health
C O L O R A DO DEP ART MENT OF PUBL I C HE AL TH AND E NVIR O N ME N T
watch
N
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January 2012
CO
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No. 82
Living Longer? Living Better? Estimates of Life Expectancy
and Healthy Life Expectancy in Colorado
Kirk Bol, MSPH, Health Statistics Section, Colorado Department of Public Health and Environment
Health Statistics Section
Alyson Shupe, Ph.D.,
Section Chief
Monica Clancy
Kieu Vu, M.S.P.H.
Maternal and Child Health
Surveillance Unit
Rickey Tolliver, M.P.H.,
Director
Janelle Mares
Irene Pinela
Public Health Informatics Unit
Chris Wells, M.S.,
Director
Geoff Bock
Doug Duncan
Gloria Mora
Jeff Scott
Bruce Straw
Paul Turtle
Survey Research Unit
Becky Rosenblatt, M.A.,
Director
Mark King
Michael Poisson
Ava Williams
Vital Statistics Unit
Mary Chase, Director
Kirk Bol, M.S.P.H.
Alison Grace Bui, M.P.H.
Juanita Galvan
Karl Herndon
4300 Cherry Creek Drive South
Denver, Colorado 80246-1530
(303)692-2160
(800)886‑7689
health.statistics@state.co.us
www.cdphe.state.co.us/hs/
Introduction
Out of Colorado’s Public Health Improvement Plan of 2009 came the recommendation to
“Ensure a comprehensive set of public health indicators.” Included in the indicators developed for this purpose are measures of health status, namely life expectancy and quality of life.
Life expectancy is a measure used frequently to assess the health of a population, and represents the average number of years an individual in a given population could expect to live if
experiencing the mortality (death) risk over a lifetime that the entire population experienced
in that year. As a summary measure, life expectancy simultaneously includes and reflects the
complete mortality experience in a population, from earliest infancy through the extreme
elder years.1 Separate quality of life measures, typically measured through survey-based public
health surveillance systems, assess in similar summary fashion the population’s self-perceived
health status. Self-reported measures of health status, such as the proportion of the population in poor health, have been demonstrated to be reliable and independent predictors of
morbidity (illness) and mortality.2
Daniel Sullivan noted in 1971 that while no one index can reflect all aspects of health, “there
is considerable agreement that an index which measures some aspects of nonfatal illness as well
as mortality would be desirable.”3 One such metric used to combine mortality and morbidity
(i.e. quality of life) into a single measure is healthy life expectancy. This is interpreted as the
average number of healthy years (i.e. years spent in ‘good or excellent’ health) an individual
in a population under study could expect to live given the mortality and general health status
of that population in some stated period of time. Unfortunately, due to concerns related to
availability of data and their statistical validity and reliability, healthy life expectancy is rarely
computed at the county or community level. Even at the statewide level, few estimates have
been generated to date regarding healthy life expectancy for Colorado. It is the intent of this
report to present estimates of life and healthy life expectancy for Colorado; and in response to
notable disparities in both life expectancy and quality of life among selected subpopulations,
present similar estimates by race and Hispanic origin and region of residence. Additionally,
this report will address concerns regarding the scarcity of these measures at the county and
community levels, as well as describe interpretive issues and limitations of these measures.
Methods
Utilizing birth and death data from the Vital Statistics Unit
in the Health Statistics Section at the Colorado Department
of Public Health and Environment (CDPHE), life expectancy
estimates among Colorado residents, including its race/ethnic
and regional subgroups, were computed. Methods employed
followed the abridged life table techniques presented by Dr.
Chin Long Chiang,4 and which are frequently used by the
National Center for Health Statistics at the Centers for Disease
Control and Prevention (CDC).5 Using these methods, life
expectancy at birth can be estimated, as can remaining years of
life at various ages.
Additionally, utilizing the Colorado Behavioral Risk Factor
Surveillance System (BRFSS) and Child Health Survey (CHS)
data from the Health Statistics Section at CDPHE, statewide,
race/ethnic and region-stratified estimates of general health
status were computed. The Colorado BRFSS is a telephone
survey conducted by random-digit dialing of adults 18 years
and older living in a household with a landline telephone.
