Age and sex-specific disability-free life expectancy in urban and rural settings of Bangladesh.

BACKGROUND: Disability-free life expectancy (DFLE) has been used to gain a better understanding of the population's quality of life. OBJECTIVES: The authors aimed to estimate age and sex-specific disability-free life expectancy (DFLE) for urban and rural areas of Bangladesh, as well as to investigate the differences in DFLE between males and females of urban and rural areas. METHODS: Data from the Bangladesh Sample Vital Statistics-2016 and the Bangladesh Household Income and Expenditure Survey (HIES)-2016 were used to calculate the disability-free life expectancy (DFLE) of urban and rural males and females in Bangladesh in 2016. The DFLE was calculated using the Sullivan method. RESULTS: With only a few exceptions, rural areas have higher mortality and disability rates than urban areas. For both males and females, statistically significant differences in DFLE were reported between urban and rural areas between the ages of birth and 39 years. In comparison to rural males and females, urban males and females had a longer life expectancy (LE), a longer disability-free life expectancy, and a higher share of life without disability. CONCLUSION: This study illuminates stark urban-rural disparities in LE and DFLE, especially among individuals aged < 1-39 years. Gender dynamics reveal longer life expectancy but shorter disability-free life expectancy for Bangladeshi women compared to men, emphasizing the need for targeted interventions to address these pronounced health inequalities.

Dynamic changes and lifetime effect of functional disability profiles for stroke patients: real-world evidence from South Korea.

PURPOSE: This work aimed to investigate the long-term dynamic changes of functional disabilities and estimate lifetime outcomes of different functional disabilities after a stroke, using real-world data from a nationally representative South Korean cohort. METHODS: Patients aged 18 and above with ischemic and hemorrhagic strokes were identified from the Korea Health Panel (KHP) data (2008-2018). Functional disabilities were repeatedly measured for patients aged 55 and over for the prevalence of disabilities associated with activities of daily living (ADL), and kernel smoothing means were estimated for each item. The lifetime survival function of stroke patients in Korea was adopted from another study utilizing the National Health Insurance Service of Korea's national sample cohort. By multiplying the disability-free proportion with the survival function throughout life, disability-free life expectancy (DFLE) for each ADL item was estimated. The loss-of-DFLE was calculated by subtracting the DFLE from age-, sex-, and calendar year-matched referents simulated from Korean life tables. RESULTS: The KHP dataset included 466 stroke patients. The overall functional disability needs increased over time after stroke diagnosis. DFLE was lowest for bathing (10.1 years for ischemic stroke and 12.8 years for hemorrhagic stroke), followed by those for dressing and washing. Loss-of-DFLE was highest for bathing for ischemic and hemorrhagic strokes (7.2 and 10.7 years, respectively), indicating that this task required the most assistance for stroke patients compared with the other tasks. DFLEs were slightly lower than the quality-adjusted life expectancy of stroke patients. CONCLUSION: Our findings provide valuable insights for resource allocation and policy decisions in long-term stroke care, potentially enhancing the quality of life for stroke survivors and caregivers.

Ethnic differences in disability-free life expectancy and disabled life expectancy in older adults in Chile.

BACKGROUND: Although about 10% of the Latin American population is indigenous, ethnic differences in disability-free life expectancy (DFLE) and life expectancy with disability (DLE) are unknown. OBJECTIVE: To estimate disability-free life expectancy and disabled life expectancy among Mapuche (the largest indigenous group) and non-indigenous older adults aged 60 years or more in Chile. METHOD: Disability was measured following a methodology that combines limitations of daily living, cognitive impairment and dependence previously validated in Chile. Finally, the DFLE was estimated using Sullivan's method combining life tables by ethnicity and disability proportions from the EDES survey designed for the study of ethnic differentials in health and longevity in Chile. RESULTS: Non-Indigenous people have a higher total and Disability-free life expectancy compared to Mapuche people at all ages. While at age 60 a Mapuche expects to live 18.9 years, of which 9.4 are disability-free, a non-Indigenous expects to live 26.4 years, of which 14 are disability-free. In addition, although the length of life with disability increases with age for both populations, Mapuche who survive to age 80 or 90 expect to live 84% and 91% of their remaining life with disability, higher proportions compared to non-indigenous people (62.9% and 75%, respectively). CONCLUSIONS: This is the first study addressing inequities in DFLE between the Mapuche and non-Indigenous population, reflected in lower total life expectancy, lower DFLE and higher DLE in Mapuche compared to the non-Indigenous population. Our results underscore the need for increased capacity to monitor mortality risks among older people, considering ethnic differences.

