中国老年人口健康预期寿命婚姻状况差异的多状态分析

基于2008～2018年4期中国老年健康影响因素跟踪调查数据,以“有配偶”和“无配偶”作为两种基本婚姻状况,利用插值马尔科夫链方法,测算65～99岁老年人口不同健康状态间的转移概率、平均预期寿命、健康预期寿命及其占余寿比重,并预测其2016～2030年的失能率。结果显示,无配偶老年人口失能-健康转移概率、平均预期寿命和健康预期寿命均低于有配偶者,但健康预期寿命占余寿比重较高;女性老年人口平均预期寿命和健康预期寿命较长,但健康预期寿命占余寿比重较低,队列失能率较高;2016～2030年中国老年人口失能率呈上升态势,在2026年前后将达到稳定状态;无配偶、高龄和女性老年人口是未来失能的高危人群。可见,婚姻状况会对老年人口的健康预期寿命产生重要影响,有配偶对老年人口健康维持具有保护作用。     

健康预期寿命国际比较及中国健康预期寿命预测研究

健康预期寿命由预期寿命衍生而来,是人群保持完全健康状态尚能存活的期望年数,是评估人群健康水平的指标。健康预期寿命既能反映生命数量(长寿水平),又能反映生命质量(健康程度)。世界卫生组织在《1997年世界卫生报告》中呼吁在关心预期寿命的同时更要重视健康预期寿命,随后与健康预期寿命相关的国际研究、国际政策的战略规划逐步推广该指标的应用。目前发达国家十分重视健康预期寿命研究,将其纳入国家战略规划。本文系统梳理了相关国家和地区的健康预期寿命发展状况,根据发达国家健康预期寿命发展特征,采用健康预期寿命年均增加法和健康预期寿命和预期寿命差值法,对我国2020年及2030年健康预期寿命进行推测,为我国制定健康中国发展规划提供对策建议。2020年中国健康预期寿命为69.2岁左右(69.1⁶9.4),其中男性为67.2岁左右(67.169.4),其中男性为67.2岁左右(67.1⁶7.4),女性为71.3岁左右(71.167.4),女性为71.3岁左右(71.1⁷1.5);2030年中国健康预期寿命为70.9岁左右(70.671.5);2030年中国健康预期寿命为70.9岁左右(70.6⁷1.2),其中男性为69.1岁左右(68.871.2),其中男性为69.1岁左右(68.8⁶9.4),女性为72.7岁左右(72.469.4),女性为72.7岁左右(72.4⁷3.1)。建议将健康预期寿命的发展纳入中国2030经济社会发展规划指标,建立中国健康预期寿命的监测指标体系。     

婚姻状况对中国老年人口健康预期寿命的影响研究

本文基于中国老年健康影响因素跟踪调查(CLHLS)2002-2018年的数据,实证分析婚姻状态对老年人健康预期寿命的影响。基础回归结果显示:有配偶的老年人健康预期寿命比没有配偶的老年人要长,其健康预期寿命的比重也显著高于没有配偶的老年人;细分老年人的婚姻状态、进一步考虑老年人上一期的健康水平及婚姻状态后,丧偶老年人健康预期寿命最短;与家人一同居住、小学及以下受教育水平、高收入、没有医疗保险、患有慢性病、患重病的老年人健康预期寿命处于劣势地位。异质性分析结果显示,婚姻状态对女性、农村老年人的影响更大,农村女性老年人以及城镇男性老年人的健康预期寿命最短。机制检验结果表明,老年人个体的健康行为(吸烟、饮酒)、社会参与和及时医疗服务的可及性是婚姻影响其健康预期寿命的渠道变量。调节效应结果表明,婚姻对老年人健康预期寿命及占比的影响受其乐观态度的正向调节,受其孤独、焦虑以及自主性的负向调节。     

中国高龄老人健康预期寿命研究

用隶属等级 (GradeofMembership ,GOM)模型将反映 1998年被访高龄老人不同健康维度的 5 0个变量进行综合得到健康、比较健康、功能受限、体弱多病、极度虚弱五个纯类。用这五个纯类将高龄老人预期寿命进行了分析     