The survey is an important tool for surveillance and evaluation of health behaviors and chronic health conditions among
the adult population. It is conducted annually by CDPHE in
collaboration with the CDC. During the BRFSS interview,
the interviewer inquires if a child between the ages of 1 and
14 years lives in the household, and about their willingness
to complete the Child Health Survey. If agreed, the parent
is called a few days later to complete a survey on a variety of
topics including his or her child’s physical activity, nutrition,
access to health and dental care, behavioral health, sun safety,
injury and many others. Data for both surveys are collected
over the calendar year; and at the end of the year, data are
weighted to reflect the general population of adults at 18 and
older and children ages 1 to 14, respectively.
General health status is most often assessed using the following
question: “Would you say your health in general is... ‘excellent, good, fair or poor?’” In this report, “unhealthy” status was
measured as the proportion of adults who responded for themselves, or on behalf of the children selected, that their general
2
Colorado Department of Public Health and Environment
health status was either ‘fair’ or ‘poor’. Proportions of fair or
poor health were utilized for the following age groups: Under 1
year, 5-year age groups through age 84, and 85 years and older.
As Colorado’s surveillance activities do not presently capture
general health status for infants, an estimate of 5 percent was
used for the proportion of infants in fair or poor health. This
is reasonable when considering the prevalence of birth complications and health conditions among infants based on birth
certificate data, as well as estimates of major congenital anomalies as generated by birth defect surveillance programs. Also,
given the dearth of general health status by subpopulation
among adolescents, the estimates for fair or poor health from
the BRFSS for the age group 18 to 24 were applied to both the
15-19 and 20-24 years age groups.
Following the work of Dr. Michael T. Molla, et al.,6 these
general health status proportions for Colorado and its race/
ethnic and regional subpopulations were incorporated into the
abridged life tables in order to compute estimates of healthy
life expectancy. Ninety-five percent (95%) confidence intervals
for both life expectancy and healthy life expectancy were also
computed in a manner consistent with the methods presented
by Dr. Chiang and Dr. Molla, et al.
Results
Life Expectancy
Since 1990, life expectancy among Colorado residents has
increased from 77.2 years to 80.4 years. While there have been
increases in both male and female life expectancy over this time
period, females continue to have higher life expectancy than
males. This gap between males and females, however, has been
shrinking over time (1990: females-80.3 years, males-74.1;
2010: females-82.4, males-78.3) (Figure 1).
Figure 1. Life expectancy in years by sex: Colorado residents, 1990-2010.
85
84
83
82
Life expectancy in years
81
80
81.5
80.3
79
80.7
80.1
80
80.6
80.4
80.2
80.6
80.4
76
77.2
77.6
77.0
77.3
77.6
77.6
77.7
80.6
74
74.1
73.9
74.4
74.4
78.1
78.0
78.2
78.6
78.4
78.3
74.4
74.8
75.1
75.5
75.6
75.9
76.3
76.3
76
81.2
81.8
79.6
79.8
79.7
77.6
77.6
77.5
80.5
79.1
82.2
80.0
78.5
77
75
73
80.5
79.3
78
77
80.4
80.7
82
81.6
76.4
77.9
82.4
80.4
78.3
76.9
72
71
70
Total
Male
Female
Error bars represent the 95% confidence interval of the life expectancy estimate.
SOURCE: Health Statistics Section, Colorado Department of Public Health and Environment.
Similarly, there have been increases in life expectancy across
Colorado’s various race/ethnic populations. On the other hand,
disparities persist, particularly among the Black population,
for which life expectancy in 2010 was 76.9 years, compared to
80.5 among White, non-Hispanic residents and 80.3 among
White, Hispanic residents (Figure 2).
