Contextual factors underpinning geographical inequalities in disability-free life expectancy in 100 French départements

Abstract

The objectives were to estimate disability-free life expectancy (DFLE) and life expectancy with disability (DLE) by gender for the 100 French départements (administrative geographical subdivisions) and to investigate associations with socioeconomic factors, supply of healthcare and services for older persons. DFLE and DLE at age 60 are estimated using the Sullivan method and based on the GALI indicator provided by the French cross-sectional survey Vie Quotidienne et Santé 2014. In 2014, DFLE for men and women aged 60 was 14.3 years and 15.6 years, respectively. Variations across départements were considerable (5.4 years for men, 6.7 years for women). Multivariate random effects meta-regression models indicated a negative association for men between DFLE and some of the socioeconomic contextual indicators (ratio of manual workers to higher-level occupations and unemployment rate); the level of in-home nursing services (HNS) was negatively associated with DFLE and density of nurses positively associated with DLE. Among women, ratio of manual workers to higher-level occupations, unemployment rate, proportion of the population living in large urban areas, density of nurses, and level of HNS were negatively associated with DFLE; density of physiotherapy supply was associated positively with DFLE and negatively with DLE. Our results suggest that geographical inequalities in health expectancies are significantly correlated with socioeconomic status and with healthcare supply, support for older persons, and urban environments, particularly among women. These results underline the importance of monitoring these indicators and disparities at infra-national-level, and of investigating their relations with local context, particularly the supply of healthcare and services.

Keywords: Disability; Disability-free life expectancy; Geographical inequalities; Healthcare supply; Mortality; Socioeconomic factors.

Fig. 1

Life expectancy (LE), disability-free life expectancy (DFLE), life expectancy with disability (DLE) at age 60, men and women, by département, 2014. VQS survey (60+), 2014, France

Fig. 2

Distribution of life expectancy (LE) at age 60 and ratio of DFLE to overall LE at age 60, by gender. VQS survey (60+), 2014, France. Note: A Men: x-axis (LE60) intersects y-axis (DFLE60/LE60) at the median value of y (= 62.1%); y-axis intersects x-axis at the median value of x (= 23.2 yrs); B Women: x-axis (LE60) intersects y-axis (DFLE60/LE60) at the median value of y (= 56.0%); y-axis intersects x-axis at the median value of x (= 28 years)