Estimating health expectancy in presence of missing data: an application using HID survey
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Estimating health expectancy in presence of missing data: an application using HID survey Cristina Giudici · Maria Felice Arezzo · Nicolas Brouard
Accepted: 21 June 2013 © Springer-Verlag Berlin Heidelberg 2013
Abstract In this article we estimate health transition probabilities using longitudinal data collected in France for the survey on handicaps, disabilities and dependencies from 1998 to 2001. Life expectancies with and without disabilities are estimated using a Markov-based multi-state life table approach with two non-absorbing states: able to perform all activities of daily living (ADLs) and unable or in need of help to perform one or more ADLs, and the absorbing state of death. The loss of follow-up between the two waves induces biases in the probabilities estimates: mortality estimates were biased upwards; also the incidence of recovery and the onset of disability seemed to be biased. Since individuals were not missing completely at random, we correct this bias by estimating health status for drop-outs using a non parametric model. After imputation, we found that at the age of 70 disability-free life expectancy decreases by 0.5 years, whereas the total life expectancy increases by 1 year. The slope of the stable prevalence increases, but it remains lower than the slope of the cross sectional prevalence. The gender differences on life expectancy did not change significantly after imputation. Globally, there is no evidence of a general reduction in ADL disability, as defined in our study. The added value of the study is the reduction of the bias induced by sample attrition.
C. Giudici · M. F. Arezzo (B) Department of Methods and Models for Economics, Territory and Finance, Sapienza, University of Rome, Via del Castro Laurenziano, 9, 00161 Rome, Italy e-mail: [email protected] C. Giudici e-mail: [email protected] N. Brouard Institut National d’Etudes Démographiques (INED), Boulevard Davout, 133, 75020 Paris, France
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Keywords Healthy life expectancy · Classification and regression trees · Sample attrition 1 Introduction The debate on aging in Europe is currently paying considerable attention on healthy life expectancy (HLE) of the elderly. Following the approach of the World Health Organization (WHO), health should be considered as having a dynamic nature,1 and should be taken into consideration in the context of life, as the ability to fulfill actions or to carry out a certain role in society. This is the so-called functional approach, taken by the WHO in the elaboration of the international frame of reference on the matter. The most suitable indicator to measure the state of health of a population is health expectancy, which measures the length of life spent in different states of health. The term is often used in a general sense for all indicators of health expressed in terms of expectancy, but the definition most frequently used in Europe is that of disabilityfree life expectancy (Perenboom 2003), where disability is defined as the impact of disease or in
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