Assessing an indicator of Healthy Working Life Expectancy or France using a longitudinal survey
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1 Assessing an indicator of Healthy Working Life Expectancy or France using a longitudinal survey Barnay Thomas (IRDES), Brieu Marie-Anne (ILC-France), Brouard Nicolas (INED), Forette Françoise (ILC-France), Jusot Florence (IRDES), Lièvre Agnès (IRDES), Robine Jean- Marie (INSERM), Sermet Catherine (IRDES)
2 First step eliminary work on French data from Survey on Health are and Health Insurance (IRDES) The Project Previous study eview and assess the existing surveys and data on health d employment in 10 European countries in order to get mparable sources of data esults : Only a few comparable indicators (self-reported alth, employment status, ) New study alculation of a Healthy Working Life Expectancy in ropean countries from European Houselhold Panel.
3 Healthy Working Life Expectancy 4 States: combining working and health dimensions - Employment state : working vs non working - Health status : healthy vs unhealthy Total Life Expectancy = LE healthy & working + LE healthy & non working + LE unhealthy & working + LE unhealthy & non working Calculation with IMaCh software 0.98 (Brouard, Lièvre)
4 Context Ageing population - The populations of industrialised countries, and European countries in particular, are getting older - Causes an imbalance between generations A new Life Cycle - In order to ensure the equilibrium of the Pay-As-You-Go retirement system, European countries have essentially increased retirement age or contribution period - Pathways during activity life and from working life to retirement is changing (unemployment, disability, ).
5 Links between health status and labour force participation Links between health status and labour force participatio ear obvious but causal relations are ambiguous (Strauss Thomas, 1998) ard working conditions may have a negative effect on people s health us towards the end of working life (Volkoff and al., 2000) oor health may result in early departure from the labour market (Currie Madrian, 1999) Health Working Life Expectancy indicator can allow to lyse states pathways due to changing in labour market ucture and health status deterioration with age.
6 Employment rate of in Europe in 2003 (OECD, 2004) Target of Stockholm conference in 2010: Employment rate for = LUX AUS ITA BEL GER FRA SPA GRE NET IRL FIN POR UK DEN SWE EU 15
7 ource: WHO/Europe, European HFA Database, January 2006 Disability-Adjusted Life Expectancy in 2002 <= 74 years <= 70 years <= 66 years <= 62 years <= 58 years No data
8 Health Care and Health Insurance Survey Coordination : IRDES and the statistics department of the Nationa Health Insurance Fund for Salaried Workers (CNAMTS) Focus : Reported diseases and disorders; public coverage and privat supplementary health insurance; recourse to a physician; consumption of medical goods and services; care and services administered by nonphysician clinicians, and hospitalization. Sampling base : Households including at least one beneficiary of one of the main national health insurance funds (for salaried workers, farmers, or the self-employed) and who live in France.
9 Problem of mortality Health Care and Health Insurance Survey (ESPS) Other caracteristics: periodicity, coverage and size 4 waves : , , and More than 95 of French households households ( persons) Limits Institutionalized and homeless groups are not included in the urvey. Thus, the most sick persons are subrepresented. High Attrition rate (50 between each wave) No distinction between dead and lost individuals
10 Health Care and Health Insurance Survey (ESPS) Available Health measures ew survey (2004) contains standardised indicators (self-perceived health, imiting longstanding illness, ) but these aren t included in previous urveys, that s necessary to have an available measure for all waves Disability index laborated by physicians who give a note (8 degrees) according to health odule s answers of respondent. Vital risk laborated by physicians and is based on seriousness in long term of the iseases declared by the respondent (6 degrees of seriousness) Activity Daily Living
11 Defining health states in ESPS Minimal disability index associated with the most serious disease [coded by physicians group] Healthy Unhealthy 0 : no difficulty 1 : very small level of difficulty 2 : small level of difficulty 3 : experiences difficulties but lives normally 4 : must diminish his/her domestic or professional activity 5 : diminished activity 6 : no domestic autonomy 7 : confined to bed
12 Defining work states in ESPS Working Nonworking - full and part-time workers - persons temporarily not at work because of illness or injury - retired - widowed benefiting from a survivor pension - unemployed - homemaker - disabled - student
13 Defining vital status in ESPS (1) To take into account the vital status (dead or alive), we use vital risk. 6 levels of vital risk: 0 : level zero of vital risk 1 : very low negative prognoses 2 : low negative prognoses 3 : possible risk 4 : probably negative prognoses (50 of death at 10 years) 5 : surely negative prognoses (death at 5 years)
14 Defining vital status in ESPS (2) We defined a vital status by considering 2 conditions: Mortality could be different according to the initial state. The total mortality rate by age and sex must match the national estimates We assume that a person is considered as dead if the vital risk is probably negative diagnosis or surely negative diagnosis
15 Transitions across work-health states Time 1 Time 2 Healthy & working Unhealthy & working Healthy & non-working Unhealthy & non-working Total : 4 x 5 = 20 transitions Healthy & working Unhealthy & working Healthy & non-working Unhealthy & non-working Death
16 Prevalence in each state healthy / working healthy / non-working unhealthy / working unhealthy / non-working ealth status = Disabling diseases index
17 ealth and Working Life Expectancie Men 25 Women 20 Years Age Age
18 Proportion of LE in each state Men Years Women Healthy /working Healthy / non-working Unhealthy / working Unhealthy / non-working Age
19 Small proportion of unhealthy-working people : confirm the assumption of causality between poor health and exit from the labour market? Main results The prevalence of working people starts to decline from age 55, corresponding to preretirement system and unemployment for seniors in France (in addition, retirement age is 60) Men are expected to spend more time healthy and employed than women, for all ages Women are expected to live in a non-working state longer than men (31 years vs 21 years for men at age 30) and often healthy (non working women are 75 in healthy state vs 66 for men at age 30), this difference remains true with age.
20 Methodological discussion Health Indicator choice - Using different health indicators such as self-rated health and ADL to validate different proportions of LE Methodological issues - Lost to follow-up (attrition, death) - Community dwelling population - Age range : only 30-70?
21 Hommes Femmes 1, , , , , , , ,00010 SPS sans poids Etat civil 1995 SPS avec poids , ,00010 SPS sans poids Etat civil 1995 SPS avec poids
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