The method of maximum likelihood is used to estimate parameterized transition probabilities of a non-homogeneous Markov chain model of movements between the health states disability-free, disabled, and death. A complication is that individuals are observed at irregular intervals, implying that particular attention must be paid to computational issues. Numerical results including estimated health expectancies and their standard errors are given for data from the Longitudinal Study on Aging (LSOA) of 1984-86-88-90 (Kovar et al. 1992). The weak ergodicity of prevalence on the non-absorbing states is established and supports the hypothesis of the compression of morbidity.

Although those with higher education have lower rates of both cognitive impairment and mortality, those who do become cognitively impaired appear to be in poorer health, leading to a reduced probability of improved cognition and increased probability of mortality relative to those with lower educational levels.

In countries with low mortality rates, the quality of the years of life is more important to consider than total life expectancy (TLE). Disability-free life expectancy (DFLE) is one of the most relevant indicators of health and the quality of life. This paper aims to estimate TLE and DFLE with four levels of severity of disability and to explore gender and educational differences in older French people. In this cohort study, four levels of disability severity were distinguished, disability being evaluated for mobility, instrumental and basic activities of daily living. For each level, TLE and DFLE were calculated using multi-state models from transition probabilities. From the population of two areas of South West France 3,777 subjects were randomly selected from the electoral rolls. At the baseline, they were aged 65 years and over, living in the community and were interviewed 6 times over the 10-year follow-up. At age 65, women lived longer than men (4.5 extra years), but shorter fully independent lives (-2.2 years). They also lived longer in each of the three degrees of disability (+4.2 years with moderate or severe disability). The higher educated lived longer (1.3 extra years at age 65), with the additional years free of disability. Regardless of age, gender and education, there appeared to be a 1-year incompressible time spent with severe disability. To conclude, these are the first health expectancies based on the longitudinal data for France. Whilst most of the studies were based on cross-sectional data, this paper gives a more realistic indicator of the health and socio-economic inequalities in France in the 1990 s.

Cette étude s’attache à mieux décrire et à comprendre le processus qui conduit les plus âgés à la perte d’autonomie et à l’entrée en dépendance. Basée sur les données de l’enquête «Handicaps, incapacités, dépendance», cette étude utilise différents indicateurs d’incapacité pour identifier plusieurs étapes de processus, pour estimer les risques de passer de l’une à l’autre et pour montrer le rôle de facteurs socio-démographiques qui sont susceptibles de modifier ces risques. La dépendance est mesurée par la déclaration de difficultés pour réaliser seul les activités de soin personnel; on identifie ensuite les situations de simples limitations fonctionnelles sans dépendance (problèmes de locomotion, de vue, d’orientation); on mesure enfin la bonne santé fonctionnelle par l’absence de limitations fonctionnelles et de difficultés dans les activité de soins personnels. On observe effectivement un processus sur deux ans allant de la bonne santé aux simples limitations fonctionnelles puis des limitations fonctionnelles à la dépendance. Peu de personnes passent directement de la bonne santé fonctionnelle à la dépendance en deux ans et, par ailleurs, une partie non négligeable des personnes interrogées sont parvenues en deux ans à retrouver une certaine autonomie pour les soins personnels, voire une meilleure santé fonctionnelle. Enfin on montre des disparités dans les risques de dégradation fonctionnelle ou dans les chances de récupération selon l’âge, le sexe et le niveau d’instruction.