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Life Expectancy and Quality of Life

Life expectancy is 84 for females and 79 for males. 78% of the population reports to be in good or very good health.

Life expectancy

1. Key messages

In 2017, the life expectancy at birth in Belgium was 81.4 years, and is evolving favorably (it was 77.8 in year 2000). Compared to the EU-15 countries, Belgium is however ranking quite poor.
A considerable gender gap is observed with life expectancy in women exceeding by almost 5 years the one of men (respectively 83.7 and 79.0 years) in 2017. This gap is decreasing over time.
Large regional disparities are observed in life expectancy at birth, that is higher in Flanders, intermediate in Brussels and lower in Wallonia (respectively 82.2, 81.2 and 79.8 years in 2017). The regional gap has slightly increased over the last 17 years.
The life expectancy reveals an important socio-economic gradient, with better life expectancy in higher than in low educated people.

2. Background

Life expectancy (LE) at a given age is the number of years a person of that age can expect to live, in average, based on current mortality conditions. Life expectancy at birth (also called longevity) is the most common life expectancy indicator. It is a good indicator of the current level of health in a population across all generations.

Life expectancy can be broken down by sex, region or several socio-economic variables, such as educational level. The life expectancy by educational level is calculated at ages 25 and over, as the educational attainment is mostly achieved at this age. In this report, we calculated the LE by educational level at ages 25, 50 and 65, using the census 2011 linked with the national register.

The educational level (EL) was measured using the International Standard Classification of Education (ISCED) categories, then grouped into 3 levels:

  • Low (categories 0, 1, 2)
  • Mid (categories 3, 4)
  • High (categories 5, 6)

3. Life expectancy

Belgium

In 2017, the life expectancy at birth in Belgium was 81.4 years. It increases continuously since decades, except in year 2015 where a slight decrease was observed; the increase from year 2000 (77.8 years) was 3.6 years.

In 2017, the LE was nearly 4.7 years higher for women (83.7 years) than for men (79.0 years). However, the LE increases faster in men than in women: during the period 2000-2017, the LE increased by 4.4 years in men and by 2.7 years in women, reducing the gender gap from 6.5 to 4.7 years.

Life expectancy at birth by sex, Belgium, 2000-2017
Source: Statbel, 2000-2017 [1]

Life expectancy and trends by region

In 2017, the life expectancy at birth was highest in Flanders (82.2 years), intermediate in Brussels (81.2) and lowest in Wallonia (79.8). During the 2000-2017 period, life expectancy increased in all regions and for both sexes, but the gap between Flanders and the other regions increased (the gap passed from 2 to 2.4 years for Wallonia, and from 0.6 to 1 year in Brussels).

Regional differences in life expectancy at birth are larger among men than among women. In men, the LE in Flanders was 3 years higher than in Wallonia and 1.6 years higher than in Brussels in 2017. In women, the LE in Flanders was 1.9 years higher than in Wallonia and 0.7 years higher than in Brussels.

  • Men
  • Women

Life expectancy at birth by region, men, 2000-2017
Source: Statbel, 2000-2017 [1]

Life expectancy at birth by region, women, 2000-2017
Source: Statbel, 2000-2017 [1]

Life expectancy by educational level

Life expectancy at any given age shows a socio-economic gradient, being highest at high educational level (EL), intermediate at intermediate and lowest at low EL. This socio-economic differential is more pronounced for men, with a 6.1 years' gap between the lowest and highest EL for the LE at 25, compared with a gap of 4.6 years in women. The following differentials are observed as well:

  • 4.4 years in men and 3.5 years in women for the life expectancy at age 50
  • 3 years in men and 2.6 years in women for the life expectancy at age 65
  • Men
  • Women

Life expectancy at age 25, 50 and 65, by educational level among men, Belgium, 2011
Source: Own calculation based on census 2011 linked data with 5 years’ mortality follow-up [2,3]

Life expectancy at age 25, 50 and 65, by educational level among women, Belgium, 2011
Source: Own calculation based on census 2011 linked data with 5 years’ mortality follow-up [2,3]

International comparison

Life expectancy at birth in Belgium is slightly lower than the EU-15 average, for both men and women: for men, Belgium has the fifth lowest life expectancy at birth among the EU-15 countries; for women, Belgium has the sixth lowest position. More important is that the gap between the LE observed in Belgium as compared with the countries with the highest one is substantial (-2 years in men when compared with Italy and -2.3 years in women when compared with Spain). At current rate of increase in LE, it would take 10 years for Belgium to catch up if the other countries stayed at the current level.