中国老年人口健康预期寿命延长还是缩短？——基于Sullivan方法的实证研究

随着老年人口数量在总人口中不断增长,中国人口的总体健康水平。特别是老年人的健康预期寿命将会发生新的变化。中国老年人口的健康预期寿命是在增长还是在缩短？老年人口的健康预期寿命在总预期寿命中的比例是在增大还是在缩小？搞清楚这个问题对于我们合理地制定老龄政策至关重要。本文尝试应用国际上最为流行的Sullivan方法回答上述问题。     

预期寿命延长对储蓄率的影响研究

随着人口预期寿命延长,国民储蓄率在某些国家和地区增加而在另一些国家和地区减少,在某些时期上升而在另一些时期下降。文章利用世界卫生组织的数据,将预期寿命分解为"不健康"预期寿命和健康预期寿命,从人口寿命结构视角观察人口在不同健康状态下的储蓄率差异。研究发现:(1)"不健康"预期寿命的长度对国民储蓄率有负面影响。即随着"不健康"预期寿命的延长,国民储蓄率趋于降低。(2)健康预期寿命的长短对国民储蓄率的影响并不显著,但其延长涉及的人群特征与国民储蓄率息息相关。具体而言,中青年人口健康状况的改善将促进储蓄率增长,而老年人口健康状况的改善则会弱化储蓄动机。这意味着健康状况的持续改善将推动新兴经济体的储蓄率形成先上升、后下降的倒"U"形走势。结合世界卫生组织的数据,可以推断目前中国国民储蓄率已进入寿命延长所诱发的下行通道。     

中国人口的流动预期寿命

随着我国人口流动率的不断增长,人口流动的长期化趋势日益明显。对于流动的长期化或处于流动状态的时间长度,一般使用流动人口在目的地的平均居住时间长度来衡量。本研究提出了一个新的概念和指标,即流动预期寿命。它是指在给定的分年龄人口流动率的条件下,人们预期在流动状态下度过的年数。它是通过编制生命表进行计算的。平均居住时间受到年龄结构的影响,而平均流动预期寿命排除了年龄结构的影响。通过人口普查数据的计算,我国人口的平均流动预期寿命在过去10年增长了一倍,由2000年的5.4年上升到2010年的10.8年,2010年男性的平均流动预期寿命略高于女性。人口流动的常态化和长期化成为日益显著的趋势。     

我国老年人口失能判别及其对健康预期寿命影响分析

老年人口失能水平对健康预期寿命的测算具有重要影响,而不同数据来源的老年人口失能水平存在着较大差异。本文以经过模型生命表调整的2015年1%人口抽样数据所计算的生命表为基础,以2010年人口普查、2015年1%人口抽样调查、2015年CHARLS数据和2014年CLHLS数据为资料来源,探讨老年人口分年龄失能状况及其对健康预期寿命测算结果的影响。老年人失能率较大程度地影响着健康预期寿命及其性别年龄模式。无论是失能的主观评价指标还是客观评价指标,不同数据来源的高龄老人失能率差别较大;CHARLS数据中高龄老人失能率偏倚原因可能产生于调查过程中的系统误差,而非样本规模较小;CLHLS和CHARLS中的问卷访题设计也是影响失能程度判别的重要因素。因此,在理论和应用层面上探讨我国老年人口特别是高龄老人失能水平的差异及其原因,逐步形成共识是学界亟待解决的重要问题。     

2010~2020年中国农村老年人口的工作预期寿命及其地区差异北大核心

基于2010年以来的全国人口普查和人口抽样调查数据,对中国农村老年人口的工作预期寿命及其变动趋势和地区差异进行了系统分析。研究结果表明,2010年以来,农村老年人口劳动参与水平持续下降,工作预期寿命稳步缩短,非工作预期寿命延长;这些变化存在显著的性别和地区差异,男性和农业发达、人口净流出地区的农村老年人需要面对工作预期寿命更长而晚年闲暇时长更短的双重劣势;各地区农村老年人口工作余寿在余寿中的拓展模式可以分为“安逸型”“劳逸结合型”“高负担型”“低负担型”“限制型”5种类型,所属类型与老年人的生活水平、劳动意愿、劳动能力和劳动条件紧密相关。政府和社会在为农村老年劳动者赋能的同时,应该为其提供设计合理、保障有力的经济安全网。     

