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