Focus on disability-free life expectancy: implications for health-related quality of life

doi:10.1007/s11136-021-02809-1

. 2021 Aug;30(8):2187-2195.

doi: 10.1007/s11136-021-02809-1. Epub 2021 Mar 17.

Focus on disability-free life expectancy: implications for health-related quality of life

Ashley E Galvin^{1

2}, Daniela B Friedman^{1

3

4}, James R Hébert^{5

6}

Affiliations

¹ Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Suite 241-2, Columbia, SC, 29208, USA.
² Pediatric Hematology-Oncology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02215, USA.
³ Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
⁴ Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
⁵ Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Suite 241-2, Columbia, SC, 29208, USA. jhebert@sc.edu.
⁶ Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene St, Columbia, SC, 29208, USA. jhebert@sc.edu.

PMID: 33733432
PMCID: PMC7970769
DOI: 10.1007/s11136-021-02809-1

Focus on disability-free life expectancy: implications for health-related quality of life

Ashley E Galvin et al. Qual Life Res. 2021 Aug.

. 2021 Aug;30(8):2187-2195.

doi: 10.1007/s11136-021-02809-1. Epub 2021 Mar 17.

Authors

Ashley E Galvin^{1

2}, Daniela B Friedman^{1

3

4}, James R Hébert^{5

6}

Affiliations

¹ Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Suite 241-2, Columbia, SC, 29208, USA.
² Pediatric Hematology-Oncology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02215, USA.
³ Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
⁴ Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
⁵ Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Suite 241-2, Columbia, SC, 29208, USA. jhebert@sc.edu.
⁶ Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene St, Columbia, SC, 29208, USA. jhebert@sc.edu.

PMID: 33733432
PMCID: PMC7970769
DOI: 10.1007/s11136-021-02809-1

Abstract

Background: Since the end of the industrial revolution, advances in public health and clinical medicine have contributed to dramatic decreases in infant and childhood mortality, improvements in health-related quality of life (HRQoL), increases in overall life expectancy (LE), and rectangularization of survival curves.

Objectives: In this article, we focus on disability that has occurred with the overall lengthening of LE in many populations and the implications this has for decreased HRQoL.

Methods: We utilize the concept of rectangularization of population survival to depict the rising prevalence of disability associated with increased LE, especially among racial and ethnic minorities and people of low socioeconomic status (SES) and relate this to HRQoL.

Results: Disability-free life expectancy (DFLE) and healthy life expectancy (HLE) are defined in terms of HRQoL. Specific attention is focused on disability experienced by disparate populations around the globe. By focusing on disparities in DFLE, and the need to expand LE to include HLE as a central component of HRQoL, this work provides an important counterpoint to the attention that has been paid to LE disparities according to race, gender, ethnicity, education, and SES.

Discussion: By calling attention to those factors that appear to be the most important drivers of the differences in quality and length of DFLE between different groups (i.e., the components of the social gradient, exposure to chronic stress, systemic inflammation, and the psychological and biological mechanisms associated with the gut-brain axis) and, by logical extension, HRQoL, we hope to promote research in this arena with the ultimate goal of improving DFLE, HLE, and overall HRQoL, especially in disparate populations around the globe.

Keywords: Chronic inflammation; Chronic stress; Disability; Discrimination; Health-related quality of life; Social determinants.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

**Fig. 1**
Rectangularization of survival curves accompanied by morbidity: the degradation of HRQoL with age

See this image and copyright information in PMC

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References

1. Rosenkrantz B. Public health and the state: Changing views in Massachusetts, 1842–1936. Harvard University; 1972.
1. Love-Koh J, Asaria M, Cookson R, Griffin S. The social distribution of health: estimating quality-adjusted life expectancy in England. Value Health. 2015;18(5):655–662. doi: 10.1016/j.jval.2015.03.1784. - DOI - PubMed
1. Modig K, Drefahl S, Ahlbom A. Limitless longevity: Comment on the Contribution of rectangularization to the secular increase of life expectancy. International Journal of Epidemiology. 2013;42(3):914–916. doi: 10.1093/ije/dyt035. - DOI - PMC - PubMed
1. Chirinda W, Chen H. Comparative study of disability-free life expectancy across six low- and middle-income countries. Geriatrics & Gerontology International. 2017;17(4):637–644. doi: 10.1111/ggi.12748. - DOI - PubMed
1. Roser, M., Ortiz-Ospina, E., Ritchi, H. (2020) “Life Expectancy”. Retrieved from: https://ourworldindata.org/life-expectancy [Online Resource]. Oxford, UK: University of Oxford.

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[1] Rosenkrantz B. Public health and the state: Changing views in Massachusetts, 1842–1936. Harvard University; 1972.

[2] Rosenkrantz B. Public health and the state: Changing views in Massachusetts, 1842–1936. Harvard University; 1972.

[3] Love-Koh J, Asaria M, Cookson R, Griffin S. The social distribution of health: estimating quality-adjusted life expectancy in England. Value Health. 2015;18(5):655–662. doi: 10.1016/j.jval.2015.03.1784. - DOI - PubMed

[4] Love-Koh J, Asaria M, Cookson R, Griffin S. The social distribution of health: estimating quality-adjusted life expectancy in England. Value Health. 2015;18(5):655–662. doi: 10.1016/j.jval.2015.03.1784. - DOI - PubMed

[5] Modig K, Drefahl S, Ahlbom A. Limitless longevity: Comment on the Contribution of rectangularization to the secular increase of life expectancy. International Journal of Epidemiology. 2013;42(3):914–916. doi: 10.1093/ije/dyt035. - DOI - PMC - PubMed

[6] Modig K, Drefahl S, Ahlbom A. Limitless longevity: Comment on the Contribution of rectangularization to the secular increase of life expectancy. International Journal of Epidemiology. 2013;42(3):914–916. doi: 10.1093/ije/dyt035. - DOI - PMC - PubMed

[7] Chirinda W, Chen H. Comparative study of disability-free life expectancy across six low- and middle-income countries. Geriatrics & Gerontology International. 2017;17(4):637–644. doi: 10.1111/ggi.12748. - DOI - PubMed

[8] Chirinda W, Chen H. Comparative study of disability-free life expectancy across six low- and middle-income countries. Geriatrics & Gerontology International. 2017;17(4):637–644. doi: 10.1111/ggi.12748. - DOI - PubMed

[9] Roser, M., Ortiz-Ospina, E., Ritchi, H. (2020) “Life Expectancy”. Retrieved from: https://ourworldindata.org/life-expectancy [Online Resource]. Oxford, UK: University of Oxford.

[10] Roser, M., Ortiz-Ospina, E., Ritchi, H. (2020) “Life Expectancy”. Retrieved from: https://ourworldindata.org/life-expectancy [Online Resource]. Oxford, UK: University of Oxford.

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Focus on disability-free life expectancy: implications for health-related quality of life

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Focus on disability-free life expectancy: implications for health-related quality of life

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