Healthy Lifespan Statistics Derived From Cross-Sectional Prevalence Data Using the Sullivan Method are Informative Summary Measures of Population Health

Abstract

Health expectancy (HE), commonly derived from cross-sectional prevalence data using the Sullivan method, serves as the most frequently used summary measure of population health. Like lifespan distribution statistics, which are often discussed alongside life expectancy (LE) in demographic studies, analogous statistics on healthy lifespans can provide valuable information on population health. We examine whether healthy lifespan distribution statistics beyond HE can be estimated based on cross-sectional prevalence data and the life table, the data inputs of the Sullivan method. To do so, we treat the Sullivan method as an extension of the stationary population model to health and distinguish between health conditions with and without recovery from the state of decreased health. Our empirical demonstration is based on the prevalence of chronic diseases in selected European countries in 2017 from the Survey of Health, Ageing and Retirement in Europe (SHARE), as well as on life tables from EUROSTAT. We find that the Sullivan method, when considered as an extension of the stationary population model to health, allows for the estimation of a healthy survival distribution and its statistics, beyond HE, for health characteristics with no recovery from the state of decreased health. We show that for such health conditions, the method requires that the number of persons in full health in a stationary population does not increase with age. We argue that for such health dimensions, HE conditional on being in good health at the life table radix age is of relevance for health policy interventions. In our empirical application, we show that the conditional and unconditional measures of HE can give substantially different pictures of population health. Furthermore, we show that across European countries, in contrast to the negative relationship between LE and lifespan inequality, higher HE is associated with greater inequality in healthy years lived when conditional on being healthy at age 50. Overall, the Sullivan method, when considered as an extension of the stationary population model, proves to be a valuable tool for deriving summary statistics of population health beyond HE, which are highly relevant to public policy. * This article belongs to a special issue on “Levels and Trends of Health Expectancy: Understanding its Measurement and Estimation Sensitivity”.