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。     

平均预期寿命、健康工作寿命与延迟退休年龄

我国劳动者能健康工作多久?退休年龄究竟延迟到哪一岁最为合理?这关系着广大劳动者切身利益因而是非常重大的政策性问题。本研究采用生命表技术编制了我国2005和2010年分性别人口平均预期寿命、健康预期寿命、工作寿命及健康工作寿命表,然后从劳动力健康工作的视角提出我国延迟退休的合理目标年龄。研究发现,2005和2010年,我国男女健康工作寿命都分别接近62岁和58岁。该发现的重要政策启示在于:我国当前可适当延迟退休年龄,女性比男性延迟退休的空间大,男女65岁同龄退休的时机还未成熟,建议我国延迟退休的目标年龄应以男性62岁,女性58岁为上限;从生命周期角度对我国退休年龄进行国际比较,若按男性62岁,女性58岁为退休年龄上限执行,那么我国劳动力的退休生涯与工作寿命之比将接近发达国家的平均水平;从政策的操作层面来看,我国延迟退休应女先男后或女快男慢,并采取弹性退休制度逐步推迟退休年龄。     

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.     

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差异的分解研究

健康预期寿命是反映人群健康长寿的重要指标,健康预期寿命差异反映了一个国家或地区的健康不平等状况。利用多状态生命表分析了中国老年人口健康预期寿命在过去十余年间的趋势与变动,并通过夏普利值分解法测算了人口社会学等11类因素对老年人口健康预期寿命差异的具体贡献值。得到以下四项重要研究结论:第一,从2005年到2018年,中国老年人口健康预期寿命差异的程度略有增加,女性、农村群体相比对应群体差距始终较高;泰尔指数分解发现,组内不平等(而非组间不平等)是造成上述差异的主要原因;老年人口健康预期寿命的性别差异呈现出高龄老人缩小而低龄老人扩大的趋势。第二,婚姻状况是健康预期寿命变动最重要的影响因素,但影响程度呈现逐年下降趋势,反之,受教育程度的影响在逐年上升;进一步将11类影响因素归类后发现:"个体特征"是最重要的影响因素,"经济因素"和"行为因素"的重要性次之,"环境因素"的影响最小。第三,上述影响因素对中国老年人口健康预期寿命的影响总体呈上升趋势,分城乡、分性别后依然呈现出相同的特征。最后,各因素在不同城乡、性别、婚姻状态的群体中的影响存在异质性。     

Differences in Life Expectancy and Disability Free Life Expectancy in Italy. A Challenge to Health Systems

Background Measures of health expectancy such as Disability Free Life Expectancy are used to evaluate and compare regional/national health statuses. These indicators are useful for understanding changes in the health status and defining health policies and decisions on the provision of services because provide useful information on possible areas needing interventions and burden of care to health systems. Methods Two databases have been used for the analysis: the Italian Health Interview Survey and the European Community Household Panel. The data were analyzed by gender and geographic area. DFLE was calculated by the Sullivan method. Results In 2005 in Italy women have a longer life expectancy than men: 84 and 78 years, respectively. But if we consider life without disability in Italy the male disadvantage reduces: men live 85% of their years without disability, women only 75%. Geographic differences do exist because Disability Free Life Expectancy is longer in Northern and in Central regions; shorter in the South. At a European level similar data can be found: on average women live longer but they have a longer time of life with disability. Conclusion In Italy women live longer but have a worse quality of health than men; in the South there is a worse quality of health. Similar findings can be identified at a European level. The Italian situation with the highest percentage of DFLE at 65 out of the total LE at 65 and one of the longest LE witnesses ageing is not necessarily associated to a worsening of health.     

中国老年人的空巢时间有多长?

