中国老年人健康预期寿命的城乡演变:2010—2020年

Urban-rural Differences on the Changes of Healthy Life Expectancy among the Older People in China:2010-2020

中国老年人的余寿在过去几十年持续增长,但是健康预期寿命的变动模式尚未达成共识,也缺乏全景式的描绘。利用第六次和第七次全国人口普查数据,以自评健康和日常生活自理能力衡量健康状况,应用Sullivan法计算健康预期寿命,深入考察老年人健康预期寿命的时空演变模式。结果表明,2010—2020年,我国老年人的余寿、健康预期寿命及其占余寿比重整体呈增长态势,以病残压缩模式为主导。健康水平和变动模式表现出明显的城乡差异:城市老年人的余寿和健康预期寿命高于镇老年人,镇老年人高于农村老年人。城市和镇低龄老年人的自评健康预期寿命占余寿比重上升,遵循病残压缩模式,生活自理预期寿命占余寿比重基本稳定,遵循动态平衡模式;城市高龄老人健康预期寿命的变化则转化为病残扩张。农村老年人的自评健康预期寿命和生活自理寿命占余寿比重均上升,遵循病残压缩模式。在城市和镇,死亡率下降是老年人自评健康预期寿命上升的主导原因,但是在农村,健康率上升是主要原因。不论城乡,死亡率下降是生活自理预期寿命上升的主要原因。健康预期寿命的城乡差异可能是由于死亡选择性,也可能是由于社会经济发展水平、医疗进步、健康战略和政策措施的城乡差异所致。

The remaining life expectancy(RLE)of the older people in China has continued to increase in the past decades,but the changes in healthy life expectancy(HLE)have not yet shown a clear pattern and lacks a panoramic view.This study examines in depth the changes of HLE with a focus on the differences between urban and rural older people,using the Sixth and Seventh census data and applying the Sullivan method.Health status was measured by self-rated health and ADL,and thus self-rated health life expectancy(SrHLE)and disability-free life expectancy(DFLE)were calculated.The results showed that,from 2010 to 2020,the RLE and HLE of the elderly and the proportion of HLE to RLE had increased continuously,supporting the hypothesis of compression of morbidity.However,there were obvious differences on the levels and changes of HLE among older people living in cities,towns and villages:the older people living in cities had higher RLE and HLE than those living in towns,and those living in towns had higher RLE and HLE than those living in villages.Among the old aged 60 to 79 living in cities and towns,the proportion of SrHLE to RLE had increased,supporting the hypothesis of compression of morbidity,while the proportion of DFLE to RLE kept stable,following a dynamic equilibrium path.But among the old aged 80 and older living in cities,the changes of both SrHLE and DFLE followed the path of expansion of morbidity.For the older people living in villages,the changes of both SrHLE and DFLE supported the hypothesis of compression of morbidity.In cities and towns,declining mortality was the main reason for the rising of SrHLE,but in villages,the increase of health rates was the dominant cause of the rising SrHLE.Mortality decline contributed more than health changes to the rise in DFLE for both urban and rural older people.Urban-rural differences on the changes of the SrHLE and DFLE may be due to selectivity in mortality,as well as to urban-rural differences on socioeconomic development,medical progresses and health policies.