Biomedical subjects
J M Robine
Publications and source records attributed to J M Robine.
How good is Sullivan's method for monitoring changes in population health expectancies?
STUDY OBJECTIVE: To compare health expectancies calculated by Sullivan's method and the multistate life table method in order to identify the magnitude of the bias in Sullivan's method and assess how seriously this limits its use for monitoring population health expectancies. DESIGN: A simulation model was used to compare health expectancies calculated using Sullivan's method and the multistate life table method under various scenarios for the evolution of disability over time in populations. The simulation model was based on abridged cohort life tables using data on French mortality from 1825-90 and disability prevalence data from the 1982 French health survey. MAIN RESULTS: The Sullivan method could not detect a sudden change in disability transition rates, but the simulations suggested that it provides a good estimate of the true multistate value if there are smooth and relatively regular changes in disability prevalence over the longer term. When disability incidence rates are increasing or decreasing smoothly over time, the absolute bias in the Sullivan estimate of disability free life expectancy is relatively constant with age. The relative bias thus increases at older ages as disability free life expectancy decreases. CONCLUSIONS: The difference between the estimates produced by the two methods was small for realistic scenarios for the evolution of population health and Sullivan's method is thus generally acceptable for monitoring relatively smooth long term trends in health expectancies for populations.
Health expectancy: an indicator for change?
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Dementia-free life expectancy in France.
OBJECTIVES: Increasing concern with the quality of gains in life years has led to the development of a new synthetic indicator of population health:health expectancy. Until now, calculations have been made for physical disabilities only. A first estimate of mental health expectancy is presented: dementia-free life expectancy. METHODS: Sullivan's method was used to calculate dementia-free life expectancy for a random representative sample of 4134 persons over 65 years of age in the Bordeaux region of France. The diagnosis of senile dementia was made in two stages, based on Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria. RESULTS: At 65 years of age, a person's dementia-free life expectancy is 16.9 years within a total life-expectancy of 17.7 years; it decreases with age in parallel with the decrease in total life expectancy so that life expectancy with dementia stays constant at 0.8 years. Although dementia prevalence increases with age, if the prevalence is adjusted for mortality, the largest number of persons with dementia are in their early eighties. At each age women have a higher dementia-free life expectancy. CONCLUSIONS: Trends in dementia-free life expectancy are similar to those found in disability-free life expectancy. Because the dementia prevalence rates used in this estimate resemble a general model derived from meta-analysis, it can be assumed that similar results will be found in other Western countries with similar mortality rates.
[Dynamics of asthma mortality in France: seasonal fluctuations and peak mortality in 1985-87].
In the face of an observed increase in asthma mortality since the end of the 70's an analysis of the time series of the deaths for the period 1979-89 was conducted; which shows a peaking of mortality between 1985 and 1987. A different seasonal component of asthma mortality has been identified for the age group 5-34 and over 34 group. For the later, mortality was found to peak during winter and dropping to the lowest point in summer, well synchronised with the mortality due to respiratory infection. For the former, mortality usually peaks during summer and troughs during the winter, independently of the mortality due to respiratory infection. A bimodal repartition of deaths was observed in the age group 5-34 with a main peak in summer (July) and a secondary peak in autumn (October). Modeling of the deaths series by season shows a dramatic rise in mortality during the years 1985, 1986 and 1987 affecting both age groups. During these 3 years, the global over-mortality is 21%. The increase has affected all the seasons allowing for seasonal variations of each age group. Factors responsible for the death seasonality in each age group are discussed. The temporary action of a non-specific factor was proposed to explain the cross-sectional character of the mortality crisis in the population; namely the influenza epidemics during the 1985 and 1986 winters.
Explaining fruit fly longevity.
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Distinguishing health expectancies and health-adjusted life expectancies from quality-adjusted life years.
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[Past and present asthma mortality: towards a shift in the secular trend?].
