Healthy life expectancy in China: Modelling and implications for public and private insurance

Li, Han; Hanewald, Katja; Wu, Shang

doi:10.1017/s1748499520000135

Cited by 7 publications

(5 citation statements)

References 43 publications

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“…The burden of morbidity and disability will also climb along with the aging trend. Although comparable in aging, China’s economic development is not on par with its high-income East Asian neighbors [ 3 ]. Therefore, the resource accumulation in China to support its aging society may be even more challenging.…”

Section: Introductionmentioning

confidence: 99%

Projections of functional dependence among the late middle-aged and older population from 2018-2048 in China: a dynamic microsimulation

Jiang,

2024

glob health res policy

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Background The population of China is aging rapidly. However, the long-term trajectories of functionally dependent late middle-aged and older Chinese people are currently absent. The present study aimed to estimate the population size and proportion of late middle-aged and older adults with difficulties and dependence on activities of daily living (ADL) and instrumental activities of daily living (IADL) in China from 2018 to 2048. Methods We constructed a dynamic microsimulation model to project the population size and proportions of late middle-aged and older Chinese people who have difficulty and dependence in ADL and IADL from 2018-2048. The model was populated with a representative sample of the target population and allowed individual-level interaction between risk factors, diseases, and health outcomes. Analyses by socioeconomic subgroups were also conducted. Results Almost 25% and 38% of late middle-aged and older people in China will become ADL- and IADL-dependent by 2048, respectively. Also, 17% of the target population will be severely ADL-disabled by 2048. The inequity in functional status across subgroups by sex, educational level, and urban/rural residency will become substantial. Conclusions The numbers and percentages of China's functionally difficult and dependent late middle-aged and older population will increase by magnitudes as of the mid-21st century, the pressure of which is compounded by its disproportionate distribution across subgroups. To alleviate the overwhelming challenge, efforts to improve the functional status of the underserved subpopulation should also be iterated.

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Section: Introductionmentioning

confidence: 99%

Projections of functional dependence among the late middle-aged and older population from 2018-2048 in China: a dynamic microsimulation

Jiang,

2024

glob health res policy

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“…Moreover, disadvantages in nutrition, health, wealth, education, employment and income that arise early in life can reinforce each other and accumulate over the life course. 17 The large heterogeneity in intrinsic capacity observed in older adults is thus likely to strongly reflect the accumulated impact of these determinants, 18 , 19 inextricably linking poorer healthy ageing trajectories to early-life inequalities. However, the cumulative contribution of health and socioeconomic inequalities over time to intrinsic capacity levels in late life has not been well studied.…”

Section: Introductionmentioning

confidence: 99%

Life-course inequalities in intrinsic capacity and healthy ageing, China

Si¹,

Hanewald²,

Chen³

et al. 2023

Bull World Health Org

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Objective To investigate the contribution of early-life factors on intrinsic capacity of Chinese adults older than 45 years. Methods We used data on 21 783 participants from waves 1 (2011) and 2 (2013) of the China Health and Retirement Longitudinal Study (CHARLS), who also participated in the 2014 CHARLS Life History Survey to calculate a previously validated measure of intrinsic capacity. We considered 11 early-life factors and investigated their direct association with participants’ intrinsic capacity later in life, as well as their indirect association through four current socioeconomic factors. We used multivariable linear regression and the decomposition of the concentration index to investigate the contribution of each determinant to intrinsic capacity inequalities. Findings Participants with a favourable environment in early life (that is, parental education, childhood health and neighbourhood environment) had a significantly higher intrinsic capacity score in later life. For example, participants with a literate father recorded a 0.040 (95% confidence interval, CI: 0.020 to 0.051) higher intrinsic capacity score than those with an illiterate father. This inequality was greater for cognitive, sensory and psychological capacities than locomotion and vitality. Overall, early-life factors directly explained 13.92% (95% CI: 12.07 to 15.77) of intrinsic capacity inequalities, and a further 28.57% (95% CI: 28.19 to 28.95) of these inequalities through their influence on current socioeconomic inequalities. Conclusion Unfavourable early-life factors appear to decrease late-life health status in China, particularly cognitive, sensory and psychological capacities, and these effects are exacerbated by cumulative socioeconomic inequalities over a person’s life course.

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“…For example, the 2020 gross domestic product (GDP) per capita in Beijing (east region) was 2·6 times that of Anhui (central region), and 4·6 times that of Gansu (west region) [ 33 ]. In 2015, the average healthy life expectancy was estimated to be around 78 years among males in Beijing, Tianjin, and Shanghai (eastern region), but only 69 years in Qinghai, Tibet, and Yunnan (western region) [ 34 ].…”

Section: Introductionmentioning

confidence: 99%

Association between multimorbidity and informal long-term care use in China: a nationwide cohort study

Chen,

Si,

Hanewald

et al. 2023

BMC Geriatr

Self Cite

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Background The impact of multimorbidity on long-term care (LTC) use is understudied, despite its well-documented negative effects on functional disabilities. The current study aims to assess the association between multimorbidity and informal LTC use in China. We also explored the socioeconomic and regional disparities. Methods The study included 10,831 community-dwelling respondents aged 45 years and older from the China Health and Retirement Longitudinal Study in 2011, 2015, and 2018 for analysis. We used a two-part model with random effects to estimate the association between multimorbidity and informal LTC use. Heterogeneity of the association by socioeconomic position (education and income) and region was explored via a subgroup analysis. We further converted the change of informal LTC hours associated with multimorbidity into monetary value and calculated the 95% uncertainty interval (UI). Results The reported prevalence of multimorbidity was 60·0% (95% CI: 58·9%, 61·2%) in 2018. We found multimorbidity was associated with an increased likelihood of receiving informal LTC (OR = 2·13; 95% CI: 1·97, 2·30) and more hours of informal LTC received (IRR = 1·20; 95% CI: 1·06, 1·37), ceteris paribus. Participants in the highest income quintile received more hours of informal LTC care (IRR = 1·62; 95% CI: 1·31, 1·99). The estimated monetary value of increased informal LTC hours among participants with multimorbidity was equivalent to 3·7% (95% UI: 2·2%, 5·4%) of China’s GDP in 2018. Conclusion Our findings substantiate the threat of multimorbidity to LTC burden. It is imperative to strengthen LTC services provision, especially among older adults with multimorbidity and ensure equal access among those with lower income.

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Healthy life expectancy in China: Modelling and implications for public and private insurance

Cited by 7 publications

References 43 publications

Projections of functional dependence among the late middle-aged and older population from 2018-2048 in China: a dynamic microsimulation

Projections of functional dependence among the late middle-aged and older population from 2018-2048 in China: a dynamic microsimulation

Life-course inequalities in intrinsic capacity and healthy ageing, China

Association between multimorbidity and informal long-term care use in China: a nationwide cohort study

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