Summary measures based on potential years of life lost (PYLL) to death and to illness would complement population health measures such as health-adjusted life expectancy. These measures can be applied to deaths and to conditions that are considered amenable to treatment by the health care system.
Data and methods
Life tables for 2007 to 2009 were used to calculate health-adjusted potential years of life lost (HAPYLL) for males and females from birth to age 75 for Canada and the provinces. Mortality rates for all causes were adjusted using the Health Utility Index 3 (HUI3) as a measure of the average value of a year in ill health. Average HUI3 was calculated for each age group for selected health conditions self-reported in the 2009/2010 Canadian Community Health Survey. HAPYLL was estimated by adding the average number of years lost due to treatable causes of death (treatable PYLL) to the average number of years lost because of ill health (HUI3 gap).
More years of life are lost because of ill health than are lost because of premature death. During the 2007-to-2009 period, age-/sex-standardized PYLL due to treatable causes of death was 1,257 years per 100,000 person-years, while the age-/sex-standardized HUI3 gap was 6,477 years. Provincial rankings change when information on deaths is combined with information on ill health.
The impact of treatable conditions is greater in terms of quality of life lost than in life-years lost.
Health Utility Index, summary measures of health, treatable mortality
In 1996, Wolfson proposed a method of measuring health-adjusted life expectancy (HALE), based on vital statistics and survey data.1 The concept of HALE had been introduced in Canada in 1993 by Berthelot et al.2 and applied worldwide by Romieu and Robine.3 The proposal was in response to a recommendation by the 1991 National Task Force on Health Information that Canada should use a synthetic measure of average population health, which combined mortality and morbidity, to examine trends in population health, inform health policy, and monitor health system performance. Any synthetic measure of average population health is a function of many determinants beyond health care, but it is possible that deterioration in the measure could signal a problem in the health care system of a country. [Full Text]
Sara Allin (email@example.com), Erin Graves, Diana Ridgeway and Li Wang are with the Canadian Institute for Health Information, Toronto, Ontario M2P 2B7. Michel Grignon is with McMaster University, Hamilton, Ontario.
- Health-adjusted life expectancy (HALE) is a widely used summary measure of health that combines information on mortality and morbidity.
- Health gaps are alternative summary measures that allow calculation of the gap attributable to specific health problems.
- This study addresses the key limitations of both HALE and disability-adjusted life years by developing a new summary measure of health—health-adjusted potential years of life lost from causes of death and from conditions that are considered treatable.
- The advantage of this measure is that it draws on the Health Utility Index 3 to allow for a continuous measure of morbidity.
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