1. Key points
- Females at birth in 2009-11 in England can expect to live a further 1.0 year with a disability than in 2006-08. For males it was a further 0.4 years.
- Women at age 65 in England in 2009-11 can expect to live a further 0.6 years without a disability. For men it was an extra 0.5 years without a disability.
- Females at birth in Herefordshire in 2009-11 have a Disability-Free Life Expectancy (DFLE) of 71.7 years. This is 16.1 years longer than females in Tower Hamlets, where DFLE was 55.6 years.
- Males at birth in Richmond upon Thames in 2009-11 have a DFLE of 69.9 years. This is 13.5 years longer than males in Liverpool, where DFLE was 56.4 years
- For males at birth, four out of the nine local authorities located in the North East had significant improvements in DFLE between 2006-08 and 2009-11. However none of these local authorities had a higher DFLE than the England average.
2. Summary
Health expectancies add a quality of life dimension to estimates of longevity by dividing expected lifespan into time spent in different states of health. The Office for National Statistics (ONS) routinely publishes two types of health expectancies. The first is Healthy Life Expectancy (HLE), which estimates lifetime spent in ‘Very good’ or ‘Good’ health based upon how individuals perceive their general health. The second is Disability-Free Life Expectancy (DFLE), which estimates lifetime free from a limiting persistent illness or disability. This is based upon a self-rated assessment of how health limits an individual’s ability to carry out day-to-day activities. Both health expectancies are summary measures of population health and key indicators of the well-being of society.
This bulletin presents estimates of Disability-Free Life Expectancy (DFLE) for Upper Tier Local Authorities (UTLAs) in England for the period 2009-11. The estimates are for each gender, at birth and at age 65. It also compares the most recent period with 2006-08 estimates to analyse the direction of change in DFLE, both nationally and sub-nationally.
Calculating DFLE at sub national level generates information on the geographical distribution of disability and provides evidence that both the government and private sector can use to make decisions. The data can be used as evidence for funding health and social care and to determine the feasibility of increases to the state pension age. It also has use in private sector pensions and provides the general public with information on how their local area’s health compares with neighbouring areas and with England as a whole.
Nôl i'r tabl cynnwys3. Background
What are health expectancies?
Life Expectancy (LE) has increased considerably since the eighties, and is expected to increase further in the UK (ONS 2013c). However, it is important that the number of years lived without a disabling health condition rises either faster or at the same rate. If this is not the case, then these additional years of life are being spent in poor health and greater dependency, putting additional strain on health and social care resources.
It is for this reason health expectancies are being used to assess the proportion of life spent in favourable health. These are summary measures of population health, which estimate the average number of years a person would live in a given health state if he/she experienced the specified population’s particular age-specific mortality and health status for that time period throughout the rest of his/her life.
The DFLE figures represent a snapshot of the mortality and health status of the whole population of a specified area in each three year time period. They are not, therefore, the number of years that a person will actually expect to live in the area in a given health state. This is because both mortality and health rates are susceptible to change in the future, and because of population movement into and out of the area.
DFLE estimates are, in part, subjective and based upon the following survey question to determine whether the survey respondent has a limiting persistent illness or disability, or not1:
Do you have any health problems or disabilities that you expect will last for more than a year?
Yes/No
If ‘Yes’ the respondent is then asked the following question:
Do these health problems or disabilities, when taken singly or together, substantially limit your ability to carry out normal day-to-day activities? If you are receiving medication or treatment, please consider what the situation would be without the medication or treatment.
Yes/No
Respondents are classified as having a limiting persistent illness (disability) only if they answered yes to both questions. In terms of the questions, problems with mobility, dexterity, sight, speech and hearing, physical coordination, memory and the ability to concentrate may limit day-to-day activities.
The subjective nature of these questions means that responses are influenced by how respondents perceive their health. Measures of self-assessed health, including general health and the more functional assessment of limiting persistent illness, are influenced by an individual’s expectations with clear differences observed across socio-demographic factors such as age, sex, socio-economic position and area deprivation.
