Barendregt J J, Bonneux L, Van der Maas P J
Department of Public Health, Erasmus University, Rotterdam, The Netherlands.
J Epidemiol Community Health. 1994 Oct;48(5):482-7. doi: 10.1136/jech.48.5.482.
Health expectancy is an increasingly used indicator of population health status. It collapses both mortality and morbidity into a single indicator, and is therefore preferred to the total life expectancy index for populations with low mortality but high morbidity rates. Three methods of calculation exist: the Sullivan, double decrement, and multi-state methods. This report aims to describe their relative advantages and limitations when used to monitor changes in population health status over time.
The differences between the three methods are explained. Using a dynamic model of heart disease, the effect of the introduction of thrombolytic treatment on the survival of patients with acute myocardial infarction is calculated. The resulting changes in health expectancy are calculated according to the Sullivan and multi-state methods.
As opposed to the double decrement and the multi-state methods, the Sullivan method produces spurious trends in health expectancy in response to the change in survival.
Estimates of health expectancy in a dynamic situation can be very misleading when based on the Sullivan method, with its attractively moderate data requirements. The multi-state method, which requires longitudinal studies of population health status, is often indispensable.
健康期望寿命是一种越来越多地用于衡量人群健康状况的指标。它将死亡率和发病率合并为一个单一指标，因此对于死亡率低但发病率高的人群而言，它比总预期寿命指数更受青睐。存在三种计算方法：沙利文法、双重递减法和多状态法。本报告旨在描述这三种方法在用于监测人群健康状况随时间的变化时各自的相对优势和局限性。
解释了这三种方法之间的差异。使用心脏病动态模型，计算了引入溶栓治疗对急性心肌梗死患者生存率的影响。根据沙利文法和多状态法计算了由此导致的健康期望寿命的变化。
与双重递减法和多状态法不同，沙利文法在应对生存率变化时会在健康期望寿命方面产生虚假趋势。
在动态情况下，基于沙利文法估算健康期望寿命可能会产生很大误导，尽管该方法的数据要求适中且颇具吸引力。多状态法需要对人群健康状况进行纵向研究，通常是不可或缺的。
