The socioeconomic distribution of life expectancy and healthy life expectancy in Chile.
Chile
Gender equity
Health equity
Healthy life expectancy
Socioeconomic disparities in health
Journal
International journal for equity in health
ISSN: 1475-9276
Titre abrégé: Int J Equity Health
Pays: England
ID NLM: 101147692
Informations de publication
Date de publication:
22 08 2023
22 08 2023
Historique:
received:
02
05
2022
accepted:
21
07
2023
medline:
24
8
2023
pubmed:
23
8
2023
entrez:
23
8
2023
Statut:
epublish
Résumé
Life expectancy (LE) has usually been used as a metric to monitor population health. In the last few years, metrics such as Quality-Adjusted-Life-Expectancy (QALE) and Health-Adjusted-Life- Expectancy (HALE) have gained popularity in health research, given their capacity to capture health related quality of life, providing a more comprehensive approach to the health concept. We aimed to estimate the distribution of the LE, QALEs and HALEs across Socioeconomic Status in the Chilean population. Based on life tables constructed using Chiang II´s method, we estimated the LE of the population in Chile by age strata. Probabilities of dying were estimated from mortality data obtained from national registries. Then, life tables were stratified into five socioeconomic quintiles, based on age-adjusted years of education (pre-school, early years to year 1, primary level, secondary level, technical or university). Quality weights (utilities) were estimated for age strata and SES, using the National Health Survey (ENS 2017). Utilities were calculated using the EQ-5D data of the ENS 2017 and the validated value set for Chile. We applied Sullivan´s method to adjust years lived and convert them into QALEs and HALEs. LE at birth for Chile was estimated in 80.4 years, which is consistent with demographic national data. QALE and HALE at birth were 69.8 and 62.4 respectively. Men are expected to live 6.1% less than women. However, this trend is reversed when looking at QALEs and HALEs, indicating the concentration of higher morbidity in women compared to men. The distribution of all these metrics across SES showed a clear gradient in favour of a better-off population-based on education quintiles. The absolute and relative gaps between the lowest and highest quintile were 15.24 years and 1.21 for LE; 18.57 HALYs and 1.38 for HALEs; and 21.92 QALYs and 1.41 for QALEs. More pronounced gradients and higher gaps were observed at younger age intervals. The distribution of LE, QALE and HALEs in Chile shows a clear gradient favouring better-off populations that decreases over people´s lives. Differences in LE favouring women contrast with differences in HALEs and QALEs which favour men, suggesting the need of implementing gender-focused policies to address the case-mix complexity. The magnitude of inequalities is greater than in other high-income countries and can be explained by structural social inequalities and inequalities in access to healthcare.
Sections du résumé
BACKGROUND
Life expectancy (LE) has usually been used as a metric to monitor population health. In the last few years, metrics such as Quality-Adjusted-Life-Expectancy (QALE) and Health-Adjusted-Life- Expectancy (HALE) have gained popularity in health research, given their capacity to capture health related quality of life, providing a more comprehensive approach to the health concept. We aimed to estimate the distribution of the LE, QALEs and HALEs across Socioeconomic Status in the Chilean population.
METHODS
Based on life tables constructed using Chiang II´s method, we estimated the LE of the population in Chile by age strata. Probabilities of dying were estimated from mortality data obtained from national registries. Then, life tables were stratified into five socioeconomic quintiles, based on age-adjusted years of education (pre-school, early years to year 1, primary level, secondary level, technical or university). Quality weights (utilities) were estimated for age strata and SES, using the National Health Survey (ENS 2017). Utilities were calculated using the EQ-5D data of the ENS 2017 and the validated value set for Chile. We applied Sullivan´s method to adjust years lived and convert them into QALEs and HALEs.
RESULTS
LE at birth for Chile was estimated in 80.4 years, which is consistent with demographic national data. QALE and HALE at birth were 69.8 and 62.4 respectively. Men are expected to live 6.1% less than women. However, this trend is reversed when looking at QALEs and HALEs, indicating the concentration of higher morbidity in women compared to men. The distribution of all these metrics across SES showed a clear gradient in favour of a better-off population-based on education quintiles. The absolute and relative gaps between the lowest and highest quintile were 15.24 years and 1.21 for LE; 18.57 HALYs and 1.38 for HALEs; and 21.92 QALYs and 1.41 for QALEs. More pronounced gradients and higher gaps were observed at younger age intervals.