Total life expectancy and disability-free life expectancy and differences attributable to cigarettes' smoking among Chinese middle-aged and older adults.

OBJECTIVES: Middle-aged and older adults smoking for years are afflicted by smoking-related diseases and functional limitations; however, little is known about the effect of smoking on nonfatal conditions in middle and later life. This study aims to investigate the impact of smoking on both total life expectancy (TLE) and disability-free life expectancy (DFLE) and the variations in such effects by educational level in China. METHODS: Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS), 2011-2018, with a total sample of 16,859 individuals aged 45 years or older involved in the final analysis. The Activities of Daily Living (ADL) scale was used to measure disability, and the population-based multistate life table method was used to estimate the differences in TLE and DFLE by smoking status and educational attainment. RESULTS: At baseline, 28.9% of participants were current smokers, 8.5% were former smokers, and 62.6% never smoked. Approximately 5.6% were identified with ADL disability. Both current smokers and former smokers experienced lower TLE and DFLE than never smokers, and such differences were particularly prominent among men. Intriguingly, former smokers manifested a lower DFLE for both sexes and a lower TLE among women, though a longer TLE among men, compared with current smokers. Similar differences in TLE and DFLE by smoking status were observed for groups with different levels of education. CONCLUSION: Never smokers live longer and healthier than current smokers and persons who quit smoking. Smoking was associated with greater reductions in TLE and DFLE among men. However, educational attainment might not moderate the adverse effect of smoking on both fatal and nonfatal conditions in the context of China. These findings have implications for disability prevention, aged care provision and informing policies of healthy aging for China and elsewhere.

[How has life expectancy without functional limitations developed in Germany? An analysis with data from the German Ageing Survey (DEAS)]. / Wie hat sich die Lebenserwartung ohne funktionelle Einschränkungen in Deutschland entwickelt? Eine Analyse mit Daten des Deutschen Alterssurveys (DEAS).

INTRODUCTION: The long-term increase in life expectancy raises the question of whether the increased life expectancy is accompanied by an extension of years without health limitations. The study analyzes how life expectancy without functional and mobility limitations from the ages of 46 and 65 and their proportions of remaining life expectancy have changed since 2008. METHODS: We analyze data from the German Ageing Survey of the 2008, 2014, and 2020/21 waves. Life expectancy without functional limitations (disability-free life expectancy-DFLE) was calculated using the Sullivan method. Severe functional limitations (using the Global Activity Limitation Indicator-GALI) and mobility limitations (climbing stairs, walking more than 1 km) were examined. RESULTS: Compression of morbidity in the GALI has been observed in 46- and 65-year-old men since 2014, but not in women of the same age. In terms of mobility, 46- and 65-year-old men show trends towards compression when climbing stairs and 46-year-old men when walking more than 1 km since 2014. The values for women have stagnated for the first two indicators mentioned, but not for 46-year-old women since 2014 when walking more than 1 km. DISCUSSION: Our analyses show different trends in DFLE depending on the indicator, age, and gender and do not allow a clear answer to the question of morbidity compression or expansion. We tend to see morbidity compression in men, whereas trends of stagnation or expansion tend to be seen in women. These results signal challenges in maintaining functional health, especially in women, and point to the need for targeted interventions to improve quality of life and healthy life expectancy.

Decomposition of Differentials in Health Expectancies From Multistate Life Tables: A Research Note.

