Health-adjusted life expectancy in Canada

Background: Over the past century, life expectancy at birth in Canada has risen substantially. However, these gains in the quantity of life say little about gains in the quality of life. Methods: Health-adjusted life expectancy (HALE), an indicator of quality of life, was estimated for the household and institutional populations combined every four years from 1994/1995 to 2015. Health status was measured by the Health Utilities Index Mark 3 instrument in two national population health surveys, and was used to adjust life expectancy. The percentage of the population living in health-related institutions was estimated based on the Census of Population. Attribute-deleted HALE was calculated to determine how various aspects of health status contributed to the differences between life expectancy and HALE. Results: HALE has increased in Canada. Greater gains among males have narrowed the gap between males and females. The ratio of HALE to life expectancy changed little for males, and a marginal improvement was observed for females aged 65 or older. Mobility problems and pain, the latter mainly among females, accounted for an increased share of the burden of ill health over time. Exclusion of the institutional population significantly increased the estimates of HALE and yielded higher ratios of HALE to life expectancy. Interpretation: Although people are living longer, the share of years spent in good functional health has remained fairly constant. Data for both the household and institutional populations are necessary for a complete picture of health expectancy in Canada.