中国老年人的教育程度与男女健康生存悖论：一项全国代表性的纵向研究。

Educational attainment and male-female health-survival paradox among older adults in China: a nationally representative longitudinal study.

作者信息

Chen He, Li Man, Zhang Ye

机构信息

School of Public Administration and Policy, Renmin University of China, Beijing, China.

Institute of Public Governance, Peking University, Beijing, China.

出版信息

BMC Geriatr. 2025 Feb 19;25(1):112. doi: 10.1186/s12877-024-05598-7.

DOI:10.1186/s12877-024-05598-7

PMID:39972253

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11837581/

Abstract

BACKGROUND

The male-female health-survival paradox is characterized by the phenomenon where "women get sicker, but men die quicker." Health expectancy, as a composite metric that encompasses both the quantity and quality of life, serves as a unique tool for analyzing this gender paradox. In this study, we investigate the relationship between educational attainment and the gender paradox among older adults in China.

METHODS

Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS), we focused on community-dwelling individuals aged 60 and above. Health was assessed using the Activities of Daily Living (ADLs). Educational attainment was dichotomized into low (primary education and below) and high (secondary education and above). We controlled for demographic, socioeconomic, and health behaviors confounders. Microsimulation techniques were employed to estimate total life expectancy (TLE), disability-free life expectancy (DFLE), and health ratio.

RESULTS

In China, educational attainment was positively associated with TLE and DFLE, with these benefits being more pronounced in females. Among individuals with lower educational attainment, females had significantly greater TLE (female-male difference: 3.82 years, 95% CI: 3.68 to 3.96) and DFLE (2.91 years, 95% CI: 2.78 to 3.04), but a lower health ratio (-2.14%, 95% CI: -2.41% to -1.87%) compared to males. In contrast, females with higher educational attainment not only lived longer but also healthier. Among these individuals, females had significantly greater TLE (5.89 years, 95% CI: 5.71 to 6.08), DFLE (6.02 years, 95% CI: 5.84 to 6.19), and a more favorable health ratio (95% CI: 2.60% to 3.19%) compared to males.

CONCLUSIONS

Education plays a crucial role in enabling females to overcome disadvantages associated with the gender paradox in China. Enhancing gender equality in educational opportunities is expected to promote healthy longevity among females in the country.

摘要

背景

男女健康生存悖论的特点是“女性患病更多，但男性死亡更快”这一现象。健康期望寿命作为一个综合衡量指标，涵盖了生活的数量和质量，是分析这一性别悖论的独特工具。在本研究中，我们调查了中国老年人的教育程度与性别悖论之间的关系。

方法

利用中国健康与养老追踪调查（CHARLS）的数据，我们聚焦于60岁及以上的社区居住个体。健康状况通过日常生活活动（ADL）进行评估。教育程度被分为低（小学及以下）和高（中学及以上）两类。我们控制了人口统计学、社会经济和健康行为等混杂因素。采用微观模拟技术来估计总预期寿命（TLE）、无残疾预期寿命（DFLE）和健康比率。

结果

在中国，教育程度与总预期寿命和无残疾预期寿命呈正相关，且这些益处在女性中更为明显。在教育程度较低的个体中，女性的总预期寿命显著高于男性（女性 - 男性差异：3.82年，95%置信区间：3.68至3.96），无残疾预期寿命也更高（2.91年，95%置信区间：2.78至3.04），但健康比率低于男性（-2.14%，95%置信区间：-2.41%至-1.87%）。相比之下，教育程度较高的女性不仅寿命更长，而且更健康。在这些个体中，女性的总预期寿命显著高于男性（5.89年，95%置信区间：5.71至6.08），无残疾预期寿命更高（6.02年，95%置信区间：5.84至6.19），健康比率也更有利（95%置信区间：2.60%至3.19%）。