Trends in healthy life expectancy in the United States, 1970–1990: gender, racial, and educational differences

https://doi.org/10.1016/S0277-9536(00)00273-2Get rights and content

Abstract

This paper examines healthy life expectancy by gender and education for whites and African Americans in the United States at three dates: 1970, 1980 and 1990. There are large racial and educational differences in healthy life expectancy at each date and differences by education in healthy life expectancy are even larger than differences in total life expectancy. Large racial differences exist in healthy life expectancy at lower levels of education. Educational differences in healthy life expectancy have been increasing over time because of widening differentials in both mortality and morbidity. In the last decade, a compression of morbidity has begun among those of higher educational status; those of lower status are still experiencing expansion of morbidity.

Introduction

Inequality in health is one of the most important health issues facing low-mortality countries today. Socioeconomic status is related to virtually all health outcomes in most countries. People with more education or income live longer and experience fewer adverse health events. Differences in healthy life expectancy summarize the combined effects of different levels of mortality and morbidity on the overall length of healthy life and provide a good summary indicator of the total health impact of differences in socioeconomic well being.

Changes over time in healthy and unhealthy life expectancy can be used to measure the overall effect on population health of time trends in the processes of mortality and morbidity (Robine, Romieu, & Cambois, 1997). Differences in time trends by socioeconomic status can be evidence of inequality in health progress. Increases in life expectancy accompanied by an increased proportion of life spent healthy can be regarded as evidence of compression of morbidity; changes in life expectancy with a decreased proportion of life healthy can be evidence of an expansion of morbidity (Bone, Bebbington, & Nicholaas, 1998; Fries, 1981).

This paper examines healthy or disability-free life expectancy at three dates for racial and education subgroups in the United States. The major questions addressed include: how does healthy life expectancy differ among educational groups of the population and how have the differences changed over two decades? Did all educational segments experience the expansion of morbidity during the 1970s and the compression during the 1980s?

Section snippets

Differences in healthy life expectancy by socioeconomic status

There is ample evidence that healthy life expectancy differs dramatically by socioeconomic status in many countries of the world. Socioeconomic differences in healthy life expectancy have been generally found to be substantial and to exceed differences in total life expectancy (Bebbington, 1993; Bone, Bebbington, Jagger, Morgan, & Nicolaas, 1995; Kaprio, Sarna, Fogelholm, & Koskenvuo, 1996; Katz et al., 1983; Sihvonen, Kunst, Lahelma, Valkonen, & Mackenbach, 1998; Valkonen, Sihvonen, & Lahelma,

Educational status

Years of school completed or the length of formal education is used as the measure of socioeconomic status in this study because it represents the best indicator of lifetime socioeconomic status across age and over time. Formal education is completed at a relatively young age and stays constant for most people across the adult life. We limit our analysis to those 30 years of age and over, an age at which formal educational levels have been achieved by most adults. Educational status in most

Results

Differences and trends in healthy life expectancy are determined by the underlying differences and trends in mortality and disability. To begin, we examine differentials and changing differentials in these inputs to healthy life expectancy.

Acknowledgements

Support for this project was partially provided by a Grant from the AARP Andrus Foundation and Grant no. R01AG11235 from the National Institute on Aging and Grant no. 10-P98354-9 from the Social Security Administration. Assistance was provided by Jung Ki Kim, Ranyan Lu, Matthew Easterlin and Tomoko Saito.

References (45)

  • E Crimmins et al.

    Trends in health among the American population

  • E.M Crimmins et al.

    Changes in life expectancy and disability-free life expectancy in the United States

    Population and Development Review

    (1989)
  • E.M Crimmins et al.

    Trends in disability-free life expectancy in the United States, 1970-90

    Population and Development Review

    (1997)
  • H.O Duleep

    Measuring socioeconomic mortality differentials over time

    Demography

    (1989)
  • J.J Feldman et al.

    National trends in educational differentials in mortality

    American Journal of Epidemiology

    (1989)
  • J Fries

    Aging, natural death, and the compression of morbidity

    New England Journal of Medicine

    (1981)
  • J.M Guralnik et al.

    Educational status and active life expectancy among older blacks and whites

    New England Journal of Medicine

    (1993)
  • M.D Hayward et al.

    Racial inequality in active life expectancy

    Demography

    (1999)
  • C Jagger

    Health expectancy calculation by the Sullivan methodA practical guides.

    (1997)
  • J Kaprio et al.

    Total and occupationally active life expectancies in relation to social class and marital status in men classified as healthy at 20 in Finland

    Journal of Epidemiology and Community Health

    (1996)
  • S Katz et al.

    Active life expectancy

    New England Journal of Medicine

    (1983)
  • E.M Kitagawa et al.

    Differential mortality in the United StatesA study in socioeconomic epidemiology

    (1973)
  • View full text