on Summary Measures of Population Health, we discuss WAHE's validity, universality, feasibility sensitivity and ensure its reproducibility. We evaluate WAHE's performance compared to life expectancy, the most commonly used indicators of health expectancy (HE) and disability-adjusted life expectancy (DALE) in an empirical application for 29 European countries. Data on health and well-being are taken from the 2018 EU-SILC, and the life tables are from Eurostat. DALE is taken from the database of the Global Burden of Disease Programme. WAHE's sensitivity to univariate and multivariate state specifications is studied using the three Minimum European Health Module health dimensions: chronic morbidity, limitations in activities of daily living, and self-rated health. The empirical tests of the indicators' correspondence reveal that WAHE has the strongest correlation with the other SMPHs. Moreover, WAHE estimates are in agreement with all other SMPHs. Additionally, WAHE and all other SMPHs form a group of reliable indicators for studying population health in European countries. Finally, WAHE estimates are robust, regardless of whether health is defined across one or multiple simultaneous dimensions of health. We conclude that WAHE is a useful and reliable indicator of population health and performs at least as well as other commonly used SMPHs. Supplementary Information: The online version contains supplementary material available at 10.1007/s10680-022-09628-1.

Cross-sectional estimates of population health from the survey of health and retirement in Europe (SHARE) are biased due to health-related sample attrition.

Cross-sectional data from the Survey of Health, Ageing and Retirement in Europe (SHARE) are a common source of information in comparative studies of population health in Europe. In the largest part, these data are based on longitudinal samples, which are subject to health-specific attrition. This implies that estimates of population health based on cross-sectional SHARE datasets are biased as the data are selected on the outcome variable of interest. We examine whether cross-sectional datasets are selected based on health status. We compare estimates of the prevalence of full health, healthy life years at age 50 (HLY), and rankings of 18 European countries by HLY based on the observed, cross-sectional SHARE wave 7 datasets and full samples. The full samples consist of SHARE observed and attrited respondents, whose health trajectories are imputed by microsimulation. Health status is operationalized across the global index of limitations in activities of daily living (GALI). HLY stands for life expectancy free of activity limitations. Cross-sectional datasets are selected based on health status, as health limitations increase the odds of attrition from the panel in older age groups and reduce them in younger ones. In older age groups, the prevalence of full health is higher in the observed cross-sectional data than in the full sample in most countries. In most countries, HLY is overestimated based on the cross-sectional data, and in some countries, the opposite effect is observed. While, due to the small sample sizes of national surveys, the confidence intervals are large, the direction of the effect is persistent across countries. We also observe shifts in the ranking of countries according to HLYs of the observed data versus the HLYs of the full sample. We conclude that estimates on population health based on cross-sectional datasets from longitudinal, attrited SHARE samples are over-optimistic.

Sex Differences in Alcohol Attributable Mortality in Poland, 2002-2018.

We study patterns and developments in sex differences in alcohol-attributable mortality (AAM) in Poland over the years 2002-2018. Sex gap and sex-specific mortality patterns according to age, educational level and urbanrural settlements are contrasted with findings for other developed countries. Premature AAM of the population 20-64 years old is quantified with age-standardized alcohol-attributable mortality rates (AASMR) by sex and selected characteristics. For the age pattern, we study the gender gap in alcohol-attributable crude death rates for 10-year age groups. Data comes from the World Health Organization database or directly from the Polish Central Statistical Office. In 2002, in Poland, men died 9-times more often than women from causes attributable to alcohol consumption. As a result of faster growth in AASMR among women, the relative sex gap halved between 2002 and 2018. However, this relative change was accompanied by an increase in the absolute gap, resulting from a larger increase in the total number of deaths attributed to alcohol consumption among men than women. Due to the substantially higher alcohol consumption and mortality among men, differences in AAM according to age, education and place of residence, and their changes over the study years, are much more pronounced for men than women. Polish men and women are characterized by similar patterns and developments of alcohol-attributable mortality in the study years. Different from that observed for other developed countries narrowing the sex gap, we observe in Poland perseverance of male elevated AAM. An important contribution of the study is the evidence that to understand differences between men and women in AAM and their developments, we need to study both relative and absolute sex gaps.