Educational Inequalities in Healthy Life Expectancy in Catalonia: Evidence of a Decline in Healthy Years from a Population-Based Study

Aïda Solé-Auró , DemoSoc Research Group, Department of Political and Social Sciences, Universitat Pompeu Fabra
Iñaki Permanyer, Center for Demographic Studies

As lifespans lengthen, a continuing challenge is to narrow the gap between longevity and healthy living. While increased life expectancy (LE) represents a major achievement, it does not indicate whether added years are healthy. The concept of healthy life expectancy (HLE) better reflects quality of life by distinguishing years lived healthily from those lived with illness (Robine et al., 2013). From a policy perspective, identifying factors that increase HLE is crucial. Education is a key determinant, and understanding educational inequalities in health can help reduce disparities and improve population wellbeing. This study examines education inequalities in health in Catalonia (Spain) using register-based diagnosed data (Solé-Auró et al, 2025). We estimate HLE by education level (low, medium, high) for men and women in two periods (2011, 2021) using the Sullivan method(1971). We also decompose the contribution of mortality and multimorbidity to the HLE (Andreev et al. 2002). Results show a persistent educational gap in LE over time, and a pronounced education gradient in LE and HLE. For both men and women, across education levels, and using both basic and complex multimorbidity, we find that HLE between 2011 and 2021 decreases while unhealthy life expectancy increases. Multimorbidity remains the main contributor to the educational differences in HLE when using basic multimorbidity, and we observe a shift from mortality to multimorbidity as the main contributor when using complex multimorbidity. These findings offer a comprehensive view of educational inequalities in health in Catalonia, identifying factors shaping both longevity and years lived in good health.

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 Presented in Session 93. Social Inequalities in Morbidity and Disparities in Mental Health