Recent trends in male and female disability-free life expectancies in France: to what extent is the "gender health paradox" reinforced?

Emmanuelle Cambois, Institut National d'Études Démographiques (INED)

In France, as in most countries, female advantage in life expectancy (LE) is balanced by a larger number of unhealthy years. Furthermore, recent trends in male and female disability-free life expectancies (DFLE) appear less favourable than in previous decades and especially for women. This paper further explores trends in DFLE in France using several dimensions of the disablement process to identify possible gender-specific health and disability patterns. An increasing number of surveys in France allow computing a full range of DFLE at age 50 estimations which can be classified according to various disability dimensions: 7 different French population surveys conducted over the 1990's and the 2000's period are used. Meanwhile, except for 3 of these surveys, inconsistency in questionnaire and design prevent from building robust time series on disability. Trends were therefore (1) assessed through a mortality/disability decomposition of the DFLE changes based on the 3 repeated surveys and (2) consolidated by a linear regression on the DFLE using the 7 surveys DFLE estimations, classified by disability dimensions. The unfavourable trend in recent years in DFLE at age 50 is due to a decrease in the 50-65 age group for women's physical limitations and activity restrictions and for men's cognitive limitations. At age 65, trends in DFLE were more favourable, except for physical and sensory limitations and general activity (for men exclusively in the decomposition vs for both sexes with the regression) as observed in previous decades. The two approaches both highlight an unexpected increasing gender gap for a selection of disability dimensions in the 50-65 cohorts. Possible reasons for the these findings range from change in sex-specific health exposure and behaviours, but also change in social, family and work situations in these cohorts which could differently affect women’s and men's health, self-perception of health and consequences on functioning.