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Using linked data to calculate summary measures of population health: Health-adjusted life expectancy of people with Diabetes Mellitus.

ABSTRACT: OBJECTIVES: To estimate the health-adjusted life expectancy (HALE) from diabetes mellitus (DM) using a population health survey linked to a population-based DM registry. METHODS: The 1996/97 Ontario Health Survey (N = 35,517) was linked to the Ontario Diabetes Database (N = 487,576). The Health Utilities Index (HUI3) was used to estimate health-related quality of life. HALE was estimated using an adapted Sullivan method. RESULTS: Life expectancy at birth of people with DM was 64.7 and 70.7 years for men and women - 12.8 and 12.2 years less than for men and women without DM. The HUI3 was lower for physician-diagnosed DM compared to self-reported DM (0.799 versus 0.872). HALE at birth was 58.3 and 62.8 years for men and women - 11.9 and 10.7 years less than that of men and women without DM. CONCLUSIONS: The linked data approach demonstrates that DM is an important cause of disease burden. This approach reduces assumptions when estimating the prevalence and severity of disability from DM compared to methods that rely on self-reported disease status or indirect assessment of disability severity.

SUBMITTER: Manuel DG

PROVIDER: S-EPMC406424 | biostudies-literature | 2004 Mar

REPOSITORIES: biostudies-literature

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Using linked data to calculate summary measures of population health: Health-adjusted life expectancy of people with Diabetes Mellitus.

Manuel Douglas G DG Schultz Susan E SE

Population health metrics 20040323 1

OBJECTIVES: To estimate the health-adjusted life expectancy (HALE) from diabetes mellitus (DM) using a population health survey linked to a population-based DM registry. METHODS: The 1996/97 Ontario Health Survey (N = 35,517) was linked to the Ontario Diabetes Database (N = 487,576). The Health Utilities Index (HUI3) was used to estimate health-related quality of life. HALE was estimated using an adapted Sullivan method. RESULTS: Life expectancy at birth of people with DM was 64.7 and 70.7 years ...[more]

PMID: 15038828

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Project description:BackgroundLife expectancy is increasingly incorporated in evidence-based screening and treatment guidelines to facilitate patient-centered clinical decision-making. However, life expectancy estimates from standard life tables do not account for health status, an important prognostic factor for premature death. This study aims to address this research gap and develop life tables incorporating the health status of adults in the United States.MethodsData from the National Health Interview Survey (1986-2004) linked to mortality follow-up through to 2006 (age ≥ 40, n = 729,531) were used to develop life tables. The impact of self-rated health (excellent, very good, good, fair, poor) on survival was quantified in 5-year age groups, incorporating complex survey design and weights. Life expectancies were estimated by extrapolating the modeled survival probabilities.ResultsLife expectancies incorporating health status differed substantially from standard US life tables and by health status. Poor self-rated health more significantly affected the survival of younger compared to older individuals, resulting in substantial decreases in life expectancy. At age 40 years, hazards of dying for white men who reported poor vs. excellent health was 8.5 (95% CI: 7.0,10.3) times greater, resulting in a 23-year difference in life expectancy (poor vs. excellent: 22 vs. 45), while at age 80 years, the hazards ratio was 2.4 (95% CI: 2.1, 2.8) and life expectancy difference was 5 years (5 vs. 10). Relative to the US general population, life expectancies of adults (age < 65) with poor health were approximately 5-15 years shorter.ConclusionsConsiderable shortage in life expectancy due to poor self-rated health existed. The life table developed can be helpful by including a patient perspective on their health and be used in conjunction with other predictive models in clinical decision making, particularly for younger adults in poor health, for whom life tables including comorbid conditions are limited.

