Rami Cosulich

Despite extensive research on educational inequalities in healthy life expectancy (HLE), most studies focus on average differences, leaving open how healthy longevity is distributed within educational groups. This study examines sex-specific educational differences in healthy longevity distributions at age 60 in Europe, using multiple health measures. We combined data from the Survey of Health, Ageing and Retirement in Europe (SHARE) with Eurostat life expectancy data (2016-2017). A Markov chain model combined with the maximum entropy method was used to estimate distributions of age at the end of healthy lifespan. Educational differences were formally compared using the healthy lifespan outsurvival statistic and the Hellinger distance. High education was often associated with more negatively skewed healthy longevity distributions. Men with low education had higher healthy lifespan variation than men with high education. Across all health measures for women, and most health measures for men, the probability that a person with low education had a longer healthy lifespan than a person of the same sex with high education was below 50%. However, a lack of statistical significance indicated that this finding did not apply to men for life free from cardiovascular conditions or a broad range of chronic conditions. By moving beyond average values and adopting a distributional perspective, this study highlights important dimensions of health inequality that are not captured by mean-based measures alone such as HLE. The findings also point to the need for further methodological development in the estimation of healthy longevity distributions.

Background: Past workplace exposure to asbestos in combination with tobacco smoking has increased the risk of lung cancer for some residents in an area within the Friuli Venezia Giulia region, Northeast Italy. In light of studies showing that lung cancer screening (LCS) with low-dose computed tomography (LDCT) can reduce mortality, local stakeholders and decision-makers decided to assess the potential benefits, harms and cost-effectiveness of a single round of LCS with LDCT versus standard care among people aged 55 to 80 who were formerly exposed to asbestos and with at least 10 pack-years of smoking. Methods: An economic model was developed using a decision tree connected to a Markov cohort model. The primary outcome was the incremental cost per additional quality-adjusted life year (QALY). Other outcomes included the number of life years saved, the number of deaths averted and overdiagnosis. Results: Per 10,000 people screened, the intervention led to 395 additional QALYs (95% credible interval: 129 to 831) and incremental total costs of EUR 1,086,345 (95% credible interval: −852,607 to 2,155,826). The incremental cost per QALY gained was EUR 2750. There was a probability of cost-effectiveness of 99.5% relative to a threshold of EUR 25,000. Conclusions: The model estimated that the intervention was cost-effective. The model’s simplifications and limitations should be considered when interpreting the findings in relation to policy-making decisions. Further research could include the costs and benefits of incidental findings and could assess the cost-effectiveness of repeated rounds of screening for the same population.

Background: The literature on healthy longevity has typically focused on average values (i.e., healthy life expectancy). Recent studies have started to expand this focus by investigating the whole healthy lifespan distribution, especially the standard deviation of healthy longevity, which captures inter-individual variation. Despite these advancements, research gaps remain on how distributions differ by health indicator and sex. This study aimed to compare healthy longevity distributions at age 60 between different health measures and sexes. Methods: We used data from the Survey of Health, Ageing and Retirement in Europe and the Human Mortality Database. A Markov chain model was used to estimate the first three statistical moments of healthy longevity distributions. The maximum entropy method was then applied to derive the full distributions. The healthy lifespan outsurvival statistic and the Hellinger distance were used to compare distributions between males and females. Results: For most health measures, the probabilities of health loss at younger ages were higher for males than for females, and females had a longer healthy life expectancy. Males had more dispersed distributions with a lower mode. For most health measures, healthy longevity distributions were negatively skewed, with a mode age (i.e., the age with the highest probability of health loss) higher than the healthy life expectancy age. The probability for a man to have a longer healthy lifespan than a female was below 50% for various health measures and was the lowest for living free of cardiovascular disease. In contrast, the probability for a man to live free of arthritis or rheumatism for longer than a female was above 50%. The most similar distributions between males and females were observed with life free of any chronic conditions and life with no more than one chronic condition. Conclusions: This study extended the scope of healthy longevity research by complementing a focus on the statistical moments with observations on the mode of the distributions and with formal comparisons based on the healthy lifespan outsurvival statistic and the Hellinger distance, which are applied for the first time in the healthy longevity field.