........................................................................................... Health Monitoring ........................................................................................... Health expectancy in Denmark, 1987–2000 Henrik Brønnum-Hansen Background: While life expectancy quantifies average length of life, health expectancy represents the average lifetime in different health states and offers the possibility to evaluate quality of life with respect to health. The purpose of the study was to estimate changes in health expectancy in Denmark from 1987 to 2000 and to assess theories about the relation between increased total lifetime and lifetime in various health states. Methods: Data on health status derived from the Danish Health Interview Surveys carried out in 1987, 1991, 1994 and 2000 were combined with life-table data. Expected lifetime in selfrated good health, life expectancy without longstanding illness and disabilityfree life expectancy were estimated by Sullivan’s method. Results: In 1987, the life expectancy of a 65-year-old man was 14.1 years, 8.9 years of which were expected to be disabilityfree. In 2000, life expectancy had increased to 15.0 years, 11.3 years of which were disabilityfree. Thus, life expectancy had increased by 0.9 years, whereas disabilityfree life expectancy had increased by 2.4 years. Among 65-year-old women, life expectancy had increased by 0.2 years and disabilityfree life expectancy by 1.1 years. Expected lifetime in selfrated good health had also improved, but the trend in life expectancy without longstanding illness went in the opposite direction, and expected lifetime with longstanding illness had increased. Conclusion: The recent rise in life expectancy in Denmark after many years of stagnation appears to be accompanied by generally improved health status among the elderly, but health expectancy trends depend on the health indicator chosen. Keypoints † Health expectancy expresses average lifetime in various states of health. † The study examines changes in expected lifetime in selfrated good health, lifetime without longstanding illness and lifetime without longterm disability. † Among 65-year-olds the percentage of disabilityfree life expectancy increased from 63.4% to 74.9% for men and from 55.6% to 61.0% for women between 1987 and 2000. † Health status among elderly Danes has apparently improved, but secular trends in health expectancy depend on the choice of health indicator. Keywords: Denmark, health expectancy, life expectancy ........................................................................................... A n earlier Danish study of trends in health expectancy, i.e. average lifetime in various states of health, concluded that expected lifetime in selfrated good health among men and longterm disabilityfree life expectancy among elderly men improved between 1987 and 1994, whereas no improvement was seen among women. 1 But life expectancy without long- standing illness did not improve for men, and the expected lifetime of women with longstanding illness even increased. 1 In Denmark, life expectancy has not changed much since the 1970s, 2 and, in fact, the life expectancy of Danish men has stagnated since the 1950s. At the end of the century, however, life expectancy began to increase (figure 1). This new development may also be reflected in health expectancy. But longer life and improved health do not necessarily go together. Life-prolonging treatment of fatal or chronic diseases increases life expectancy but can hardly be said to increase expected lifetime in good health at the population level unless the incidence of the diseases declines. Improved population health also does not necessarily extend life expectancy, but postpone- ment of the onset of chronic disease prolongs lifetime in good health. Three main theories about the relationship between increasing life expectancy and expected lifetime without chronic diseases or disability have been discussed since the 1980s. The claim that postponement of death aggravates chronic diseases is called the ‘pandemic of mental disorders, chronic diseases and disabilities’ 3 or the ‘expansion of morbidity hypothesis’. 4 The opposite view is the hypothesis of ‘compression of morbidity’, arguing that length of life has an upper limit but onset of chronic diseases is delayed. Therefore lifetime with morbidity is compressed into a shorter period. 5 The third assertion is that of ‘dynamic equilibrium’ according to which mortality declines and prevalence of chronic diseases increases. But the diseases will generally be less severe. 6 Thus, longer life may involve more healthy years as well as more unhealthy years, and besides examining the absolute lifetime in different states of health the theories can be described by relating healthy lifetime to life expectancy, as we would expect this proportion to decline (expansion), increase (compression) or change depending on severity of diseases (equilibrium). Robine et al. discussed the theories in the light of the development of disabilityfree life expectancy in six countries 7 and the conclusion tends to support the theory of dynamic equilibrium. The present study updates the previous paper on trends in health expectancy in Denmark 1 and comprises data from four health interview surveys. It specifically examines whether the development supports the hypothesis of expansion, com- pression or equilibrium. Funding: The Danish Ministry of Health grant for research and analysis. Correspondence: Henrik Brønnum-Hansen, National Institute of Public Health, Øster Farimagsgade 5, DK-1399, Copenhagen K, Denmark, tel: +45 39 20 77 77, fax: +45 39 20 80 10, e-mail: hbh@niph.dk European Journal of Public Health, Vol. 15, No. 1, 20–25 European Journal of Public Health, Vol. 15, No. 1, q European Public Health Association 2005; all rights reserved Doi: 10.1093/eurpub/cki106 Downloaded from https://academic.oup.com/eurpub/article-abstract/15/1/20/506599 by guest on 09 December 2018