Self-assessed general health and limiting persistent illness (ONS, 2012, Manor et al., 2001) are linked to more objective measures of health, and have been shown to have value in predicting health care need/usage and subsequent mortality. Research evidence indicates people with poor self-assessed health (both general health and limiting persistent illness) die sooner than those who report their health more positively (Mossey and Shapiro, 1982; Idler and Benyamini, 1997; Miilunpalo et al., 1997; DeSalvo et al., 2006; Bopp et al., 2012; Ng et al., 2012).
In terms of morbidity (disability or poor health) the evidence is more limited. Studies have shown that self-assessed health, measured in terms of general health or limiting illness has some predictive value in the subsequent use of health and social care services. This is shown in increased physician visits (Miilunpalo et al., 1997), hospital admission and nursing home placement (Weinberger et al., 1986). Studies have also shown that poor self-assessed health correlates well with retirement due to disability or poor health (Pietilainen et al., 2011; Dwyer and Mitchell, 1999) and poor health outcomes (Lee, 2000).
Survey measurements of general health and limiting persistent illness are used globally to identify health inequality between administrative areas, inform health and social care service needs, indicate unmet care needs, and target and monitor the allocation of health care resources amongst population groups (Marmot, 2010). International organisations and networks such as the World Health Organisation, Eurostat and the Reves Network on Health Expectancy use this information to compare morbidity across countries, and to monitor trends over time.
Quality information about ONS health expectancies (185.7 Kb Pdf) is available on the ONS website.
Notes for background
- Please see background note 3 for details of questionnaire changes relating to the disability questions (from 2010 onwards), and how they might affect the DFLE estimates presented.
4. England
At birth
In 2009-11, Disability-Free Life Expectancy (DFLE) for males at birth was 63.9 years, for females it was longer at 64.4 years. Despite having shorter DFLE, males expect to spend a greater proportion of their lives (81.0%) free from disability, compared to females (77.8%).
When comparing the 2009-11 data with the nearest time period 2006-08, where no years overlap, the estimate for males has increased significantly by 0.6 years, from 63.3 years to 63.9 years. For females the DFLE estimate decreased by 0.1 of a year, from 64.5 years to 64.4 years.
DFLE has significantly increased for males at birth between 2006-08 and 2009-11. However, although DFLE increased it did not keep pace with the increase in life expectancy. The result of this is that males in 2009-11 can expect to live a further 0.4 years or a further 0.3 percentage points of their lives with a disability than in 2006-08. Females at birth in England can expect to live an additional year with a disability, or a further 1.0 percentage point of their lives with a disability.
At age 65
DFLE for both men and women at age 65 increased significantly between 2006-08 and 2009-11. For men the increase was 0.5 years to 10.5 years, and for women the increase was 0.6 years to 11.2 years. Most importantly, the number of years expected to live with a disability increased by 0.2 years for males and 0.1 years for women. Compared with 2006-08 men can expect to live an additional 0.6 percentage points of their remaining lives without a disability, for women it was an increase of 1.1 percentage points without a disability.
Nôl i'r tabl cynnwys5. Regions
At birth
In 2009-11, as at previous time points, there was considerable variation between the DFLE of different regions. There was a clear North-South divide, with the southern regions having higher DFLE. Figure 1 and 2 show how the regions differ from the England estimate.
Figure 1: Difference in DFLE estimates from the England average by region for males at birth, 2009-11
Source: Office for National Statistics
Figure 2: Difference in DFLE Estimates from the England average by Region for females at birth, 2009-11
Source: Office for National Statistics
At birth, for both males and females, the South East had the longest DFLE at 66.4 and 66.9 years respectively. The North East had the shortest DFLE at 60.7 years for males and 61.1 years for females. Females in the North East can expect to live a quarter of their shorter lives with a disability while in the South East females can only expect to live one fifth of their longer lives with a disability.
