School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Nuffield Department of Population Health, University of Oxford, Oxford, UK.
J Glob Health. 2024 Sep 6;14:04156. doi: 10.7189/jogh.14.04156.
Understanding how disability progresses with ageing is important for shaping policies aimed at improving older adults' quality of life, especially when considering the global trends in ageing, life expectancy (LE), and gender disparity. We aimed to assess the health transition probabilities of daily living activities and their implications on LE and gender gaps in global middle-aged and elderly populations.
In this multi-cohort study with a sample of 74 101 individuals aged ≥50 years, we analysed data from six international cohorts: the China Health and Retirement Longitudinal Study (CHARLS), the English Longitudinal Study of Ageing (ELSA), the Health and Retirement Study (HRS) in the USA, the Mexican Longitudinal Study of Ageing (MHAS), the Korean Longitudinal Study of Ageing (KLoSA), and the Survey of Health, Ageing and Retirement in Europe (SHARE). We estimated probabilities between robust health; disabilities related to instrumental activities of daily living (IADL) and basic activities of daily living (BADL); and mortality through multi-state Markov models. We included gender as a covariate in the models to calculate hazard ratios (HRs), while we calculated LE within the distinct health states of robust health, IADL disabilities, BADL disabilities, and mortality using the stochastic population analysis for complex events (SPACE) microsimulation.
Women had higher progressions to disability (IADL: HR = 1.392; BADL: HR = 1.356) compared to men, who conversely showed lesser progression from IADL to BADL disability (HR = 0.856) and lower mortality rates (span of HRs = 0.232-0.692). LE at age 50 favoured women (32.16-38.22 years) over men (28.99-33.58 years), yet they spent more time in states of disability. We otherwise observed significant regional and gender disparities in healthy LE.
We identified ageing patterns in which longer lives are often coupled with extended periods of disability. Pronounced gender and regional differences indicate a need for targeted health interventions to address inequities and improve seniors' quality of life. Our findings highlight the necessity for policy interventions focussed on health equity to more completely respond to the demographic shift towards older populations.
了解残疾如何随年龄增长而发展对于制定旨在提高老年人生活质量的政策非常重要，尤其是在考虑到全球老龄化趋势、预期寿命 (LE) 和性别差距时。我们旨在评估全球中年和老年人群体日常生活活动的健康过渡概率及其对 LE 和性别差距的影响。
在这项多队列研究中，我们对 74101 名年龄≥50 岁的个体进行了样本分析，这些个体来自六个国际队列：中国健康与退休纵向研究 (CHARLS)、英国老龄化纵向研究 (ELSA)、美国健康与退休研究 (HRS)、墨西哥老龄化纵向研究 (MHAS)、韩国老龄化纵向研究 (KLoSA) 和欧洲健康、老龄化和退休调查 (SHARE)。我们通过多状态马尔可夫模型估计了从稳健健康到与工具性日常生活活动 (IADL) 和基本日常生活活动 (BADL) 相关的残疾再到死亡之间的概率。我们将性别作为模型中的协变量纳入其中，以计算风险比 (HR)，同时我们使用复杂事件的随机人口分析 (SPACE) 微模拟在稳健健康、IADL 残疾、BADL 残疾和死亡的不同健康状态下计算预期寿命 (LE)。
与男性相比，女性残疾进展的可能性更高（IADL：HR=1.392；BADL：HR=1.356），而男性从 IADL 向 BADL 残疾的进展则较低（HR=0.856）且死亡率也较低（HR 范围为 0.232-0.692）。50 岁时的预期寿命对女性有利（32.16-38.22 岁）而对男性不利（28.99-33.58 岁），但她们在残疾状态下度过的时间更多。此外，我们还观察到了显著的区域和性别在健康预期寿命方面的差异。
我们确定了衰老模式，即更长的寿命往往伴随着更长的残疾期。明显的性别和区域差异表明需要有针对性的健康干预措施来解决不平等问题并提高老年人的生活质量。我们的研究结果强调了需要采取政策干预措施来实现健康公平，以更全面地应对向老年人口转变的人口趋势。
