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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 2018, the life expectancy at birth in Belgium was 81.5 years, which is an increase of 3.7 years since 2000. Belgium is however ranking quite poor among the EU-15 countries.
Life expectancy among women is 83.7 years while it is only 79.2 years among men. The gender gap (4.5 years) is consistent, but has decreased over time: it was for instance 6.3 years in 2000. The life expectancy in women did not increase since 2016, the observed improvements in LE are thus mainly due to a LE increase in men.
Large regional disparities are observed in life expectancy. Flanders has the highest life expectancy at birth (82.3), followed by Brussels (81.5) and Wallonia (79.9).
An important socio-economic gradient is also observed with better life expectancy in higher than in lower educated people.

2. Background

Life expectancy 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 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 is presented in this report by sex, by region and by socio-economic level.

The education level has been chosen as socioeconomic indicator. 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 2018, the life expectancy at birth was 81.5 years in Belgium. It has increased continuously since decades, except in 2012 and in 2015 where slight decreases were observed. Since 2000, 3.7 years were gained.

In 2018, the LE was 4.5 years higher for women (83.7 years) than for men (79.2 years). However, the LE increased faster in men than in women. During the period 2000-2018, the LE increased by 4.6 years in men and by 2.8 years in women, thus reducing the gender gap. Since 2016, the LE even did not increase in women, while it continued increasing in men.

Life expectancy at birth by sex, Belgium, 2000-2018
Source: Statbel [1]

Trends and regional differences

In 2018, the life expectancy at birth was highest in Flanders (82.3), intermediate in Brussels (81.5) and lowest in Wallonia (79.9). During the period 2000-2018, the LE increased in all three regions. However, the gap between Flanders and the other regions increased: from 2 to 2.5 years for the difference between Flanders and Wallonia, and from 0.5 to 0.9 for the difference between Flanders and Brussels.

The regional differences in LE at birth are larger in men than in women. In men, the LE in Flanders was 3 years higher than in Wallonia and 1.2 years higher than Brussels while in women, the LE in Flanders was 2 years higher than in Wallonia and 0.7 years higher than Brussels.

During the period 2000-2018, the gains in LE were larger in men than in women in all 3 regions: men gained 4.7, 4.4, and 4.3 years in Flanders, Brussels, Wallonia respectively while women gained 3, 2.8, and 2.4 years.

  • Men
  • Women

Life expectancy at birth by region, men, 2000-2018
Source: Statbel [1]

Life expectancy at birth by region, women, 2000-2018
Source: Statbel [1]

Socio-economic differences

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 lower than the EU-15 average, and this is true for both men and women. Belgium has the fifth lowest LE among the EU-15 countries for both sexes. In addition, the difference between Belgium and the EU countries with the highest LE is substantial: 1.8 years in men when compared with Sweden and 2.5 years in women when compared with Spain.

  • Men
  • Women

Life expectancy at birth among men, EU-15 countries, 2017
Source: OECD Health Data [4]

Life expectancy at birth among women, EU-15 countries, 2017
Source: OECD Health Data [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, 2000-2018. 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 merger 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 2018, 77% of the Belgian population reported their health to be good or very good. This proportion is slightly higher in men (79%) than in women (75%), and decreases with age. More people report being in good health in Flanders (78.5%) and Brussels (78.4%) than in Wallonia (74.0%). Finally, there is an important socio-economic gradient, with the proportion of people reporting to be in good health increasing as the socio-economic status increases.
The mean Health-Related Quality of Life (HRQoL) score is 0.79 in Belgium, which is a decrease since 2013, where it was 0.81. HRQoL is higher in men (0.82) than in women (0.77) and strongly decreases with age. People in Flanders have a better HRQoL (0.82) than people in Brussels (0.79) or Wallonia (0.75). As for self-rated health, there is an important socio-economic gradient in 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]. This domain has been explored here via two different concepts: the Self-Rated Health (SRH) and Health-Related Quality of Life (HRQoL) score.

Self-rated health is defined as an individual’s appreciation of its own health status. Despite its subjective nature, self-rated health is a good predictor of people’s future morbidity, disability, healthcare use, and mortality. Information has been drawn here from the percentage of people rating their health as good or very good as reported in the Belgian Health Interview Survey for national results. For the international comparisons, however, the data were derived from the OECD database and were coming from the EU-SILC surveys.

Health-Related Quality of Life (HRQOL) refers to the effects that the health 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 Belgian Health Interview survey. This tool is allowing to assess HRQoL with 5 dimensions: mobility, self-care, usual activity, pain/discomfort, anxiety/depression. The answers to these dimensions are weighted with preference values drawn from the Belgian population to produce an HRQoL score (on a scale where 1 corresponds to perfect health, and 0 to death). No international comparison is presented for this indicator due to the lack of international data.

