Article Text

Download PDFPDF
Measuring the health burden of chronic disease and injury using health adjusted life expectancy and the Health Utilities Index
  1. D G Manuel1,2,
  2. S E Schultz1,
  3. J A Kopec1,2,3
  1. 1Institute for Clinical Evaluative Sciences, Toronto, Canada
  2. 2Department of Public Health Sciences, University of Toronto, Canada
  3. 3University of British Columbia, Vancouver, Canada
  1. Correspondence to:
 Dr D Manuel, Institute for Clinical Evaluative Sciences, G-119, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5;


Objectives: To estimate the burden of illness from chronic disease and injury using a population based health survey, which contains both measures of chronic disease and a utility based health related quality of life (HRQOL) measure.

Design: An adapted Sullivan method was used to calculate cause deleted health adjusted life expectancies for chronic conditions.

Setting: Ontario, Canada, 1996/97.

Subjects: The 1996/97 Ontario Health Survey (n=35 527) was used to estimate the prevalence of chronic conditions. A cause deleted approach was used to estimate the impact of these conditions on the Health Utilities Index (HUI). Cause deleted probabilities of dying were derived with the cause eliminated life table technique and death data from vital statistics for Ontario 1996/97 (n=156 610).

Results: Eliminating cardiovascular disease and cancer will cause an “expansion of morbidity”, while eliminating mental conditions and musculosketal disorders will result in a “contraction of morbidity”. The HUI score varies depending on chronic condition, age, and sex—most of which were assumed not to vary in previous summary measures of population health.

Conclusions: Health adjusted life expectancy estimated for chronic conditions using a utility based measure of health related quality of life from population health surveys addresses several limitations of previous studies that estimate the burden of disease using either a categorical measure of disability or expert opinion and related epidemiological evidence.

  • health expectancy
  • life expectancy
  • morbidity
  • disability
  • HUI
  • Health Utilities Index
  • HRQOL, health related quality of life
  • SMPH, summary measures of population health
  • HALE, health adjusted life expectancy
  • DALY, disability adjusted life year
  • DFLE, disability free life expectancy

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding: Dr Manuel is a supported in part by a Career Scientist Award, Ontario Ministry of Health, Dr Kopec is supported in part by an Investigator Award, Canadian Institute for Health Research.

  • Conflicts of interest: none.

Linked Articles