Aging in good health: The inequalities are widening
UNIGE researchers have been analyzing the rise in healthy life expectancy in Switzerland since 1990 and measuring the differences based on an individual's level of education.
15 nov 2019--Life expectancy in Switzerland has been growing steadily for decades. But have these additional years been spent in good health or, on the contrary, do they only prolong the ills of an aging population? In an attempt to answer this question, researchers from the University of Geneva (UNIGE), Switzerland, collated data from the Swiss National Cohort (SNC) and the Swiss Health Surveys between 1990 and 2015, all within the framework of the "LIVES" National Centre of Competence in Research (NCCR LIVES). The results, which are published in the International Journal of Public Health, show that although the life expectancy of the Swiss population as a whole is growing, people who only attended compulsory schooling are living longer in poor health.
Between 1990 and 2015, the life expectancy of Swiss men rose from 78 to 82 years, while for Swiss women it increased from 83 to 86 years. But are these additional years of life spent in good health or do they only prolong the development of morbidity? "The principle of morbidity expansion means that, yes, life expectancy is on the rise, but that these same individuals are spending more years in poor health before they finally die," explains Adrien Remund, a researcher at the Institute of Demography and Socioeconomics in UNIGE's Faculty of Social Sciences (SDS), and first author of the study.
Over 11 million people tracked for 25 years
The UNIGE demographers and medical sociologists calculated the increase in Swiss life expectancy using data from the Swiss National Cohort (SNC), which records everyone who ever lived in Switzerland from 1990 to 2015. "This enabled us to track over 11,650,000 people, including migratory movements and 1.47 million deaths," states Michel Oris, a professor at the Institute of Demography and Socioeconomics. The researchers then cross-referenced this information with data from the Swiss Health Surveys (which took place every five years during the period 1990-2015) to ascertain how many years of healthy life expectancy the Swiss population had gained over 25 years.
"We found that the number of healthy years increases in parallel with life expectancy at national level," says Adrien Remund. Between 1950 and 2015, men lived five years longer, including 4.5 years in good health. Women, meanwhile, gained three years in good health, a figure identical to their increase in life expectancy. "Women have a smaller gap in increased life expectancy because they already live much longer, so the progression is necessarily lower than for men," explains Stéphane Cullati, a researcher in the SDS Institute of Sociological Research at UNIGE, where he works alongside Stefan Sieber, the study's co-author. But are these patterns identical across the entire Swiss population?
Level of education plays a role in expanding morbidity
The UNIGE researchers divided the Swiss population from 1990 to 2015 into three categories based on the socio-economic factor of education, depending on whether they completed compulsory, secondary or tertiary studies. They then once more cross-referenced the SNC and Swiss Health Survey data, whereupon they observed large differences both in the level of education and between men and women. "The data on men who have compulsory schooling shows that there was no increase in their healthy life expectancy in the 2000s: it stagnates at 73 years," says Adrien. The healthy life expectancy of men with secondary education increases continuously to reach 78 years in 2010, and for tertiary-educated men it climbs to 81 years. "The difference in years spent in good health between men with compulsory education and men with tertiary education is 7.6 in 1990, but 8.8 years in 2010, showing that the gap is widening," says the Geneva-based demographer.
For women who only attended compulsory schooling, their life expectancy in good health declined slightly from 1990 to 1995, before rising to 79 years in 2010. Women with secondary and tertiary-level education develop the same curve and see their healthy life expectancy rise to 84 in 2010. There is a difference of 3.3 years in 1990 and five years in 2010 between women with compulsory schooling and the others. "The gap between women with secondary and tertiary education is indistinguishable here because our data covers women born in the years 1920-1930, when access to higher education was restricted and few women worked. It would be interesting to repeat this survey in 50 years, now that women study and work just as much as men," notes Stéphane Cullati.
Why are there such differences?
The Organisation for Economic Co-operation and Development (OECD) has pointed to Switzerland as having an excellent health system for acute care but that there is room for improvement regarding the preventive system. "Our study supports the OECD finding since the difference between people with compulsory and tertiary education can be explained by socio-economic inequalities. These factors drive people on low incomes to put off—or abandon—regular checks with their doctor for as long as possible or to avoid screenings because they're too expensive and aren't covered by their health insurance," says professor Oris. "In fact, the less prevention there is, the less quickly the onset of chronic diseases can be detected, and the more rapidly our health deteriorates."
More information: Longer and healthier lives for all? Successes and failures of a universal consumer-driven healthcare system, Switzerland, 1990–2014, International Journal of Public Health (2019). DOI: 10.1007/s00038-019-01290-5
Provided by University of Geneva
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