Changing of Mortality and Morbidity of Chinese Elderly

REVES@30, MICDA, May 30 - June 1, 2018 Changing of Mortality and Morbidity of Chinese Elderly Xiaochun Qiao, PhD and Professor Jilei Wu, PhD and Associate Professor Xinchao Zhao, MSS Institute of Population Research Peking University, China

OUTLINE BACKGROUND OBJECTIVE DATA & MATHOD RESULT CONCLUSION

BACKGROUND China has experienced two exceptional changes since the last quarter of the last century: Demographic Transition (45years) Economic Transition (40 years)

BACKGROUND DEMOGRAPHIC TRANSITION (1949-2012) 50 Birth rate( ) 45 40 35 Death rate( ) 30 25 20 15 10 5 0 1949 1952 1955 1958 1961 1964 1967 1970 1973 1976 1979 1982 1985 1988 1991 1994 1997 2000 2003 2006 2009 2012 Year Data source: National Bureau of Statistics of China Note: Figures 1981 (inclusive) are from household registrations; for the year 1982, 1990, 2000 and 2010 are the census year estimates; the rest of the data covered in those years have been estimated on the basis of the annual national sample surveys of population.

BACKGROUND POPULATION AGING Changing of age structure and related demographic factors in China 1982 2050 (From UN sources)

BACKGROUND ECONOMIC TRANSITION (1978- )

BACKGROUND Life Expectancies at Age 60 By Sex and Year of the Censuses, 1982, 1990, 2000 and 2010 80 78 76 74 72 70 68 66 64 62 Years Total Male Female 60 1982 1990 2000 2010 Year Data source: The census office of the state council. National Bureau of Statistics PRC. Data of the Third/Fourth/Fifth/Sixth Population Census China. [EB/OL]. Beijing: China Statistics Press, 1982/1990/2000/2010

OBJECTIVE (QUESTION) Whether health status of Chinese elderly increased, following the increase of life expectancy and the increase of GDP and GDP per capita since the economic take-off at the late of 1980s?

DATA ISSUE There were almost no reliable data dealing with mortality and morbidity before 1980s due to lack of national surveys involving health and death in China at that time. It was the first time that China enumerated the death within the year of 1981 at the third national population census in 1982, and the first national elderly survey and the first disabled survey were all conducted by the government in 1987.

DATA Mortality related data: All national censuses and intercentral censuses (1% survey), that is, 1982, 1987, 1990, 1995, 2000, 2005, 2010, and 2015. Health related data: Perceived (Self rated) Health: Elderly survey by the China Social Science Academy in 1987, and aging surveys by the China Research Center on Aging in 1992, 2000, 2006, 2010, and 2015. Ability of self-care: Elderly survey by the China Social Science Academy in 1987, and aging surveys by the China Research Center on Aging in 1992, 2000, 2006, 2010, and 2015. The question was asked : Can you take care of yourself in your daily living?

DATA AND METHODS Chronic Disease: The China Research Center on Aging in 1992, 2000, 2006, 2010, and 2015. By the question: Do you have any diseases? The answer provided was only Yes or No. This subjective response depended on if the diseases had been discovered by doctors and had been known by respondents. Disability: 1987 and 2006 national sample survey of the disability. The sampling survey with the classification and definition of diverse disability had been determined prior to the enumeration implementation, and relevant doctors had been conscientiously chosen to ultimately make examination on whether the identified person was a real disabled, the quality of the data is good enough to use to calculate the disability-free life expectancy(dfle) of China. The Sullivan method

The Life Expectancies at Age 60 and 80, by Sex and Years 35.0 30.0 Male 60 Male 80 Female 60 Female 80 28.58 25.0 23.43 23.56 24.07 20.0 18.19 19.06 19.82 20.17 20.58 20.96 20.01 20.12 20.55 23.81 15.0 15.71 16.10 16.60 17.09 17.31 17.73 13.95 10.0 5.0 6.29 5.29 7.20 7.74 8.03 8.41 8.16 6.02 6.26 7.00 6.97 6.51 10.13 10.14 10.17 8.27 8.30 8.39 10.98 0.0 1982 1987 1990 1992 1995 2000 2005 2006 2010 2015