Life expectancy estimates for Colorado’s Asian American/
Pacific Islander and American Indian/Native Alaskan populations are unstable and likely unreliable, and are shown here
for illustrative purposes only. Because of the relatively small
populations as well as the small numbers of deaths in each of
these groups, life expectancies tend to be overestimated, and
fluctuate greatly over time. This overestimation is the natural
result of attempting to use life table methods when there are
few or no deaths in the various abridged age groups used in
the life table, and made worse when there are few or no deaths
in the oldest age groups. As a result, the best and most stable
estimates for these populations will need to be based on more
robust multistate or national data. For the remainder of this
report, and for these reasons, race/ethnic-specific estimates
will be limited to White, non-Hispanic; White, Hispanic; and
Black populations in Colorado.
3
Health Statistics Section
Figure 2. Life expectancy in years by race/ethnicity: Colorado residents, 1990-2010.
110
108
106
104
102
100
Life expectancy in years
98
96
94
92
90
88
86
84
82
80
78
76
74
72
77.5
77.9
76.3
77.0
73.4
72.9
70
White, non-Hispanic
78.8
79.4
77.3
78.0
80.5
80.3
76.9
75.4
White, Hispanic
73.7
Black/African American
Asian American/Pacific Islande
American Indian/Native Alaskan
Error bars represent the 95% confidence interval of the life expectancy estimate.
SOURCE: Health Statistics Section, Colorado Department of Public Health and Environment.
General Health Status
Healthy Life Expectancy
Based on Colorado BRFSS estimates, the proportion of Colorado adults reporting in 2009-2010 that they were in fair or
poor health was 11.3 percent, a proportion consistent with the
2003-2004 reporting period (11.7%). Persistent over this time
period was a significant disparity among Colorado Hispanic
residents, among whom the proportion reporting fair or poor
health in 2009-2010 was 22.7 percent, compared to White,
non-Hispanics at 9.0 percent. Additionally, emerging in 20052006, and growing since, is a higher proportion of the Black
population reporting fair or poor health, which in 2009-2010
was 16.6 percent. According to data from Colorado’s 2010
Child Health Survey, 2.2 percent of children ages 1-14 were
reported as being in fair or poor health. This has been consistent since 2007 and is similar across the different race/ethnic
populations.
When looking at life and healthy life expectancies, a couple
questions should be asked: “What are the life and healthy
life expectancies, both overall/at birth and at various ages
throughout life?” and “What is the difference between life and
healthy life expectancy, that is, the proportion of life expected
to be spent in fair or poor health?” The following estimates of
healthy life expectancy and their relationship to life expectancy
are examined with the above questions in mind.
4
Colorado Department of Public Health and Environment
In addition to having a higher life expectancy than males for
the combined time period 2008-2010 (female: 82.1 years;
males: 77.9), females have a higher healthy life expectancy as
well (female: 72.7, male: 69.4). These differences exist for life
and healthy life expectancy at birth, as well as when looking at
remaining years of life or remaining years of healthy life at various ages, for which the gap between male and female narrows,
but never closes completely (Figure 3). Regardless of gender,
approximately 11 percent of one’s life is expected to be spent in
fair or poor health.
Life- and healthy life expectancy in years
Figure 3. Life expectancy and healthy life expectancy in years by sex: Colorado residents, 2008-2010.
90
85
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
82.1
77.9
72.7
69.4
Age group in years
Life expectancy- female
Healthy life expectancy- female
Life expectancy- male
Healthy life expectancy- male
SOURCE: Health Statistics Section, Colorado Department of Public Health and Environment.
As overall life expectancy varies across Colorado’s race/ethnic
populations, so does healthy life expectancy. White, nonHispanic residents have both the highest life and healthy life
expectancies (80.2 and 73.0 years, respectively). While White,
Hispanic residents have only a slightly lower life expectancy
(79.2 years), their healthy life expectancy is lowest among the
race/ethnic groups described here (61.1 years). Black residents
have the lowest life expectancy (76.8 years), which is more
than three years lower than White, non-Hispanic residents; but
healthy life expectancy among Black residents (64.0 years) is
higher than that for White, Hispanic residents. That said, there
remains a noteworthy gap between life and healthy life expectancy. Among White, non-Hispanic residents, approximately
9 percent of one’s life is expected to be spent in fair or poor
health; while for Black residents, this proportion increases to
17 percent; and among White, Hispanic residents, 23 percent
of one’s life is expected to be in fair or poor health (Figure 4).