在中国人口老龄化过程中,随着空巢老人比重的持续上升,老年人在空巢状态度过的时间也在不断延长.文章使用中国健康与养老追踪调查(CHARLS) 2011、2013年的数据和多状态生命表法,估计60岁及以上老年人的预期寿命和空巢预期寿命,及其性别、城乡和受教育程度差异.结果表明,中国老年人整个老年期中超过一半的余寿都处在空巢状态;女性老年人的空巢预期寿命高于男性老年人;农村老年人的空巢预期寿命高于城市老年人;而受教育水平越高,老年人空巢预期寿命也越长.另外,老年人的空巢预期寿命与他们当前所处居住状态有很大关系,当前处在空巢状态的老年人的空巢预期寿命及其占余寿比重都远远高于处于非空巢状态的老年人.     

中国1998年健康长寿调查及高龄老人生活自理期望寿命

在有关领导部门的指导及各地老龄工作部门同志们的大力协助和参与下,北京大学人口研究所与中国老龄科研中心于1998年在全国22个省、自治区、直辖市组织开展了高龄老人健康长寿调查.本文概述这一调查的意义,样本计方案及数据质量评估,并根据这次调查搜集到的数据资料,首次对中国高龄老人先后自理期望寿命进行估算、分析与讨论.     

Changing Life Expectancy and Health Expectancy Among Russian Adults: Results from the Past 20 Years

The decade following the collapse of the Soviet Union was characterized by wide fluctuations in Russian mortality rates, but since the early 2000s, life expectancy has improved progressively. Recent upturns in longevity have promoted policy debates over extending the retirement age in the country. However, whether observed gains in life expectancy are accompanied by improving health remains to be addressed. Using data from the 1994–2014 Russian Longitudinal Monitoring Survey of the Higher School of Economics, this study investigates trends over 20 years in healthy life expectancy (HLE) and illness-free life expectancy (IFLE) for men and women at adult ages. Analyses using the Sullivan method show that men and women at adult ages have experienced large increases in health expectancies during the post-Soviet period. Increases in HLE exceeded increases in total life expectancy for both genders. Further, health expectancies have evolved over time through cycles of increases and decreases, just like life expectancy. These results suggest increases in good-quality years among men and women at working ages, offering support for changing the official retirement age. The extent of the change in the retirement age, however, needs to be carefully considered, given that, despite recent improvements, the health expectancy of the Russian population still remains low.     

中国老年人口的自理预期寿命变动——社会性别视角下的差异分析

基于2005年"小普查"及2010年"六普"汇总数据,本文利用生命表技术及Sullivan法,分析了男性与女性老年人口预期寿命、自理预期寿命及其差异的变化。研究发现,随着年龄的提高,预期寿命与自理预期寿命的性别差异均呈缩减趋势;5年间,老年人口预期寿命的性别差异在低龄阶段有略微的扩张趋势,而自理预期寿命的性别差异则在各年龄均呈扩张趋势;男性老年人口自理预期寿命占余寿的比重始终高于女性,而且与以往研究结论不同的是,5年间老年人口自理预期寿命占余寿的比重呈上升趋势,且女性该比重的上升幅度高于男性。     

Bayesian Probabilistic Projections of Life Expectancy for All Countries

We propose a Bayesian hierarchical model for producing probabilistic forecasts of male period life expectancy at birth for all the countries of the world to 2100. Such forecasts would be an input to the production of probabilistic population projections for all countries, which is currently being considered by the United Nations. To evaluate the method, we conducted an out-of-sample cross-validation experiment, fitting the model to the data from 1950–1995 and using the estimated model to forecast for the subsequent 10 years. The 10-year predictions had a mean absolute error of about 1 year, about 40 % less than the current UN methodology. The probabilistic forecasts were calibrated in the sense that, for example, the 80 % prediction intervals contained the truth about 80 % of the time. We illustrate our method with results from Madagascar (a typical country with steadily improving life expectancy), Latvia (a country that has had a mortality crisis), and Japan (a leading country). We also show aggregated results for South Asia, a region with eight countries. Free, publicly available R software packages called bayesLife and bayesDem are available to implement the method.     

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.     