PHE and LE for Males and Females by Years 1987 1992 2000 LE PHE s.e. PHE/LE( LE PHE s.e. PHE/LE( LE PHE s.e. PHE/LE( Male 60 16.10 12.07 0.04 75.0 17.09 13.74 0.11 80.4 17.73 13.75 0.06 77.6 65 12.83 9.53 0.05 74.3 13.76 10.83 0.12 78.7 14.15 10.64 0.06 75.2 80 6.02 4.57 0.08 76.0 7.00 5.40 0.19 77.1 6.51 4.51 0.06 69.4 Female 60 19.06 13.51 0.05 70.9 20.17 15.33 0.08 76.0 20.96 14.70 0.07 70.1 65 15.40 11.00 0.05 71.5 16.39 12.28 0.08 74.9 17.05 11.51 0.07 67.5 80 7.20 5.42 0.07 75.3 8.03 5.91 0.10 73.1 8.16 5.10 0.08 62.5 2005 2010 2015 LE PHE s.e. PHE/LE( LE PHE s.e. PHE/LE( LE PHE s.e. PHE/LE( Male 60 20.12 15.69 0.06 78.0 20.55 16.19 0.06 78.8 23.81 18.12 0.03 76.1 65 16.40 12.40 0.06 75.6 16.76 12.83 0.06 76.6 19.90 14.71 0.03 73.9 80 8.30 5.48 0.07 66.1 8.39 5.54 0.06 66.1 10.98 7.47 0.03 68.0 Female 60 23.56 16.75 0.08 71.1 24.07 17.45 0.08 72.5 28.58 19.52 0.03 68.3 65 19.49 13.36 0.07 68.5 19.89 13.89 0.07 69.9 24.25 16.03 0.03 66.1 80 10.14 6.05 0.08 59.7 10.17 6.13 0.07 60.2 13.95 8.48 0.03 60.8

PHE for Males and Females at Age 60 Males Year 30.0 25.0 20.0 15.0 10.0 5.0 0.0 healthy unhealthy 5.69 4.43 4.36 3.34 3.98 4.03 12.07 13.74 13.75 15.69 16.19 18.12 1987 1992 2000 2006 2010 2015 35.0 30.0 healthy unhealthy Females Year 25.0 20.0 15.0 5.55 4.84 6.26 6.80 6.62 9.06 10.0 5.0 13.51 15.33 14.70 16.75 17.45 19.52 0.0 1987 1992 2000 2006 2010 2015

Healthy Proportions for PHE at Age 60 82% 80% 78% 76% Proportion( 74% 72% 70% 68% 66% 64% males females 62% 1987 1992 2000 2006 2010 2015 males 75.00% 80.43% 77.56% 77.99% 78.80% 76.10% females 70.89% 76.00% 70.13% 71.13% 72.49% 68.30%

Life Expectancy with Ability of Self-Care by Years and Sex LE ASLE s.e. 1987 1992 2000 ALSE/LE( LE ASLE s.e. ALSE/LE( LE ASLE s.e. ALSE/LE( Male60 16.10 13.08 0.04 81.3 17.09 15.89 0.05 93.0 17.73 16.47 0.04 92.9 65 12.83 9.89 0.04 77.1 13.76 12.58 0.05 91.4 14.15 12.91 0.05 91.2 80 6.02 3.48 0.07 57.9 7.00 5.84 0.10 83.5 6.51 5.31 0.08 81.7 Female60 19.06 15.49 0.05 81.3 20.17 18.32 0.06 90.8 20.96 18.78 0.06 89.6 65 15.40 11.90 0.05 77.3 16.39 14.59 0.07 89.0 17.05 14.90 0.06 87.4 80 7.20 4.54 0.06 63.0 8.03 6.26 0.10 78.0 8.16 6.05 0.08 74.2 LE ASLE s.e. 2006 2010 2015 ALSE/LE( LE ASLE s.e. ALSE/LE( LE ASLE s.e. ALSE/LE( Male60 20.12 17.82 0.06 88.6 20.55 17.27 0.06 84.1 23.81 19.38 0.03 81.4 65 16.40 14.11 0.06 86.0 16.76 13.55 0.05 80.8 19.90 15.57 0.03 78.2 80 8.30 5.96 0.08 71.8 8.39 5.22 0.06 62.3 10.98 6.95 0.03 63.3 Female60 23.56 19.90 0.07 84.5 24.07 19.23 0.07 79.9 28.58 21.59 0.03 75.5 65 19.49 15.84 0.07 81.3 19.89 15.15 0.07 76.2 24.25 17.43 0.03 71.9 80 10.14 6.52 0.08 64.3 10.17 5.85 0.07 57.5 13.95 7.80 0.03 55.9

