Trends in Education-specific Differences in Disability-Free Life Expectancy in Spain, 2008-2017

Background: There is mounting evidence for a recent increase of social disparities in chronic disease prevalence and mortality. However, little is known about how these trends are reflected in combined measures of morbidity, disability and mortality.Method: We use two nationally representative surveys of the Spanish population for the years 2008 to 2017 and standard measures of expected duration of disability and illness to assess time trends and social disparities in mortality, morbidity and expected years lived in disability (DFLE) and with chronic illness (chrDFLE). We provide empirical evidence of shifting trends for these measures. We then decompose these changes into contributions associated with disability, chronic illness and mortality. Finally, we estimate the size of education differentials in DFLE and chrDFLE and evaluate the magnitude and direction of changes of these differentials over time. Results: While the disability based indicator suggests a decrease of expected years without disability for both men and women (expansion of morbidity), the morbidity based indicator shows an increase in time spend free of chronic disease for women but a slight decrease for men. The decrease in time spent without disability was observed for all education groups but is particularly marked for those with low education.Conclusion: We find evidence of an expansion of morbidity in Spain between 2008 and 2017. The bulk of this development is related to increases in time spent with functional limitations over this period. These patterns occur in conjuncture with growing social disparities in time spend with chronic illness or disability.Peer reviewe