Concept Architecture
Concept
Theoretically, Sullivan Method is a demographic and epidemiological method used to estimate health expectancy by combining mortality data from life tables with the prevalence of health states within a population. It partitions total life expectancy into years lived in different health states, such as healthy and unhealthy life, thereby integrating mortality and morbidity into a single summary measure. The method assumes that age-specific prevalence of health states applies to the life table population.
Mathematically, the Sullivan Method combines person-years lived at each age from a period life table with age-specific prevalence estimates for the health state of interest. Healthy person-years are calculated by weighting life table person-years by the proportion of the population in a healthy state, and the resulting healthy person-years are accumulated to estimate health expectancy at a given age.
In practice, the method uses routinely available mortality statistics and cross-sectional health survey data. Age-specific prevalence of disability, disease, or self-reported health is applied to the corresponding life table intervals to estimate measures such as disability-free life expectancy (DFLE), healthy life expectancy (HALE), or quality-adjusted life expectancy. The Sullivan Method is widely used by national statistical agencies and public health organisations because it requires only period life tables and prevalence data.
Purpose
Used to estimate health expectancy by integrating mortality and population health prevalence data to quantify expected years lived in specified health states.
Mathematical Formulae
Primary Formula
HE? = [????? L?(1 ? �?)]?l?
where:
- HE? = health expectancy at age x
- L? = person-years lived in life table interval i
- �? = prevalence of the unhealthy state in interval i
- 1 ? �? = prevalence of the healthy state
- l? = number of survivors at age x
- ? = final life table age interval
Supporting Formulae
Healthy person-years:
L?? = L?(1 ? �?)
Total healthy person-years remaining:
T?? = ????? L??
Health expectancy:
HE? = T???l?
Related Mathematical Methods
- Life table analysis
- Health expectancy estimation
- Prevalence-based modelling
- Disability-free life expectancy estimation
- Healthy life expectancy estimation
Example
A life table reports 90,000 person-years lived between ages 65 and 66. The prevalence of disability at age 65 is 20%.
Healthy person-years are:
90,000 ? (1 ? 0.20) = 72,000
If the total remaining healthy person-years from age 65 onwards are 1,080,000 and there are 80,000 survivors at age 65:
HE?? = 1,080,000?80,000 = 13.5 years
The estimated healthy life expectancy at age 65 is 13.5 years.
Excel Implementation
| Function | Example Formula | Health Economics Application |
|---|---|---|
| SUMPRODUCT | =SUMPRODUCT(B2:B21,1-C2:C21) | Calculates healthy person-years by weighting life table person-years by healthy prevalence. |
| SUM | =SUM(D2:D21) | Totals healthy person-years remaining. |
| INDEX | =INDEX(A2:A21,MATCH(65,A2:A21,0)) | Retrieves life table values for a specified starting age. |
/ | =SUM(D2:D21)/B2 | Calculates health expectancy by dividing total healthy person-years by survivors at the starting age. |
VBA (Optional)
Automate the application of age-specific prevalence data to life tables and generate health expectancy estimates for multiple populations or health states.
Sources
- Sullivan DF. A single index of mortality and morbidity. HSMHA Health Reports. 1971;86(4):347?354.
- Jagger C, Cox B, Le Roy S, eds. Health Expectancy Calculation by the Sullivan Method: A Practical Guide. European Health Expectancy Monitoring Unit.
- Mathers CD. Health expectancies: An overview and critical appraisal. In: Summary Measures of Population Health.
- Drummond MF, et al. Methods for the Economic Evaluation of Health Care Programmes. Oxford University Press.
- NICE. Health Technology Evaluation Manual.
Related Concepts (2)
Library
Publications
1
Measuring and Valuing Health Benefits for Economic Evaluation — Brazier, Ratcliffe, Salomon & Tsuchiya, 2nd Edition ed., 2017 (Oxford University Press)
The comprehensive text on the measurement and valuation of health benefits for economic evaluation — defining health, valuation techniques (time trade-off, standard gamble), whose values to use, preference-based measures (EQ-5D, SF-6D), and the construction of QALYs.
BookView source →
Frequently Asked Questions (6)
What is the Sullivan method?
A technique for calculating health expectancy measures by combining age-specific mortality rates from a life table with age-specific prevalence rates of disability.
Source: Sullivan 1971
What data does the Sullivan method combine?
The method needs two ingredients that are widely available. The first is a life table giving the years of life expected at each age from mortality data; the second is the prevalence of disability or ill health at each age, taken from a cross-sectional survey. Applying the prevalence rates to the life table's years partitions expected life into years lived with and without the condition. Its modest data requirements are the main reason it is so commonly used. Sullivan (1971) set out this combination.
Source: Sullivan 1971
How does the Sullivan method work?
The method takes the years lived at each age from a standard life table and multiplies them by the proportion of people at that age who are healthy, from cross-sectional prevalence data, to give the healthy years lived at each age. Summing these across ages and dividing by the number surviving to a given age yields the health expectancy from that age. It applies current prevalence to life-table years without modelling transitions between states.
Source: Sullivan 1971
Why is the Sullivan method widely used?
The Sullivan method is widely used because it requires only a life table and cross-sectional prevalence of the health state, both of which are commonly available, rather than the longitudinal transition data that multi-state methods need. This makes it feasible for many populations and periods, and its results are comparable when the same definitions are used. Its simplicity and modest data requirements have made it the standard approach for computing health expectancies internationally.
Source: Sullivan 1971
What are the limitations of the Sullivan method?
The Sullivan method uses cross-sectional prevalence, which reflects the current health of people of different ages rather than the future experience of a cohort, so it can mislead when health patterns are changing over time. It does not model transitions between health states, so it cannot capture recovery directly. Estimates depend on how health is defined and measured. These limitations mean it approximates health expectancy rather than tracking a cohort's actual course.
Source: Sullivan 1971
How does the Sullivan method differ from multi-state life tables?
The Sullivan method applies cross-sectional prevalence to an ordinary life table, treating health as a static division of years, whereas a multi-state life table uses transition probabilities between health states, modelling movement in both directions including recovery. The Sullivan method is simpler and needs only prevalence, while the multi-state approach is more accurate where transitions matter but demands longitudinal data. The Sullivan method is used where such transition data are unavailable.
Source: Sullivan 1971
Trust Record
Verified by Dr Darrin Baines
British health economist
Professional identity: darrinbaines.org
Verification date: 2 Sep 2025
Content version: 1.0.0
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- Term code
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