Demography

, Volume 41, Issue 2, pp 335–361 | Cite as

A new method for correcting under-estimation of disabled life expectancy and an application to the chinese oldest-old

Article

Abstract

This article demonstrates that disabled life expectancies that are based on conventional multistate life-table methods are significantly underestimated because of the assumption of no changes in functional status between age x and death. We present a new method to correct the bias and apply it to data from a longitudinal survey of about 9,000 oldest-old Chinese aged 80–105 collected in 1998 and 2000. In our application, the age trajectories of disability (activities of daily living—ADL), status-specific death rates, and the probabilities of transitions between ADL states of the oldest-old were investigated for the first time in a developing country. In this article, we report estimates of bias-corrected disabled and active life expectancies of the Chinese oldest-old and demonstrate patterns of large differences associated with initial status, gender, and advances in ages. Using combined information on ADL disabilities and length of having been bedridden before dying, we analyze gender and age patterns of the extent of morbidity before dying among the oldest-old and their implications for debates on the hypothesis of compression of morbidity.

Keywords

Health Expectancy Healthy Life Expectancy Active Life Expectancy Chinese Longitudinal Healthy Longevity Survey Multistate Life Table 

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References

  1. Andersen-Ranberg, K., L. Vasegard, and B. Jeune. 2001. “Dementia Is Not Inevitable: A Population-Based Study of Danish Centenarians.” Journal of Gerontology: Psychological Sciences 56B:P152-P159.Google Scholar
  2. Chen, A.J. and G. Jones. 1989. Aging in ASEAN: Its Socioeconomic Consequences. Singapore: Institute of Southeast Asian Studies.Google Scholar
  3. Chiang, C.L. 1960. “A Stochastic Study of the Life Table and Its Application: II. Sample Variance of the Observed Expectation of Life and Other Biometric Functions.” Human Biology 32:221–38.Google Scholar
  4. Coale, A.J. and S.M. Li. 1991. “The Effect of Age Misreporting in China on the Calculation of Mortality Rates at Very High Ages.” Demography 28:293–301.CrossRefGoogle Scholar
  5. Crimmins, E.M., M.D. Hayward, and Y. Saito. 1994. “Changing Mortality and Morbidity Rates and the Health Status and Life Expectancy of the Older Population.” Demography 31:159–75.CrossRefGoogle Scholar
  6. —. 1996. “Differentials in Active Life Expectancy in the Older Population of the United States.” Journal of Gerontology: Social Sciences 51B(3):S111-S120.Google Scholar
  7. Crimmins, E.M., Y. Saito, and D. Ingegneri. 1989. “Changes in Life Expectancy and Disability-Free Life Expectancy in the United States.” Population and Development Review 15:235–67.CrossRefGoogle Scholar
  8. —. 1997. “Trends in Disability-Free Life Expectancy in the United States, 1970–1990.” Population and Development Review 23:555–72.CrossRefGoogle Scholar
  9. Evert, J., E. Lawler, H. Bogan, and T. Perls. 2003. “Morbidity Profiles of Centenarians: Survivors, Delayers, and Escapers.” Journal of Gerontology: Medical Sciences 58A:232–37.Google Scholar
  10. Fillenbaum, G.G. 1988. Multidimensional Functional Assessment of Older Adults: The Duke Older Americans Resources and Services Procedures. Hillsdale, NJ: Lawrence Erlbaum.Google Scholar
