The joint distribution of years lived in good and poor health.

IF 3.2 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Population Health Metrics Pub Date : 2024-11-23 DOI:10.1186/s12963-024-00354-w

Tim Riffe, Iñaki Permanyer Ugartemendia, Rustam Tursun-Zade, Magdalena Muszyńska-Spielauer

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Abstract

Background: Incidence-based multistate models of population health are commonly applied to calculate state expectancies, such as a healthy life expectancy (HLE), or unhealthy life expectancy (UHE). These models also allow the computation of other summary indices, such as the distributions of healthy or unhealthy lifespans.

Objective: We aim to show how a multistate health model implies a multistate death distribution, giving joint information on years lived in good and poor health. We also propose three aggregate indices of joint health and mortality inequality.

Methods: We propose a double-accounting approach to increment-decrement life table methods to intuitively derive a multistate health distribution over age and cumulative duration spent in each state. We then define a variety of summary lifespan inequality indices based on different distance metrics, namely Euclidean, Chebyshev, and Manhattan distances.

Results: We apply the method to multistate transition probabilities between health states based on the activities of daily living index for Italian women from the Survey of Health, Ageing and Retirement in Europe in 2015-2017. We demonstrate the added value of accounting for joint years lived in health states in multistate models for our understanding of the period health and mortality conditions from the perspective of health-specific lifespans of individuals.

Conclusions: Multivariate state distributions and summary indices derived from them give a holistic representation of population health inequality. We offer selected summary indices of the multivariate distribution with different demographic interpretations from the measures derived from univariate distributions. Although more theoretical and methodological work is required to motivate a single comprehensive population health inequality index, this direction is a promising path for a better understanding of population health dynamics and relationships between univariate statistics.

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健康状况良好和健康状况较差的生活年数的共同分布。

背景：基于发病率的多态人口健康模型通常用于计算国家预期寿命，如健康预期寿命（HLE）或不健康预期寿命（UHE）。这些模型还可以计算其他综合指数，如健康或不健康寿命的分布：我们旨在说明多态健康模型如何意味着多态死亡分布，从而提供关于健康状况良好和健康状况不佳的寿命的联合信息。我们还提出了健康和死亡率不平等的三个综合指数：方法：我们提出了一种双重核算的递增-递减生命表方法，直观地推导出多州健康状况在年龄上的分布以及在各州的累计寿命。然后，我们根据不同的距离指标（即欧几里得距离、切比雪夫距离和曼哈顿距离）定义了多种寿命不平等指数：我们将该方法应用于基于意大利女性日常生活活动指数的健康状态之间的多态转换概率，该指数来自 2015-2017 年欧洲健康、老龄化和退休调查。我们证明了在多态模型中考虑在健康状态下的共同生活年数对我们从个人健康寿命的角度理解时期健康和死亡状况的附加价值：结论：多变量状态分布及其衍生的汇总指数全面反映了人口健康的不平等。我们提供了多变量分布的选定汇总指数，其人口学解释与单变量分布得出的测量结果不同。尽管还需要更多的理论和方法工作来激发单一的综合人口健康不平等指数，但这一方向是更好地理解人口健康动态和单变量统计之间关系的一条有希望的道路。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Population Health Metrics PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

6.50

自引率

0.00%

发文量

审稿时长

29 weeks

期刊介绍： Population Health Metrics aims to advance the science of population health assessment, and welcomes papers relating to concepts, methods, ethics, applications, and summary measures of population health. The journal provides a unique platform for population health researchers to share their findings with the global community. We seek research that addresses the communication of population health measures and policy implications to stakeholders; this includes papers related to burden estimation and risk assessment, and research addressing population health across the full range of development. Population Health Metrics covers a broad range of topics encompassing health state measurement and valuation, summary measures of population health, descriptive epidemiology at the population level, burden of disease and injury analysis, disease and risk factor modeling for populations, and comparative assessment of risks to health at the population level. The journal is also interested in how to use and communicate indicators of population health to reduce disease burden, and the approaches for translating from indicators of population health to health-advancing actions. As a cross-cutting topic of importance, we are particularly interested in inequalities in population health and their measurement.