HLE-S.

The progressive incorporation of quality of life indicators in health planning meets a critical need: The evaluation of the performance of health services, which are under stress by multiple causes, but in particular by an ageing population. In general, national health plans rely on health expectancies obtained using the Sullivan method. The Sullivan health expectancy index combines age-specific mortality rates and age-specific prevalence of healthy life, obtained from health surveys. The objective of this work is to investigate an equivalent estimation, using available information from morbidity and mortality datasets. Mortality and morbidity information, corresponding to years 2016 and 2017, was obtained for the population of the county of Baix Empordà (Catalonia), N = 91,130. Anonymized individual information on diagnoses, procedures and pharmacy consumption contained in the individual clinical record (ICD and ATC codes), were classified into health states. Based on the observed health transitions and mortality, life expectancies by health state were obtained from a multistate microsimulation model. Healthy life expectancies at birth and 65 years for females and males were respectively HLE0female = 39.94, HLE0male = 42.87, HLE65female = 2.43, HLE65male = 2.17. These results differed considerably from the Sullivan equivalents, e.g., 8.25 years less for HLE65female, 9.26 less for HLE65male. Point estimates for global life expectancies at birth and 65 years of age: LE0female = 85.82, LE0male = 80.58, LE65female = 22.31, LE65male = 18.86. Health indicators can be efficiently obtained from multistate models based on mortality and morbidity information, without the use of health surveys. This alternative method could be used for monitoring populations in the context of health planning. Life Expectancy results were consistent with the standard government reports. Due to the different approximation to the concept of health (data-based versus self-perception), healthy life expectancies obtained from multistate micro simulation are consistently lower than those calculated with the standard Sullivan method.将生活质量指标逐步纳入卫生规划，可满足一项核心需求：开展卫生服务绩效评估——当前卫生服务受多重因素影响承压，尤以人口老龄化问题最为突出。总体而言，各国卫生规划均依赖通过沙利文法（Sullivan method）测算得到的健康期望寿命。沙利文健康期望寿命指数整合了年龄别死亡率与健康生命的年龄别患病率，此类数据源自健康调查。本研究旨在利用发病率与死亡率数据集的现有信息，探索一种等效的测算方法。本研究获取了西班牙加泰罗尼亚自治区拜斯恩波达县（Baix Empordà）2016年与2017年的人口死亡与发病数据，研究人群总规模N=91130。对个体临床记录（包含国际疾病分类（International Classification of Diseases, ICD）与解剖学治疗学及化学分类（Anatomical Therapeutic Chemical, ATC）编码）中的匿名化个人诊断、诊疗操作及药品消费信息进行健康状态分类。基于观测到的健康状态转移与死亡数据，本研究通过多状态微观模拟模型（multistate microsimulation model）测算得到了不同健康状态下的期望寿命。男女出生时及65岁时的健康期望寿命（Healthy Life Expectancy, HLE）分别为：女性出生时HLE0female=39.94、男性出生时HLE0male=42.87；女性65岁时HLE65female=2.43、男性65岁时HLE65male=2.17。上述结果与沙利文法测算的对应结果存在显著差异：例如女性65岁时健康期望寿命较沙利文法结果低8.25年，男性则低9.26年。男女出生时及65岁时的总期望寿命（Life Expectancy, LE）点估计值为：女性出生时LE0female=85.82、男性出生时LE0male=80.58；女性65岁时LE65female=22.31、男性65岁时LE65male=18.86。无需借助健康调查，仅基于死亡与发病数据即可通过多状态模型高效获取健康指标。该替代方法可用于卫生规划场景下的人群健康监测。总期望寿命测算结果与官方标准报告数据一致。由于对健康概念的界定方式存在差异（基于观测数据与基于自我感知），通过多状态微观模拟得到的健康期望寿命始终低于标准沙利文法的测算结果。