A Systematic Literature Review of Studies Analyzing Inequalities in Health Expectancy among the Older Population

PLoS One. 2015 Jun 26;10(6):e0130747. doi: 10.1371/journal.pone.0130747. eCollection 2015.


Aim: To collect, organize and appraise evidence of socioeconomic and demographic inequalities in health and mortality among the older population using a summary measure of population health: Health Expectancy.

Methods: A systematic literature review was conducted. Literature published in English before November 2014 was searched via two possible sources: three electronic databases (Web of Science, Medline and Embase), and references in selected articles. The search was developed combining terms referring to outcome, exposure and participants, consisting in health expectancy, socioeconomic and demographic groups, and older population, respectively.

Results: Of 256 references identified, 90 met the inclusion criteria. Six references were added after searching reference lists of included articles. Thirty-three studies were focused only on gender-based inequalities; the remaining sixty-three considered gender along with other exposures. Findings were organized according to two leading perspectives: the type of inequalities considered and the health indicators chosen to measure health expectancy. Evidence of gender-based differentials and a socioeconomic gradient were found in all studies. A remarkable heterogeneity in the choice of health indicators used to compute health expectancy emerged as well as a non-uniform way of defining same health conditions.

Conclusions: Health expectancy is a useful and convenient measure to monitor and assess the quality of ageing and compare different groups and populations. This review showed a general agreement of results obtained in different studies with regard to the existence of inequalities associated with several factors, such as gender, education, behaviors, and race. However, the lack of a standardized definition of health expectancy limits its comparability across studies. The need of conceiving health expectancy as a comparable and repeatable measure was highlighted as fundamental to make it an informative instrument for policy makers.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aging
  • Female
  • Health Status Disparities*
  • Health Status*
  • Humans
  • Male
  • Middle Aged
  • Socioeconomic Factors

Grants and funding

All relevant data are within the paper, the reference list and its Supporting Information files. The authors have declared that no competing interests exist. This work has been supported by the Economic and Social Research Council (ESRC)+3 Studentship grant award (URL: http://www.esrc.ac.uk/). The grant number is ES/J500021/1. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.