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Health expectancies in the European Union: same concept, different methods, different results
  1. João Vasco Santos1,2,3,
  2. João Viana1,2,
  3. Brecht Devleesschauwer4,5,
  4. Juanita A Haagsma6,
  5. Cristina Costa Santos1,2,
  6. Walter Ricciardi7,
  7. Alberto Freitas1,2
  1. 1MEDCIDS—Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
  2. 2CINTESIS—Centre for Health Technology and Services Research, Porto, Portugal
  3. 3Public Health Unit, ACES Grande Porto VIII - Espinho/Gaia, ARS Norte, Espinho/Gaia, Portugal
  4. 4Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
  5. 5Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
  6. 6Erasmus MC, University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
  7. 7Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Fondazione Policlinico “A. Gemelli” IRCCS, Rome, Italy
  1. Correspondence to João Vasco Santos, MEDCIDS – Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; jvasco.santos{at}


Background Healthy life expectancy (HLE) is a population health measure that combines mortality and morbidity, which can be calculated using different methods. In this study, we aimed to assess the correlation, reliability and (dis)agreement between two estimates monitored in the European Union (EU), that is, the European Commission's HLE based on self-perceived health (SPH-HLE) and the Institute for Health Metrics and Evaluation's HLE based on disability weight (DW-HLE), by sex, and comparing these results with LE and proportion of life spent in good health (%GH).

Methods We performed a retrospective study in the EU28 countries, between 2010 and 2017. The HLE methods differ in definition, measurement and valuation of health states. While SPH-HLE relies directly on one question, DW-HLE relies on epidemiological data adjusted for DW. Spearman’s r, intraclass correlation coefficient, information-based measure of disagreement and Bland-Altman plots were used to assess reliability, correlation and disagreement in HLE resulting from both methods and in LE or %GH measured by both institutions.

Results Correlation and reliability between SPH-HLE and DW-HLE were good (better for males), with low disagreement, and were even better for LE between both institutions. The HLE Bland-Altman plots suggest a variability range of approximately 6 years for both sexes, higher for females. There was also an increasing HLE difference between methods with higher average HLE for both sexes.

Conclusion We showed wide variations between both methods with a clear and different high impact on female and male HLE, showing a tendency for countries with higher health expectancies to yield larger gaps between SPH-HLE and DW-HLE.

  • health expectancy
  • health status
  • self-rated health
  • biostatistics

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  • Contributors All authors contributed for data interpretation and critically reviewed the manuscript. JVS, JV, CCS, WR and AF designed the study. JVS, JV and CCS conducted the data analysis and drafted the initial manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplemental information. All data used in the study are uploaded as online supplemental information (online supplemental table 1).

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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