Project description:BackgroundWhile many studies have examined differences between body mass index (BMI) categories in terms of mortality risk and health-related quality of life (HRQL), little is known about the effect of body weight on health expectancy. We examined life expectancy (LE), health-adjusted life expectancy (HALE), and proportion of LE spent in nonoptimal (or poor) health by BMI category for the Canadian adult population (age ? 20).MethodsRespondents to the National Population Health Survey (NPHS) were followed for mortality outcomes from 1994 to 2009. Our study population at baseline (n=12,478) was 20 to 100 years old with an average age of 47. LE was produced by building abridged life tables by sex and BMI category using data from the NPHS and the Canadian Chronic Disease Surveillance System. HALE was estimated using the Health Utilities Index from the Canadian Community Health Survey as a measure of HRQL. The contribution of HRQL to loss of healthy life years for each BMI category was also assessed using two methods: by calculating differences between LE and HALE proportional to LE and by using a decomposition technique to separate out mortality and HRQL contributions to loss of HALE.ResultsAt age 20, for both sexes, LE is significantly lower in the underweight and obesity class 2+ categories, but significantly higher in the overweight category when compared to normal weight (obesity class 1 was nonsignificant). HALE at age 20 follows these same associations and is significantly lower for class 1 obesity in women. Proportion of life spent in nonoptimal health and decomposition of HALE demonstrate progressively higher losses of healthy life associated with lowered HRQL for BMI categories in excess of normal weight.ConclusionsAlthough being in the overweight category for adults may be associated with a gain in life expectancy as compared to normal weight adults, overweight individuals also experience a higher proportion of these years of life in poorer health. Due to the descriptive nature of this study, further research is needed to explore the causal mechanisms which explain these results, including the important differences we observed between sexes and within obesity subcategories.

Project description:BackgroundSmoking and obesity are risk factors causing a large burden of disease. To help formulate and prioritize among smoking and obesity prevention activities, estimations of health-adjusted life expectancy (HALE) for cohorts that differ solely in their lifestyle (e.g. smoking vs. non smoking) can provide valuable information. Furthermore, in combination with estimates of life expectancy (LE), it can be tested whether prevention of obesity and smoking results in compression of morbidity.MethodsUsing a dynamic population model that calculates the incidence of chronic disease conditional on epidemiological risk factors, we estimated LE and HALE at age 20 for a cohort of smokers with a normal weight (BMI < 25), a cohort of non-smoking obese people (BMI>30) and a cohort of 'healthy living' people (i.e. non smoking with a BMI < 25). Health state valuations for the different cohorts were calculated using the estimated disease prevalence rates in combination with data from the Dutch Burden of Disease study. Health state valuations are multiplied with life years to estimate HALE. Absolute compression of morbidity is defined as a reduction in unhealthy life expectancy (LE-HALE) and relative compression as a reduction in the proportion of life lived in good health (LE-HALE)/LE.ResultsEstimates of HALE are highest for a 'healthy living' cohort (54.8 years for men and 55.4 years for women at age 20). Differences in HALE compared to 'healthy living' men at age 20 are 7.8 and 4.6 for respectively smoking and obese men. Differences in HALE compared to 'healthy living' women at age 20 are 6.0 and 4.5 for respectively smoking and obese women. Unhealthy life expectancy is about equal for all cohorts, meaning that successful prevention would not result in absolute compression of morbidity. Sensitivity analyses demonstrate that although estimates of LE and HALE are sensitive to changes in disease epidemiology, differences in LE and HALE between the different cohorts are fairly robust. In most cases, elimination of smoking or obesity does not result in absolute compression of morbidity but slightly increases the part of life lived in good health.ConclusionDifferences in HALE between smoking, obese and 'healthy living' cohorts are substantial and similar to differences in LE. However, our results do not indicate that substantial compression of morbidity is to be expected as a result of successful smoking or obesity prevention.

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Using linked data to calculate summary measures of population health: Health-adjusted life expectancy of people with Diabetes Mellitus.

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Using linked data to calculate summary measures of population health: Health-adjusted life expectancy of people with Diabetes Mellitus.

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