Differentials in disability-free life expectancy in France: the double burden of social condition.

Emmanuelle Cambois, Institut National d'Études Démographiques (INED)
Caroline Laborde, Institut National d'Études Démographiques (INED)
Jean Marie Robine, Institut National de la Santé et de la Recherche Médicale (INSERM)

This study aims to present estimations of disability-free life expectancies (DFLE) for occupational groups in France to highlight both the mortality differentials and differentials in health and functioning. The 2002-2003 French health interview survey comprises different sets of questions on disability. In parallel, data on mortality recorded in the census sample between 1999 and 2003 have been used to compute life tables according to the occupation class reported at census (1999). Combination of life tables and disability, with Sullivan method, allows to compute DFLE by occupational class at age 35 and 60. We used different disability indicators to compute three DFLE for each occupational class in order to assess differences in various disability situations (sensory and physical functional limitations, general activity limitations, restrictions in personal care activities). Our estimates point out a 6 year differential in life expectancy (LE) at age 35 between the upper managerial class and the manual workers (3 years for women). The differentials are even larger when considering functioning: upper managerial class benefit 34 years of life expectancy without functional limitations (73% of LE) and 44 years without personal care activity restrictions (95% of LE) while manual workers can expect to live 24 years without functional limitations (59% of LE) and 37 years without personal care activity restrictions (92%). Differentials in DFLE remain at age 60 both for the functional limitations (which are spread over 45% of LE for upper class and 65% for manual workers) and personal car activity restrictions (spread over respectively 9% and 14% of LE). Manual workers not only have shorter life expectancy but moreover undergo a longer period in the various disability situations. Differences in health damaging exposures over the life course and occupational career as well as health behaviours and access to care explain this cumulative disadvantage.