Multistate modeling is a commonly used method to compute healthy life expectancy. However, there is currently no analytical method to decompose the components of differentials in summary measures calculated from multistate models. In this research note, we propose a derivative-based method to decompose the differentials in population-based health expectancies estimated via a multistate model into two main components: the proportion resulting from differences in initial health structure and the proportion resulting from differences in health transitions. We illustrate the method using data on activities of daily living from the U.S. Health and Retirement Study to decompose the sex differential in disability-free life expectancy (HLE) among older Americans. Our results suggest that the sex gap in HLE results primarily from differences in transition rates between disability states rather than from the initial health distribution of female and male populations. The methods introduced here will enable researchers, including those working in fields other than health, to decompose the relative contribution of initial population structure and transition probabilities to differences in state-specific life expectancies from multistate models.

Changes in time spent walking and disability-free life expectancy in Japanese older people: The Ohsaki Cohort 2006 Study.

An increase in time spent walking is significantly associated with lower risks of mortality and disability. This study aimed to investigate the association between changes in time spent walking and disability-free life expectancy (DFLE) in community-dwelling older people. Thirteen-year follow-up data from a cohort study of 7105 Japanese older adults (age ≥ 65 years) in 2006 were analyzed. Information on time spent walking was collected using questionnaires at two time points (1994 and 2006). Based on this information, the participants were categorized into four groups according to changes in time spent walking: remained inactive, became inactive, became active, and remained active. DFLE was defined as the average number of years a person could expect to live without disability. The multistate life table method using a Markov model was used to calculate DFLE. Of those who were inactive in 1994, DFLE of those who became active in 2006 (20.30 years in men; 24.06 years in women) was longer by about 2 years than of those who remained inactive (17.96 years in men; 21.87 years in women), and it was as long as those who remained active (20.34 years in men; 24.16 years in women). The 2-year difference in DFLE did not change after the participants were stratified by body mass index, motor function, cognitive function, and history of diseases. Increase in time spent walking is associated with longer DFLE in Japanese older people. Encouraging simple physical activity such as walking at the population level could increase life-years lived in good health.

Association Between Social Participation and Disability-free Life Expectancy in Japanese Older People: The Ohsaki Cohort 2006 Study.

BACKGROUND: Although social participation has been reported to be associated with significantly lower risks of mortality and disability, to our knowledge, no study has estimated its impact on disability-free life expectancy (DFLE). Therefore, this study aimed to investigate the association between social participation and DFLE in community-dwelling older people. METHODS: We analyzed 11-year follow-up data from a cohort study of 11,982 Japanese older adults (age ≥65 years) in 2006. We collected information on the number of social participations using a questionnaire. Using this information, we categorized the participants into four groups. DFLE was defined as the average number of years a person could expect to live without disability. The multistate life table method using a Markov model was employed for calculating DFLE. RESULTS: The results revealed that DFLE according to the number of social participations was 17.8 years (95% confidence interval [CI], 17.3-18.2) for no activities, 20.9 (95% CI, 20.4-21.5) for one activity, 21.5 (95% CI, 20.9-22.0) for two activities, and 22.7 (95% CI, 22.1-23.2) for three activities in men, and 21.8 (95% CI, 21.5-22.2), 25.1 (95% CI, 24.6-25.6), 25.3 (95% CI, 24.7-25.9), and 26.7 years (95% CI, 26.1-27.4), respectively, in women. This difference in DFLE did not change after the participants were stratified for smoking, body mass index, physical activity, and depression. CONCLUSION: Social participation is associated with longer DFLE among Japanese older people; therefore, encouraging social participation at the population level could increase life-years lived in good health.

Comparing Cohort Survival in Good Health: A Research Note on Decomposing Sex Differentials in the United States.

We introduce a method for decomposing differences in healthy cross-sectional average length of life (HCAL). HCAL provides an alternative to the health expectancy (HE) indicator by including the health and mortality history of all cohorts present at a given time. While decompositions of HE differences account for contributions made by health and mortality, differences in HCAL are further disentangled into cohort-specific contributions. In this research note we illustrate the technique by analyzing the sex gap in health and mortality for the United States. We use the harmonized version of the Health and Retirement Survey data and define the health status in terms of activities of daily living. Our results suggest that the female advantage in cohort survival is partly compensated by women's lower cohort-specific health levels. At older ages, however, the sex differences in health are not large enough to compensate men's disadvantage in cohort survival.

