Multistate analysis and decomposition of disability-free life expectancy trends at mid-to-older ages in Italy, 2004–19

Italy has witnessed increases in life expectancy and population ageing, raising concerns about their impact on population health. Disability status greatly affects the participation of mid-to-older-aged adults in various aspects of life. We examine the long-term trend in disability-free life expectancy (DFLE) in Italy, over three different periods between 2004 and 2019, and explore disability dynamics (onset and recovery) and changes in disability-specific mortality. We use IT-SILC longitudinal data to estimate transition probabilities and DFLE between ages 50 and 79 and decompose DFLE changes in terms of these transitions. Overall, DFLE has improved over recent decades but not always as favourably as life expectancy. The trends indicate compression of disability between ages 50 and 79 in the most recent years. Changes in disability transitions have had the greatest influence, whereas disability-specific mortality has had much less impact on DFLE changes. The greatest contributions have come from increases in the probability of recovery from disability.