OBJECTIVES: Our objective was to assess morbidity trends in Europe and to classify European countries based on population ageing theories: the compression, expansion and dynamic equilibrium of morbidity. METHODS: The proportions of healthy life years were calculated for 31 European countries for the period 2005-2019 based on life expectancy values and healthy life years at age 65 years adopted from the Eurostat database. European countries were classified according to morbidity patterns applying the standard deviation distance from the average of relative change method between the selected years. RESULTS: A large degree of variation in terms of life expectancy and healthy life years at age 65 years was determined between 2005 and 2019. While the life expectancy differences between men and women were consistent across all the European countries, the gender gap concerning healthy life years was more diverse. Approximately one-third of the countries fell into the expansion, compression and dynamic equilibrium categories, respectively. CONCLUSION: Significant variations were identified in healthy life year trends across European countries, which underscores the need for preventive strategies.

Department of Demography and Geodemography Faculty of Science Charles University Prague Czechia

Department of Social Geography and Regional Development Faculty of Science Charles University Prague Czechia

See more in PubMed

Walshe K, McKee M, McCarthy M, Groenewegen P, Hansen J, Figueras J, et al. Health Systems and Policy Research in Europe: Horizon 2020. Lancet. (2013) 382(9893):668–9. 10.1016/S0140-6736(12)62195-3 PubMed DOI

Budych K, Karle CA, Helms TM. Perspectives on Europe’s Health Care Systems: Meeting Future Challenges through Innovative Health Care Strategies. EPMA J (2014) 5(S1):A82. 10.1186/1878-5085-5-s1-a82 DOI

Bongaarts J. How Long Will We Live? Popul Dev Rev (2006) 32(4):605–28. 10.1111/j.1728-4457.2006.00144.x DOI

Wilmoth JR. Demography of Longevity: Past, Present, and Future Trends. Exp Gerontol (2000) 35(9–10):1111–29. 10.1016/s0531-5565(00)00194-7 PubMed DOI

Doblhammer G, Kytir J. Compression or Expansion of Morbidity? Trends in Healthy-Life Expectancy in the Elderly Austrian Population Between 1978 and 1998. Soc Sci Med (2001) 52(3):385–91. 10.1016/s0277-9536(00)00141-6 PubMed DOI

Fries JF. Aging, Natural Death, and the Compression of Morbidity. N Engl J Med (1980) 303(3):130–5. 10.1056/NEJM198007173030304 PubMed DOI

Fries JF. Measuring and Monitoring Success in Compressing Morbidity. Ann Intern Med (2003) 139(5 Pt 2):455–9. 10.7326/0003-4819-139-5_part_2-200309021-00015 PubMed DOI

Fries JF. The Compression of Morbidity: Near or Far? Milbank Q (1989) 67(2):208–32. 10.2307/3350138 PubMed DOI

Fries JF, Bruce B, Chakravarty E. Compression of Morbidity 1980–2011: A Focused Review of Paradigms and Progress. J Aging Res (2011) 2011:261702–10. 10.4061/2011/261702 PubMed DOI PMC

Gruenberg EM. The Failures of Success. 1977. Milbank Q (2005) 83(4):779–800. 10.1111/j.1468-0009.2005.00400.x PubMed DOI PMC

Kramer M. The Rising Pandemic of Mental Disorders and Associated Chronic Diseases and Disabilities. Acta Psychiatr Scand (1980) 62(S285):382–97. 10.1111/j.1600-0447.1980.tb07714.x PubMed DOI

Olshansky SJ, Rudberg MA, Carnes BA, Cassel CK, Brody JA. Trading off Longer Life for Worsening Health. J Aging Health (1991) 3(2):194–216. 10.1177/089826439100300205 DOI

Manton KG. Changing Concepts of Morbidity and Mortality in the Elderly Population. Milbank Mem Fund Q Health Soc (1982) 60(2):183–244. 10.2307/3349767 PubMed DOI

Graham P, Blakely T, Davis P, Sporle A, Pearce N. Compression, Expansion, or Dynamic Equilibrium? The Evolution of Health Expectancy in New Zealand. J Epidemiol Community Health (2004) 58(8):659–66. 10.1136/jech.2003.014910 PubMed DOI PMC

