The Socioeconomic Disparity Of Disability-free Life Expectancy And Life Expectancy Among Chinese Older Adults

Objective China-WHO country cooperation strategy 2016-2020 pointed out that health inequality and disparity will be a key challenge for China in the coming years.With the rapid aging,improving the health of older adults and reducing the health inequality are of great significance to achieve healthy aging in China.Therefore,using two comprehensive health evaluation indicators,life expectancy and disability-free life expectancy,we quantify the maganitude,time trend and mechanism of the health disaparity among Chinese older adults with different socioeconomic status(SES).It is expected to provide a scientific theoretical basis for the formulation of policies and intervention measures related to health equality and aging in China.Methods The data from the Chinese Longitudinal Healthy Longevity Survey collected during 2002-2018 were used and divided into two cohorts for analysis:The CLHLS 2002-2011 and CLHLS 2011-2018.CLHLS 2002-2011 and CLHLS 2011-2018 were used to estimate socioeconomic disparities of disability-free life expectancy and life expectancy in 2002 and 2011,respectively.The CLHLS 2002-2011 and CLHLS 20112018 includes 13374 and 8018 participants aged≥65 years,respectively.SES was assessed by economic status,educational attainment,occupational position and comprehensive indicators of the above three,respectively,and they were categorized into high,intermediate,and low.The comprehensive socioeconomic status index was synthesized through principal component analysis,and divided into three categories based on the principal component score and its percentile(P33 and P67).Disability was measured by activity of daily llving(ADL).Risk factors includes smoking,drinking,inadeauqte fruit and vegetable intake,lack of physical exercise,lack of social participation,frequent feelings of stress and fear,lack of regular physical examinations,and inability to get medical services in time when they are seriously ill.Multi-state Markov models and micro-simulation were fitted to calculate disability-free life expectancy(DFLE65),life expectancy(LE65),and the proportion of DFLE65(DFLE65/LE65).The socioeconomic disparities of DFLE65,LE65 and DFLE65/LE65 were calculated as the absolute value of difference between the group of high and low SES.Finally,we calculate the change of the socioeconomic disparity of DFLE65,LE65 and DFLE65/LE65 after elimination of risk factors(that is,reducing the risk factors of the elderly with different socioeconomic status to zero)to quantify the effect of each risk factor on these disparities.Results The older adults with higher SES had higher DFLE65 and LE65,but lower DFLE65/LE65.The maganitude,time trend and mechanism of these socioeconomic disparities in DFLE65,LE65 and DFLE65/LE65 are as follows.When taking the comprehensive SES index as the mark of SES,the socioeconomic disparity of DFLE65(95%CI)was 0.94(0.14,1.64)years for males and 0.48(-0.23,1.22)years for females;the socioeconomic disparity of LE65(95%CI)was 1.53(0.62,2.39)years for males and 1.30(0.59,2.09)years for females;the DFLE65/LE65 disparity in SES(95%CI)was 2.67%(1.40%,4.16%)and 3.40%(1.71%,5.05%)for males and females,respectively.Disparities of DFLE65 and LE65 in education were of a similar magnitude with these disparities in economic status(DFLE65 disparities in economic status:1.53 years for males and 1.28 years for females;LE65 disparities in economic status:2.25 years for males and 2.07 years for females).Taking occupational position as the measurement SES,these disparities in SES were not statistically significant.When taking the comprehensive SES index as the mark of SES,from 2002 to 2011,the socioeconomic disparity of DFLE65 increased by 0.24 years for males and 0.06 years for females;the socioeconomic disparity of LE65 increased by 0.42 years for males and 0.38 years for females;the socioeconomic disparity of DFLE65/LE65 increased by 1.18%for males and 3.28%for females.These disparities of DFLE65 and LE65 in economic status and education increased with time,whereas these disparities in occupational position declined with time.These disparities of DFLE65/LE65 in economic status and occupational position increased with time,whereas these disparities in education declined with time.When taking the comprehensive SES index as the mark of SES,for males,51.06%of the DFLE65 disparity and 16.34%of the DFLE65 disparity were attributed to inadeauqte fruit and vegetable intake,lack of physical exercise,lack of social participation,frequent feelings of stress and fear,lack of regular physical examinations,and inability to get medical services in time when they are seriously ill;and for females,100.00%of the DFLE65 disparity and 13.08%of the DFLE65 disparity were attributed to the above factors.The contribution of inadeauqte fruit/vegetable intake,lack of physical exercise,and lack of regular physical examinations to the socioeconomic disparities in DFLE65 was greater(For male,the contribution was 37.23%,19.15%and 15.96%,respectively;For female,the contribution was 47.92%,37.50%,and 12.50%,respectively).The contribution of inadeauqte fruit/vegetable intake to the socioeconomic disparities in LE65 was greater(The contribution was 24.84%for male and 22.31%for female).When taking economic status as the mark of SES,inadeauqte fruit/vegetable intake,lack of physical exercise,and lack of regular physical examinations had greater contribution to the socioeconomic disparities in DFLE65 and LE65.The contribution of inadeauqte fruit/vegetable intake,lack of physical exercise,and lack of regular physical examinations to DFLE65 disparity were 30.07%,12.47%and 16.34%for male,and 23.44%,11.72%and 20.31%for feamle,respectively;and the contribution to LE65 disparity were 24.00%,4.00%,and 12.44%for male,as well as 18.36%,1.45%and 8.21%for feamle,respectively.When taking educational attainment as the mark of SES,lack of physical exercise had a greater contribution to the socioeconomic disparities in DFLE65 and LE65(The contribution to DFLE65 disparity were 19.77%for male and 30.67%for female;and the contribution to LE65 disparity were 7.41%for male and 17.14%for female).Conclusion This study yeiled 4 mian conclusions:(1)there existed socioeconomic disparities of DFLE65 and LE65 in China,and the disparity of LE65 was higher than the disparity of DFLE65.(2)The socioeconomic disparities of DFLE65 and LE65 are widening with time.(3)The socioeconomic disparities of DFLE65 and LE65 were partly attributed to inadeauqte fruit/vegetable intake,lack of physical exercise,lack of social participation,frequent feelings of stress and fear,lack of regular physical examinations,and inability to get medical services in time when they are seriously ill.And the contribution of the inadeauqte fruit/vegetable intake,lack of physical exercise,and lack of regular physical examinations to these disparities was greater.(4)The maganitude,time trend and mechanism of DFLE65 and LE65 varied by the measurement of SES,when taking economic status,educational attainment,and occupational position as the measurement SES,respectively.