Measuring health expectancy in the European Union

Abstract Background Healthy life expectancy (HLE) is a population health measure that combines mortality and morbidity, which can be calculated using different methods. In this study, we aimed to assess the correlation, reliability and (dis)agreement between two estimates monitored in the European Union (EU), that is, the European Commission's HLE based on self-perceived health (SPH-HLE) and the Institute for Health Metrics and Evaluation's HLE based on disability weight (DW-HLE), by sex, and comparing these results with LE and proportion of life spent in good health (%GH). Methods We performed a retrospective study in the EU28 countries, between 2010 and 2017. The HLE methods differ in definition, measurement and valuation of health states. While SPH-HLE relies directly on one question, DW-HLE relies on epidemiological data adjusted for DW. Spearman's r, intraclass correlation coefficient, information-based measure of disagreement and Bland-Altman plots were used to assess reliability, correlation and disagreement in HLE resulting from both methods and in LE or %GH measured by both institutions. Results Correlation and reliability between SPH-HLE and DW-HLE were good (better for males), with low disagreement, and were even better for LE between both institutions. The HLE Bland-Altman plots suggest a variability range of approximately 6 years for both sexes, higher for females. There was also an increasing HLE difference between methods with higher average HLE for both sexes. Conclusions We showed wide variations between both methods with a clear and different high impact on female and male HLE, showing a tendency for countries with higher health expectancies to yield larger gaps between SPH-HLE and DW-HLE. Acknowledgements: This presentation was supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia,I.P., within CINTESIS, R&D Unit (reference UIDP/4255/2020) Key messages • Different methods for evaluating health expectancy lead to significantly different results. • There is a systematic tendency with countries with higher health expectancies to yield larger gaps between SPH-HLE and DW-HLE.


Background:
Healthy life expectancy (HLE) is a population health measure that combines mortality and morbidity, which can be calculated using different methods.In this study, we aimed to assess the correlation, reliability and (dis)agreement between two estimates monitored in the European Union (EU), that is, the European Commission's HLE based on selfperceived health (SPH-HLE) and the Institute for Health Metrics and Evaluation's HLE based on disability weight (DW-HLE), by sex, and comparing these results with LE and proportion of life spent in good health (%GH).

Methods:
We performed a retrospective study in the EU28 countries, between 2010 and 2017.The HLE methods differ in definition, measurement and valuation of health states.While SPH-HLE relies directly on one question, DW-HLE relies on epidemiological data adjusted for DW.Spearman's r, intraclass correlation coefficient, information-based measure of disagreement and Bland-Altman plots were used to assess reliability, correlation and disagreement in HLE resulting from both methods and in LE or %GH measured by both institutions.

Results:
Correlation and reliability between SPH-HLE and DW-HLE were good (better for males), with low disagreement, and were even better for LE between both institutions.The HLE Bland-Altman plots suggest a variability range of approximately 6 years for both sexes, higher for females.There was also an increasing HLE difference between methods with higher average HLE for both sexes.

Conclusions:
We showed wide variations between both methods with a clear and different high impact on female and male HLE, showing a tendency for countries with higher health expectancies to yield larger gaps between SPH-HLE and DW-HLE.

Background:
People experiencing homelessness (PEH) have higher prevalence of adverse health outcomes and premature mortality compared to the general population, and often experience significant barriers in accessing healthcare services.This study aimed to better understand the health needs of PEH, as well as to identify the barriers and facilitators to their timely and equitable access to health services from the perspective of PEH and relevant health professionals and social care workers.

Methods:
During autumn 2021, a cross-national qualitative study was conducted within the framework of the Horizon 2020 funded CANCERLESS project.Semi-structured interviews were conducted across four European settings (Austria, Greece, Spain and the UK).Interviews were audio-recorded, transcribed verbatim and analyzed according to the inductive thematic approach set out by Saldan ˜a (2021).

Results:
In total, 69 interviews were completed with a sample comprising 15 professionals working in homelessness support services, 19 health professionals, and 35 PEH.Three overarching themes relating to the research question were identified: (a) Health needs of people experiencing homelessness; (b) Barriers to access healthcare services and (c) Facilitators to access healthcare services.Overall, the general health of PEH was depicted as extremely poor and mainstream health services were portrayed as ill-equipped to respond to the needs of this population, with many organizational and system-level barriers noted.Tailored approaches to care, and in particular involving trusted professionals in the delivery of care, were identified as a key strategy for overcoming existing barriers.

Conclusions:
While a number of context-specific findings were identified, results indicated there to be a high degree of overlap and consistency in the health needs of PEH, and in the barriers and facilitators that exist when accessing healthcare across four different healthcare systems.

Key messages:
Homelessness is a determinant of health that is linked to poor health outcomes.

Background:
People experiencing homelessness (PEH) are known to have increased burden of cancer and higher cancer-related mortality when compared to the general population.These outcomes are linked to a variety of etiological factors, as well as the existence of significant barriers in accessing cancer prevention services.The aim of this study was to better understand current practices and knowledge relating to cancer prevention among PEH, health professionals and social care workers.

Methods:
During autumn 2021, a cross-national qualitative study was conducted within the framework of the Horizon 2020 funded CANCERLESS project.Data were collected in Austria, Greece, Spain and the UK through semi-structured interviews.
Interviews were transcribed verbatim and thematically analyzed in accordance with the approach set out by Saldan ˜a (2021).

Results:
In total, 69 interviews were conducted with a sample comprising 15 professionals working in homelessness support services, 19 health professionals, and 35 PEH.Two overarching themes relating to the research question were identified, namely (a) experiences and understanding of cancer prevention and treatment, and (b) considerations for program intervention.While cancer was a major source of concern, tailored cancer prevention programs for the homeless population were described as effectively non-existent, and very few homeless participants recalled being invited to a screening appointment.Health professionals also indicated that because of barriers to health care, opportunities for the early diagnosis of cancer among PEH were often being missed.