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  • Title: Health expectancy calculations: a novel approach to studying population health in Bulgaria.
    Author: Mutafova M, van de Water HP, Perenboom RJ, Boshuizen HC, Maleshkov C.
    Journal: Bull World Health Organ; 1997; 75(2):147-53. PubMed ID: 9185367.
    Abstract:
    The measurement of life expectancy in terms of either good or poor health is a novel approach to studying the health of the population in Bulgaria. The pilot study reported here-carried out among people aged > or = 60 years in a middle-sized Bulgarian town-was designed to obtain information on the years of functional restrictions expected among the elderly. In accordance with the answers to a series of questions (recommended by WHO), subjects were categorized as disabled, handicapped, or having different states of perceived health. The indicators "disability-free life expectancy", "handicap-free life expectancy" and "healthy life expectancy" (based on self-perceived health) were calculated according to Sullivan's method. The results show, for example, that 8.0 of the 16.0 years that men aged 60 years may expect to live, on average, will be free of disability. For men aged 80 years the figures are 1.3 of 5.5 years. For women at 60 years and 80 years the results are 7.3 and 0.5 disability-free years of 19.2 and 7.3 expected life years, respectively. Similar results were found for handicap-free life expectancies and healthy life expectancies. At all ages, the proportion of life in a condition free of disability, free of handicap, or in perceived good health is substantially lower for women than for men. Women may expect to live longer, but a greater proportion of their life will be spent in poor health. The approach presented here for measuring the health status of the elderly may be helpful as an aid to planning medical and social care and for the development of public health policies. The first pilot health interview survey in Bulgaria, conducted among 1390 men and women 60 years of age and over residing in the middle-sized town of Svishtov, yielded life expectancy estimates generally comparable to those in other countries. On the basis of questions developed by the World Health Organization, study subjects were categorized as disabled, handicapped, or having different states of perceived health (good, fair, poor). Life expectancy indicators were calculated according to Sullivan's method. The results indicated that, although women have a longer life expectancy than men, they experience fewer years of good health. For example, 8 of the additional 16 years that men age 60 years may expect to live will be free of disability. For men 80 years old, 1.3 of the 5.5 remaining years will be disability-free. In contrast, only 7.3 of the additional 19.2 years a 60-year-old woman can expect to live will be free of disability. For women 80 years old, 0.5 of 7.3 expected life years will be disability-free. At all ages, the proportion of life in perceived good health is substantially lower for women than men. For both men and women, the number of years with handicap is less than that with disability. Broader application of this approach to measurement of the health status of the elderly is recommended in Bulgaria to facilitate medical and social care planning and health policy development.
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