Trends in Disability-Free Life Expectancy (DFLE) from 1995 to 2017 in the older Norwegian population by sex and education: The HUNT Study.

AIM: Understanding whether increasing Life Expectancy (LE) translates to improved health and function among older adults is essential, but results are inconclusive. We aimed to estimate trends in Disability-Free Life Expectancy (DFLE) in the older Norwegian population by sex and education from 1995 to 2017. METHOD: National life table data were combined with cross-sectional data on functional ability for 70+ year-olds from the population-based Trøndelag Health Surveys 2-4 (1995-1997, 2006-2008 and 2017-2019) (n=24,733). Self-reported functional ability was assessed on a graded scale by a combination of Instrumental Activities of Daily Living (IADL) such as paying bills, going out or shopping (mild disability) and Personal Activities of Daily Living (PADL) such as washing, dressing or eating (severe disability). LE, DFLE, Mild-Disability LE and Severe-Disability LE at age 70 were estimated by the Sullivan method. RESULTS: From 1995 to 2017 DFLE at age 70 increased from 8.4 to 13.0 years in women, and from 8.0 to 12.1 years in men. DFLE increased in the basic and high educational groups, but more so in the high educational group among men. Educational inequalities in years spent with disability however, remained low. CONCLUSIONS: From the mid-1990s and over the past three decades both LE and DFLE at 70 years increased in the older Norwegian population, for both men and women, and across basic and high educational levels. Educational inequalities in DFLE increased, especially in men, but years spent with disability were similar across the three decades.

Socioeconomic inequalities in life expectancy and disability-free life expectancy among Chilean older adults: evidence from a longitudinal study.

BACKGROUND: Chile has one of the longest life expectancies of Latin America. The country is characterised by an important macroeconomic growth and persisting socioeconomic inequalities. This study analyses socioeconomic differences in life expectancy (LE) and disability-free life expectancy (DFLE) among Chilean older people. METHODS: The sample of the Social Protection Survey, a longitudinal study, was analysed. Five waves, from 2004 to 2016, were considered. The indicator was disability, defined as having difficulties to perform at least one basic activity of daily living. Type of health insurance was used to determine socioeconomic position (SEP). Total LE and DFLE were estimated with multistate life table models. RESULTS: At age 60, men in the higher SEP could expect to live 3.7 years longer (22.2; 95% CI 19.6-24.8) compared to men of the same age in the medium SEP (18.4; 95% CI 17.4-19.4), and 4.9 years longer than men of the same age in the lower SEP (17.3; 95% CI 16.4-18.2). They also had a DFLE (19.4; 95% CI 17.1-21.7) 4 (15.4; 95% CI 14.6-16.1) and 5.2 (14.2; 95% CI 13.4-14.9) years longer, compared to the same groups. Women aged 60 years in the higher SEP had a LE (27.2; 95% CI 23.7-30.8) 4.6 (22.7; 95% CI 21.9-23.5) and 5.6 (21.6; 20.6-22.6) years longer, compared to women in the medium and the lower SEP. The difference in DFLE, for the same age and groups was 4.9 and 6.1 years, respectively (high: 21.4; 95% CI 19.5-23.3; medium: 16.5; 95% CI 15.8-17.1; low: 15.3; 95% CI 14.6-16.0). Socioeconomic differences in LE and DFLE were observed among both sexes until advanced age. DISCUSSION: Socioeconomic inequalities in LE and DFLE were found among Chilean older men and women. Older people in the highest SEP live longer and healthier lives. CONCLUSION: A reform to the Chilean health system should be considered, in order to guarantee timely access to care and benefits for older people who are not in the wealthiest group.

Impact of musculoskeletal disorders on healthy life expectancy in Japan.