3. Self-rated health

Belgium

In 2018, 77% of the population aged 15 years or older rated their health as good or very good. Self-rated health is higher in men (78.7%) than in women (76.2%). This difference is reversed among the younger people but starting from the age group 45-54, men are more frequently rating their health as good or very good than women.

As expected, the prevalence of good self-rated health decreases strongly with age: from 91.8% among the people aged 15-24 rate to only 58.3% of people aged 75 and over.

Prevalence of (very) good self-rated health by age and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano [3]

Trends and regional differences

After the improvements observed between 1997 and 2013, the age-standardized proportions of Belgians reporting good self-rated health remained stable with 78.1% in 2013 and 77.3% in 2018. A higher age-standardized prevalence is observed in Flanders and in Brussels compared to Wallonia and this difference is statistically significant.

Between 1997 and 2013, the percentage of people reporting good health increased in Wallonia (from 68.3% to 74.7%) and in Flanders (from 77.0% to 80.2%). This evolution is not observed anymore in 2018 as the rate stayed stable when compared to 2013: 74% in Wallonia and 79.3% in Flanders. In Brussels however, the percentage of people reporting good health increased between 2013 and 2018, from 73.7% to 77.2%.

  • Men
  • Women

Age-standardized prevalence of (very) good self-rated health in men aged 15 and older, by region, 1997-2018
Source: Own calculations based on Health Interview Survey, Sciensano [3]

Age-standardized prevalence of (very) good self-rated health in women aged 15 and older, by region, 1997-2018
Source: Own calculations based on Health Interview Survey, Sciensano [3]

Socio-economic differences

An important socio-economic gradient, measured by educational level, is observed in the self-rated health in Belgium. After standardization for age, only 57% of people with a primary education level rate their health positively versus 84% of the people with tertiary education.

Age-standardized prevalence of (very) good self-rated health by level of education, Belgium, 2018
Source: Own calculations based on Health Interview Survey, Sciensano [3]

International comparison

The prevalence of self-rated health in Belgium ranks favorably among the EU-15 countries since 2004. In 2017, men ranked fifth among the EU-15, while women were just above the EU-15 average.

  • Men
  • Women

Prevalence of (very) good self-rated health among men aged 15 and older, EU-15, 2017
Source: OECD Health Statistics (based on EU-SILC) [5]

Prevalence of (very) good self-rated health among women aged 15 and older, EU-15, 2017
Source: OECD Health Statistics (based on EU-SILC) [5]

Evolution of the prevalence of (very) good self-rated health among people aged 15 and older, Belgium and EU-15 mean, 2005-2017
Source: OECD Health Statistics (based on EU-SILC) [5]

4. Health-related quality of life

Belgium

In 2018, the population aged 15 years or more had an average HRQOL score of 0.79, as measured by the EQ-5D questionnaire. The quality of life score is significantly higher for men (0.82) than for women (0.77).

The HRQoL score is significantly decreasing with age. The decrease is more pronounced in women: between the two extreme age groups, women are losing about 26% of their HRQoL score (from 0.84 to 0.62) while men are losing only 17% (from 0.86 to 0.71).

Health-related quality of life score by age and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano [4]

Trends and regional differences

The average HRQoL score measured by the EQ-5D questionnaire in 2018 (0.79) was lower than in 2013 (0.81).

Despite the important proportion of people reporting problems of pain/discomfort and anxiety/depression in 2013, these proportions have further increased in 2018:

  • pain/discomfort was reported by 56% of the population in 2018 versus 50% in 2013.
  • anxiety/depression was reported by 31% in 2018 versus 26% in 2013.

In 2018, the HRQoL score was higher in Flanders (0.82) than in Brussels (0.79) and Wallonia (0.75).

The HRQoL score decreased in Flanders (from 0.83 in 2013 to 0.82 in 2018) and in Wallonia (from 0.78 to 0.75). In Wallonia, the decrease was more substantial in women (0.76 to 0.72) than in men. The gaps between Wallonia and the two other regions have increased between 2013 and 2018.

  • Men
  • Women

Average health-related quality of life score among men aged 15 years or older, by region, 2013-2018
Source: Health Interview Survey, Sciensano [4]

Average health-related quality of life score among women aged 15 years or older, by region, 2013-2018
Source: Health Interview Survey, Sciensano [4]

Socio-economic differences

The average HRQoL score increases with educational level: from 0.65 for people from the lowest educational group to 0.83 for people with a high education level.

