1. Gender, Educational and Ethnic Differences in Active Life Expectancy among Older Singaporeans Angelique Chan, Duke-NUS Rahul Malhotra, Duke-NUS David Matchar, Duke-NUS Stefan Ma, Ministry of Health, Singapore Yasuhiko Saito, Duke-NUS

2. Healthy Life Expectancy (HLE) Average number of healthy years a person at a given age is expected to live Rapidly expanding aging population and the need to set and evaluate health policy and population-wide health promotion interventions require computations of HLE at older ages

3. Beyond prevalence based HLE estimates HLE has been calculated for Singapore using prevalence rates (Yong, Saito and Chan 2011) Previous work based on prevalence data does not: Indicate expected life cycle of events of individuals exposed to current morbidity transitions Allow for HLE computations by subgroups, e.g., education or ethnicity

4. Background Gender: Women live longer than men but in poorer health Education: –Creates a foundation for the factors that ultimately determine socioeconomic status and impact upon health –lower levels of education correlate with less years of active, healthy life

5. Background (2) Ethnicity –In the US, Whites have longer HLE compared to African-Americans Cultural differences in health behaviors and health utilization patterns may influence health over the life course

6. Aims To examine gender, education and ethnicity differences in active life expectancy among older Singaporeans at age 60

7. Data A nationally representative longitudinal (2 waves; 2009 and 2011) survey in Singapore –N=4,990 at baseline –60+ –Analysis sample: N=3,378

8. Measures HLE= Active life expectancy (no ADL or IADL) Low education = primary education or less Ethnicity = Chinese/non-Chinese

9. Measures Gender Education –High: At least secondary education –Low: No formal education or only primary education Ethnicity –Chinese –Non-Chinese (including Malay, Indian, others)

10. Method Transition probabilities and multistate life tables were constructed using IMaCH ActiveInactive Death Worsening health transitions

11. RESULTS

12. Women (13%) Vs. Men (5%) Less educated (5%) Vs. Better educated (2%) Non Chinese (14%) Vs. Chinese (8%) Proportion passed away higher among men Vs. women, for those starting out active (5% vs. 2%) for those starting out with ADL/IADL (28% vs. 18%) Worsening health transitions more likely for women, less educated, non-Chinese

13. Population-based estimates at age 60 TLEALEIALE%(ALE/TLE) Sex Women 25.9*18.17.8* 69.9% Men21.618.92.687.8% Education High28.5*23.5*5.182.0% Low22.517.15.475.9% Ethnicity Chinese24.419.4*5.079.5% non-Chinese21.715.06.618.3% TLE: Total Life Expectancy; ALE: Active Life Expectancy; IALE: Inactive Life Expectancy * p < 0.05 comparing TLE, ALE or IALE between sex, education or ethnicity groups.

14. Are increases in longevity associated with more years spent in an active state? Does this association extend across population subgroups? Provide evidence for planning for financial health care at later ages and predicting health care utilization behavior among older Singaporeans. Discussion

15. Gender differences in active life expectancy will have significant implications for future caregiving strategies Caregiving is primarily provided by women within families however enabling environments are needed for women to care for themselves at older ages Policies targeted at preventive measures starting early in life may increase ALE in later life Discussion 2

16. This research is supported by the Singapore Ministry of Health’s National Medical Research Council under its Singapore Translational Research Investigator AWARD (STaR) “Establishing a Practical and Theoretical Foundation for Comprehensive and Integrated Community, Policy and Academic Efforts to Improve Dementia Care in Singapore” (NMRC-STAR-0005-2009). Thank you to Jane Lim for editorial assistance. Acknowledgements