  • Men
  • Women

Life expectancy at birth among men, EU-15 countries, 2016 or nearest year
Source: OECD, Health Data, 2016 or nearest year [4]

Life expectancy at birth among women, EU-15 countries, 2016 or nearest year
Source: OECD, Health Data, 2016 or nearest year [4]

4. Read more

View the metadata for this indicator

SPMA: Standardized Procedures for Mortality Analysis in Belgium

Definitions

EU-15
The EU-15 corresponds to all countries that belonged to the European Union between 1995 and 2004: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden and the United Kingdom. We compare the Belgian health status to that of the EU-15 because these countries have similar socioeconomic conditions.
International Standard Classification of Education (ISCED)
ISCED is the reference international classification for organizing education programs and related qualifications by levels and fields. It contains categories from 0 to 6:
  • 0: Early childhood education (‘less than primary’)
  • 1: Primary education
  • 2: Lower secondary education
  • 3: Upper secondary education
  • 4: Post-secondary non-tertiary education
  • 5: Short-cycle tertiary education, Bachelor’s, Master’s
  • 6: Doctoral or equivalent level
Life expectancy at 25 by educational level
This computation is more complex than the simple life expectancy by sex or region, because life tables by educational level have to be built. This requires to merge different databases: the first one constitute the cohort of individuals (it can be the whole population or a sample), from which we know the individual educational level. This cohort is then linked with the mortality register. In this report, we used the census 2011 linked with the national register for a 5 year follow up of mortality.
Life expectancy at a given age
Life expectancy at a given age is the average number of years remaining to be lived by a person of that given age.
Life expectancy at birth
Life expectancy at birth is the average number of years a newborn can expect to live, if death rates of the reference are considered and do not change in the coming years.

References

  1. Statbel, 2000-2017. https://statbel.fgov.be/en/themes/population/life-expectancy-and-life-tables
  2. Mortality follow-up of census 2011 (dataset: National Mortality database 2011, which is a merge of the 2011 census, the National Register and the causes of death register, Statbel)
  3. Renard F, Devleesschauwer B, Van Oyen H, Gadeyne S, Deboosere P (2019) Evolution of educational inequalities in life and health expectancies at 25 years in Belgium between 2001 and 2011: a census-based study. Arch Public Health 77:6. doi: 10.1186/s13690-019-0330-8
  4. OECD, Health Data. https://stats.oecd.org/

Quality of life

1. Key messages

In 2013, 78% of the Belgian population reported their health to be good or very good. This proportion is slightly higher in men. In Flanders, more people report to be in good health than in Wallonia or Brussels. There is an important socio-economic gradient, with persons from the highest socio-economic level reporting better health than people from the lowest level. Belgium ranks favorably among the EU-15 countries for the level of self-rated health.
Quality of life, as measured by the Health-Related Quality of Life (HRQOL) score, appears to be higher for men than for women. Quality of life is strongly decreasing with age: when people get older, their HRQOL score declines, regardless of sex. People in Flanders seem to have a better HRQOL than people in Brussels or Wallonia. There is also an important socio-economic gradient: persons from the lowest socio-economic level have a lower HRQOL.

2. Background

Quality of life is a subjective perception of the individual about his life in his own context and value system, according to his goals and expectations. This perception can be influenced by several factors like physical and mental health but also by the social relationships for example [1]. We explore the quality of life here throughout two indicators, self-rated health and Health-Related Quality of Life score.

Self-rated health is defined as an individual’s appreciation of their own health status. Despite its subjective nature, self-rated health is a good predictor of people’s future morbidity, disability, healthcare use, and mortality. In this report, we describe the percentage of people rating their health as good or very good as reported in the Health Interview Surveys. International comparisons come from Eurostat and are derived from the EU-SILC surveys.

Health-Related Quality of Life (HRQOL) refers to the effects that the health status can have on quality of life. Different tools exist to measure HRQOL, we will focus here on the EuroQol 5 Dimensions questionnaire (EQ-5D) [2], as measured in the Health Interview survey.

