Decomposition of Differentials in Health Expectancies From Multistate Life Tables

Abstract

Multistate modeling is a commonly used method to compute healthy life expectancy. However, there is currently no analytical method to decompose the components of differentials in summary measures calculated from multistate models. In this research note, we propose a derivative-based method to decompose the differentials in population-based health expectancies estimated via a multistate model into two main components: the proportion resulting from differences in initial health structure and the proportion resulting from differences in health transitions. We illustrate the method using data on activities of daily living from the U.S. Health and Retirement Study to decompose the sex differential in disability-free life expectancy (HLE) among older Americans. Our results suggest that the sex gap in HLE results primarily from differences in transition rates between disability states rather than from the initial health distribution of female and male populations. The methods introduced here will enable research­ers, includ­ing those work­ing in fields other than health, to decom­pose the rel-ative contribution of initial population structure and transition probabilities to differences in state-spe­cific life expec­tan­cies from mul­ti­state mod­els.