Papers by Emmanuelle Cambois
Objectives: The study presents new disability-free life expectancies (DFLE) estimates for France ... more Objectives: The study presents new disability-free life expectancies (DFLE) estimates for France and discusses recent trends in the framework of the three ‘health and aging’ theories of compression, dynamic equilibrium and expansion of disability. The objectives are to update information for France and to compare two methods to analyse recent trends. Methods: DFLE at ages 50, 65 and in the 50–65 age group are computed for several disability dimensions, using data from five French surveys over the 2000s. Owing to scarce time series, we used two methods to assess trends and consolidate our conclusions: (i) decomposition of the DFLE changes using the available time series; (ii) linear regression using all the available estimates, classified by disability dimensions. Results: Trends in DFLE65 prolonged the dynamic equilibrium of the previous decades: increasing life expectancy with functional limitations but not with activity restrictions. Meanwhile, partial DFLE50–65 has decreased for various disability dimensions, including some activity restrictions, especially for women. Conclusion: France has recently experienced an unexpected expansion of disability in mid-adulthood while it is still on a trend of dynamic equilibrium at older ages. The study highlights the importance of monitoring trends in DFLE for various disability dimensions and broadens the scope of interest to the mid-adulthood.
International Journal of …, Jan 1, 2012
Objectives: To evaluated the female–male health–survival paradox by estimating the contribution o... more Objectives: To evaluated the female–male health–survival paradox by estimating the contribution of women’s mortality advantage versus women’s disability disadvantage. Methods: Disability prevalence was measured from the 2006 Survey on Income and Living Conditions in 25 European countries. Disability prevalence was applied to life tables to estimate healthy life years (HLY) at age 15. Gender differences in HLY were split into two parts: that due to gender inequality in mortality and that due to gender inequality in disability. The relationship between women’s mortality advantage or disability disadvantage and the level of population health between countries was analysed using random-effects meta-regression. Results: Women’s mortality advantage contributes to more HLY in women; women’s higher prevalence of disability reduces the difference in HLY. In populations with high life expectancy women’s advantage in HLY was small or even a men’s advantage was found. In populations with lower life expectancy, the hardship among men is already evident at young ages. Conclusions: The results suggest that the health–survival paradox is a function of the level
Population, Jan 1, 2011
Mortality differentials between French occupations and occupational classes are large and widenin... more Mortality differentials between French occupations and occupational classes are large and widening. But considerable inequalities also exist within occupational classes by career history. Changes in the labour market and occupational pathways in recent decades – notably among women – have altered the composition of occupational classes and their average mortality levels. This article analyses the changes in mortality differentials between occupational classes by studying occupational mobility and associated mortality using data from the permanent demographic sample (Échantillon démographique permanent, EDP), a long-term sample representative of the French population at different dates. Analysis of mortality in 1975 (EDP75) and 1999 (EDP99) by occupational class and past occupational moves shows that mortality has declined for all classes but in different ways, causing a slight widening of differentials for both sexes. Within occupational classes, differentials by past moves increased in the EDP99 for men and were now observed in all classes for women. Changes in the composition of occupational classes and in excess mortality associated with certain moves has contributed to this increase in inequalities between occupational classes. This fi nding highlights the importance of interpreting changes in mortality differentials in the light of sociodemographic developments.
Demographic …, Jan 1, 2011
Increasing life expectancy (LE) raises expectations for social participation at later ages. We co... more Increasing life expectancy (LE) raises expectations for social participation at later ages. We computed health expectancies (HE) to assess the (un)equal chances of social/work participation after age 50 in the context of France in 2003. We considered five HEs, covering various health situations which can jeopardize participation, and focused on both older ages and the pre-retirement period. HEs reveal large inequalities for both sexes in the chances of remaining healthy after retirement, and also of reaching retirement age in good health and without disability, especially in low-qualified occupations. These results challenge the policy expectation of an overall increase in social participation at later ages.
Background: Recent research shows that adverse experiences, such as economic hardships or exclusi... more Background: Recent research shows that adverse experiences, such as economic hardships or exclusion, contribute to deterioration of health status. However, individuals currently experiencing adverse experiences are excluded from conventional health surveys, which, in addition, often focus on current social situation but rarely address past adverse experiences. This research explores the role of such experiences on health and related social inequalities based on a new set of ad hoc questions included in a regular health survey. Methods: In 2004, the National Health, Health Care and Insurance Survey included three questions on lifelong adverse experiences (LAE): financial difficulties, housing difficulties due to financial hardship, isolation. Logistic regressions were used to analyse associations between LAE, current socio-economic status (SES) (education, occupation, income) and health status (self-perceived health, activity limitation, chronic morbidity), on a sample of 4308 men and women aged ≥35 years. Results: LAE were reported by 20% of the sample. They were more frequent in low SES groups but concerned >10% of the highest income group. LAE increased the risk of poor self-perceived health, diseases and activity limitations, even after controlling for current SES [odds ratio (OR) > 2]. LAE experienced only during childhood are also linked to health. LAE account for up to 32% of the OR of activity limitations associated with the lowest quintile among women and 26% among men. Conclusions: LAE contribute to the social health gradient and explain variability within social groups. It is useful to take lifetime social factors into account when monitoring health inequalities.