Table 1: DFLE, expected years with a disability, LE and proportion of life with a disability by region for males at birth, 2009-11
Years | ||||
Region /Country Name | DFLE | Expected years with a disability | LE | Proportion of life with a disability % |
North East | 60.7 | 16.8 | 77.5 | 21.7 |
North West | 61.4 | 16.0 | 77.4 | 20.7 |
Yorkshire and The Humber | 62.0 | 16.1 | 78.1 | 20.6 |
West Midlands | 62.7 | 15.8 | 78.4 | 20.1 |
East Midlands | 63.7 | 15.1 | 78.7 | 19.2 |
London | 64.5 | 14.8 | 79.3 | 18.7 |
East of England | 65.2 | 14.7 | 79.9 | 18.4 |
South West | 65.4 | 14.3 | 79.8 | 18.0 |
South East | 66.4 | 13.6 | 80.0 | 17.0 |
England | 63.9 | 15.0 | 78.9 | 19.0 |
Table source: Office for National Statistics | ||||
Notes: | ||||
1. Regions have been ordered by DFLE. | ||||
2. Figures may not sum due to rounding. |
Download this table Table 1: DFLE, expected years with a disability, LE and proportion of life with a disability by region for males at birth, 2009-11
.xls (34.8 kB)
Table 2: DFLE, expected years with a disability, LE and proportion of life with a disability by region for females at birth, 2009-11
Years | ||||
Region /Country Name | DFLE | Expected years with a disability | LE | Proportion of life with a disability % |
North East | 61.1 | 20.4 | 81.5 | 25.0 |
Yorkshire and The Humber | 62.0 | 20.0 | 82.0 | 24.4 |
North West | 62.1 | 19.4 | 81.5 | 23.8 |
East Midlands | 62.8 | 20.0 | 82.8 | 24.2 |
West Midlands | 63.6 | 19.0 | 82.6 | 23.0 |
London | 65.2 | 18.4 | 83.6 | 22.0 |
East of England | 66.1 | 17.4 | 83.6 | 20.9 |
South West | 66.3 | 17.5 | 83.7 | 20.9 |
South East | 66.9 | 16.8 | 83.8 | 20.1 |
England | 64.4 | 18.4 | 82.9 | 22.2 |
Table source: Office for National Statistics | ||||
Notes: | ||||
1. Regions have been ordered by DFLE. | ||||
2. Figures may not sum due to rounding. |
Download this table Table 2: DFLE, expected years with a disability, LE and proportion of life with a disability by region for females at birth, 2009-11
.xls (34.3 kB)At age 65
Regional data for those aged 65 can be found in the data section of this release. At age 65 the North-South divide is also present, as well as men having shorter DFLE but a higher proportion of their lives without a disability, compared to women.
Nôl i'r tabl cynnwys9. Conclusions
At the England level, men and women at age 65 have seen an increase in their DFLE, and the proportion of their remaining lives they can expect to live disability-free. This means those above age 65 are living longer and for a greater proportion of their lives without health conditions that disable them.
The improvements at age 65 are not reflected in the figures at birth. Although DFLE has significantly increased for males and has remained broadly stable for females, the proportion of expected life with a disability has increased. This increase in the proportion of life with disability is driven by faster increases in Life Expectancy than in DFLE. Taking England as a whole, males and females at birth in 2009-11 can expect to live more years with a disability than in 2006-08.
It is interesting that, while Life Expectancy has increased both at birth and at age 65 for males and females, it is only at birth that the proportion of life spent with a disability has increased. Therefore the increase in the proportion of life with disability at birth is largely down to an increase in disability rates among those under 65. So why did the health of those under 65 not increase in line with those over 65? One explanation, of many possible, is that the period 2009-11 falls entirely in a time of recession and slow recovery. 2009-11 was economically less favourable than 2006-08 (the data was collected largely before the effects of the banking crisis). It is feasible that the functional health (including conditions such as anxiety and depression) of those under 65 may have been more affected by pressures on individuals and households. These pressures were due to the weakening economy and a fall in living standards brought about by wage restraint. Those over 65 are more likely to be pensioners, not economically active and therefore less affected by the struggling economy. Data from a recent release on the effects of taxes and benefits on household income shows the income of pensioners has been largely protected compared to those of working age (ONS, 2014a).
