You are here

Health inequalities and inequities by age: Persistence for the Health Utilities Index and divergence for the frailty index

TitleHealth inequalities and inequities by age: Persistence for the Health Utilities Index and divergence for the frailty index
Year of Publication2017
AuthorsAsada, Y., Hurley J., Grignon M., and Kirkland S.
InstitutionCHESG Canadian Health Economics Study Group
CityHalifax, NS

Successful aging is an important policy goal in aging society. A key indicator of successful aging of a population is whether health inequalities (differences) and inequities (ethically problematic differences) in the population increase or decrease with age. Available empirical studies investigating the equity and age-related dynamics of health distributions have focused almost exclusively on issues of health and socioeconomic status. This study investigates how health inequalities and inequities differ among age groups in the Canadian population by explicitly incorporating a broad framework of health equity and by comparing equity in two widely used measures of general health. Data come from a representative sample of non-institutionalized adults from the Canadian Health Measures Survey, cycle 2. We calculate the Gini coefficient for the distribution of the Health Utilities Index Mark 3 (HUI) and the Frailty Index (FI) within three age groups (20-44, 45-64, and 65-79 years). We compute the Gini coefficient for each health measure and within the same age groups after standardizing fairness. We use both direct and indirect standardization. We base our fairness judgment on the equity framework of equal opportunity for health, which considers health outcomes due to factors beyond individual control as inequitable. This study shows the magnitudes of inequality and inequity in both the HUI and the FFI in all age groups are substantial from a policy perspective. This study also shows persistent inequality and inequity in the HUI across the three age groups and mixed evidence for the FFI: divergent inequality and inequity when estimated by indirect standardization but persistence when estimated by direct standardization. As the populations age, extending the examination of health inequalities and inequities in the context of aging populations can support more equitable policies for successful aging. Choices of measures of health and the fairness-standardization methods matter greatly in such examinations.

Document URL