Health-related quality of life score by education level, Belgium, 2018
Source: Health Interview Survey, Belgium, 2018 [4]

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: Subjective Health, Sciensano, 1997-2018. https://his.wiv-isp.be/fr/Documents%20partages/SH_FR_2018.pdf
  4. Health Interview Survey: Health-Related Quality of Life, Sciensano, 2013-2018. https://his.wiv-isp.be/fr/Documents%20partages/QL_FR_2018.pdf
  5. OECD Health Statistics, 2005-2017. http://stats.oecd.org/

Health expectancy

1. Key messages

In 2018, men aged 65 could expect to live another 12.5 years without disability (Disability-Free Life Expectancy at 65 years, DFLE65) and women 12.4 years. Between 2004 and 2018, the DFLE65 increased by 2.7 years for men and 1.4 years for women.
DFLE65 is higher in Flanders for men (compared to the two other regions), and higher in Brussels and Flanders (compared to Wallonia) for women. The DFLE furthermore shows a positive socioeconomic gradient, with increasing DFLE according to the level of educational attainment.
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 synthetic population health measurements 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). They are taking into account the number of remaining years expected to be lived in this specific health state at a particular age. The estimation of the Disability-Free Life Expectancy (DFLE) assumes that the current rates of mortality and morbidity will stay unchanged in the future.

The mortality rates are computed based on exhaustive death data from the population. Disability prevalences are usually obtained from population surveys. In this report, we used the Healthy Life Years (HLY) indicator based on the Global Activity Limitation Instrument (GALI) to assess DFLE. We used mainly data from the Belgian Health Interview Survey since they allow regional comparisons. For international comparison, we used data from the Statistics on Income and Living Conditions survey (EU-SILC), leading to small differences between national or international values.

When estimating DFLE by educational level the calculation process is more complex as the two components of the indicator (mortality and disability rates) need to be calculated by educational level as well.

Since the GALI question is only asked to people aged 15 years and older, we do not compute DFLE at birth. We focused on DFLE at 65 years to allow for international comparisons. DFLE is also presented by educational level at ages 25, 50 and 65.

3. Disability-Free Life Expectancy

Belgium

In 2018, the Disability-Free Life Expectancy at age 65 (DFLE65) in Belgium was 12.5 years for men and 12.4 years for women. Men and women are thus expected to live respectively 68% and 57% of the remaining life without disability. While women live much longer, they only live slightly longer without disability and as a consequence, they live more years disabled (in absolute number of years and in % of the remaining life).

In the period 2001-2018, the DFLE65 has increased by about 3.7 years for men and 2.7 years for women.

Life Expectancy (LE) and Disability-Free Life Expectancy (DFLE) at 65, by sex, Belgium, 2001-2018
Source: Own calculation based on Statbel mortality tables [1] and Health Interview Surveys, Sciensano [2]

Regional differences

The following regional differences in DFLE65 are observed in Belgium in 2018:

  • Among men, Flanders has the highest DFLE followed by Wallonia (-0.7 years) and Brussels (-1.5)
  • Among women, Brussels and Flanders have higher DFLE than Wallonia (-2.7)
  • Men
  • Women

Disability-Free Life Expectancy at age 65 among men, by region, 2001-2018
Source: Own calculation based on Statbel mortality tables [1] and Health Interview Surveys, Sciensano [2]

Disability-Free Life Expectancy at age 65 among women, by region, 2001-2018
Source: Own calculation based on Statbel mortality tables [1] and Health Interview Surveys, Sciensano [2]

Socio-economic differences

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

When considering the DFLE65, Belgium ranks favorably among the EU-15 countries. DFLE in men is close to the EU-15 average, while DFLE in women exceeds the EU-15 average by more than one year (11.7 for Belgium vs 10.6 for EU-15).

  • Men
  • Women

Disability-Free Life Expectancy at 65 among men by country of residence, EU-15, 2017
Source: Eurostat [4]

Disability-Free Life Expectancy at 65 among women by country of residence, EU-15, 2017
Source: Eurostat [4]

4. Read more

View the metadata for this indicator

HISIA: Interactive Analysis of Belgian Health Interview Survey

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. 
Disability-Free Life Expectancy 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).
Global Activity Limitation Instrument (GALI)
The Global Activity Limitation Instrument (GALI) is a one question instrument assessing the presence of long-standing activity limitation: "For at least the past 6 months, to what extent have you been limited because of a health problem in activities people usually do? Would you say you have been..." severely limited / limited but not severely / not limited at all? The question was developed by the Euro-REVES project. It is used in the Belgian Health Interview Survey (BHIS) and EU Statistics on Income and Living Conditions (EU-SILC).
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. Statbel, 2000-2018. https://statbel.fgov.be/en/themes/population/life-expectancy-and-life-tables
  2. Health Interview Survey: Subjective Health, Sciensano, 1997-2018. https://his.wiv-isp.be/fr/Documents%20partages/SH_FR_2018.pdf
  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. Eurostat, 2017. http://ec.europa.eu/eurostat/fr/data/database