3. Self-rated health

Belgium

The successive Health Interview Surveys from 1997 to 2008 showed a significant gender difference, with men rating their health better than women. In 2013, 79.6% of men and 76.4% of women declared to be in good or very good health, but this gender difference was no longer significant. As expected, the prevalence of good self-rated health decreases strongly with age: 93% of the people aged 15-24 rate their health as good or very good, compared to only 56% of people aged 75 and over.

Prevalence of (very) good self-rated health by age group and sex, Belgium, 2013
Source: Health Interview Survey, Sciensano, 2013 [3]

Trends and regional disparities

The evolution over time shows a slight but significant increase of people rating their health as (very) good in Belgium between 1997 (77.1%, age adjusted prevalence) and 2013 (80.4%). This evolution is sharper in Wallonia (from 71.5% in 1997 to 77.8% in 2013).

In all Health Interview Surveys, important regional disparities are observed with higher rates of good self-rated health in Flanders than in Wallonia or Brussels. In 2013, these regional disparities had reduced, but still existed: the age-adjusted prevalence of people perceiving their health as (very) good was higher in Flanders (82.3%) than in Wallonia (77.8%) or Brussels (76.2%). This reduction of the regional disparity was mainly due to a sharp increase of the women with a good self-rated health in Wallonia (from 67.1% in 1997 to 78% in 2013).

  • Men
  • Women

Prevalence of (very) good self-rated health among men, for regions and Belgium, 1997-2013
Source: Health Interview Survey, Sciensano, 1997-2013 [3]

Prevalence of (very) good self-rated health among women, for regions and Belgium, 1997-2013
Source: Health Interview Survey, Sciensano, 1997-2013 [3]

Disparities by educational level

Using education level as indicator of socio-economic level, an important socio-economic gradient is observed: after adjustment for age, only 61% of people with a low educational level rate their health positively, versus 86% of the people in the highest level.

Prevalence of (very) good self-rated health by level of education, Belgium, 2013
Source: Health Interview Survey, Sciensano, 2013 [3]

International comparison

Belgium ranks favorably among the EU-15 countries for the proportion of people rating their health favorably, in both sexes, and this since 2004.

  • Men
  • Women

Prevalence of (very) good self-rated health among men, EU-15, 2016
Source: OECD Health Statistics, 2016 [4]

Prevalence of (very) good self-rated health among women, EU-15, 2016
Source: OECD Health Statistics, 2016 [4]

Evolution of the prevalence of (very) good self-rated health, Belgium and EU-15 mean, 2004-2016
Source: OECD Health Statistics, 2004-2016 [4]

4. Health-related quality of life

In 2013, Belgians reported an average HRQOL score of 81.5, as measured by the EQ-5D questionnaire. The quality of life score appears to be significantly higher for men (83.8) than for women (79.4), and in Flanders (83.6) than in Brussels (80.3) or Wallonia (77.7).

There is a strong decreasing gradient with age. When people get older, their HRQOL declines. The decrease is more pronounced in women, with a relative decrease of more than 25% (from 87.4 to 65 between the two extreme age groups), while the relative difference is of 20% only in men (from 91.9 to 73.6).

Health-related quality of life score by sex and age, Belgium, 2013
Source: Health Interview Survey, Sciensano, 2013 [3]

Differences by educational level

HRQOL scores increase with education level: from 67 for the lowest educated group compared to 85 for the highest educated group. This socio-educational gradient remains significant after standardization for age and sex.

Health-related quality of life score by education level, Belgium, 2013
Source: Health Interview Survey, Belgium, 2013 [3]

