Nowcasting and forecasting the care needs of the older population in China: analysis of data from the China Health and Retirement Longitudinal Study (CHARLS).
Nowcasting and forecasting the care needs of the older population in China: analysis of data from the China Health and Retirement Longitudinal Study (CHARLS).
复制标题
临近预测和预测中国老年人口的护理需求：中国健康与退休追踪研究（CHARLS）的数据分析
DOI：
10.1016/s2468-2667(22)00203-1
复制
发表时间：
2022-12
影响因子：
50
通讯作者：
Zhao, Yaohui
中科院分区：
文献类型：
--
作者：
Gong, Jinquan;Wang, Gewei;Wang, Yafeng;Chen, Xinxin;Chen, Yanfeng;Meng, Qinqin;Yang, Peng;Yao, Yao;Zhao, Yaohui
人口老龄化加上发病率上升，给卫生和社会保健系统带来了相当大的负担。本研究的目的是评估中国老年人功能依赖的趋势，并预测未来的护理需求。我们分析了来自中国健康与退休纵向研究的数据，这是一项具有全国代表性的调查，来自28个省的150个县或区和450个村庄或城市社区的中国人（年龄≥45岁）队列，采用多阶段分层概率比例抽样。基线调查于2011年进行，后续调查于2013年，2015年，2018年和2020年进行。我们排除了60岁以下的人或在五次随访中缺失依赖变量的人。根据日常生活活动（ADL）和工具性日常生活活动（IADL）确定三个依赖性水平：任何ADL项目（1级依赖）;任何ADL项目或烹饪，购物或服用药物的困难（2级依赖）;以及任何ADL或IADL项目的困难（3级依赖）。对抚养率进行了外推，以得出2011年至2020年中国60岁以上需要抚养的人数。我们使用回归模型来预测未来的变化，并预测2021年至2030年之间有依赖性的老年人口的规模。共有89031名个人在五个阶段完成了调查，其中46619人符合资格。中国老年人1级依赖的患病率从2011年的11.7%（95%CI 10.6 - 12.8）下降到2020年的8.1%（7.5 - 8.7）。2级和3级受扶养人也有所减少。2020年需要护理的老年人总数为2061万（95%CI 19.01 - 22.20），1级依赖，3633万（34.27 - 38.40），3级依赖和4530万（43.02 - 47.59）。教育、住房和医疗保健的改善与2011年至2020年3级依赖患病率下降的41.84%相关。到2030年，预计1级抚养率将下降到8.04%，2级抚养率将下降到13.28%，3级抚养率将下降到16.05%。尽管如此，队列规模仍将增长，导致2030年需要护理的中国老年人更多（1级2971万[27.07 - 32.36]，2级4907万[45.98 - 52.16]，3级5932万[55.94 - 62.70]）。到2030年，我们估计中国需要护理的老年人将比2020年增加1402万。人口的迅速老龄化可能抵消依赖性的下降，导致需要复杂护理的人口大幅增加。促进健康老龄化和投资于对老年人友好的环境对于减轻中国的护理负担非常重要。国家自然科学基金委员会老龄研究所，中华医学会。
An ageing population coupled with an increase in morbidity places a considerable burden on health and social care systems. The aim of our study was to estimate the trends in functional dependency and project future care needs for older people in China. We analysed data from the China Health and Retirement Longitudinal Study, a nationally representative survey of a cohort of Chinese people (aged ≥45 years) from 150 counties or districts and 450 villages or urban communities across 28 provinces, who were selected by use of multistage stratified probability-proportionate-to-size sampling. The baseline survey was conducted in 2011 and follow-up surveys were conducted in 2013, 2015, 2018, and 2020. We excluded people younger than 60 years or people who had missing variables on dependency in the five follow-up interviews. Three dependency levels were determined on the basis of activities of daily living (ADLs) and instrumental activities of daily living (IADLs): any ADL items (level 1 dependency); any ADL items or difficulty cooking, shopping, or taking medications (level 2 dependency); and difficulty in any ADL or IADL items (level 3 dependency). The dependency rates were extrapolated to derive the number of people older than 60 years with dependency in China from 2011 to 2020. We used a regression model to project future changes and forecast the size of the older population with dependency between 2021 and 2030. A total of 89 031 individuals across five waves completed the surveys, of whom 46 619 were eligible for inclusion. The prevalence of level 1 dependency among older Chinese adults declined from 11·7% (95% CI 10·6–12·8) in 2011 to 8·1% (7·5–8·7) in 2020. Level 2 and level 3 dependency also declined. The total number of older people requiring care in 2020 was 20·61 million (95% CI 19·01–22·20) with level 1 dependency, 36·33 million (34·27–38·40) with level 2 dependency, and 45·30 million (43·02–47·59) with level 3 dependency. Improved education, housing, and access to health care was associated with 41·84% of the decline in level 3 dependency prevalence between 2011 and 2020. By 2030, the projected dependency rates could decline to 8·04% for level 1 dependency, 13·28% for level 2 dependency, and 16·05% for level 3 dependency. Nonetheless, the cohort size will grow, resulting in more older Chinese people who need care (29·71 million [27·07–32·36] in level 1, 49·07 million [45·98–52·16] in level 2, and 59·32 million [55·94–62·70] in level 3) in 2030. By 2030, we estimate that 14·02 million more older Chinese people will need care than in 2020. Rapid ageing of the population could offset the decline in dependency and result in a substantial increase in the population with complex care needs. Promoting healthy ageing and investing in an age-friendly environment are important in reducing care burdens in China. National Institute on Aging, Natural Science Foundation of China, China Medical Board.