Survival gains and healthy life expectancy across 185 countries: A global ageing surveillance study, 2000-2021

Longer life does not necessarily mean healthier ageing, and surveillance needs to distinguish survival gains from healthy-life gains.

We used a longitudinal conversion framework to examine whether national life expectancy (LE) gains were matched by healthy life expectancy (HALE) gains.

WHO LE and HALE series were linked with IHME burden and sociodemographic indicators, WHO expenditure data, and United Nations population data for 2000-2021. We decomposed survival gains into HALE gains and an unconverted remainder, reporting population-weighted trends, country-level conversion shares (ΔHALE/ΔLE), non-ratio checks, and a secondary age-60 module. WHO uncertainty bounds were propagated through 2000 Monte Carlo draws.

Population-weighted global LE rose from 67.92 to 73.29 years in 2000-2019, while HALE rose from 59.17 to 63.69 years. The LE-HALE gap widened from 8.75 to 9.60 years, leaving 0.85 years of survival gain not matched by healthy-life gain (95% UI 0.50 to 1.21). HALE captured 84.2% of the LE gain (95% UI 77.9% to 90.5%). Among 185 countries, 181 (97.8%) had wider gaps; among 179 countries with positive LE gains, 177 (98.9%) had conversion shares below 1.0. In the age-60 module, LE60 rose by 1.92 years and HALE60 by 1.36 years.

Added survival years were not fully converted into healthy years before 2020. Longer survival should not be treated as healthier survival unless HALE gains keep pace with LE gains.