5
Health Statistics Section
Life-and healthy life expectancy in years
Figure 4. Life expectancy and healthy life expectancy in years at selected ages by race/ethniciy: Colorado residents, 2008-2010.
85
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
80
80.2
79.2
76.8
56.1
56.2
55.4
71.0
73.0
61.1
64.0
48.2
49.7
38.8
Total
White, White,
nonHispanic
Hispanic
Infancy
53.6
Black
Total
White,
nonHispanic
White,
Hispanic
37.2
37.3
30.9
31.8
36.5
35.1
24.0
25.3
42.0
Black
Total
25-29 years
Healthy life expectancy
White,
nonHispanic
White,
Hispanic
45-49 years
Black
20
20
19.8
19.1
15.8
16.1
12.4
13.5
Total
White,
nonHispanic
White,
Hispanic
Black
65-69 years
Life expectancy
Error bars represent the 95% confidence interval of the life expectancy estimate.
SOURCE: Health Statistics Section, Colorado Department of Public Health and Environment.
Noteworthy, too, is the persistence of differences in life- and
healthy life expectancy by race and ethnicity over a lifetime. As
seen in Figure 4, the smallest number of years of life remaining
at various periods in life, namely at 25-29, 45-49, and 65-69
years of age, is found among Black residents (53.6, 35.1, and
19.1 years, respectively, compared to White, non-Hispanic
residents with 56.2, 37.3, and 20.0 years). Additionally, the
difference between remaining years and healthy years of life
is largest among White, Hispanic residents at these three ages
(16.6, 12.5, 7.4 years, respectively, compared to White, nonHispanic residents with 6.5, 5.5, and 3.9 years). The nature
of these disparities hint that risk factors, behaviors, and causes
of morbidity and mortality that affect life and healthy life
expectancy likely affect disproportionately Black and White,
Hispanic residents at any and all ages compared to White,
non-Hispanic residents.
Both life expectancy and healthy life expectancy vary by geographic region of residence. Across Colorado’s Health Statistics
6
Colorado Department of Public Health and Environment
Regions, which are often used to examine regional differences
within Colorado, life expectancy ranged from 76.3 years to
83.7 in the 2008-2010 time period. The difference between
the minimum and maximum healthy life expectancy was a bit
larger, with estimates ranging from 64.5 years to 77.1. Across
regions, the difference between life and healthy life expectancy
ranged from 5.8 to 13.3 years. Regions in the state in which
life expectancy and/or healthy life expectancy were lower than
the statewide estimate include those in southern (region 8) and
southeast Colorado (region 6), the south-central mountains
(region 13), as well as Adams, Denver, and Mesa Counties.
Areas in which life and healthy life expectancy were higher
include the mountain resort/west I-70 area (region 12) and
Boulder, Douglas, and Larimer Counties (Figures 5 and 6).
Figure 5. Life expectancy and healthy life expectancy by region of residence: Colorado residents, 2008-2010.
90
85
80
75
82.9
81.6
83.7
79.6
76.3
70
Life- and healthy life expectancy in years
80.4
80.2
79.6
77
79.9
80.6
78.5
77.9
80.4
81.7
80.4
78.1
80.2
80.2
78.8
78.2
67.6
67.0
Colorado life
expectancy:
80.0 years
Colorado healthy
life expectancy:
71.0 years
65
60
55
50
45
40
35
30
73.1
66.3
77.1
71.7
72.7
71.4
64.5
65.8
65.6
70.4
72.6
75.8
70.3
72.6
67.1
75.7
73.3
69.6
72.8
25
20
15
10
5
0
Life expectancy
Healthy life expectancy
Error bars represent the 95% confidence interval of the life expectancy estimate.
SOURCE: Health Statistics Section, Colorado Department of Public Health and Environment.
7
Health Statistics Section
Figure 6. Map of life expectancy (LE) and healthy life expectancy (HLE) in years (with 95% confidence intervals) by geographic region of residence:
Colorado residents, 2008-2010.
