Beyond healthy life expectancy: educational differences in healthy longevity distributions in Europe

Despite extensive research on educational inequalities in healthy life expectancy (HLE), most studies focus on average differences, leaving open how healthy longevity is distributed within educational groups. This study examines sex-specific educational differences in healthy longevity distributions at age 60 in Europe, using multiple health measures. We combined data from the Survey of Health, Ageing and Retirement in Europe (SHARE) with Eurostat life expectancy data (2016-2017). A Markov chain model combined with the maximum entropy method was used to estimate distributions of age at the end of healthy lifespan. Educational differences were formally compared using the healthy lifespan outsurvival statistic and the Hellinger distance. High education was often associated with more negatively skewed healthy longevity distributions. Men with low education had higher healthy lifespan variation than men with high education. Across all health measures for women, and most health measures for men, the probability that a person with low education had a longer healthy lifespan than a person of the same sex with high education was below 50%. However, a lack of statistical significance indicated that this finding did not apply to men for life free from cardiovascular conditions or a broad range of chronic conditions. By moving beyond average values and adopting a distributional perspective, this study highlights important dimensions of health inequality that are not captured by mean-based measures alone such as HLE. The findings also point to the need for further methodological development in the estimation of healthy longevity distributions.