Klar MK, Geyer S, Safieddine B, Tetzlaff F, Tetzlaff J, Sperlich S. Trends in Healthy Life Expectancy Between 2002 and 2018 in Germany - Compression or Expansion of Health-Related Quality of Life (HRQOL)? SSM - Popul Heal (2021) 13:100758. 10.1016/j.ssmph.2021.100758 PubMed DOI PMC

Steensma C, Loukine L, Choi BC. Evaluating Compression or Expansion of Morbidity in Canada: Trends in Life Expectancy and Health-Adjusted Life Expectancy From 1994 to 2010. Heal Promot Chronic Dis Prev Can Res Pol Pract (2017) 37(3):68–76. 10.24095/hpcdp.37.3.02 PubMed DOI PMC

Kreft D, Doblhammer G. Expansion or Compression of Long-Term Care in Germany Between 2001 and 2009? A Small-Area Decomposition Study Based on Administrative Health Data. Popul Health Metr (2016) 14:24. 10.1186/s12963-016-0093-1 PubMed DOI PMC

Majewska J, Trzpiot G. The Transition in Health in a Population Aged 65 Years and over in Europe. Commun Stat Case Stud Data Anal Appl (2020) 6(1):3–18. 10.1080/23737484.2019.1613456 DOI

Welsh CE, Matthews FE, Jagger C. Trends in Life Expectancy and Healthy Life Years at Birth and Age 65 in the UK, 2008-2016, and Other Countries of the EU28: An Observational Cross-Sectional Study. Lancet Reg Heal Eur (2021) 2:100023. 10.1016/j.lanepe.2020.100023 PubMed DOI PMC

Newton JN. Trends in Health Expectancies across Europe: Countries That Are Achieving Compression of Morbidity and Those That Are Not. Lancet Reg Heal Eur (2021) 3:100078. 10.1016/j.lanepe.2021.100078 PubMed DOI PMC

Eurostat. Database (2022). Available from: https://ec.europa.eu/eurostat/data/database (Accessed January 21, 2022).

Eurostat. Mortality (National Level) (Demo_mor) (2024). Available from: https://ec.europa.eu/eurostat/cache/metadata/en/demo_mor_esms.htm (Accessed August 18, 2024).

Jagger C, Robine JM. Healthy Life Expectancy. In: Rogers RG, Crimmins EM, editors. International Handbook of Adult Mortality International Handbooks of Population. Dordrecht: Springer; (2011). p. 551–68.

Sullivan DF. A Single Index of Mortality and Morbidity. HSMHA Health Rep (1971) 86(4):347–54. 10.2307/4594169 PubMed DOI PMC

Imai K, Soneji S. On the Estimation of Disability-Free Life Expectancy. J Am Stat Assoc (2007) 102(480):1199–211. 10.1198/016214507000000040 PubMed DOI PMC

European Commission. European Health Interview Survey (EHIS Wave 2) – Methodological Manual. Report No.: KS-RA-13-018. Luxembourg: (2013). Available from: https://ec.europa.eu/eurostat/web/products-manuals-and-guidelines/-/KS-RA-13-018 (Accessed February 7, 2023).

Eurostat. Healthy Life Years by Sex (From 2004 Onwards) (Hlth_hlye) (2022). Available from: https://ec.europa.eu/eurostat/cache/metadata/en/hlth_hlye_esms.htm (Accessed January 21, 2022).

Kurtinová O. Self-perceived Health in the Czech Population: Recent Evidence. Cent Eur J Public Health (2015) 23(1):45–53. 10.21101/cejph.a3996 PubMed DOI

Luy M, Gast K. Do Women Live Longer or Do Men Die Earlier? Reflections on the Causes of Sex Differences in Life Expectancy. Gerontology (2014) 60(2):143–53. 10.1159/000355310 PubMed DOI

Sundberg L, Agahi N, Fritzell J, Fors S. Why Is the Gender Gap in Life Expectancy Decreasing? The Impact of Age- and Cause-Specific Mortality in Sweden 1997–2014. Int J Public Health (2018) 63(6):673–81. 10.1007/s00038-018-1097-3 PubMed DOI PMC

Wensink M, Alvarez J-A, Rizzi S, Janssen F, Lindahl-Jacobsen R. Progression of the Smoking Epidemic in High-Income Regions and its Effects on Male-Female Survival Differences: A Cohort-By-Age Analysis of 17 Countries. BMC Public Health (2020) 20(1):39. 10.1186/s12889-020-8148-4 PubMed DOI PMC

