Compression or expansion of morbidity: evaluating life expectancy with and without cardiovascular diseases in Denmark

Abstract Background Cardiovascular diseases (CVDs) are among the leading causes of death in high-income countries and represent a major source of morbidity across the life course. Understanding how the time spent with CVD has evolved over time and how it differs between men and women requires going beyond summary measures of health expectancy, which condense complex health trajectories into a single number. Methods Using Danish population registers from 2005 to 2018, we employ novel bivariate age-at-death distributions to examine how the experience of cardiovascular morbidity is distributed across the population, how it has changed over time and how it varies by sex. Results Our findings point towards an expansion of CVD morbidity, with individuals experiencing a CVD hospital contact spending more years with the condition before death. This coincides with declining CVD incidence, as a growing proportion reach advanced ages without a hospital-recorded CVD event. Women are more likely than men to do so and spend fewer years with CVD before death. Conclusions The coexistence of expanding morbidity and declining incidence reflects progress on both prevention and treatment fronts, and need not be interpreted as a sign of worsening population health. The bivariate framework and visualisations introduced offer a valuable complement to existing health indicators, capturing the full distribution of morbidity experiences that summary measures conceal.