The elimination of selected chronic diseases in a population: the compression and expansion of morbidity.

OBJECTIVES: This study evaluates the effect of eliminating a specific disease on the mortality, long-term disability, and overall health status of a population. Primarily, it examines whether elimination leads to a compression of morbidity. METHODS: The Sullivan method was used to calculate disability-free life expectancy. Cause-deleted disability prevalence was estimated with a multiple logistic regression model that used data from the Dutch National Survey of General Practice. Cause-deleted probabilities of dying were derived with the cause-elimination life-table technique, assuming independence among competing causes of death. RESULTS: Eliminating disabling nonfatal diseases such as arthritis/back complaints results in a decline in life expectancy with disability--that is, an absolute compression of morbidity. Eliminating highly fatal diseases such as cancer leads to an increase in the number of years and the proportion of life with disability--that is, a relative expansion of morbidity. CONCLUSIONS: While eliminating fatal diseases leads to an increase in disability-free life expectancy, life expectancy with disability may increase as well. This represents an increasing burden to society. On the other hand, eliminating nonfatal disabling diseases leads to absolute compression of morbidity.

Results of two methods to determine health expectancy in The Netherlands in 1981-1985.

Health expectancy is a measure providing summarizing information on mortality on one hand and morbidity and/or disability on the other hand. In this article health expectancy is determined with two approaches: method 1 leads to life expectancy free of disability at birth and at other ages; method 2 leads to life expectancy in good health. Results of the various calculations show that according to method 1 life expectancy free of disability at birth for men in the Netherlands was 58.8 years and for women 57.3 years (based on data from the period 1981-1985). Results of method 2 are different from method 1; life expectancy in good health for men was 58.9 years and for women 60.7 years. Results of both methods are compared with studies which have been carried out in other countries. The comparison shows that method 1 leads to results which deviate from the other studies while results of method 2 are to a large extent similar to the other studies. Reasons are given which explain why the results of method 1 deviate from the other studies. In spite of the fact that the two methods lead to different outcomes, the conclusion is drawn that the difference in health expectancy between men and women is much smaller than the difference in total life expectancy between men and women. The difference in total life expectancy by sex in the period 1981-1985 was 6.7 years.

Associations of moderate and severe overweight with self-reported illness and medical care in Dutch adults.

Data on height, weight, illness, medical care consumption, and demographic variables for 19,126 Dutch adults aged 20 years or older were obtained from three annual Health Interview Surveys. Data on severely overweight (Body Mass Index 30.0-40.0 kg/m2) and moderately overweight (BMI 25.0-29.9 kg/m2) subjects were compared with those on non-overweight persons (BMI 20.0-24.9 kg/m2), taking into account effects of sex, age, and educational level. In men, severe overweight was associated with hypertension, especially in men under 50 years of age. In women, severe overweight was associated with hypertension, diabetes, varicose veins, asthma/bronchitis, and hemorrhoids. Increased utilization of medical care and medications were also associated with severe overweight. For moderately overweight subjects, these associations were less clear or absent.

[Applications of the OECD disability questions in the Netherlands (author's transl)]. / Applications aux Pays-Bas des questions de l'O.C.D.E. relatives à l'incapacité.

In the Netherlands a research survey consisting of two main versions (self-administered and interview) was carried out in March'79, covering among other subjects the complete set of OECD items. A short description of the purposes, the survey design, the sampling method and the fieldwork is given in the paper. The sampling method and sample size only permit rather restricted comparisons between both versions and proxy and non-proxy respondents. Difficulties and alterations in the translation into dutch are mentioned. An outline is given of preliminary results, and a comparison is made with long-term disability indicators from other dutch surveys. The research survey appears to be of limited value for generalising to the whole population.