Disability-free life expectancy of older French people: gender and education differentials from the PAQUID cohort

Abstract

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.

Occupational inequalities in health expectancies in France in the early 2000s: Unequal chances of reaching and living retirement in good health

“…More recent studies confirm this finding (Majer et al 2010;Bronnum-Hansen et al 2004;Bronnum-Hansen and Baadsgaard 2008;Matthews, Jagger, and Hancock 2006;Matthews et al 2009;Minicuci and Noale 2005;Pérès et al 2005;Van Oyen et al 2005;Lievre, Alley, and Crimmins 2008;Bossuyt et al 2004). Although these studies have already illustrated the unequal share of life between years in good and poor health, they are often of limited utility in the debate concerning the prolongation of working life.…”

“…LE 50 with ADL restrictions reflects periods over which care and assistance are required: it is around three years for manual workers and two years for the highly qualified occupations. A study of a French elderly cohort (PAQUID) measured educational differentials in HE and concluded that there is probably an incompressible minimum period of time at the end of life to be lived with severe disability such as ADL restrictions, whatever the social status (Pérès et al 2005). Small absolute differentials in LE 50 with ADL restrictions mean large differentials in LE 50 without ADL restrictions: almost six years for men and three and a half years for women.…”

Gender gaps in life expectancy and expected years with activity limitations at age 50 in the European Union: associations with macro-level structural indicators

“…However, few go beyond the mere description and explore the role of determinants on the gender difference (Bélanger et al 2005;Crimmins et al 2002;Pérès et al 2005). The aim of this article is to describe the pattern of the gender difference in life expectancy, the life expectancy with and without activity limitations at age 50 across 25 EU countries and to explore the association with macro-level factors that may explain any diversity in gender difference in life expectancy with activity limitations between countries.…”

Social participation and independence in activities of daily living: a cross sectional study

“…However, it is not clear whether the years gained are years in good health or years lived with disability and in need of help [ 1 ]. In this light, the quality of the extra years of life is more important than overall life expectancy [ 2 ]. Indeed, 'adding life to the years' has become a key concept of 'successful ageing' [ 3 ], itself a prominent theme in contemporary applied gerontology [ 4 ].…”