5. Read more

View the metadata for Self-rated health

View the metadata for Health-related quality of life

HISIA: Interactive Analysis of Belgian Health Interview Survey

Definitions

EU-15
The EU-15 corresponds to all countries that belonged to the European Union between 1995 and 2004: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden and the United Kingdom. We compare the Belgian health status to that of the EU-15 because these countries have similar socioeconomic conditions.
EuroQol Five Dimensions Questionnaire (EQ-5D)
The EuroQol Five Dimensions questionnaire is a quick and simple instrument that assesses the impact of health status on the quality of life. The EQ-5D comprises two components, i.e., the EQ-5D-5L descriptive system and the EQ-5D visual analogue scale. The descriptive system covers five dimensions (mobility, personal autonomy, daily activities, pain/discomfort and anxiety/depression), each having five possible response levels (ranging from no problems to extreme problems).
EQ-5D score
Combining the reply to each of the items of the EQ-5D questionnaire, a global score is produced and is scaled by two anchor points: 0, representing death, and 100, representing the best imaginable health state. Negative score is possible, representing a health state worse than death.
Health-related quality of life
Quality of Life is an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It is a broad ranging concept affected in a complex way by the person's physical health, psychological state, personal beliefs, social relationships and their relationship to salient features of their environment. When the quality of life concept is restricted to the effects of health status, it is called health-related quality of life.
Prevalence of good self-rated health
Percentage of people rating their health as good or very good.
Self-rated health
Self-rated health is the individual's subjective assessment of their own health status. To answer the question “How is your general health status?” people have to choose between five categories: very good, good, fair, bad, or very bad.

References

  1. World Health Organization, Measuring Quality of Life. http://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/
  2. EuroQol Five Dimensions Questionnaire. https://euroqol.org/
  3. Health Interview Survey, Sciensano, 1997-2013. https://his.wiv-isp.be/fr/Documents%20partages/SH_FR_2013.pdf
  4. OECD Health Statistics, 2004-2016. http://stats.oecd.org/

Health expectancy

1. Key messages

In 2016 in Belgium, men at age 65 could expect to live 10.3 years without disability (Disability-Free Life Expectancy at 65 years, DFLE65) and women 11.4 years.
Between 2004 and 2016 there has been an increase in DFLE65 by about 1.5 years for men and 2.7 years for women.
There are regional differences in DFLE with the highest DFLE in Flanders and the lowest in Wallonia.
DFLE by educational level shows a classical socio-economic gradient, with DFLE increasing with educational level.
DFLE among Belgian men is at the EU-15-average, while DFLE among Belgian women is higher than the EU-15-average.

2. Background

Health expectancy indicators are measures of population health that combine length and quality of life into a single metric. They include a whole family of indicators, expressed in terms of “life expectancy in a given state of health” (for instance without disability, or in good self-rated health), that is the number of remaining years expected to be spent in this specific health state at a particular age.

There are as many different health expectancies as definitions of health. One of the most common indicator is the Disability-Free Life Expectancy (DFLE), also called Healthy Life Years (HLY): it is measuring the number of remaining years that a person is expected to live without limitations in daily activities, at a given age.

The estimation of the DFLE assumes current rates of mortality and morbidity staying unchanged. Two types of data are needed: prevalence of disability and mortality rate. The prevalence of disability are usually obtained from surveys. Therefore, small differences can be observed between national or international values. 

When estimating DFLE by educational level or region, the process becomes more complex as the two components of the indicator need to be calculated by educational level as well.

In this report, the focus is on the trends in DFLE at 65, over time and by region. In addition, we present DFLE by educational level at ages 25, 50 and 65.

3. Disability-Free Life Expectancy

Belgium

In 2016, the Disability-Free Life Expectancy at age 65 (DFLE65) in Belgium were 10.3 years for men and 11.4 for women. According to the life expectancy at that age,  56% and 52% of the remaining life is expected to be lived in good health respectively in men and women. While women live much longer than men, they only live slightly longer in good health; women also live longer than men in bad health (in absolute number of years and in % of the remaining life).

In the period 2004-2016, the DFLE65 has increased in both genders, by about 1.5 years (with an unexpected drop in 2016) for men and 2.7 years for women.

  • Men
  • Women

Life Expectancy (LE) and Disability-Free Life Expectancy (DFLE) at 65 among men, Belgium, 2004-2016
Source: Eurostat, 2004-2016, based on EU-SILC surveys [1]

Life Expectancy (LE) and Disability-Free Life Expectancy (DFLE) at 65 among women, Belgium, 2004-2016
Source: Eurostat, 2004-2016, based on EU-SILC surveys [1]

Differences between regions

There are important regional differences in DFLE, with Flanders having the highest DFLE and Wallonia the lowest, in both sexes. At age 65, the difference between:

  • Flanders and Wallonia in DFLE in 2013 was 2.4 years in both sexes
  • Flanders and Brussels was 2.3 years for men and 1.8 for women

Those regional differences remained quite stable over time.