Today, problems of dependence concern women more than men. First, more women than men become depe... more Today, problems of dependence concern women more than men. First, more women than men become dependent, partly because they live to older ages. Second, it is mainly women who shoulder the burden of caring for elderly dependent parents or spouses. Based on an overview of research in this field, Carole Bonnet, Emmanuelle Cambois, Chantal Cases and Joëlle Gaymu describe likely demographic trends over coming decades and examine how men may be called upon to play a greater role in the family.
org-www.sante.gouv.fr
En 2008, un adulte d’âge actif sur huit déclare des limitations fonctionnelles physiques, mentale... more En 2008, un adulte d’âge actif sur huit déclare des limitations fonctionnelles physiques, mentales ou sensorielles sévères qui les exposent à des situations de handicap. Douze profils type « à risque de handicap » ont été identifiés dans cette étude. La participation à la vie sociale de ces personnes, de 18 à 59 ans, est mesurée par le travail, les relations avec les autres et les activités élémentaires du quotidien. Cette participation sociale varie fortement d’un profil à un autre. Les femmes déclarent plus souvent des limitations physiques mais de moindre gravité, et moins souvent une reconnaissance administrative de handicap. Les limitations cognitives et sensorielles sont parmi les plus fréquentes mais elles s’accompagnent moins souvent de difficultés de participation sociale que les limitations intellectuelles et physiques en particulier, et que les limitations motrices (membres inférieurs ou tous les membres). Les personnes déclarant des limitations fonctionnelles sévères y associent une santé nettement moins bonne que la moyenne de la population. À caractéristiques socio-économiques comparables, les personnes déclarant des atteintes motrices ou intellectuelles souffrent d’un plus grand nombre de pathologies et de symptômes, qu’ils soient à l’origine des limitations ou qu’ils en soient la conséquence. Tous les profils présentent un risque plus élevé de mauvaise santé buccodentaire, qui s’explique en partie par les difficultés d’accès aux soins dentaires. Le cumul de pathologies et de symptômes amenuise les chances de participation sociale de ces adultes d’âge actif. Dès lors, une prise en charge globale de leur santé (physique, psychique et sociale) pourrait améliorer leur qualité de vie, et favoriser leur participation à une vie sociale.
Retraite et société, Jan 1, 2010
L'espérance de vie française est l'une des plus élevées au monde dépassant 80 ans depuis le début... more L'espérance de vie française est l'une des plus élevées au monde dépassant 80 ans depuis le début des années 2000 (Pison, 2005). Les conséquences de cette grande longévité sur l'état de santé de la population sont devenues un enjeu majeur de santé publique. Les années de vie gagnées au cours des dernières décennies sont-elles des années vécues en bonne santé ou avec des maladies, des incapacités ou en situation de dépendance (Fries, 1980; Kramer, 1980) ? Les dynamiques démographiques et sanitaires doivent être analysées conjointement afin d’évaluer les besoins de la population et d'y répondre par une offre de soins, d'assistance ou de prise en charge adaptée. Mais l'analyse de ces dynamiques devient aussi fondamentale pour évaluer les chances de participation sociale des plus âgés compte tenu de leur état de santé. On s'interroge notamment sur les chances de participation au marché du travail des personnes de plus de 50 ans. Cette question s'inscrit naturellement dans le débat public alors que l’augmentation de la durée de cotisation requise pour obtenir une retraite à taux plein se poursuit depuis 1993 et qu'on évoque un possible report de l'âge légal de départ à la retraite au-delà de 60 ans.
