The impact of population's educational composition on Healthy Life Years: An empirical illustration of 16 European countries

Abstract

Healthy Life Years (HLY) is a prominent summary indicator for evaluating and comparing the levels of population health status across Europe. Variations in HLY, however, do not necessarily reflect underlying differences in health and mortality levels among countries and the indicator is particularly sensitive when broken down by subpopulations. For instance, despite European countries showing large HLY inequalities by educational level, these countries are also heterogenous regarding their population composition by educational attainment, which most likely affects their HLY levels. We demonstrate how this compositional effect shapes HLY levels by providing estimates for HLY by educational attainment and gender for 16 European countries using the Sullivan method. We use prevalence data about limitations in daily activities from the European Union Statistics on Income and Living Conditions (EU-SILC) and mortality data from the Eurostat database. Finally, we adjust for compositional effects by means of standardization. The education-adjusted HLY estimates do not differ much from conventional HLY. Yet, we find that in some countries HLY levels are indeed affected by the population composition by educational attainment. For example, low-, medium-, and high educated individuals in Portugal show more HLY than their counterparts in Poland. Still, Poland's total HLY value slightly exceeds that of Portugal, indicating favorable health and mortality conditions in Poland. It is Poland's lower relative number of low educated individuals in its population that is responsible for producing this higher total HLY value. We conclude that differentials in HLY due to differences in the relative size of educational subpopulations are generally small in HLY across Europe but they can play an important role for countries that experienced large differences in their educational expansion.

Assessment of the evolution of the educational attainment in economically active population in the regions of the Slovak Republic

“…Education is associated with more active participation in civic life, volunteering and charitable activities. Sauerberg (2021) found that some countries achieve higher levels of the Healthy Life Years (HLY) indicator as a result of higher educational attainment of the population in the countries given.…”

The impact of interpersonal reporting heterogeneity on cross-country differences in Healthy Life Years in Europe

“…First, there are different trends in mortality and morbidity across countries as well as across regions, 6 , 7 and second, past evidence has suggested that inequalities in socioeconomic development between EU member states translate into differentials in HLY. 4 , 6 , 8 Cross-country variations in HLY have therefore generated a substantial interest among policy makers, public health officials, and journalists. Of particular interest is the ranking of the countries by HLY.…”

The Sensitivity of the Healthy Life Years Indicator: Approaches for Dealing with Age-Specific Prevalence Data

“…It is the offi cial European Union indicator for developing strategies for national health plans and monitoring health policy targets such as the 2000 Lisbon Strategy and the European Innovation Partnership on Active and Healthy Ageing to increase the average HLY of Europeans by two years by 2020 (Robine et al 2013;Bogaert et al 2018;Eurostat 2020). It has also been used to investigate important research questions, such as trends over time in the proportion of total life years spent in good or poor health (the "compression-expansion debate"), socioeconomic inequalities in health and mortality, compositional effects of education on health indicators across regions and the male-female health survival paradox (Murray et al 2002;Bocquet-Appel 2008;Ekholm/Brønnum-Hansen 2009;Nusselder et al 2010Nusselder et al , 2019Van Oyen et al 2013;Jagger et al 2013;Füssenich et al 2019;di Lego et al 2020;Welsh et al 2021;Sauerberg 2021).…”