Health inequalities and inequities by age: Stability for the Health Utilities Index and divergence for the Frailty Index

Abstract

Successful aging is an important policy goal in an aging society. A key indicator of successful aging of a population is whether health inequalities (differences) and inequities (unfair differences) in the population increase or decrease with age. This study investigates how health inequalities and inequities differ across age groups in the Canadian population within the equity framework of equal opportunity for health, using two popular measures of health, the Health Utilities Index Mark 3 (HUI) and the Frailty Index (FI). We use the 2009-10 Canadian Health Measures Survey. We first quantify the degree of health inequality by calculating the Gini coefficient for the distributions of the HUI and the FI within three age groups (20–44, 45–64, and 65–79 years). We then identify sources of health inequality by using regression models and decomposing inequality into ethically acceptable and unacceptable components. We finally quantify the degree of health inequity by calculating the Gini coefficient for each health measure and each age group after standardizing for fairness. We find that the magnitudes of inequality and inequity in the HUI and the FI in each of the three age groups are policy relevant. The magnitude and age-related dynamics of health inequality and inequity depend on the choice of the health measures. In all three age groups, inequality and inequity in health measured by the HUI are larger than those measured by the FI. Across the three age groups, inequality and inequity are stable in the HUI but divergent in the FI. This study contributes to the methodological development to support policies for successful aging. Examination of alternative notions of health captured by the HUI and the FI contributes to the exploration of how the fair distribution of each aspect of health may characterize a successfully aging population.

Successful Aging and Frailty: A Systematic Review

“…All used a cross-sectional analytic design. The primary objective and actual findings in four studies was to establish an association between frailty and SA, while in one [38] the purpose was to use frailty and SA criteria to test for health inequality in a population. For frailty, all four used the Cardiovascular Health Study Phenotype criteria [19].…”

Development of frailty subtypes and their associated risk factors among the community-dwelling elderly population

“…Frailty Index (FI), based on a model of accumulation of multi-component deficits, is currently a widely used approach to measure frailty [10,11]. However, the FI score is a ratio of the number of deficits present to the total number of deficits considered [12], it does not reflect the weight of individual components and it is uncertain how components are clustered [12,13]. Exploring potential subtypes may improve our understanding of the condition, by explaining the diversity of interactions between different components in elderly people [13,14].…”

A Cross-National Comparison on Life Expectancy of Non-Hispanic White Americans

“…There have been very few studies which examine health inequities across age groups. Yukiko Asada [ 29 ] proposed the idea that health inequality and inequity analysis results vary by choice, as age increases, the ability of individuals to make choices also increases, therefore, this may lead to a reduction in health inequities. Damien Bricard [ 30 ] proved that inequalities of opportunity in health and mortality deepen with age, at least until middle age, because of differences in the environment of a person’s upbringing, by a cohort of 17,500 people.…”