In 2008, the life expectancy (LE) of men and women was 78 years and 84 years, respectively. With ... more In 2008, the life expectancy (LE) of men and women was 78 years and 84 years, respectively. With the increase in LE, it has become of crucial importance for public health and care planning to know whether the years gained are years of good or poor health. It has also become a social and economic issue due to the growing expectation for social participation of the elderly. How many years are lived in good functional health? What can be said about recent trends? To answer these questions, this study presents the new estimates of disability-free life expectancies (DFLE) in France. While trends must be analysed with caution due to breaks in the time series, the overall picture appears, for the first time, to be gender-specific. These results also suggest that it is important not only to focus on the elderly, but also to study functional health at much earlier ages due to the occurrence of functional problems before age 65, especially in the late working ages. The results finally suggest that various dimensions of disability should be studied in order to better anticipate future needs. The comparison of past and more recent trends reveals stagnation in DFLE in recent years. This pattern, which is less favourable for women, could be explained by the improved survival of people with chronic diseases and functional limitations. It could also be explained by an increased perception of altered functional health or by an actual deterioration. In the female population, this pattern concerns generations of women who were more numerous in the labour force and who are now in their late working ages or entering retirement. Do these trends reflect changes in perceptions or worsening functional health among persons in their 50s? In-depth analysis of the social and health context is required in order to better document this new situation in France.
An important aspect of population health is increasingly measured by disability indicators. Activ... more An important aspect of population health is increasingly measured by disability indicators. Active life expectancy, also often referred to as health expectancy, has emerged as a useful indicator of population health. This indicator was first proposed by the U.S. Department of Health, Education and Welfare (1969) nearly 40 years ago and has been widely adopted for use by the World Health Organization and governments throughout the world to monitor population health. Researchers commonly partition total life expectancy into two parts. One part is healthy life expectancy, also often referred to as active life expectancy or disability-free life expectancy. This component is a measure of the years an individual can expect to live free of disability. The second part measures the years a person can expect to live with disability, also commonly referred to as inactive life expectancy or disabled life expectancy. Although the phrase “active life expectancy” refers to the period of life without disability, the same phrase is often used to describe this entire research area. Thus, a researcher who studies active life expectancy is interested to estimate the periods of life spent with and without disability.
Demographic Research
Mortality follow-up of two census samples allowed an estimate of socio-economic differentials in ... more Mortality follow-up of two census samples allowed an estimate of socio-economic differentials in mortality for old men, using occupational classes and levels of education reported by individuals when they were active. The study shows persisting mortality differentials after 60 years of age. Over the 1960-65 and 1990-95 periods mortality differentials remained constant between non-manual upper classes and manual workers, while differentials have increased between the upper classes and the least skilled manual workers. Educational status has an impact on the mortality risks, independently from occupational status; the magnitude of its impact slightly changed over time. Level of education partly explains occupational differentials in mortality. The study shows that a differentiated increase in the average level of education can impact on trends in occupational differentials in mortality.
Population (english edition), Jan 1, 2011
This new study goes beyond the well-established correlation between mortality differentials and o... more This new study goes beyond the well-established correlation between mortality differentials and occupational status, to focus on the impact of professional careers on mortality risk. It shows heterogeneity in the mortality risks within occupational classes, strongly related to the type of occupational moves experienced.
The occupational data are taken from the French longitudinal census sample—using 1968 and 1975 census records—and mortality risks are estimated over the 1975–1980 period, for both occupational classes and pathways between classes. Results show a close relationship between occupational mobility and mortality. For men, favorable occupational moves—e.g. from clerks to upper class—put them less at risk of mortality than their counterparts who remained in their class. An inverse relationship is found for unfavorable moves. In most cases, the mortality risks of the movers are in between the risks in the class left and in the class joined. Similar patterns apply to specific groups of women only (upper classes, manual workers, clerks) for which occupational moves are probably driven, as for most men, by mortality related determinants (level of education, qualifications, health, etc.). The findings strongly support the use of a dynamic approach, based on individuals’ experiences, to improve our understanding of mortality differentials.
Population, Jan 1, 2007
In 2002-2003, the French Health Survey included – for the third time since 1980 – a general quest... more In 2002-2003, the French Health Survey included – for the third time since 1980 – a general question on “limitations or handicaps in daily life”. The responses obtained suggest that the prevalence of disability has fallen far more rapidly in the past decade than in earlier periods. Indeed, the drop exceeds the most optimistic scenarios. Our study devotes special attention to changes in the survey protocol and their possible influence on comparability of the latest results with those of previous surveys. The analysis shows that the general question in the 2002-2003 survey mainly records severe activity restrictions and proven (and thus relatively rare) handicap situations, whereas the wording was designed to identify “basic limitations” as well, which are far more common. This selection was more pronounced in the latest survey than in its predecessors. In conclusion, the limitations or handicaps question does not provide continuity with the time series begun in 1980, but it yields additional information on the various types of functional problems via that situations of social disadvantage that it more specifically brings to light.
