The Impacts of Major Chronic Diseases on Changes in Healthy Life Expectancy among Older Adults in China from 2011 to 2020

OBJECTIVES: This study aimed to quantify the impact of major chronic diseases on changes in healthy life expectancy (HLE) from 2011 to 2020 in China using an age-specific disability weights (DW) estimation method. METHODS: HLE at age 60 (HLE ₆₀) was used as the indicator of HLE in China. Cause-specific mortality rates were obtained from the cause-of-death database of the National Health Commission. Self-reported disease and disability status were derived from the China Health and Retirement Longitudinal Study. A total of 55,861 participants were included for DW estimation. Rates of disability, which was assessed using the Activities of Daily Living questionnaires, were estimated using data from 5,465 participants in 2011 and 9,910 participants in 2020. Age-specific DWs were calculated using a Bayesian logistic regression model. Changes in HLE ₆₀ were decomposed into mortality and disability effects by cause, based on the estimated DWs. RESULTS: HLE ₆₀ in China increased by 0.83 years from 2011 to 2020. Ischemic heart disease (IHD) contributed the most to the decline in HLE ₆₀, remaining the leading cause of reduction in terms of mortality effects. Diabetes showed the greatest impact on HLE ₆₀ due to disability, followed by stroke. The largest sex disparities in HLE ₆₀ were associated with disability from arthritis. CONCLUSION: HLE ₆₀ in China improved from 2011 to 2020 and IHD remained the leading contributor to its decline, particularly through increased mortality. Disabilities related to diabetes, stroke, and arthritis had significant negative impacts. These findings highlight the need to strengthen integrated chronic disease prevention and rehabilitation services at community health centers.