Comparison Of Three Methods For Constructing Healthy Days-Adjusted Life Expectancy

Background:Improving people’s health does not only mean prolonging life expectancy.The indicators reflecting the level of death(such as mortality,life expectancy at birth,etc.)cannot fully reflect the quality of life of people,therefore,we consider using Health-adjusted Life Expectancy(HALE)as a measurement.The purpose of this study is to take the data from Weifang City of Shandong Province as an example and adopt three methods,namely Sullivan method,GOM model method and synthetic method.To construct the Healthy Days-adjusted Life Expectancy(HDALE)based on the Health Related Quality of Life version 4(HRQOL-4).In this study,we compared and judged the advantages and disadvantages of various methods,thus to lay a foundation for the construction of new burden of disease summary indicators and to provide new ideas for burden of disease methodology.Methods:The health status data of residents based on HRQOL-4 scale were obtained by using the cross-sectional survey database of health status and behavioral risk factors of multi-stage stratified cluster sampling in Weifang City from 2018 to 2019.Sullivan method,GOM model and synthetic method were used to estimate the Health Status Weight(HSW)of different levels of health status obtained by HRQOL-4 scale.Combined with the death data of Weifang cause of death surveillance system from 2010 to 2017,the HDALE calculated by the above three methods and its proportion in life expectancy were estimated.Results:1)The crude mortality rate in Weifang City showed an overall upward trend from 2010 to 2017.The standardized mortality rate decreased overall in the past seven years in both male and female.In 2017,the crude mortality of men in all age groups was higher than that of women except 5-10 age-group.2)The total number of the subjects surveyed was 26614,among whom 51.58%were male.The proportions of“Health”among six indicators,namely“self-rated health”,"mentally unhealthy days","physically unhealthy days","total unhealthy days","daily activities limited" and "self-care ability limited",were 70.9%,95.0%,92.6%,91.3%,97.2%and 98.5%,respectively.The performance of these six indicators was similar in different genders.There were statistical differences between distributions in income,urban,rural,age,education levels.The results showed that the older the people,the lower the education level,the lower the income,and the people living in the city,the worse the health status.Other demographic characteristics,such as smoking,alcohol consumption,physical activity,or marital status,were not statistically significant related to health status.3)The HSW calculated by Sullivan method,GOM model method and synthetic method were slightly different,but the overall trend in different age groups is consistent.Except for special age groups(15-25 years old group),the HSW values of other age groups gradually increased with the increase of age,and the HSW values of women in different age groups were generally higher than men.The HSW value calculated by Sullivan method was relatively the smallest,the sum of three kinds of weight values calculated by GOM model method was the largest,and the synthetic method was in the middle.For people over 80 years old,the HSW values calculated by Sullivan method,GOM model method and synthetic method were 6.20%,12.02%and 7.99%respectively,and the HSW values calculated by GOM model for mild,moderate and severe were 6.55%,2.02%and 3.45%respectively.4)In 2017,the HD ALE calculated by Sullivan method,GOM model method and synthetic method of 65-70 years old people were 13.55 years old(95%CI:13.34-13.75),12.59 years old(95%CI:12.53-12.65)and 13.29 years old(95%CI:12.98-13.60),which accounted for 93.38%,86.77%and 91.59%of life expectancy(14.51 years old),respectively.There was no significant difference between Sullivan method and synthetic method.The results of GOM model and the other two methods were statistically significant.From different years,the trend of the three methods was basically the same.Among them,HD ALE calculated by Sullivan method and the synthetic method were stable,and there was no statistical significance in other years except 2010,which was lower.The results of GOM model in 2010 and 2013 were significantly lower than those of other years.Conclusions:The HSW and HDALE calculated by Sullivan method and synthetic method were similar,and the difference between these two methods was not statistically significant.The HSW estimated by GOM method was higher,and the HDALE was significantly lower.The HDALE proposed in this study is simple and easy to operate,which can provide a new idea for the construction of new disease burden index.