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