BACKGROUND: Musculoskeletal disorders are a key cause of morbidity in elderly people. How musculoskeletal disorders relate to healthy life expectancy remain elusive. Hence, we aimed to estimate gains in healthy life expectancy from the elimination of musculoskeletal diseases and injuries by using recent national health statistics data in Japan. METHODS: Mortality data were taken from Japanese national life tables and death certificates in 2016. Information on medical diagnoses, injuries, and activity were obtained from the 2016 Comprehensive Survey of Living Conditions. We examined five disorders: rheumatoid arthritis, arthrosis, low back pain, osteoporosis, and fracture. The prevalence of limitations in activities of daily living (ADL) in the population after eliminating the disorder was estimated as the proportion of outpatients without the disorder and ADL limitations, inpatients without the disorder in hospitals and clinics, and people without the disorder who reside in long-term elderly care facilities. RESULTS: There were small gains in life expectancy from elimination of all selected musculoskeletal disorders (0.0-0.1 years). Elimination of rheumatoid arthritis, osteoporosis, and fracture slightly increased the expected years without activity limitation (0.1-0.4) and slightly decreased years with activity limitation (0.1-0.4 years). Meanwhile, elimination of arthrosis, low back pain, and arthrosis and low back pain moderately increased expected years without activity limitation (0.3-1.5 years) and decreased years with activity limitation (0.3-1.5 years). In addition, elimination of rheumatoid arthritis, arthrosis, low back pain, osteoporosis, and fracture decreased expected years with ADL limitations (0.0-0.8 years) and non-ADL limitations (0.0-0.3 years). A combination of arthrosis and low back pain showed a moderate decrease in expected years with both ADL limitations (0.7-1.1 years) and non-ADL limitations (0.3-0.4). CONCLUSIONS: These findings provide clinical evidence that among the musculoskeletal disorders low back pain and arthrosis are the key factors for the elongation of healthy life expectancy.

Disability-free life expectancy at old ages in Egypt.

This study aimed to estimate among the older population in Egypt (aged 60 years and over): 1) disability prevalence rates, their levels of severity and the common types and 2) disability-free life expectancy (DFLE) by sex, age and disability type. Data were from the nationally representative 2016 Household Observatory Survey (HOS-2016), with 4658 persons aged 60+ constituting the study sample population. To identify individuals with disabilities, the HOS asked respondents a short set of questions on functional difficulties, as suggested by the United Nations Washington Group on Disability Statistics. The DFLE was estimated using the Sullivan method. Older (60+) women reported a higher prevalence of disability than older men. Women had longer DFLEs and longer disabled life expectancies (DLEs) than men but had lower proportions of DFLE to their total lifetime. The findings suggest that, at age 60, around 30% of life expectancy in Egypt can be expected to be with limitations in mobility and vision. Men, although they live for fewer years than women, can expect to have a greater proportion of their life expectancy free of disability. The findings of the study suggest that the contextual differences in how the process of ageing is experienced need to be considered by decision-makers when designing gender-responsive health policies.

Estimating the number and length of episodes in disability using a Markov chain approach.

BACKGROUND: Markov models are a key tool for calculating expected time spent in a state, such as active life expectancy and disabled life expectancy. In reality, individuals often enter and exit states recurrently, but standard analytical approaches are not able to describe this dynamic. We develop an analytical matrix approach to calculating the expected number and length of episodes spent in a state. METHODS: The approach we propose is based on Markov chains with rewards. It allows us to identify the number of entries into a state and to calculate the average length of episodes as total time in a state divided by the number of entries. For sampling variance estimation, we employ the block bootstrap. Two case studies that are based on published literature illustrate how our methods can provide new insights into disability dynamics. RESULTS: The first application uses a classic textbook example on prednisone treatment and liver functioning among liver cirrhosis patients. We replicate well-known results of no association between treatment and survival or recovery. Our analysis of the episodes of normal liver functioning delivers the new insight that the treatment reduced the likelihood of relapse and extended episodes of normal liver functioning. The second application assesses frailty and disability among elderly people. We replicate the prior finding that frail individuals have longer life expectancy in disability. As a novel finding, we document that frail individuals experience three times as many episodes of disability that were on average twice as long as the episodes of nonfrail individuals. CONCLUSIONS: We provide a simple analytical approach for calculating the number and length of episodes in Markov chain models. The results allow a description of the transition dynamics that goes beyond the results that can be obtained using standard tools for Markov chains. Empirical applications using published data illustrate how the new method is helpful in unraveling the dynamics of the modeled process.