  • Men
  • Women

Disability-Free Life Expectancy at age 65 among men, Belgium and regions, 2001-2013
Source: Own calculation based on Stabel mortality tables and Health Interview Survey, Sciensano, 2001-2013 [2]

Disability-Free Life Expectancy at age 65 among women, Belgium and regions, 2001-2013
Source: Own calculation based on Stabel mortality tables and Health Interview Survey, Sciensano, 2001-2013 [2]

Differences by educational level

There are substantial socio-economic inequalities in DFLE at any given age, and these are more pronounced in women. In 2011, the gap in DFLE at age 25 between the low and high educated categories reached 10.5 years in men and 13.4 in women. At age 50, the gap is about 6.7 years in men and 7.7 years in women. At age 65, this gap is still existing and reached 2.5 years in men and 4.6 years in women. In relative terms, gaps are increasing with age in women but not in men.

  • Men
  • Women

Disability-Free Life Expectancy at 25, 50 and 65 years old among men, by educational level, Belgium, 2011
Source: Own calculation based on the census 2011 linked with the National Registrer (5 years’ follow-up), and Health interview Surveys, Sciensano [3]

Disability-Free Life Expectancy at 25, 50 and 65 years old among women, by educational level, Belgium, 2011
Source: Own calculation based on the census 2011 linked with the National Registrer (5 years’ follow-up), and Health interview Surveys, Sciensano [3]

International comparison

In 2016, with a DFLE65 of 10.3 years, Belgian men are exactly on the EU-15 average. Belgian women have a better ranking with 11.4 DFLE65 as compared with the EU-15 average of 10.4 years.

  • Men
  • Women

Disability-Free Life Expectancy at 65 among men by country of residence, EU-15, 2016
Source: Eurostat, 2016 (EU-15 average: unweighted average) [1]

Disability-Free Life Expectancy at 65 among women by country of residence, EU-15, 2016
Source: Eurostat, 2016 (EU-15 average: unweighted average) [1]

4. Read more

View the metadata for this indicator

SPMA: Standardized Procedures for Mortality Analysis

Definitions

EU-15
The EU-15 corresponds to all countries that belonged to the European Union between 1995 and 2004: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden and the United Kingdom. We compare the Belgian health status to that of the EU-15 because these countries have similar socioeconomic conditions.
Disability-Free Life Expectancy at a given age
The Disability-Free Life Expectancy (DFLE) at a given age indicator, also called Healthy Life Years (HLY), measures the number of remaining years that a person of that given age is expected to live without disability. It combines both mortality and ill/health information. The prevalence data are obtained from surveys. Depending on the survey used, small differences can be observed. In this report, the Belgian values used for regional comparisons are based on the HIS data, while international values use the SILC data. 
Health Life Years at 25 by educational level
The Disability-Free Life Expectancy by educational level is generally computed from a compilation of different databases. In this report, it was computed from:
  1. a linkage and follow up of the 2011 population census with the National Register, in order to estimate the mortality by educational level
  2. the prevalence values of disability from the Health Interview Surveys (2008 and 2013 pooled).
International Standard Classification of Education (ISCED)
ISCED is the reference international classification for organizing education programs and related qualifications by levels and areas. It contains 7 categories, from 0 to 6:
  • 0: Early childhood education (‘less than primary’)
  • 1: Primary education
  • 2: Lower secondary education
  • 3: Upper secondary education
  • 4: Post-secondary non-tertiary education
  • 5: Short-cycle tertiary education, Bachelor’s, Master’s
  • 6: Doctoral or equivalent level
The educational level was grouped here into 3 categories, according to the International Standard Classification of Education (ISCED):
  • Low: Lower secondary education or less (categories 0, 1, 2),
  • Intermediate: Upper secondary or post-secondary non-tertiary education (categories 3, 4),
  • High: Tertiary education (categories 5, 6).

References

  1. Eurostat, 2004-2016. http://ec.europa.eu/eurostat/fr/data/database
  2. HISIA, Sciensano, Health expectancy 2011-2013.
  3. Renard F, Devleesschauwer B, Van Oyen H, Gadeyne S, Deboosere P (2019) Evolution of educational inequalities in life and health expectancies at 25 years in Belgium between 2001 and 2011: a census-based study. Arch Public Health 77:6. doi: 10.1186/s13690-019-0330-8

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