Measuring population health using health expectancy estimates from morbidity and mortality data

Abstract Background National health plans frequently rely on health expectancies, which are systematically calculated in the EU countries using the Sullivan method. The Sullivan health expectancy index combines age-specific mortality rates and age-specific prevalence of healthy life. The main limitation of the Sullivan method is that prevalence data depends on expensive national health surveys. The objective of this work is to investigate an equivalent estimation, considering multiple health states, but using available information on morbidity and mortality. Methods Mortality and morbidity information, corresponding to years 2016 and 2017, was obtained for the population of the county of Baix Empordà (Catalonia), N = 91,130. The set of anonymized individual information on diagnoses, procedures and pharmacy consumption contained in the individual clinical record (ICD and ATC codes), were classified into health states according to the 3M-Clinical Risk Groups. The information analysed included acute inpatient care, acute outpatient care, primary care, pharmacy prescriptions, diagnostic tests, emergencies and long-term residential care services. Based on the health transitions observed between 2016 and 2017, life expectancies by health state were obtained from a multistate microsimulation model. Results Healthy life expectancies at birth and 65 years for females and males were respectively HLE0female = 39.94, HLE0male = 42.87, HLE65female = 2.43, HLE65male = 2.17. Point estimates for global life expectancies at birth and 65 years of age: LE0female = 85.82, LE0male = 80.58, LE65female = 22.31, LE65male = 18.86. Life expectancies were consistent with the government estimates for 2017. Healthy life expectancies substantially differed from the government estimates based on self-reported health surveys and the calculation method of prevalence. Conclusions Health expectancies can be efficiently obtained from multistate models based on mortality and morbidity information and can be useful for monitoring the population according to their health status, in the context of health planning. The results obtained were not comparable with those calculated with the standard Sullivan method.