  11. Fried, L.P., R.A. Kronmal, A.B. Newman, D.E. Bild, M.B. Mittelmark, J.F. Polak, J.A. Robbins, and J.M. Gardin. 1998. “Risk Factors for 5-Year Mortality in Older Adults: The Cardiovascular Health Study.” Journal of the American Medical Association 279:585–92.CrossRefGoogle Scholar
  12. Fries, J.F. 1980. “Aging, Natural Death, and the Compression of Morbidity.” New England Journal of Medicine 303:130–35.CrossRefGoogle Scholar
  13. Fries, J.F. and L.M. Crapo. 1981. Vitality and Aging. San Francisco: W.H. Freeman.Google Scholar
  14. Gill, T.M., S.E. Hardy, and C. Williams. 2002. “Underestimation of Disability in Community-Living Older Persons.” Journal of the American Geriatrics Society 50:1492–97.CrossRefGoogle Scholar
  15. George, L.K. 2002. “Research Design in End of Life Research: State of the Science.” The Gerontologist 42:86–98.Google Scholar
  16. Grab, B., J.E. Dowd, and J.-P. Michel. 1991. “Estimate of Disability-Free Life Expectancy in China.” Paper presented at the fourth meeting of REVES, Noordwijkerhout, the Netherlands.Google Scholar
  17. Gruenberg, E.M. 1977. “The Failures of Success.” Milbank Memorial Fund Quarterly/Health and Society 55:3–24.CrossRefGoogle Scholar
  18. Guralnik, J.M. and L. Ferrucci. 2002. “Underestimation of Disability Occurrence in Epidemiological Studies of Older People: Is Research on Disability Still Alive?” Journal of the American Geriatrics Society 50:1599–601.CrossRefGoogle Scholar
  19. Guralnik, J.M., A.Z. LaCroix, L. Branch, S. Kasl, and R. Wallace. 1991. “Morbidity and Disability in Older Persons in the Years Prior to Death.” American Journal of Public Health 81:443–47.CrossRefGoogle Scholar
  20. Ham-Chande, R. 2003. “Ageing and Health Expectancies in Urban Latin America.” Pp. 318–33 in Determining Health Expectancies 2003, edited by J.-M., Robine, C. Jagger, C.D. Mathers, E.M. Crimmins, and R.M. Suzman. Chichester, England: John Wiley and Sons.Google Scholar
  21. Hayward, M., E.M. Crimmins, and Y. Saito. 1998. “Cause of Death and Active Life Expectancy in the Older Population of the United States.” Journal of Aging and Health 102:192–213.CrossRefGoogle Scholar
  22. Himes, C.L., S.H. Preston, and G.A. Condran. 1994. “A Relational Model of Mortality at Older Ages in Low Mortality Countries.” Population Studies 48:269–91.CrossRefGoogle Scholar
  23. Hubert, H.B., D.A. Bloch, J.W. Oehlert, and J. Fries. 2002. “Lifestyle Habits and Compression of Morbidity.” Journal of Gerontology: Medical Sciences 57A(6):M347-M351.Google Scholar
  24. Jagger, C., E. Hauet, and N. Brouard. 1997. Health Expectancy Calculation by the Sullivan Method: A Practical Guide. Paris: Institute National d’Etudes Demographiques, European Concerted Action on the Harmonization of Health Expectancy Calculations in Europe EURO-REVES.Google Scholar
  25. Kannisto, V. 1991. “Frailty and Survival.” Genus 47(3–4):101–18.Google Scholar
  26. Katz, S., A.B. Ford, R.W. Moskowitz, B.A. Jack, and M.W. Jaffe. 1963. “Studies of Illness in the Aged.” Journal of the American Medical Association 185:94–99.Google Scholar
  27. Keyfitz, N. 1968. Introduction to the Mathematics of Population With Revisions. Reading, MA: Addison Wesley.Google Scholar
  28. Kramer, M. 1980. “The Rising Pandemic of Mental Disorders and Associated Chronic Diseases and Disabilities.” Acta Psychiatrica Scandinavica 62(Suppl.):282–97.CrossRefGoogle Scholar