BOULDER
BROOMFIELD
GILPIN
ADAMS
DENVER
21
LE: 78.2 (78.0-78.4)
HLE: 67.0 (65.8-68.2)
PARK
LE: 80.4 (79.6-81.2)
GARFIELD
1 6LE: 81.7 (81.4-82.0)
SUMMIT
EAGLE
MESA
PITKIN
LE: 78.8 (78.4-79.2)
HLE: 67.6 (65.7-69.5)
SAN MIGUEL
DOLORES
LAKE
CHAFFEE
9
OURAY
SAN JUAN
LE: 80.4 (79.8-81.0)
HLE: 72.7 (71.0-74.4)
LA PLATA
MONTEZUMA
17
8
LE: 77.9 (77.1-78.7)
HINSDALE HLE: 65.6 (63.4-67.8)
MINERAL
ALAMOSA
RIO GRANDE
ARCHULETA
CONEJOS
Colorado Department of Public Health and Environment
5
ELBERT
LE: 79.6 (79.4-79.8)
HLE: 71.7 (70.8-72.6)
EL PASO
LE: 80.2 (79.3-81.1)
HLE: 71.4 (69.5-73.3)
LINCOLN
CHEYENNE
KIOWA
7
CROWLEY
LE: 77.0 (76.6-77.4)
HLE: 65.8 (64.3-67.4)
PUEBLO
OTERO
6
BENT
PROWERS
LE: 76.3 (75.6-77.0)
HLE: 64.5 (62.4-66.6)
HUERFANO
COSTILLA
SOURCE: Health Statistics Section, Colorado Department of Public Health and Environment.
8
YUMA
WASHINGTON
4
13
CUSTER
LE: 79.6 (79.0-80.2)
HLE: 66.3 (64.1-68.5)
KIT CARSON
DOUGLAS
LE: 80.4 (79.6-81.2)
HLE: 73.3 (71.5-75.1)
TELLER
FREMONT
SAGUACHE
MORGAN
14
DENVER
15
3
LE: 78.5 (77.9-79.1)
HLE: 70.3 (68.9-71.7)
LE: 79.9 (79.3-80.5)
HLE: 70.4 (68.9-71.9)
MONTROSE
22 00
PARK
GUNNISON
10
21
PHILLIPS
1
HLE: 75.7 (74.7-76.7)
BOULDER
CLEAR CREEK
GILPIN
12
LOGAN
18
WELD
LE: 83.7 (83.2-84.2)
HLE: 75.8 (74.2-77.4)
DELTA
SEDGWICK
LARIMER
GRAND
EL PASO
LE: 80.2 (79.8-80.6)
HLE: 69.6 (68.2-71.0)
2
RIO BLANCO
19
TELLER
LE: 81.6 (81.3-81.9)
HLE: 73.1 (71.8-74.4)
ROUTT
5
ELBERT
LE: 82.9 (82.5-83.3)
HLE: 77.1 (75.7-78.5)
LE: 80.4 (79.6-81.2)
JACKSON
3
DOUGLAS
HLE: 73.3 (71.5-75.1)
ARAPAHOE
LE: 80.4 (80.2-80.6)
HLE: 72.6 (71.6-73.6)
15
LE: 80.2 (80.0-80.4)
HLE: 72.8 (72.0-73.6)
11
14
22 00
JEFFERSON
MOFFAT
LE: 80.6 (79.7-81.5)
HLE: 72.6 (70.8-74.4)
LE: 78.1 (77.8-78.4)
HLE: 67.1 (65.8-68.4)
LAS ANIMAS
BACA
14
Discussion
Measures of life- and healthy life expectancy are summary
measures: They represent the combined morbidity and mortality experience within a population, and distill that information into an average number of years of life or healthy life
remaining for the members of that population. These types
of summary measures are most commonly computed at the
national level and for other countries around the world, and
are useful in estimating overall population health and the
global burden of disease.7 Summary measures are necessary to
facilitate discussions about the ability of countries to provide
for and maintain the health of their respective populations,
particularly in light of increasing life expectancies, aging populations, and increased chronic disease maintenance and care.