CONCLUSION
The distribution of LE, QALE and HALEs in Chile shows a clear gradient favouring better-off populations that decreases over people´s lives. Differences in LE favouring women contrast with differences in HALEs and QALEs which favour men, suggesting the need of implementing gender-focused policies to address the case-mix complexity. The magnitude of inequalities is greater than in other high-income countries and can be explained by structural social inequalities and inequalities in access to healthcare.
Identifiants
pubmed: 37608366
doi: 10.1186/s12939-023-01972-w
pii: 10.1186/s12939-023-01972-w
pmc: PMC10463281
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
160Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
Soc Sci Med. 1993 Feb;36(4):409-18
pubmed: 8434266
Lancet. 2008 Dec 20;372(9656):2124-31
pubmed: 19010526
Health Policy Plan. 2018 Apr 1;33(3):456-463
pubmed: 29309581
Popul Health Metr. 2022 Jan 4;20(1):1
pubmed: 34983576
Health Qual Life Outcomes. 2020 Feb 27;18(1):45
pubmed: 32103763
BMC Geriatr. 2021 Mar 11;21(1):176
pubmed: 33706709
Salud Publica Mex. 2011;53 Suppl 2:s132-43
pubmed: 21877079
Public Health. 2003 Nov;117(6):424-9
pubmed: 14522158
J Epidemiol Community Health. 1998 Mar;52(3):153-60
pubmed: 9616419
Popul Health Metr. 2003 Apr 14;1(1):6
pubmed: 12773210
J Epidemiol Community Health. 2000 Jun;54(6):451-5
pubmed: 10818121
JAMA. 2016 Apr 26;315(16):1750-66
pubmed: 27063997
Gerontologist. 2015 Dec;55(6):901-11
pubmed: 26561272
Rev Med Chil. 2004 Apr;132(4):453-60
pubmed: 15382517
Qual Life Res. 2012 Jun;21(5):813-25
pubmed: 21842378
Value Health. 2015 Jul;18(5):655-62
pubmed: 26297094
Annu Rev Public Health. 2002;23:115-34
pubmed: 11910057
Salud Publica Mex. 2002 Jan-Feb;44(1):60-8
pubmed: 11910721
Public Health Rep. 1994 Sep-Oct;109(5):665-72
pubmed: 7938388
Health Econ. 2015 Jun;24(6):742-54
pubmed: 24798212
BMJ. 2019 Mar 27;364:l969
pubmed: 30917970
Value Health. 2011 Dec;14(8):1135-41
pubmed: 22152184
Qual Life Res. 2016 May;25(5):1159-68
pubmed: 26506992
Health Technol Assess. 1999;3(10):1-152
pubmed: 10627631
Crisis. 2015;36(4):281-90
pubmed: 26440625
Demography. 2018 Dec;55(6):2045-2070
pubmed: 30324395
Gerontology. 2023;69(2):149-162
pubmed: 35390788
J Prev Med Public Health. 2022 Jan;55(1):1-9
pubmed: 35135043
PLoS One. 2015 Sep 29;10(9):e0138227
pubmed: 26418354
Int J Equity Health. 2012 Dec 18;11:81
pubmed: 23249481
PLoS One. 2016 Jan 12;11(1):e0146047
pubmed: 26756869
Health Sci Rep. 2023 Jul 04;6(7):e1197
pubmed: 37415675
Eur J Public Health. 2015 Dec;25(6):978-83
pubmed: 25876883
Science. 2002 May 10;296(5570):1029-31
pubmed: 12004104
Rev Med Chil. 2011 May;139(5):685-7
pubmed: 22051725
PLoS One. 2022 Jan 24;17(1):e0263008
pubmed: 35073367
Int J Environ Res Public Health. 2021 Mar 27;18(7):
pubmed: 33801588
Am J Public Health. 1994 Jun;84(6):932-7
pubmed: 8203689
SSM Popul Health. 2021 Nov 04;16:100954
pubmed: 34805476
Value Health. 2013 Jun;16(4):599-603
pubmed: 23796294
J Public Health Res. 2012 Dec 28;1(3):222-8
pubmed: 25170468
BMJ. 2018 Aug 15;362:k2562
pubmed: 30111634
Clin Ther. 2001 Jan;23(1):168-75
pubmed: 11219476
Rev Med Chil. 2021 Jul;149(7):1047-1057
pubmed: 34751307
Bull World Health Organ. 2000;78(6):717-31
pubmed: 10916909
Rev Panam Salud Publica. 2011 Jun;29(6):457-68
pubmed: 21829971