  29. Laditka, S.B. and M.D. Hayward. 2003. “The Evolution of Demographic Methods to Calculate Health Expectancies.” Pp. 221–34 in Determining Health Expectancies 2003, edited by J.-M., Robine, C. Jagger, C.D. Mathers, E.M. Crimmins, and R.M. Suzman. Chichester, England: John Wiley and Sons.Google Scholar
  30. Laditka, S.B. and D.A. Wolf. 1998. “New Method for Analyzing Active Life Expectancy.” Journal of Aging and Health 102:214–41.CrossRefGoogle Scholar
  31. Lamb, V.L. 1992. “A Cross-national Study of Disability Among the Elderly in Less Developed Countries.” Unpublished Ph.D. dissertation, Department of Sociology, Duke University.Google Scholar
  32. —. 1999. “Active Life Expectancy of the Elderly in Selected Asian Countries.” Research Paper Series No. 69. Tokyo: Population Research Institute, Nihon University.Google Scholar
  33. Land, K.C., J.M. Guralnik, and D.G. Blazer. 1994. “Estimating Increment-Decrement Life Tables With Multiple Covariates From Panel Data: The Case of Active Life Expectancy.” Demography 31:297–319.CrossRefGoogle Scholar
  34. Lauderdale, D.S. and B. Kestenbaum. 2002. “Mortality Rate of Elderly Asian American Populations Based on Medicare and Social Security Data.” Demography 39:529–40.CrossRefGoogle Scholar
  35. Lawton, M.P., M. Moss, and A. Glicksman. 1990. “The Quality of the Last Year of Life of Older Persons.” Milbank Quarterly 68(1):1–28.CrossRefGoogle Scholar
  36. Li, Q. and Z. Tang. 2002. “Application of Multi-State Life Table Model in Research on Health of Elderly Population.” Journal of Chinese Population Science 6(6):40–48.Google Scholar
  37. Liao, Y., D.L. McGee, G. Cao, and R.S. Cooper. 2000. “Quality of the Last Year of Life of Older Adults: 1986 vs. 1993.” Journal of the American Medical Association 283:512–18.CrossRefGoogle Scholar
  38. Losonczy, K.G., L.R. White, and D.B. Brock. 1998. “Prevalence and Correlates of Dementia: Survey of the Last Days of Life.” Public Health Reports 113:273–80.Google Scholar
  39. Lubitz, J. and R. Prihoda. 1983. “The Use and Costs of Medicare Services in the Last Two Years of Life.” Health Care Financing Review 5:117–31.Google Scholar
  40. Magaziner, J., E.M. Simonsick, T.M. Kasher, and J.R. Hebel. 1988. “Patient-Proxy Response Comparability on Measures of Patient Health and Functional Status.” Journal of Clinical Epidemiology 41:1065–74.CrossRefGoogle Scholar
  41. Manton, K.G. 1982. “Changing Concepts of Morbidity and Mortality in the Elderly Population.” Milbank Memorial Fund Quarterly/Health and Society 60:183–244.CrossRefGoogle Scholar
  42. —. 1997. “Demographic Trends Among the Aging Female Population.” Journal of the American Medical Women’s Association 523:99–105.Google Scholar
  43. Manton, K.G. and K.C. Land. 2000a. “Active Life Expectancy Estimates for the U.S. Elderly Population: A Multidimensional Continuous-Mixture Model of Functional Change Applied to Completed Cohorts, 1982–1996.” Demography 373:253–65.CrossRefGoogle Scholar
  44. —. 2000b. “Multidimensional Disability/Mortality Trajectories at Ages 65 and Over: The Impact of State Dependence.” Social Indicators Research 51:193–221.CrossRefGoogle Scholar
  45. Mathers, C.D., C.J.-L. Murray, A.D. Lopez, J.A. Salomon, and R. Sadana. 2003. “Global Patterns of Health Expectancy in the Year 2000.” Pp. 221–34 in Determining Health Expectancies 2003, edited by J.-M., Robine, C. Jagger, C.D. Mathers, E.M. Crimmins, and R.M. Suzman. Chichester, England: John Wiley and Sons.Google Scholar
