Inequalities in healthy life years in the 25 countries of the European Union in 2005: a cross-national meta-regression analysis

Background: Although life expectancy in the European Union (EU) is increasing, whether most of these extra years are spent in good health is unclear. This information would be crucial to both contain health-care costs and increase labour-force participation for older people. We investigated inequalities in life expectancies and healthy life years (HLYs) at 50 years of age for the 25 countries in the EU in 2005 and the potential for increasing the proportion of older people in the labour force. Methods: We calculated life expectancies and HLYs at 50 years of age by sex and country by the Sullivan method, which was applied to Eurostat life tables and age-specific prevalence of activity limitation from the 2005 statistics of living and income conditions survey. We investigated differences between countries through meta-regression techniques, with structural and sustainable indicators for every country. Findings: In 2005, an average 50-year-old man in the 25 EU countries could expect to live until 67·3 years free of activity limitation, and a woman to 68·1 years. HLYs at 50 years for both men and women varied more between countries than did life expectancy (HLY range for men: from 9·1 years in Estonia to 23·6 years in Denmark; for women: from 10·4 years in Estonia to 24·1 years in Denmark). Gross domestic product and expenditure on elderly care were both positively associated with HLYs at 50 years in men and women (p<0·039 for both indicators and sexes); however, in men alone, long-term unemployment was negatively associated (p=0·023) and life-long learning positively associated (p=0·021) with HLYs at 50 years of age. Interpretation: Substantial inequalities in HLYs at 50 years exist within EU countries. Our findings suggest that, without major improvements in population health, the target of increasing participation of older people into the labour force will be difficult to meet in all 25 EU countries. Funding: EU Public Health Programme.

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