Global Patterns of Healthy Life Expectancy for Older Women

SUMMARY

This paper focuses on patterns of healthy life expectancy for older women around the globe in the year 2000, and on the determinants of differences in disease and injury for older ages. Our study uses data from the World Health Organization for women and men in 191 countries. These data include a summary measure of population health, healthy life expectancy (HALE), which measures the number of years of life expected to be lived in good health, and a complementary measure of the loss of health (disability-adjusted life years or DALYs) due to a comprehensive set of disease and injury causes. We examine two topics in detail: (1) cross-national patterns of female-male differences in healthy life expectancy at age 60; and (2) identification of the major injury and disability causes of disability in women at older ages. Globally, the male-female gap is lower for HALE than for total life expectancy. The sex gap is highest for Russia (10.0 years) and lowest in North Africa and the Middle East, where males and females have similar levels of healthy life expectancy, and in some cases, females have lower levels of healthy life expectancy. We discuss the implications of the findings for international health policy.     

Recent Perspectives on Active Life Expectancy for Older Women

SUMMARY

This article provides a critical review of recent active life expectancy literature, describing trends of special interest to women. We review findings from leading perspectives used to study life expectancy and active life expectancy, including gender, racial and socioeconomic differences, disease-specific effects, and biodemography. We examine three competing theories of population health that frame active life expectancy research—compression of morbidity, expansion of morbidity, and dynamic equilibrium—concluding there is support for both the compression of morbidity and dynamic equilibrium theories. Policy implications for women include a greater understanding of the role of education and racial and ethnic diversity in active life trends, and an increased public policy emphasis on prevention and treatment of chronic disease, together with adoption of more healthy lifestyles.     

Decomposition of Chinese Life Expectancy via Occupation

In this article, we applied the concept of partial life expectancy to calculate the expected years of working life via occupation for the Chinese population beyond age 15. The calculations were based on the data from the population censuses of China in 1982, 1990 and 2000, which covered the period of eighteen years from the early economic reform years to the end of last century when the market economy became the official goal of the Chinese government. From our study, we found that, using partial life expectancy as the indicator, majority of the working life of the Chinese population has been on farming although it was slowly declining for both sexes from 1982 to 2000. In 1982, the expected years of working life on farming were 30.98 years for males and 26.45 years for females. In 2000, these values decreased to 27.09 and 26.16 years respectively. However, the expected years of working life in service sector increased from 1.88 years and 1.57 years in 1982 for males and females to 3.35 years for both sexes in 2000.     

Adjusting Life Expectancy to Account for Disability in a Population: A Comparison of Three Techniques

Sullivan (1971) first suggested weighting life expectancy (LE) to account for the health of a population using a single indicator. Known as disability free life expectancy (DFLEs), this measure was somewhat limited due to a overly simplistic weighting scheme. Its introduction, however, spurred the development of a whole new class of measures known as health expectancy indicators. One of the first, disability-adjusted life expectancy (DALEs) (Wilkins and Adams, 1983), identified the period of time in a particular level of disability and weighted each level accordingly. While the weighting allowed for a health related quality-of-life distinction to be introduced into the DALE measure, the weights, by level of disability, were arbitrarily chosen and fixed for all ages and gender. To overcome this limitation, a health-adjusted life expectancy (HALE) was developed based in large part on the DALE methodology but utilizes more refined weights. The McMaster Health Utility Index Mark III (HUI3)) scores health on a continuum from 0 to 1 and when included on a national health survey, provides estimates that reflect important age, gender, and socio-economic factors. All three measures were calculated for the years 1986, 1991, and 1994 (household and institutional populations). Analysis revealed that HALEs were more appropriate for policy purposes due to their ability to account for indirect morbidity in both a disabled and non-disabled population.     

