Norwegian Institute of Public Health, Oslo, Norway; Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, NY, USA.
Institute for Health Metrics and Evaluation, Seattle, WA, USA.
Lancet Healthy Longev. 2022 May;3(5):e332-e338. doi: 10.1016/S2666-7568(22)00075-7. Epub 2022 May 4.
The old-age dependency ratio (OADR), which is the ratio of older people (aged ≥65 years) to working age people (aged 20-64 years), is the most common way to assess and compare the burden of population ageing in different countries. However, the relationship between chronological age and dependency varies widely across countries. We therefore present the health-adjusted dependency ratio (HADR), a new measure of ageing burden based on the ageing-related health of the adult population.
In this population-based study we used health data for diseases and injuries for 2017 from the Global Burden of Disease project and population data for 2017 from the UN's Population Division to identify the number of adults (aged >20 years) in each country who have the same or higher ageing-related disease burden as the global average 65-year-old. We then calculated the HADR as the ratio of adults who were less healthy than the average 65-year-old (dependent population) to those in better health (supporting population) and compared the HADR with the OADR for 188 countries. We also used cross-sectional, bivariate regression analysis to investigate whether the HADR is a more powerful predictor of changes in per capita health-care expenditure than the OADR as a measure of predictive validity.
Many demographically younger populations have an earlier onset of ageing-related disease, and many demographically older populations have a later onset. For instance, Pakistan has an OADR of 0·09 and an HADR of 0·19, and France has an OADR of 0·35 and an HADR of 0·13. Relative to the OADR, the HADR suggests that Asia, western Europe, and North America have a lower ageing burden, whereas central Asia, southern Asia, and Africa have a greater burden. While Japan and countries in western Europe have the highest OADR, Russia, Papua New Guinea, and countries in southeast Europe have the highest HADR. Relative to the OADR, the HADR suggests that there is much less variation in the burden of ageing across countries than has previously been assumed. HADR was also more closely associated with growth in health spending than the OADR. A 0·1 increase in the HADR was associated with a 2·9 percentage points larger growth rate in per capita spending (p=0·0001), and a 0·1-point increase in the OADR was associated with a 1·8 percentage point larger growth rate.
The OADR probably overestimates the burden of population ageing in many demographically older countries and underestimates the ageing burden in many demographically younger countries, which implies that the challenges associated with ageing are more universal than previously thought, and that the world cannot easily be divided in a young and an old groups of nations.
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老年抚养比（OADR）是指老年人口（≥65 岁）与劳动年龄人口（20-64 岁）的比例，是评估和比较不同国家人口老龄化负担的最常用方法。然而，年龄和抚养关系在各国之间差异很大。因此，我们提出了健康调整后的抚养比（HADR），这是一种基于成年人口老龄化相关健康状况的新的老龄化负担衡量标准。
在这项基于人群的研究中，我们使用了 2017 年全球疾病和伤害负担研究中的疾病和伤害数据以及联合国人口司的 2017 年人口数据，以确定每个国家中与全球平均 65 岁老年人具有相同或更高老龄化相关疾病负担的成年人（>20 岁）数量。然后，我们将 HADR 计算为比平均 65 岁老年人健康状况差的成年人（依赖人口）与健康状况较好的成年人（支持人口）的比例，并将 HADR 与 188 个国家的 OADR 进行比较。我们还使用横截面、双变量回归分析来研究 HADR 是否比 OADR 作为预测有效性的衡量标准更能预测人均医疗保健支出的变化。
许多人口较年轻的国家人口老龄化相关疾病的发病年龄更早，而许多人口较年长的国家人口老龄化相关疾病的发病年龄更晚。例如，巴基斯坦的 OADR 为 0.09，HADR 为 0.19，法国的 OADR 为 0.35，HADR 为 0.13。与 OADR 相比，HADR 表明亚洲、西欧和北美地区的老龄化负担较低，而中亚、南亚和非洲地区的老龄化负担较重。尽管日本和西欧国家的 OADR 最高，但俄罗斯、巴布亚新几内亚和东南欧国家的 HADR 最高。与 OADR 相比，HADR 表明各国之间老龄化负担的变化要小得多。HADR 与卫生支出的增长也比 OADR 更为密切相关。HADR 增加 0.1，人均支出增长率增加 2.9 个百分点（p=0.0001），OADR 增加 0.1 点，人均支出增长率增加 1.8 个百分点。
OADR 可能高估了许多人口较年长国家的人口老龄化负担，低估了许多人口较年轻国家的老龄化负担，这意味着与老龄化相关的挑战比以前想象的更为普遍，世界不能轻易地分为年轻和年老的国家群体。
OADR 可能高估了许多人口较年长国家的人口老龄化负担，低估了许多人口较年轻国家的老龄化负担，这意味着与老龄化相关的挑战比以前想象的更为普遍，世界不能轻易地分为年轻和年老的国家群体。
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