Life Expectancy Index: Age Structure of Population and Environment Evolution

Social Indicators Research - Tolerance, Technology and Talent indexes that are found in the literature and used to compare cities tend to focus more on economic and technologic progress. However,...     

A Comparative Study of Handicap-free Life Expectancy of China in 1987 and 2006

After the first large scale national sampling survey on handicapped persons in 1987, China conducted its second national sampling survey in 2006. Using the data from these two surveys and the national life tables, we computed and compared the expected years of life free of handicapped condition by the Sullivan method. The expected years of life lived with handicap for the Chinese population increased from 4.87 years for males and 5.81 years for females in 1987 to 5.55 years and 6.32 years in 2006, respectively. The same trend was observed for people in working ages (15–64) and old ages (65+). However, the expected years of life lived with handicap decreased for children (0–14). Our results also showed that the effect of skeletal handicap increased notably for both sexes. Healthy life expectancy is an important indicator in measuring quality of life of a population. Our study utilized this measurement to quantify one aspect of quality of life of the Chinese population.     

Estimating Increment-Decrement Life Tables with Multiple Covariates from Panel Data: The Case of Active Life Expectancy*

A fundamental limitation of current multistate life table methodology-evident in recent estimates of active life expectancy for the elderly-is the inability to estimate tables from data on small longitudinal panels in the presence of multiple covariates (such as sex, race, and socioeconomic status). This paper presents an approach to such an estimation based on an isomorphism between the structure of the stochastic model underlying a conventional specification of the increment-decrement life table and that of Markov panel regression models for simple state spaces. We argue that Markov panel regression procedures can be used to provide smoothed or graduated group-specific estimates of transition probabilities that are more stable across short age intervals than those computed directly from sample data. We then join these estimates with increment-decrement life table methods to compute group-specific total, active, and dependent life expectancy estimates. To illustrate the methods, we describe an empirical application to the estimation of such life expectancies specific to sex, race, and education (years of school completed) for a longitudinal panel of elderly persons. We find that education extends both total life expectancy and active life expectancy. Education thus may serve as a powerful social protective mechanism delaying the onset of health problems at older ages.     

对我国人口平均预期寿命的间接估算及评价——基于第六次全国人口普查数据

本研究应用直接法(寿命表法)和间接法(模型生命表法)对全国第六次人口普查数据资料进行分析,分别计算我国人口平均预期寿命。两种方法计算结果表明:直接法计算人口平均预期寿命数值偏高,经过间接估算方法调整后,我国人口平均预期寿命已经达到73.65岁,人口平均预期寿命的地区差别非常大。我国应采取措施进一步缩小人口平均预期寿命地区间差异,提高人口预期寿命。     

Multidimensional Quality of Life: A New Measure of Quality of Life in Adults

This paper presents a new measure for assessing quality of life (QOL) –the Multidimensional Quality of Life (MQOL)– and describes its derivation, characteristics, structure and several applications. Reasons for developing the MQOL include the restricted range of assessed domains and the heavy emphasis on health in many standard assessment tools. The MQOL was derived by meaning probes into QOL in different samples. It is a 60-item self-report tool of high reliability and validity covering various themes and forming, in line with factor and cluster analyses, 17 scales that constitute five factors according to confirmatory factor analysis. It has been applied with thousands of individuals, in English, Hebrew, Russian and Arabic, and is adequate for healthy and physically or mentally sick individuals, under regular or challenging circumstances. Described studies present findings in samples of sick or healthy individuals (e.g., unemployed, members of a collapsing Kibbutz); relations between the MQOL and coping strategies in partners of sick individuals; and interrelations of overall and scale scores in new and old immigrants. Conclusions focus on the structure of the MQOL, the specificity of coping effects, and the stabilizing mechanisms of QOL.     

Objective Inequality Indexes Joining Income with Life Expectancy Through the Life Quality Index of Sub-populations

Social Indicators Research - Two indexes are developed to compare inequality: one within, the other between countries. The indexes are objective, more transparent and comprehensive. They integrate...     

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。