In recent years disconcerting observations have been published concerning changes in mortality from asthma in France and other countries. These conclusions are difficult to assess due to uncertainty regarding the underlying asthma mortality trends. We have attempted to address this question by constituting a statistical series of asthma deaths from 1925 to 1989. The 1925 to 1989 mortality trend is clearly decreasing. This decrease follows the same rhythm as the general mortality decline, since the proportion of asthma in total deaths remained between 3 to 4/1000. Three periods are emphasized: from 1925 to 1965 where the decreasing trend is interrupted by an important crisis in mortality, from 1965 to 1980 where the decrease is regular, and the last period since 1980 with an important crisis in 1985 and 1986; crisis applying to all genders and ages. The latest trend is uncertain. Careful epidemiologic surveillance will decide between a change in the secular trend or a transitory crisis and thus determine the cause(s). An effect due to the reinclusion by ICD 9 of a fluctuating component in asthma mortality cannot be excluded.
[The future of mortality: epidemiological centering].
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The relationship between age and the prevalence of senile dementia: a meta-analysis of recent data.
A linear regression model derived from a meta-analysis of 13 epidemiological studies of senile dementia conducted since 1980, and employing internationally-known case-finding procedures, suggests a much lower general rate of dementia prevalence than has been previously estimated. An exponential increase with age is observed, with senile dementia prevalence diagnosed by Diagnostic and Statistical Manual (DSM-III) criteria doubling every 6 years and senile dementia of the Alzheimer's type (SDAT) every 4.2 years. Studies providing data for the oldest ages indicating a drop in the rate of increase after the age of 80 suggest that senile dementia may be age-related rather than ageing-related. Estimates derived from this model may provide a reasonably accurate means of estimating dementia prevalence in the general population. The limitations of this method for the purposes of prediction and studies of risk factors are discussed in relation to the hypothesized heterogeneity of senile dementia and possible cohort effects.
Measurement and utilization of healthy life expectancy: conceptual issues.
The periodic calculation of healthy life expectancies permits the evaluation of the impact of new health policies at a given moment, as well as the assessment of trends under changing health conditions. In spite of their apparent simplicity, the results obtained will have to be interpreted by experts. Useful reference values can be provided by international comparisons. However, several choices remain to be made, such as (i) the types of morbidity and disability data to be associated with mortality data; (ii) the multiple indicators available; (iii) the type of observations to be recorded, i.e., "abilities" or "performances"; (iv) whether or not the recovery of lost functions should be considered; (v) the mode of computation, i.e., life expectancy before the first morbid event or global healthy life expectancy; and (vi) the determination of thresholds based on either relative or absolute criteria.
Healthy life expectancy: evaluation of global indicator of change in population health.
OBJECTIVE: To review and evaluate the usefulness of healthy life expectancy as a global indicator of changes in a population's health. DESIGN: Review of all known studies to date from the United States, mainland Europe, Canada, and the United Kingdom that have used Sullivan's method of calculating disability free life expectancy. MAIN OUTCOME MEASURES: Life expectancy and disability free life expectancy. RESULTS: Over the past decade the average healthy life expectancy was 60 years for men and 64 for women, with the proportion of years of disability ranging from 11% to 21% in men and from 14% to 24% in women. At the age of 65 men could expect eight years of disability free life and women 10, with the life expectancy being respectively 14 and 19 years. The difference between the wealthiest and poorest income quintiles was 6.3 years in life expectancy and 14.3 in disability free life expectancy for men and 2.8 and 7.6 respectively for women. These results suggest that disparities in health are greater between social groups than between the sexes. Diseases affect mortality and morbidity differently. The order of importance for affecting life expectancy was circulatory disease, cancer, and accidents and for disability free life expectancy, circulatory disease, locomotor disorders, and respiratory disorders. CONCLUSIONS: Healthy life expectancy is a valuable index for the appreciation of changes in both the physical and the mental health states of the general population, for allocating resources, and for measuring the success of political programmes. Future calculations should also take into account the probability of recovery and thus extend the applicability of the indicator to populations in poor health rather than focusing on the well population.
[Life expectancy in good health, a future indicator for measuring the health status of populations].
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[Longitudinal study of the functional capacity of aged persons in Upper Normandy, 1978-1985].
