Changes in Disability, Severe Disability, and Dependence in Spain (1986-2020).

Objectives: This study examines changes in disability, severe disability, and dependence in Spain between 1986 and 2020, highlighting implications for long-term care planning. Methods: We analyzed microdata from four nationally representative disability surveys (1986, 1999, 2008, 2020) and applied the Sullivan method to estimate disability-free, severe-disability-free, and autonomous life expectancy at ages 6, 45, 65, and 85 years, stratified by sex. Results: Disability-free life expectancy increased in both sexes, with slightly greater gains in men. However, years lived with severe disability and dependence also rose, especially among older adults. Women consistently lived longer but spent more years with disability and dependence than men. These patterns suggest a partial compression of morbidity, concentrated in milder forms of disability. Conclusion: Spain has experienced a relative compression of disability over the last four decades, accompanied by a growing burden of severe disability and dependence in old age. These trends raise challenges for care systems in aging societies, particularly where informal caregiving remains central. Our findings provide evidence to support health and social policy reforms aimed at building resilient and equitable long-term care models.