These measures are also important in identifying and exploring
health and outcome disparities among different race/ethnic
and geographic populations. How to combat these disparities
poses a challenge to today’s health care and public health care
systems in the U.S.. This is particularly true given the variation
in disparities, and the uncertain roles that lacking health insurance, health-related behaviors, risk factors, and social risks play
in both the presence and magnitude of disparities.8 Life- and
healthy life expectancy are also found among the foundation
health measures for Healthy People 2020 under measures of
general status, which are used for monitoring progress toward
the goals of increasing life expectancy and eliminating disparities set forth by this initiative.9
The estimates of life expectancy found in this report are
among the most current presented for Colorado, while those
for healthy life expectancy are among the first of their kind
generated for Colorado and its race/ethnic and geographic
subpopulations. These measures provide the unique opportunity to compare Colorado’s experience with the country as a
whole, as well as discuss differences in these measures among
Colorado’s residents and the disparities found. Life expectancy
for the United States was 77.9 years (based on 2007 data, the
latest available), compared to 79.8 years in Colorado for 2007.
Over time, Colorado’s life expectancy has mirrored the general increase in life expectancy observed in the U.S., although
Colorado life expectancy is generally about two years greater
than the U.S. estimate in any year. Colorado and the U.S.
share similar trends in life expectancy by race/ethnicity as well:
Overall, life expectancies increased, though disparities persist.
Most notable among these were consistently lower life expectancies within the Black population.1,10
A few concerns regarding interpretation, methodology, and statistical limitations warrant discussion. As previously described,
life expectancy represents the combined, lifetime mortality
experienced by the population from which the mortality data
utilized arise. As such, life expectancy is influenced by such
myriad events as infant mortality, injury and suicide deaths
among teens and young adults, and deaths due to cancer,
cardiovascular disease, diabetes, and respiratory diseases among
adults and seniors (as well as all other causes of death across all
ages). It is therefore impossible to point to any one cause as the
reason why life expectancy would be higher in one group than
another. Healthy life experience adds to the summary mortality experience a second dimension of general health status in
the population, as derived from self-assessed and reported testaments of general health. One’s health status can be affected
by a great number of factors, including presence of acute or
chronic conditions, nutrition, physical activity, mental health,
as well as differences in interpretation of what “fair” or “poor”’
health status is in comparison to “excellent” or “good.” Consequently, as with life expectancy, one cannot identify any single
component affecting health as the root cause of differences in
healthy life expectancy.
There are also some statistical limitations associated with
measures of life- and healthy life expectancy. Most of the estimates presented in this report are accompanied by 95 percent
confidence intervals, which account for and reflect the uncertainty in these measures. Such uncertainties arise from possible
errors in collection or estimation of the death, population, or
health status components used in computing life and healthy
life expectancy. Uncertainty is also introduced by the relatively
small populations, numbers of deaths, or limited populations
surveyed for general health status. The abridged life table
technique applied here utilizes 19 age groups; for all of these
9
Health Statistics Section
groups, mortality rates and estimates of general health status
are required. There are several recommendations concerning
the minimum population, number of deaths, or sample size
required in order to compute reliable life and healthy life expectancy estimates. Examples include a required total population of 5,000 or more; a total of 700 deaths or more across all
age groups; and/or a minimum of 50 respondents, within any
single age group.
For the combined three-year time period used in this report
(2008-2010), and through the regionalization of less-populous
counties in Colorado, requisite population sizes and death
counts are generally met for the race/ethnic and geographic
groups presented. Such, however, is not always the case for
the Child Health Survey or BRFSS estimates of general health
status. It would be possible to utilize additional years of data,
or to incorporate larger age ranges/fewer age groups in the
abridged life tables; however, the results would be even more
difficult to interpret. When broader time periods are used,
estimates of mortality or health status are less timely as they
are lumped with earlier years of data, making it more difficult
to measure changes over time. Similarly, if resolution of age
groups is sacrificed, the ability to explore remaining life- and
healthy years of life at specific ages is lost. This is therefore
a case of using the best and most appropriate data available
to achieve the most meaningful results. Even though ideal
conditions were not always met when generating the estimates
presented in this report, it is evident based on the confidence
intervals for life and healthy life expectancy that these estimates are sufficiently reliable to be explored and to serve as the
basis for continued discussion and use in assessing population
health.