A longitudinal study of 1,082 elderly persons was conducted by INSERM over a six-year period in order to identify risk factor in pathological ageing. Several functional capacities were selected for study on the basis of their relevance to independent daily living. This article describes the methodology and the extent to which research objectives were able to be fulfilled. The initial survey took place in 1978-79. A follow-up study targeted two distinct areas of interest: the monitoring of mortality rates and the re-evaluation of the performance of survivors at three and six year intervals. Re-evaluation of performance involved the exploration of the individual's mobility, capacity to carry out activities of daily living etc. The consistency of the entire data set assembled over the six-year period was assessed in various ways. At six year follow-up survival rate could be determined for 98.8% of the initial cohort, and 87.1% of the survivors were able to be reinterviewed. The different probabilities of healthy survival, by sex and age, are tabulated in the appendices.
[Estimating the value of disability-free life expectancy for western countries in the last decade. How can this new health status indicator be used?].
Disability-free life expectancy (DFLE) is an indicator of the mean duration of life in good health, based on the measurement of mortality combined with the measurement of disability. To date, some experimental calculations have been carried out mainly in Canada, England, France, the Netherlands and the United States of America. Taking these studies as a whole, disability-free life expectancy in the last decade can be estimated at about 59 years for men and about 63 years for women. The share of years of disability within life expectancy ranges from 11% to 27%. The calculations show that women suffer disability for a greater part of their life expectancy than men. The calculations also reveal social inequalities in health. Health authorities in Western countries are showing increasing interest in this indicator today. The main points in its favour are its simplicity in practice, its usefulness for determining objectives, allocating resources, measuring the success or failure of health policies, assessing current needs and defining future scenarios.
[Risk and risk factors of disability in the aged].
Since 1978 the INSERM's Research (Unit-164) has been conducting a research programme on risk factors of mortality and disability. This study is based on a 5-year follow up of 4,200 elderly persons 60 and over in three regions of France. The aim is to provide the first results on 1082 people 65 and over living in upper Normandy. Initial level of disability appears the best predictive factor of 3-year mortality. Other predictive variables are age, sex, dyspnea during exertion and recent hospitalization. Pathologies reported by general practitioners are less informative on 3-year survival probability than variables related to frailty of subjects. The 5-year mortality is predicted by such pathologies as mental deterioration or cardio-respiratory diseases and age, sex, institutionalization and early smoking habits. The incidence of disability within 3 years is essentially predicted by pathologies: osteo-articular diseases (osteo-arthritis), mental deterioration and respiratory track diseases. These results favour a model of slow sequential decrease of health status, with mortality occurring after a long period of disability.
[Indicators of disability-free life expectancy. Global indicators of the health status of populations].
Disability free life expectancy (DFLE) is an index of mean length of healthy life. It aims at measuring the evolution in the populations state of health. The first calculations were achieved at the end of the 60s and about ten experimental calculations have been made until now, mostly in the United States, Canada, Japan and France. Nowadays this index is very well accepted. Its major qualities are its usefulness for setting health targets and determining the present and future needs. Is DFLE destined for becoming a conjonctural index of health state? The circumstances are undoubtedly propitious. Nevertheless, in order to be used in routine the DFLE index must answer three conditions, which the current approach does not fulfil i.e. the viability of disability measurement for comparisons in time; a registration of period data which is based on the incidence of entrance in disability; a calculation which is adapted to the disability whether it is reversible or not.
[The role of a cultural factor in the educational practices of mothers of young children].
Through 3 groups of mothers, defined as belonging to 3 different geographical areas which are considered to represent cultural heritage, a series of educational practices towards infant under one year of age was studied. Among factors acting on practices which further the infants' contacts with others and exploration of environment, the usual sociodemographic characteristics play a part which is not greater than the one of the personal mother's dynamic and mostly of the cultural context (geographical area), which occurs as the first variable in a stepwise regression. When the child is 3 years old, durability of the maternal behavior is brought to the fore. The authors discuss the repercussion of these differences on the future of the children belonging to each of these groups.