Health-Adjusted Life Expectancy among Canadian Adults with and without Hypertension

Hypertension can lead to cardiovascular diseases and other chronic conditions. While the impact of hypertension on premature death and life expectancy has been published, the impact on health-adjusted life expectancy has not, and constitutes the research objective of this study. Health-adjusted life expectancy (HALE) is the number of expected years of life equivalent to years lived in full health. Data were obtained from the Canadian Chronic Disease Surveillance System (mortality data 2004–2006) and the Canadian Community Health Survey (Health Utilities Index data 2000–2005) for people with and without hypertension. Life table analysis was applied to calculate life expectancy and health-adjusted life expectancy and their confidence intervals. Our results show that for Canadians 20 years of age, without hypertension, life expectancy is 65.4 years and 61.0 years, for females and males, respectively. HALE is 55.0 years and 52.8 years for the two sexes at age 20; and 24.7 years and 22.9 years at age 55. For Canadians with hypertension, HALE is only 48.9 years and 47.1 years for the two sexes at age 20; and 22.7 years and 20.2 years at age 55. Hypertension is associated with a significant loss in health-adjusted life expectancy compared to life expectancy

Depression and health-adjusted life expectancy in the Canadian adult population: a descriptive study

Background: Few studies have evaluated the overall population health-related impact of depression in terms of losses to both premature mortality and health-related quality of life (HRQL). Purpose: To estimate health-adjusted life expectancy (HALE) for Canadian adults according to depression status

Portrait de la compression et de l'expansion de la morbidité au Canada : évolution de l'espérance de vie et de l'espérance de vie ajustée en fonction de la santé, 1994-2010

Introduction : Notre étude visait à examiner s'il y a eu une expansion ou une compression de la morbidité au Canada, à l'échelle tant nationale que provinciale, en suivant l'évolution de l'espérance de vie (EV) et de l'espérance de vie ajustée en fonction de la santé (EVAS) entre 1994 et 2010. Une « compression », qui correspond à une diminution de la proportion de la vie marquée par des problèmes de santé, survient lorsque l'EVAS augmente plus rapidement que l'EV. Inversement, une « expansion », qui désigne une augmentation de la proportion de la vie marquée par des problèmes de santé, survient lorsque l'EVAS est stable ou augmente plus lentement que l'EV. Méthodologie : Nous avons estimé l'EV à l'aide des données de Statistique Canada sur la mortalité et sur la population. Nous avons utilisé les données sur la qualité de vie liée à la santé (c.-à-d. morbidité) de l'Enquête nationale sur la santé de la population (1994-1999) et de l'Enquête sur la santé dans les collectivités canadiennes (2000-2010) pour calculer l'EVAS. Nous avons établi des tables de mortalité abrégées pour sept intervalles de temps correspondant aux cycles d'enquête disponibles durant la période de 1994 à 2010, ainsi que pour les deux sexes et les dix provinces canadiennes. Les tendances nationales et provinciales ont été examinées à la naissance, à 20 ans et à 65 ans. Résultats : Dans l'ensemble, nous avons constaté une hausse annuelle moyenne statistiquement significative de l'EVAS chez les deux sexes aux trois âges évalués, sauf chez les nouveau-nés de sexe féminin. L'EVAS à la naissance a augmenté en moyenne par année, entre 1994 et 2010, de 0,2 % (p = 0,08) chez les sujets de sexe féminin et de 0,3% (p < 0,001) chez ceux de sexe masculin. À l'échelle nationale, les trois groupes d'âge ont présenté une augmentation annuelle moyenne non statistiquement significative de la proportion de la vie marquée par des problèmes de santé, sauf les hommes de 65 ans, qui ont présenté une diminution non significative. À l'échelle provinciale, nous avons observé une augmentation significative de la proportion de la vie marquée par des problèmes de santé à Terre-Neuve-et-Labrador et à l'Île-du-Prince-Édouard. Conclusion : Notre étude n'a fait ressortir aucune tendance générale nette indiquant une compression ou une expansion de la morbidité à l'échelle nationale au Canada entre 1994 et 2010. Nos résultats indiquent qu'il y a eu une expansion de la morbidité à Terre-Neuve-et-Labrador et à l'Île-du-Prince-Édouard. L'étude a mis en évidence l'importance de continuer à suivre les tendances à long terme concernant l'EV et l'EVAS pour vérifier la présence d'une compression ou d'une expansion de la morbidité. D'autres études devraient être entreprises pour éclaircir les causes de l'expansion de la morbidité observée à Terre-Neuve-et-Labrador et à l'Île-du-Prince-Édouard

Evaluating compression or expansion of morbidity in Canada: trends in life expectancy and health-adjusted life expectancy from 1994 to 2010