Dossiers solidarité et santé, Jan 1, 2006
Résumé/Abstract Dans les enquêtes santé en population, l'incapacité peut être mesurée à ... more Résumé/Abstract Dans les enquêtes santé en population, l'incapacité peut être mesurée à partir d'approches diverses: le handicap ressenti, la santé fonctionnelle, la dépendance, la reconnaissance administrative du handicap... De chacune de ces dimensions découlent ...
Population (French Edition), Jan 1, 1998
Les indicateurs d'espérance de vie appliquée à des statuts spécifiques, tels que l&#... more Les indicateurs d'espérance de vie appliquée à des statuts spécifiques, tels que l'état de santé ou le statut professionnel, sont apparus dès la fin des années trente et connaissent un regain d'intérêt. Parce qu'elles associent la mortalité à des domaines divers (santé, ...
… of epidemiology and …, Jan 1, 2011
Background Life expectancy gaps between Eastern and Western Europe are well reported with even la... more Background Life expectancy gaps between Eastern and Western Europe are well reported with even larger variations in healthy life years (HLY). Aims To compare European countries with respect to a wide range of health expectancies based on more specific measures that cover the disablement process in order to better understand previous inequalities. Methods Health expectancies at age 50 by gender and country using Sullivan's method were calculated from the Survey of Health and Retirement in Europe Wave 2, conducted in 2006 in 13 countries, including two from Eastern Europe (Poland, the Czech Republic). Health measures included co-morbidity, physical functional limitations (PFL), activity restriction, difficulty with instrumental and basic activities of daily living (ADL), and self-perceived health. Cluster analysis was performed to compare countries with respect to life expectancy at age 50 (LE50) and health expectancies at age 50 for men and women. Results In 2006 the gaps in LE50 between countries were 6.1 years for men and 4.1 years for women. Poland consistently had the lowest health expectancies, however measured, and Switzerland the greatest. Polish women aged 50 could expect 7.4 years fewer free of PFL, 6.2 years fewer HLY, 5.5 years less without ADL restriction and 9.5 years less in good self-perceived health than the main group
… Observatoire européen des …, Jan 1, 2005
This chapter assesses life expectancy with and withoutchronic morbidity in Europe. After a review... more This chapter assesses life expectancy with and withoutchronic morbidity in Europe. After a review of the historicalbackground to health expectancies we report comparisonsacross Europe of life expectancy with chronic morbidity(LEwCM) at age 65. LEwCM is based on the global chronicmorbidity question of the Minimum European HealthModule (MEHM) in the Statistics of Income and LivingConditions (SILC) survey 2005. Previously developed by theEuroHIS Chronic Physical Conditions Network, the form of the question ‘Do you suffer from (have) any chronic (long-standing) illness or condition (health problem)?’ with asimple yes/no response. Data was available for 25 countries(the EU Member States in 2005, excluding Bulgaria andRomania who have since joined the Union). As comparabletrend data on global chronic morbidity is unavailable, trendsin life expectancy at age 65 are presented since this is anintegral part of LEwCM.
… European Journal of …, Jan 1, 1999
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Papers by Emmanuelle Cambois
The occupational data are taken from the French longitudinal census sample—using 1968 and 1975 census records—and mortality risks are estimated over the 1975–1980 period, for both occupational classes and pathways between classes. Results show a close relationship between occupational mobility and mortality. For men, favorable occupational moves—e.g. from clerks to upper class—put them less at risk of mortality than their counterparts who remained in their class. An inverse relationship is found for unfavorable moves. In most cases, the mortality risks of the movers are in between the risks in the class left and in the class joined. Similar patterns apply to specific groups of women only (upper classes, manual workers, clerks) for which occupational moves are probably driven, as for most men, by mortality related determinants (level of education, qualifications, health, etc.). The findings strongly support the use of a dynamic approach, based on individuals’ experiences, to improve our understanding of mortality differentials.
The occupational data are taken from the French longitudinal census sample—using 1968 and 1975 census records—and mortality risks are estimated over the 1975–1980 period, for both occupational classes and pathways between classes. Results show a close relationship between occupational mobility and mortality. For men, favorable occupational moves—e.g. from clerks to upper class—put them less at risk of mortality than their counterparts who remained in their class. An inverse relationship is found for unfavorable moves. In most cases, the mortality risks of the movers are in between the risks in the class left and in the class joined. Similar patterns apply to specific groups of women only (upper classes, manual workers, clerks) for which occupational moves are probably driven, as for most men, by mortality related determinants (level of education, qualifications, health, etc.). The findings strongly support the use of a dynamic approach, based on individuals’ experiences, to improve our understanding of mortality differentials.