Persistent social inequality in life expectancy and disability-free life expectancy: Outlook for a differential pension age in Denmark?

AIMS: The state old-age pension in Denmark increases to keep pace with the projected increase in average life expectancy (LE) without any regard to the social gap in LE and expected lifetime in good health. The purpose of this study was to compare changes in LE and disability-free life expectancy (DFLE) between groups of Danes with high, medium and low levels of education. METHODS: Nationwide register data on education and mortality were combined with data from the Surveys of Health, Ageing and Retirement in Europe (SHARE) surveys in 2006-2007, 2010-2011 and 2013-2014 and the DFLE by educational level was estimated by Sullivan's method for each of these three time points. RESULTS: Between 2006-2007 and 2013-2014, LE among 65-year-old men and women with a low educational level increased by 1.3 and 1.0 years, respectively, and by 1.4 and 1.3 years for highly educated men and women. The gap in LE between people with high and low levels of education remained more than 2 years. In 2006-2007, 65-year-old men with a high level of education could expect 3.2 more years without disability than men of the same age with a low level of education. In 2013-2014, the difference was 2.9 years. For women, the results were 3.7 and 3.4 years, respectively. CONCLUSIONS: With the persistent social inequality in LE of more than 2 years and the continuous gap between high and low educational groups in DFLE of about 3 years, a differential pension age is recommended.

Burden of diabetes in Australia: life expectancy and disability-free life expectancy in adults with diabetes.

AIMS/HYPOTHESIS: The aim of this work was to estimate the life expectancy (LE) and disability-free life expectancy (DFLE) for adults with and without diabetes. METHODS: The Chiang method and the adapted Sullivan method were used to estimate LE and DFLE by age and sex. Mortality data in 2011 were available from the National Diabetes Services Scheme for diabetes and from standard national mortality datasets for the general population. Data on prevalence of disability and severe or profound core activity limitation were derived from the 2012 Australian Survey of Disability, Ageing and Carers (SDAC). The definitions of disability used in the SDAC followed the International Classification of Functioning, Disability and Health. Data on diabetes prevalence were derived from the Australian Diabetes, Obesity and Lifestyle study. RESULTS: The estimated LE and DFLE (with 95% uncertainty interval [UI]) at age 50 years were 30.2 (30.0, 30.4) and 12.7 (11.5, 13.7) years, respectively, for men with diabetes, and the estimates were 33.9 (33.6, 34.1) and 13.1 (12.3, 13.9) years, respectively, for women with diabetes. The estimated loss of LE associated with diabetes at age 50 years was 3.2 (3.0, 3.4) years for men and 3.1 (2.9, 3.4) years for women, as compared with their counterparts without diabetes. The corresponding estimated loss of DFLE was 8.2 (6.7, 9.7) years for men and 9.1 (7.9, 10.4) years for women. Women with diabetes spent a greater number of absolute years and a greater proportion of their life with disability as compared with men with diabetes and women without diabetes. The gains in LE and DFLE across the whole population at age 50 years after hypothetically eliminating diagnosed diabetes were 0.6 (0.5, 0.6) years and 1.8 (1.0, 2.8) years. CONCLUSIONS/INTERPRETATION: In adults, diabetes results in a modest reduction in LE and a substantial reduction in DFLE. Efforts to identify the specific causes of disability and effective interventions are needed.

Inequalities in healthy life expectancy between ethnic groups in England and Wales in 2001.

