Office for National Statistics

1. UPTAP Meeting University of Leeds, 21-23 March 2007 Decomposition of changes in disability-free life expectancy by cause. England, 1991-2001. Domenica Rasulo Office for National Statistics

2. Hosting research institute CASS Business School Faculty of Actuarial Science and Insurance City University MENTORS: Prof. Les Mayhew Dr. Ben Rickayzen MENTOR at ONS: Dr. M. Bajekal 12 months part-time fellowship (start date: 1 April 2007).

3. Disability-free life expectancy (DFLE) The DFLE provides the number of expected years of life without limiting illness affecting normal daily activities. It is computed using period life tables and disability-free rate from surveys (Sullivan 1971): For each age band, the number of survivors – provided by period life tables – is multiplied by the disability-free rate to obtain the number of survivors free-of disability.

4. Change in DFLE: Underlying factors t+n t Δt,t+n disability-free life expectancy Δ mortality rates Δ disability rates Δ causes of disability A recent study has provided a method to disentangle these effects (Nusselder & Looman 2004). This method has not been applied in UK yet.

5. Changes in DFLE in Great Britain and England between 1991 and 2001. Source: Office for National Statistics.

6. Research proposal Quantify the change in disability rate underlying the change in DFLE observed in England in the period 1991-2001. Identify the causes of disability most responsible for the change in DFLE. Identify the age bands whose change in causes of disability most contributed to the change in DFLE.

7. Data The Health Survey for England from 1991 to 2001 which includes questions on limiting-long term illness and causes of illness for each year. The General Household Survey for the available years in the decade (i.e., 1991-1996, 2001) to validate findings based on HsfE. Number of deaths by cause, age and sex and population at risk for each year in the period 1991-2001 (Office for National Statistics).

8. Methods Disability-free life expectancy from 1991 to 2001. Cause-specific death rates and cause-specific disability rates from 1991 to 2001 (ICD10 used as reference). Nusselder & Looman’s method (2004) to investigate the change in DFLE: • The method decomposes a difference in DFLE in the effect of mortality and disability. • The effects of mortality and disability are further decomposed by causes of death and disability. Comparison of the results using the HsfE and the GHS.

9. Policy relevance Research findings will help to understand: • Which causes of disability have mostly contributed to the change in DFLE • in the period 1991-2001 and these results may facilitate priority-setting in • health. • The relationship between an ageing population and the demand for health care. • Whether the increase of DFLE will increase the pressure on health and social care system.

10. Networking The fellowship will enable skills to be transferred from academia to government departments. Seminars will be organised at the Office for National Statistics to meet the wider community of government departments (DWP, DH, GAD). Networking opportunities will be expanded by participation at conferences in 2007 and 2008 (e.g., BSPS, REVES, European Population Conference).

11. Thank you