Life Expectancy with and without Ability of Self-care at 60, by Sex Males 30.0 25.0 self-care no self-care 20.0 15.0 3.02 1.24 1.26 2.30 3.28 4.43 10.0 5.0 13.08 15.84 16.47 17.82 17.27 19.38 0.0 1987 1992 2000 2006 2010 2015 35.0 30.0 self-care no self-care Females 25.0 20.0 15.0 3.57 1.99 2.18 3.66 4.84 6.99 10.0 5.0 15.49 18.18 18.78 19.90 19.23 21.59 0.0 1987 1992 2000 2006 2010 2015

Life Expectancy Free of Illness(chorionic diseases) Age, Sex and Years Free of illness of Life Expectancy for Males 1992 2000 2006 2010 2015 LE FILE s.e. FILE/LE( LE FILE s.e. FILE/LE( LE FILE s.e. FILE/LE( LE FILE s.e. FILE/LE( LE FILE s.e. FILE/LE( 60 17.09 5.68 0.03 33.22 17.73 7.59 0.04 42.80 20.12 5.67 0.03 28.17 20.55 5.28 0.03 25.67 23.81 4.43 0.01 18.59 65 13.76 4.39 0.03 31.91 14.15 5.82 0.04 41.14 16.40 4.29 0.02 26.14 16.76 3.86 0.02 23.05 19.90 3.25 0.00 16.34 80 7.00 2.24 0.05 32.03 6.51 2.83 0.05 43.50 8.30 2.03 0.02 24.50 8.39 1.58 0.02 18.90 10.98 1.53 0.00 13.90 Free of illness of Life Expectancy for Females 1992 2000 2006 2010 2015 LE FILE s.e. FILE/LE( LE FILE s.e. FILE/LE( LE FILE s.e. FILE/L E( LE FILE s.e. FILE/LE( LE FILE s.e. FILE/LE( 60 20.17 5.68 0.03 28.14 20.96 7.63 0.04 36.42 23.56 5.12 0.02 21.75 24.07 4.81 0.02 20.00 28.58 3.62 0.00 12.67 65 16.39 4.57 0.03 27.90 17.05 6.18 0.04 36.24 19.49 4.03 0.02 20.68 19.89 3.58 0.02 18.00 24.25 2.71 0.00 11.16 80 8.03 2.30 0.04 28.59 8.16 3.26 0.05 39.90 10.14 2.05 0.02 20.20 10.17 1.60 0.01 15.70 13.95 1.42 0.00 10.20

Life Expectancy Free of Illness(chronic diseases) Males and Females at Age 60 30.00 25.00 20.00 15.00 10.00 11.41 10.14 14.45 15.27 19.38 14.50 13.33 18.43 19.25 24.96 5.00 0.00 7.59 7.63 5.68 5.67 5.28 4.43 5.68 5.12 4.81 3.62 1992 2000 2006 2010 2015 1992 2000 2006 2010 2015 FILE ILE Males Females

Disability Free Life Expectancy by Age, Sex and Years Male Female Age 1987 2006 LE DFLE SE DFLE/LE( LE DFLE SE DFLE/LE( 60 16.10 12.32 0.04 76.5 20.12 10.49 0.03 51.2 65 12.83 9.20 0.04 71.7 16.40 6.45 0.03 39.3 80 6.02 3.18 0.06 52.8 8.30 4.70 0.03 56.6 60 19.06 13.9 0.04 73.1 23.56 11.86 0.03 50.4 65 15.40 10.49 0.04 68.1 19.49 7.84 0.03 40.2 80 7.2 3.56 0.05 49.4 10.14 5.73 0.03 56.5 25.0 DFLE at Age 60 20.0 15.0 3.8 9.6 5.1 11.7 10.0 5.0 12.3 10.5 13.9 11.9 0.0 1987 2006 1987 2006 Males DFLE DLE Females

Proportions with Healthy Status for Males at 60 & 80 100% 1987 1992 2000 2006 2010 2015 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% PHE ASLE FILE PHE ASLE FILE Male 60 yrs Male 80 yrs

Proportions with Healthy Status for Females at 60 & 80 1987 1992 2000 2006 2010 2015 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% PHE ASLE FILE PHE ASLE FILE Female 60 yrs Female 80 yrs

CONCLUSIONS Compressions of morbidity happened at the early time and expansions usually happened at the late time after 1992 or 2000 Usually, the higher of the age, the higher the extent of expansion, with exception of DFLE The proportion of disability free life expectancies decreased greatly from 1987 to 2006, showing the high expansion of morbidity for young elderly and compression for oldest old. Life expectancy free from illness accounted for the lowest proportions of healthy status, while the life expectancy free from self care accounted for the highest proportions; the perceived health expectancy and disability free life expectancy located in the middle. In general, the increase of income and increase of LE were unable to improve health status for Chinese elderly.

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