OBJECTIVES: We aim to develop robust estimates of disability-free life expectancy (DFLE) and healthy life expectancy (HLE) for ethnic groups in England and Wales in 2001 and to examine observed variations across ethnic groups. DESIGN: DFLE and HLE by age and gender for five-year age groups were computed for 16 ethnic groups by combining the 2001 Census data on ethnicity, self-reported limiting long-term illness and self-rated health using mortality by ethnic group estimated by two methods: the Standardised Illness Ratio (SIR) method and the Geographically Weighted Method (GWM). RESULTS: The SIR and GWM methods differed somewhat in their estimates of life expectancy (LE) at birth but produced very similar estimates of DFLE and HLE by ethnic group. For the more conservative method (GWM), the range in DFLE at birth was 10.5 years for men and 11.9 years for women, double that in LE. DFLE at birth was highest for Chinese men (64.7 years, 95% CI 64.0-65.3) and women (67.0 years, 95% CI 66.4-67.6). Over half of the ethnic minority groups (men: 10; women: 9) had significantly lower DFLE at birth than White British men (61.7 years, 95% CI 61.7-61.7) or women (64.1 years, 95% CI 64.1-64.2), mostly the Black, Asian and mixed ethnic groups. The lowest DFLE observed was for Bangladeshi men (54.3 years, 95% CI 53.7-54.8) and Pakistani women (55.1 years, 95% CI 54.8-55.4). Notable were Indian women whose LE was similar to White British women but who had 4.3 years less disability-free (95% CI 4.0-4.6). CONCLUSIONS: Inequalities in DFLE between ethnic groups are large and exceed those in LE. Moreover, certain ethnic groups have a larger burden of disability that does not seem to be associated with shorter LE. With the increasing population of the non-White British community, it is essential to be able to identify the ethnic groups at higher risk of disability, in order to target appropriate interventions.

Modelling changes in small area disability free life expectancy: trends in London wards between 2001 and 2011.

Existing analyses of trends in disability free life expectancy (DFLE) are mainly at aggregate level (national or broad regional). However, major differences in DFLE, and trends in these expectancies, exist between different neighbourhoods within regions, so supporting a small area perspective. However, this raises issues regarding the stability of conventional life table estimation methods at small area scales. This paper advocates a Bayesian borrowing strength technique to model trends in mortality and disability differences across 625 small areas in London, using illness data from the 2001 and 2011 population Censuses, and deaths data for two periods centred on the Census years. From this analysis, estimates of total life expectancy and DFLE are obtained. The spatio-temporal modelling perspective allows assessment of whether significant compression or expansion of morbidity has occurred in each small area. Appropriate models involve random effects that recognise correlation and interaction effects over relevant dimensions of the observed deaths and illness data (areas, ages), as well as major spatial trends (e.g. gradients in health and mortality according to area deprivation category). Whilst borrowing strength is a primary consideration (and demonstrated by raised precision for estimated life expectancies), so also is model parsimony. Therefore, pure borrowing strength models are compared with models allowing selection of random age-area interaction effects using a spike-slab prior, and in fact borrowing strength combined with random effects selection provides better fit.

A Multi-State Model Study of the Disability-Free Life Expectancy Among Older Adults with Chronic Multimorbidity Based on CHARLS - China, 2011-2020.

What is already known about this topic?: Chronic disease multimorbidity is prevalent among older Chinese people, seriously affecting their well-being and quality of life. What is added by this report?: This study estimated the impact of multimorbidity on the risk of health state transitions and health expectancy among older adults in China. It used population-representative, long-term longitudinal data and multi-state Markov modeling along with microsimulation methods. What are the implications for public health practice?: The study results suggest that the Chinese government should strengthen the prevention and management of multimorbidity and accelerate the transition from chronic disease management to multimorbidity management.

Healthy Aging in Colombia 2018 and Its Variation in Relation to Social Conditions.

The population aging in the region is occurring under scenarios of inequality, raising concerns about how the increase in life expectancy is experienced and what factors affect the quality of life of older adults. This research quantified the differentials of healthy aging in Colombia in 2018 and its association with social indicators through a cross-sectional, descriptive, and correlational observational study. Healthy aging was quantified using the Disability-Free Life Expectancy (DFLE) indicator and later correlated with social indicators and subjected to a Multiple Factor Analysis (MFA). The results showed a healthy life expectancy of 71.5 years for women and 66.9 years for men, with a disability expectancy of 8.3 and 6.4 years, respectively. Negative associations emerged with health problems, disability, lack of medical care, illiteracy, school absenteeism, and poverty, while higher education levels and retirement showed positive associations. The factor analysis by area of residence highlighted urban areas as conducive to healthy aging. In conclusion, the accelerated aging of the Colombian population faces health disparities that policies must address by improving education, economic security, and health services, especially for women and rural areas.