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A note on the use of sensitivity analysis to explore the potential impact of declining institutional care utilisation on disability prevalence

DOI: 10.1186/1478-7954-2-3

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Prevalence measures of disability, functional limitation and other health states are important descriptive statistics for assessing population health and are integral to the construction of summary measures such as health expectancy [1]. Commonly used health and disability survey sampling frames exclude individuals living in institutions such as hospitals or retirement homes. For example, reports based on the United States National Health Interview Survey [2], the French Health and Medical Care Survey [3], the Finnish and Norwegian Surveys of Living Conditions [4] and the New-Zealand Household Health Survey [5] all note that the survey data refer to the non-institutionalised population. Because the prevalence of limiting and disabling conditions is likely to be higher among the population in institutional care, prevalence estimates based solely on the non-institutionalised population are likely to underestimate prevalence for the full population, particularly at older ages. In the context of health expectancy calculations, one response to this situation has been to define institutional care as a distinct health state and to produce estimates of the expectation of life in institutional care, not in institutional care but with functional limitations or disability and not in institutional care and free of limitations or disabilities [2,6]. Surveys of the non-institutionalised population produce estimates of the conditional prevalence, Pr(limitation|non-institutionalised), which is exactly what is required to compute the expectation of life with non-institutionalised disability in a health expectancy calculation, partitioned as just discussed.The strategy of defining institutional care as a distinct health state yields a coherent set of point-in-time health state prevalences and health expectancy estimates, covering the entire population. However changes in the prevalence of institutionalisation complicate the interpretation of changes in non-institutionalised health st


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