BACKGROUND: The Virginia Department of Health uses maps of life expectancy (LE) and disability free life expectancy (DFLE) at the census tract level to reflect the importance of place-based environmental factors and as a healthy living metric.
METHODS: The Virginia Department of Health participated in Phase II of CDC/CSTE Sub-County Assessment of Life Expectancy collaboration and calculated median LE and DFLE at birth for each census tract. The Chiang II method with Silcock’s adjustment was used to calculate life expectancy and Sullivan’s method was used to calculate DFLE. Disability was defined as saying yes to one or more of the six American Community Survey disability questions. The 2010 Census was used as the midpoint population for 7 years of mortality data (2007-2013). Deaths from 2007 to 2009 were reassigned to census 2010 tracts. Abridged life tables were calculated using 19 age categories. Census tracts with population years below 5000 or with no deaths in 10 or more age categories were omitted. LE, DFLE, and the LE:DFLE ratio were mapped onto census 2010 tract boundaries using ArcGIS v10.2.2.
RESULTS: Life expectancy at birth ranged from 64.3 to 99.1 years with a median of 78.8 years. DFLE ranged from 37 to 86 with a median of 65 years. The ratio of DFLE : LE was ranged from 0.48 to 0.98 with a median of 0.82 which means some areas could expect to live half of their life with a disability and other areas could expect only a few years of disability before death. A hotspot analysis identified regions with significantly high proportion of life spent with a disability. Years of life spent with disability were significantly associated with multiple social determinants of health such as education and income in regression models.
CONCLUSIONS: Low LE and DFLE in census tracts or a differential value between nearby tracts were used to identify vulnerable areas where health inequities might exist. Areas with a high DFLE : LE ratio can be expected to live healthy lives, whereas those with a low DFLE : LE ratio are more likely to live lives with disability. Maps give informative visuals that inform efforts to reduce disability and disability-associated health disparities. Identified social determinant local drivers provide stakeholders with levers to improve health equity where it is lacking.