Permanyer I, Villavicencio F, Trias-Llimós S. Healthy Lifespan Inequality: Morbidity Compression From a Global Perspective. Eur J Epidemiol (2023) 38(5):511–21. 10.1007/s10654-023-00989-3 PubMed DOI PMC

Seaman R, Höhn A, Lindahl-Jacobsen R, Martikainen P, van Raalte A, Christensen K. Rethinking Morbidity Compression. Eur J Epidemiol (2020) 35(5):381–8. 10.1007/s10654-020-00642-3 PubMed DOI PMC

Beltrán-Sánchez H, Razak F, Subramanian SV. Going Beyond the Disability-Based Morbidity Definition in the Compression of Morbidity Framework. Glob Health Action (2014) 7(1):24766. 10.3402/gha.v7.24766 PubMed DOI PMC

Walter S, Beltrán-Sánchez H, Regidor E, Gomez-Martin C, del-Barrio JL, Gil-de-Miguel A, et al. No Evidence of Morbidity Compression in Spain: A Time Series Study Based on National Hospitalization Records. Int J Public Health (2016) 61(7):729–38. 10.1007/s00038-016-0829-5 PubMed DOI PMC

Chen H, Ning J, Hu H, He H. Distribution of the Compression and Expansion of Morbidity in 194 Countries and Territories, 1990–2016: The Role of Income Inequality. Sociol Health Illn (2023) 45(7):1523–40. 10.1111/1467-9566.13645 PubMed DOI

Hunt K, Adamson J, Hewitt C, Nazareth I. Do Women Consult More Than Men? A Review of Gender and Consultation for Back Pain and Headache. J Health Serv Res Policy (2011) 16(2):108–17. 10.1258/jhsrp.2010.009131 PubMed DOI PMC

Warner D, Procaccino JD. Toward Wellness: Women Seeking Health Information. J Am Soc Inf Sci Technol (2004) 55(8):709–30. 10.1002/asi.20016 DOI

Case A, Paxson C. Sex Differences in Morbidity and Mortality. Demography (2005) 42(2):189–214. 10.1353/dem.2005.0011 PubMed DOI

Idler EL. Discussion: Gender Differences in Self-Rated Health, in Mortality, and in the Relationship Between the Two. Gerontologist (2003) 43(3):372–5. 10.1093/geront/43.3.372 DOI

Benyamini Y, Leventhal EA, Leventhal H. Gender Differences in Processing Information for Making Self-Assessments of Health. Psychosom Med (2000) 62(3):354–64. 10.1097/00006842-200005000-00009 PubMed DOI

Deeks A, Lombard C, Michelmore J, Teede H. The Effects of Gender and Age on Health Related Behaviors. BMC Public Health (2009) 9:213. 10.1186/1471-2458-9-213 PubMed DOI PMC

Vlassoff C. Gender Differences in Determinants and Consequences of Health and Illness. J Health Popul Nutr (2007) 25(1):47–61. PubMed PMC

Verbrugge LM. Multiple Roles and Physical Health of Women and Men. J Health Soc Behav (1983) 24(1):16–30. 10.2307/2136300 PubMed DOI

Ross CE, Bird CE. Sex Stratification and Health Lifestyle: Consequences for Men’s and Women’s Perceived Health. J Health Soc Behav (1994) 35(2):161–78. 10.2307/2137363 PubMed DOI

Guberman N, Maheu P, Maille C. Women as Family Caregivers: Why Do They Care? Gerontologist (1992) 32(5):607–17. 10.1093/geront/32.5.607 PubMed DOI

Bastos A, Casaca SF, Nunes F, Pereirinha J. Women and Poverty: A Gender-Sensitive Approach. J Socio Econ (2009) 38(5):764–78. 10.1016/j.socec.2009.03.008 DOI

Riecher-Rössler A. Sex and Gender Differences in Mental Disorders. The Lancet Psychiatry (2017) 4(1):8–9. 10.1016/S2215-0366(16)30348-0 PubMed DOI

Brennan P, Perola M, van Ommen G-J, Riboli E, European Cohort Consortium. Chronic Disease Research in Europe and the Need for Integrated Population Cohorts. Eur J Epidemiol (2017) 32(9):741–9. 10.1007/s10654-017-0315-2 PubMed DOI PMC

Changes in disease burden and epidemiological transitions