Introduction: The objective of this study was to investigate whether morbidity in Canada, at the national and provincial levels, is compressing or expanding by tracking trends in life expectancy (LE) and health-adjusted life expectancy (HALE) from 1994 to 2010. "Compression" refers to a decrease in the proportion of life spent in an unhealthy state over time. It happens when HALE increases faster than LE. "Expansion" refers to an increase in the proportion of life spent in an unhealthy state that happens when HALE is stable or increases more slowly than LE. Methods: We estimated LE using mortality and population data from Statistics Canada. We took health-related quality of life (i.e. morbidity) data used to calculate HALE from the National Population Health Survey (1994-1999) and the Canadian Community Health Survey (2000-2010). We built abridged life tables for seven time intervals, covering the period 1994 to 2010 and corresponding to the year of each available survey cycle for females and males and for each of the 10 Canadian provinces. National and provincial trends were assessed at birth, and at ages 20 years and 65 years. Results: We observed an overall average annual increase in HALE that was statistically significant in both Canadian females and males at each of the three ages assessed, with the exception of females at birth. At birth, HALE increased an average of 0.2% (p = .08) and 0.3% (p < .001) annually for females and males respectively over the 1994 to 2010 period. At the national level for all three age groups, we observed a statistically non-significant average annual increase in the proportion of life spent in an unhealthy state, with the exception of men at age 65, who experienced a non-significant decrease. At the provincial level at birth, we observed a significant increase in proportion of life spent in an unhealthy state for Newfoundland and Labrador (NL) and Prince Edward Island (PEI). Conclusion: Our study did not detect a clear overall trend in compression or expansion of morbidity from 1994 to 2010 at the national level in Canada. However, our results suggested an expansion of morbidity in NL and PEI. Our study indicates the importance of continued tracking of the secular trends of life expectancy and HALE in Canada in order to verify the presence of compression or expansion of morbidity. Further study should be undertaken to understand what is driving the observed expansion of morbidity in NL and in PEI

Early Experience Analyzing Dietary Intake Data from the Canadian Community Health Survey—Nutrition Using the National Cancer Institute (NCI) Method

Background: One of the underpinning elements to support evidence-based decision-making in food and nutrition is the usual dietary intake of a population. It represents the long-run average consumption of a particular dietary component (i.e., food or nutrient). Variations in individual eating habits are observed from day-to-day and between individuals. The National Cancer Institute (NCI) method uses statistical modeling to account for these variations in estimation of usual intakes. This method was originally developed for nutrition survey data in the United States. The main objective of this study was to apply the NCI method in the analysis of Canadian nutrition surveys. Methods: Data from two surveys, the 2004 and 2015 Canadian Community Health Survey&mdash;Nutrition were used to estimate usual dietary intake distributions from food sources using the NCI method. The effect of different statistical considerations such as choice of the model, covariates, stratification compared to pooling, and exclusion of outliers were assessed, along with the computational time to convergence. Results: A flowchart to aid in model selection was developed. Different covariates (e.g., age/sex groups, cycle, weekday/weekend of the recall) were used to adjust the estimates of usual intakes. Moreover, larger differences in the ratio of within to between variation for a stratified analysis or a pooled analysis resulted in noticeable differences, particularly in the tails of the distribution of usual intake estimates. Outliers were subsequently removed when the ratio was larger than 10. For an individual age/sex group, the NCI method took 1 h&ndash;5 h to obtain results depending on the dietary component. Conclusion: Early experience in using the NCI method with Canadian nutrition surveys data led to the development of a flowchart to facilitate the choice of the NCI model to use. The ability of the NCI method to include covariates permits comparisons between both 2004 and 2015. This study shows that the improper application of pooling and stratification as well as the outlier detection can lead to biased results. This early experience can provide guidance to other researchers and ensures consistency in the analysis of usual dietary intake in the Canadian context

Impact of diabetes mellitus on life expectancy and health-adjusted life expectancy in Canada

<p>Abstract</p> <p>The objectives of this study were to estimate life expectancy (LE) and health-adjusted life expectancy (HALE) for Canadians with and without diabetes and to evaluate the impact of diabetes on population health using administrative and survey data.</p> <p>Mortality data from the Canadian Chronic Disease Surveillance System (2004 to 2006) and Health Utilities Index data from the Canadian Community Health Survey (2000 to 2005) were used. Life table analysis was applied to calculate LE, HALE, and their confidence intervals using the Chiang and the adapted Sullivan methods.</p> <p>LE and HALE were significantly lower among people with diabetes than for people without the disease. LE and HALE for females without diabetes were 85.0 and 73.3 years, respectively (males: 80.2 and 70.9 years). Diabetes was associated with a loss of LE and HALE of 6.0 years and 5.8 years, respectively, for females, and 5.0 years and 5.3 years, respectively, for males, living with diabetes at 55 years of age. The overall gains in LE and HALE after the hypothetical elimination of prevalent diagnosed diabetes cases in the population were 1.4 years and 1.2 years, respectively, for females, and 1.3 years for both LE and HALE for males.</p> <p>The results of the study confirm that diabetes is an important disease burden in Canada impacting the female and male populations differently. The methods can be used to calculate LE and HALE for other chronic conditions, providing useful information for public health researchers and policymakers.</p