Abstract

Background

Over the past century, life expectancy at birth in Canada has risen substantially. However, these gains in the quantity of life say little about gains in the quality of life.

Methods

Health-adjusted life expectancy (HALE), an indicator of quality of life, was estimated for the household and institutional populations combined every four years from 1994/1995 to 2015. Health status was measured by the Health Utilities Index Mark 3 instrument in two national population health surveys, and was used to adjust life expectancy. The percentage of the population living in health-related institutions was estimated based on the Census of Population. Attribute-deleted HALE was calculated to determine how various aspects of health status contributed to the differences between life expectancy and HALE.

Results

HALE has increased in Canada. Greater gains among males have narrowed the gap between males and females. The ratio of HALE to life expectancy changed little for males, and a marginal improvement was observed for females aged 65 or older. Mobility problems and pain, the latter mainly among females, accounted for an increased share of the burden of ill health over time. Exclusion of the institutional population significantly increased the estimates of HALE and yielded higher ratios of HALE to life expectancy.

Interpretation

Although people are living longer, the share of years spent in good functional health has remained fairly constant. Data for both the household and institutional populations are necessary for a complete picture of health expectancy in Canada.

Keywords

Gender differences, health expectancy, Health Utility Index, morbidity, mortality, summary measures of health

Findings

Over the past century, life expectancy at birth in Canada has risen substantially to 79.8 years for males, and 83.9 years for females. These increases in the quantity of life say little about the quality of life. How quality of life is keeping pace with the increase in life expectancy is an important health indicator. [Full Text]

Authors

Tracey Bushnik (tracey.bushnik@canada.ca) and Michael Tjepkema are with the Health Analysis Division and Laurent Martel is with the Demography Division at Statistics Canada, Ottawa, Ontario.

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What is already known on this subject?

  • Life expectancy has increased substantially in Canada over the past century
  • Life expectancy describes quantity of life, whereas health-adjusted life expectancy (HALE) describes quality of life
  • As of 2010, there has been little evidence of a faster increase in HALE than in life expectancy among the household population.

What does this study add?

  • Between 1994/1995 and 2015, HALE increased in Canada.
  • The gap between males and females in life expectancy and in HALE narrowed because of greater gains by males.
  • Males spent a larger share of their years of life in good functional health, compared with females.
  • The percentage of years in good functional health was relatively unchanged over time for males, with a marginal improvement for females aged 65 or older.
  • The importance of sensory problems declined, while mobility problems and pain accounted for an increased share of the burden of ill health.
  • Excluding the institutional population significantly increased estimates of HALE, resulting in higher ratios of HALE to life expectancy, particularly for people aged 65 or older.

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