Trends in life expectancy and healthy life years at birth and age 65 in the UK, 2008-2016, and other countries of the EU28: An observational cross-sectional study

Abstract

Background: As society ages, promoting the health of the extra years of life is of paramount importance for health, social care and pension provision. Increases in life expectancy in the UK and elsewhere have slowed in recent years, but the reasons for this are unclear. No formal comparison of trends in healthy life years between the UK and the other countries of the EU28 in recent times has been published. These countries are geographically proximate, and share many social, cultural and demographic properties, making them interesting and useful comparators, especially as the UK prepared to leave the European Union in 2020.

Methods: We calculated sex-specific healthy life years (HLY), unhealthy life years (ULY), mild and severe ULY at birth and age 65 using life tables and age-specific prevalence of activity limitation amongst the EU28 between 2008 and 2016 from EuroHex. Trends in life expectancy, HLY, ULY and proportion of life spent healthy (HLY%) were compared. We then decomposed HLY temporal changes into relative effects of changes in healthy life and mortality, by age group.

Findings: Life expectancy at birth, and age 65, in the UK were increasing rapidly in 2008 but slowed around 2011. Germany, Portugal and France showed evidence of a similar slowing. HLY at birth in the UK decreased, whereas it increased in most EU28 countries. The UK experienced a period of absolute expansion of unhealthy life in both sexes. The reduction in HLY at birth in the UK was mainly attributable to increases in unhealthy life in younger age groups.

Interpretation: The UK's performance relative to the other countries of the EU28 was poor after 2011, combining static life expectancy and reductions in healthy life years. These trends suggest that the UK government's Ageing Society Grand Challenge (to increase the healthy life expectancy by five years by 2035) will be difficult to attain.

Funding: National Institute for Health Research (NIHR) Policy Research Programme conducted through the NIHR Older People and Frailty Policy Research Unit, PR-PRU-1217-21502. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Fig. 1

Comparison of life expectancy at birth for men in the EU or UK in 2008 and 2016, ranked by 2008 values.

Fig. 2

Comparison of life expectancy at birth for women in the EU or UK in 2008 and 2016, ranked by 2008 values.

Fig. 3

Estimated simple linear model gradient of life expectancy at birth in the UK before and after 2011 compared to the other countries of the EU28 between 2008 and 2016. Those countries whose gradient changed significantly are represented by their pre- and post-changepoint gradients.

Fig. 4

Comparison of Healthy Life Years (HLY) at birth in EU and UK men in 2008 and 2016, ranked by 2008 values.

Fig. 5

Comparison of Healthy Life Years (HLY) at birth in EU and UK women in 2008 and 2016, ranked by 2008 values.

Fig. 6

Sex-specific change in HLY at birth between 2008 and 2016 for all countries of the EU28. Croatia omitted due to missing data before 2010.

Fig. 7

Life expectancy and HLY proportion at birth in 2016 in all countries of the EU28. Blue lines indicate sex-specific 80th percentiles for each dimension.

Fig. 8

Presence of absolute (Abs.) or relative (Rel.) compression (Comp) or expansion (Exp) of disability, or dynamic equilibrium (DE), for males and females of each country of the EU28 for the period 2008 to 2016. Simple linear gradients in LE and HLY over the study period were estimated (with 95% CI) for each country and compared. Red boxes indicate that LE gradient was significantly greater than HLY gradient, and blue indicates the opposite. Dynamic equilibrium was noted where 95% CI of LE and HLY gradients overlapped, ULY was increasing but severe ULY was not.

Fig. 9

Contribution of mortality and unhealthy life (reductions above zero, increases below zero) on changes in HLY at birth between 2008 and 2016, by gender for Austria, Luxemburg, UK (where HLY declined) and Germany and Italy (where HLY increased the most).