中国老年人生活自理健康预期寿命的多状态模型分析

Multi-state Model Analysis on Self-care Healthy Life Expectancy of the Elderly in China

文章基于中国老年健康影响因素跟踪调查(CLHLS)2008、2011和2014年数据,以65~99岁老年人口为目标人群,利用插值马尔可夫链方法,计算了分性别年龄的老年人口不同健康状态间的转移概率、健康预期寿命及其余寿占比,依据风险转移概率之间的相关程度对老年人口失能率进行预测。结果显示,随着年龄增长,健康—失能的转移概率逐渐上升,失能—健康恢复概率逐渐下降,在高龄阶段,健康—失能转移概率迅速增加,且恢复概率很低;女性老年人预期寿命和健康预期寿命较长,但健康预期寿命的余寿占比低于男性;2016~2030年中国老年人口失能率呈上升态势,支持“疾病拓展假说”,在2026年前后达到“稳定”状态。上述研究结果提示,老年人口健康服务应注重预防,在政策设计、生活照料及设施安排上减少老年人失能的风险,延长健康生存期;同时从健康不平等的社会性别出发,关注女性老年人口的健康服务需要,提高其生命质量。

Based on data of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2008, 2011 and 2014, this paper uses interpolation Markov chain to calculate the risk transfer probability by gender and age, healthy life expectancy, and average life expectancy among different health states of the elderly who were 65-99 years old, and then predicts the disability rate of the elderly according to the correlation of the risk transfer probabilities. The results show that the probability of healthdisability transition increases gradually along with age, and the probability of disability-health recovery decreases gradually. At the oldest ages, the probability of health-disability transition increases rapidly, and the probability of recovery is very low. The average life expectancy and healthy life expectancy of female elderly are longer, but the proportion of healthy life expectancy is lower than that of the male. The disability rate of the elderly in China increased from 2016 to 2030, supporting the“disease expansion hypothesis”and reaching a“stable”state in 2026 or so. These findings suggest that health services for the elderly should focus on prevention, reduce the risk of disability and prolong the healthy life expectancy in policy design, care providing and facility arrangement. At the same time, we should pay attention to the health needs of the female elderly and improve their quality of life.