In response to the interpretive and statistical limitations
concerning life- and healthy life expectancy, it is imperative
that these measures not be used in isolation in an attempt to
describe in comprehensive fashion the health status of a population. Rather, it is in conjunction with additional measures
of morbidity and mortality, risk factors and health behaviors,
and social and economic factors—such as those in Colorado’s
Health Indicator Set11 and other data products—that the sum10
Colorado Department of Public Health and Environment
mary measures such as those presented here are most meaningful.
While respectful of the summary nature of life and healthy life
expectancy estimates and their limitations, it is expected that these
measures will supplement discussions concerning health status and
health disparities in Colorado, assist in ongoing public health assessment and planning activities, and aid in the continued protection and improvement of the health of the people of Colorado.
Acknowledgements
The author would like to acknowledge Kieu Vu, MSPH, Colorado Behavioral Risk Factor Surveillance System Coordinator,
and Rickey Tolliver, MPH, Colorado Maternal and Child
Health Surveillance Coordinator, both in the Health Statistics
Section at CDPHE, for their assistance with this report, and
specifically for providing the child and adult general health
status statistics needed to compute healthy life expectancy.
11
Health Statistics Section
References
1. Health, United States, 2010: With Special Feature on Death and Dying. National Center for Health Statistics, 2010.
2. Race/ethnic Disparities in Self-Rated Health Status among Adults With and Without Disabilities: United States, 20042006. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report: 47(39); 1069-1073, 2008.
3. Sullivan, Daniel. A Single Index of Mortality and Morbidity. Health Services and Mental Health Administration. Vol. 86,
No. 4, April 1971.
4. Chiang, Chin Long. Introduction to Stochastic Processes in Biostatistics. Wiley Publications in Applied Statistics. John
Wiley & Sons, Inc, 1968.
5. Anderson, Robert N. Method for Constructing Complete Annual U.S. Life Tables. National Center for Health Statistics.
Vital Health Statistics: 2(129), 1999.
6. Molla, Michael T; Wagener, Diane K; Madans, Jennifer H. Summary Measures of Population Health: Methods for
Calculating Health Life Expectancy. National Center for Health Statistics. Healthy People Statistical Notes: No. 21, 2001.
7. Masseria, Christina, et al. What are the methodological issues related to measuring health and drawing comparisons across
countries. Research Note. European Commission, 2007.
8. Kulkarni, Sandeep, et al. Falling behind: life expectancy in U.S. counties from 2000-2007 in an international context.
Population Health Metrics: 9(16), 2011.
9. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People
2020. Washington, D.C.
10. Arias, Elizabeth. United States Life Tables, 2007. National Center for Health Statistics. National Vital Statistics Report: Vol.
59, No. 9, 2011.
11. Colorado Health and Environmental Data. http://www.chd.dphe.state.co.us
Additional State Reports
1. New Jersey Department of Health and Senior Services. Martin, Rose Marie. Estimates of Healthy Life Expectancy in New
Jersey for Selected Race/Sex Subpopulations, 1996-1998. Topics in Health Statistics, August 2002.
2. Rhode Island Department of Health. Jiang, Yongwen and Hesser, Jan. Healthy Life Expectancy in Rhode Island. Health by
Numbers, Vol. 7, No. 8, August 2005.
3. North Carolina Public Health. Healthy Life Expectancy in North Carolina, 1996-2000. Special Report Series by the State
Center for Health Statistics, No. 129, January 2002.
4. Utah Department of Health. Years of Healthy Life in Utah. Utah BRFSS Brief, July 2002.
5. Washington State Department of Health. Years of Healthy Life Expectancy, Washington State. Office of Epidemiology,
August 2007.