Vienna Institute of Demography, Austrian Academy of Sciences, Vienna, Austria.
Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), Vienna, Austria.
Popul Health Metr. 2020 Aug 31;18(1):21. doi: 10.1186/s12963-020-00220-5.
Healthy life years have superseded life expectancy (LE) as the most important indicator for population health. The most common approach to separate the total number of life years into those spent in good and poor health is the Sullivan method which incorporates the health dimension to the classic period life table, thus transforming the LE indicator into the health expectancy (HE) indicator. However, life years derived from a period life table and health prevalence derived from survey data are based on different conceptual frameworks.
We modify the Sullivan method by combining the health prevalence data with the conceptually better fitting cross-sectional average length of life (CAL). We refer to this alternative HE indicator as the "cross-sectional average length of healthy life" (HCAL). We compare results from this alternative indicator with the conventional Sullivan approach for nine European countries. The analyses are based on EU-SILC data in three empirical applications, including the absolute and relative level of healthy life years, changes between 2008 and 2014, and the extent of the gender gap.
HCAL and conventional HE differ in each of these empirical applications. In general, HCAL provides larger gains in healthy life years in recent years, but at the same time greater declines in the proportion of healthy life years. Regarding the gender gap, HCAL provides a more favourable picture for women compared to conventional HE. Nonetheless, the extent of these differences between the indicators is only of minor extent.
Albeit the differences between HE and HCAL are small, we found some empirical examples in which the two indicators led to different conclusions. It is important to note, however, that the measurement of health and the data quality are much more important for the healthy life years indicator than the choice of the variant of the Sullivan method. Nonetheless, we suggest to use HCAL in addition to HE whenever possible because it widens the spectrum of empirical analyses and serves for verification of results based on the highly sensitive HE indicator.
健康寿命年已取代预期寿命（LE）成为衡量人口健康的最重要指标。将总寿命年数分为健康和不健康两部分的最常用方法是沙利文方法，该方法将健康维度纳入经典时期生命表，从而将 LE 指标转化为健康期望寿命（HE）指标。然而，基于时期生命表得出的寿命年数和基于调查数据得出的健康流行率是基于不同的概念框架。
我们通过将健康流行率数据与概念上更合适的横截面上的平均寿命（CAL）相结合，对沙利文方法进行了修改。我们将这个替代的 HE 指标称为“横截面上的健康平均寿命”（HCAL）。我们将这一替代指标的结果与九个欧洲国家的传统沙利文方法进行了比较。这些分析基于欧盟调查数据中的三个实证应用，包括健康寿命年的绝对和相对水平、2008 年至 2014 年期间的变化以及性别差距的程度。
HCAL 和传统 HE 在这些实证应用中都存在差异。一般来说，HCAL 在近几年提供了更大的健康寿命年增长，但同时也导致了健康寿命年比例的下降。关于性别差距，HCAL 为女性提供了比传统 HE 更有利的画面。尽管如此，这两个指标之间的差异程度仅为次要程度。
尽管 HE 和 HCAL 之间存在差异，但我们发现了一些实证案例，其中这两个指标导致了不同的结论。然而，需要注意的是，与健康寿命年指标相比，健康的衡量和数据质量对 HE 指标更为重要。尽管如此，我们建议尽可能使用 HCAL 代替 HE，因为它拓宽了实证分析的范围，并验证了基于高度敏感的 HE 指标的结果。