Modeling Quality-Adjusted Life Expectancy Loss Resulting from Tobacco use in the United States

Purpose  To describe the development of a model for estimating the effects of tobacco use upon Quality Adjusted Life Years (QALYs) and to estimate the impact of tobacco use on health outcomes for the United States (US) population using the model. Method  We obtained estimates of tobacco consumption from 6 years of the National Health Interview Survey (NHIS). In addition, NHIS data were used to impute the Quality of Well-Being (QWB) Scale using a new methodology known as QWBX1. The QWB places health status on a continuum ranging from death (0.0) to full functioning without symptoms (1.0). The method allows the adjustment of life expectancy for reduced quality of life associated with health conditions. NHIS data were matched to the National Death Index for 14,464 deaths occurring by December 31, 1997. The analysis is limited to adults between the ages of 18 and 70 years. Results  Quality of Well-Being scores were broken down by age and for six smoking categories: (1) non-smokers, (2) those who smoke 1–10 cigarettes per day, (3) 11–20 cigarettes per day, (4) 21–30 cigarettes per day, and (5) 31–40 cigarettes per day, and (6) 40 or greater cigarettes per day. There was a systematic relationship between current tobacco use and health-related quality of life at each point along the age spectrum and there was a clear and systematic separation of quality-adjusted life expectancy by number of cigarettes smoked per day. Teenagers who continue to smoke loose 3.5 QALYs between ages 18 and 70 in comparison to non-smokers. A greater portion in the loss in QALE is attributable to quality of life than to shorten life expectancy. Conclusions  The overall goal of Healthy People 2010 is to increase Years of Healthy Life (or QALE) in the United States. Each year, tobacco use results in hundreds of thousands of quality-adjusted life years lost. Combined models of morbidity and mortality incorporating a range of tobacco consumption levels are required to best represent the impact of tobacco use. Supported by a Grant 11RT-0243 from the Californian Tobacco Related Disease Research Program (TRDRP)     

中国老年人带残预期寿命及疾病影响的城乡差异分析

为了明确各种疾病对我国城乡老年人残疾以及带残预期寿命的影响,本文基于第二次全国残疾人抽样调查数据,首先对残疾现患率进行归因分析,得到分疾病的残疾现患率,然后结合死亡率数据,利用苏利文方法计算分疾病的带残预期寿命。结果显示,在60岁时,城市男性预期将有4.08年(城市女性:4.95年)生活在残疾状态中,低于农村男性的4.72年(农村女性:5.46年)。老年性耳聋、白内障、脑血管疾病、骨关节炎和未分类的伤害是老年人的最重要的5种致残疾病。而且,各种疾病对老年人的残疾现患率和带残预期寿命的影响存在明显的城乡差异。本研究为政府在城乡老年人中提出具有针对性的残疾预防战略提供了实证支持。     

我国人口预期寿命分析与预测

本文通过对我国人口年龄和性别构成现状的分析,运用蒋庆琅法利用2003年我国人口抽样和死亡率资料编制当年的简略寿命表,估算我国现阶段人口的预期寿命。接着,对我国自解放至今人口预期寿命的变化及其原因进行分析,并最终利用我国自第四次人口普查至第五次人口普查阶段人口预期寿命增长率等相关资料,对我国人口2001-2020年的预期寿命作出预测,得出今后我国人口预期寿命将继续增长,但增长率依年度的推移而递减。     

“人均预期寿命提高1岁”的实证研究

温家宝总理在政府工作报告中首次提出十二五时期人均预期寿命提高1岁的目标。本文在生命表数据基础上,通过计算平均预期寿命贡献率并进行相关分析与回归分析后得出:我国目前平均预期寿命虽然已高于绝大多数发展中国家,但其绝对增速正逐渐放慢。而降低60～90岁年龄段老年人口死亡率、提高居民消费水平、缩小家庭规模、迁移有条件的离退休老人到低海拔地区养老是实现人均预期寿命提高1岁目标的有效路径。     

我国年龄组平均预期寿命变动的实证研究

平均预期寿命是国内外评价一个国家或地区人口健康状况的重要指标。国家统计局只公布0岁组平均预期寿命,而要进一步研究,则需要分年龄组资料。利用1995年、2005年全国1%人口抽样数据编制分性别、分城乡的完全生命表,在此基础上定量分析得出:我国各年龄组平均预期寿命,女性>男性,城镇>乡村;暂时平均预期寿命的相对增长速度,1995~2005年快于1981~1995年,女性快于男性;老年组死亡率的降低对0岁组平均预期寿命的贡献率最大。