A North-South divide was observed at birth and at age 65 for both sexes, with the North having lower rates of DFLE. The North East as a region has had the lowest rates of DFLE but encouragingly, for males at birth, four out of the nine UTLAs located in the North East had significant improvements between 2006-08 and 2009-11. However, despite this all nine UTLAs in the North East did not have a significantly higher DFLE than the England estimate for both sexes in 2009-11. In the South East, where DFLE estimates are amongst the highest in the country, almost half of all UTLAs had DFLEs that were significantly higher than the England estimate for both sexes.
A feature of the local authorities that have the lowest or highest DFLE is their link with measures of deprivation; those experiencing higher levels of deprivation (ONS, 2014b) have lower DFLE and vice versa. A consistent pattern of longer lives and smaller proportions of life spent in less favourable health states are associated with decreasing exposure to deprivation (ONS 2010, ONS 2013b). Health agencies place importance on deprivation as a measure of health, shown by its high prominence in health strategy documents such as the Public Health Outcomes Framework. Tackling deprivation is therefore a key goal in reducing the health divide between the least and most advantaged areas, while continuing to bring about health improvement for all.
Nôl i'r tabl cynnwys10. Methods
Calculating Disability-Free Life Expectancy
This is the second release of sub-national DFLE using revised mid-year population estimates based on the 2011 Census. Reference tables for the aggregate data 2006-08, 2007-09, 2008-10 and 2009-11, using revised mid-year population estimates, have been published alongside this report.
The data used in calculating the prevalence of disability was obtained from the Annual Population Survey (APS) and aggregated over a three-year period to achieve sufficiently large sample sizes to enable meaningful statistical comparison.
The prevalence of disability among males and females in private households in England was compared across regions and UTLAs. UTLAs include unitary authorities, London boroughs and metropolitan districts in England. This analysis excludes the City of London and the Isles of Scilly. DFLE was calculated using the Sullivan method. This method combines disability prevalence data with mortality and mid-year population estimates (MYPE) over the same period and geographical coverage to calculate estimates of LE and DFLE at birth and age 65 by sex ( ONS Life Table Template (192.5 Kb Excel sheet) , Jagger et al, 2007). The MYPEs used to estimate DFLE for this bulletin are the revised backdated estimates based on the 2011 Census.
The APS provides disability prevalence information for those over the age of 16. We are able to estimate DFLE at birth by directly imputing disability prevalence at age 16-19 for those under 16 (ONS, 2013a). The age band structure used for calculating DFLE is not that outlined in the update to the methodology to calculate health expectancies (ONS, 2013a). It is the age band structure of <1, 1-4, 5-9, 10-14, 15-19…85+.
Results are presented with 95% confidence intervals in reference tables to aid interpretation. Confidence intervals in this bulletin indicate the uncertainty surrounding DFLE estimates and allow more meaningful comparisons between areas. When comparing the estimates of two areas, non-overlapping confidence intervals are indicative of statistical significance but to confirm this, a test of significance should be carried out. When the statistical significance is noted in the text, this is based on a statistical test of the differences (Jagger et al, 2007). All differences noted in the text have been calculated to more than one decimal place.
Interpretation of DFLE
DFLE at a given age for a specific period and population, such as at birth among those residing in private households in UTLAs in 2008-10, is an estimate of the average number of years a person would live without a limiting illness (i.e. disability). This is only if they experienced the specified population’s age-specific mortality and disability rates for that time period throughout the rest of their life.
The figures reflect the mortality and health status of a population in a given time period residing in that area, rather than only those born in the area. It is not therefore the number of years that a person will actually expect to live free from disability. This is because both the death rates and health status of the specified population will change in the future, due to changing attitudes to health, availability of treatments, healthcare and people moving in and out of the area.
Results are comparable by age, sex and between specified populations as health expectancies take into account differences in the age structures of populations.
Nôl i'r tabl cynnwys11. Feedback
If you have any comments or suggestions, we’d like to hear them. Please email us at hle@ons.gov.uk.
Nôl i'r tabl cynnwys