  46. Molla, M.T., D.K. Wagener, and J.H. Madans. 2001. “Summary Measures of Population Health: Methods for Calculating Healthy Life Expectancy.” Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention. Available on-line at http://www.cdc.gov/nchs/data/statnt/statnt21.pdfGoogle Scholar
  47. Muhidin, S. 2002. The Population of Indonesia—Regional Demographic Scenarios Using a Multiregional Method and Multiple Data Sources. Amsterdam: Rozenberg.Google Scholar
  48. Namboodiri, N.K. and C.M. Suchindran. 1987. Life Table Techniques and Their Applications. Orlando, FL: Academic Press.Google Scholar
  49. OriginLab. 2002. Origin Version 7. Northampton, MA: Origin Lab Corporation.Google Scholar
  50. Palloni, A. 2001 “Increment-Decrement Life Tables.” Pp. 256–72 in Demography: Measuring and Modeling Population Processes 2001, edited by S. Preston, P. Heuveline, and M. Guillot. Oxford, England: Blackwell.Google Scholar
  51. Parker, M.G., M. Thorslund, O. Lundberg, and I. Kareholt. 1996. “Predictors of Physical Function Among the Oldest Old: A Comparison of Three Outcome Variables in a 24-Year Follow-up.” Journal of Aging and Health 8:444–60.CrossRefGoogle Scholar
  52. Penning, M.J. and A.S. Laurel. 1994. “Gender Difference in Disability, Assistance and Subjective Well-being in Later Life.” Journal of Gerontology: Social Science 49:S202-S208.Google Scholar
  53. Pollard, J.H. 1989. “On the Derivation of a Full Life Table From Mortality Data Recorded in Five-Year Age Groups.” Mathematical Population Studies 21:1–14.CrossRefGoogle Scholar
  54. Preston, S.H. and A.J. Coale. 1982. “Age Structure, Growth, Attrition, and Accession: A New Synthesis.” Population Index 48:217–59.CrossRefGoogle Scholar
  55. Qiao, X.C. 1997. “Healthy Expectancy of China.” Paper presented at the tenth meeting of REVES, Tokyo.Google Scholar
  56. Qiao, Z.-K., R. Wilkins, M. Yang, Y. Lan, X. Chen, Y. Xu, and E. Ng. 1993. “Health Expectancy of Adults in Xichang, China, 1990: Autonomy in Various Activities of Daily Living.” Pp. 359–70 in Calculation of Health Expectancies: Harmonization, Consensus Achieved and Future Perspectives 1993, edited by J.-M. Robine, C.D. Mathers, M.R. Bone, and I. Romieu. Paris: John Libbey Eurotext.Google Scholar
  57. Robine, J.-M., A. Colvez, D. Bucquet, F. Hatton, B. Morel, and S. Lelaidier. 1986. “L’Espérance de Vie Sans Incapacité en France en 1982” [Life expectancy without incapacity in France in 1982]. Population 41:1025–42.CrossRefGoogle Scholar
  58. Robine, J.-M., C.D. Mathers, and D. Bucquet. 1993. “Distinguishing Health Expectancies and Health-Adjusted Life Expectancies From Quality-Adjusted Life Years.” American Journal of Public Health 836:797–98.CrossRefGoogle Scholar
  59. Rogers, A. 1975. Introduction to Multi-Regional Mathematical Demography. New York: John Wiley and Sons.Google Scholar
  60. Rogers, A., R.G. Rogers, and A. Belanger. 1990. “Longer Life But Worse Health? Measurement and Dynamics.” Gerontologist 305:640–49.Google Scholar
  61. Rogers, A., R.G. Rogers, and L.G. Branch. 1989. “Multistate Analysis of Active Life Expectancy.” Public Health Report 1043:222–26.Google Scholar
  62. Roos, N.P., P. Montgomery, and L.L. Roos. 1987. “Health Care Utilization in the Years Prior to Death.” Milbank Memorial Fund Quarterly 65:231–54.Google Scholar
  63. Saito, Y., X. Qiao, and S. Jitapunkul. 2003. “Health Expectancy in Asian Countries.” Pp. 289–317 in Determining Health Expectancies 2003, edited by J.-M., Robine, C. Jagger, C.D. Mathers, E.M. Crimmins, and R.M. Suzman. Chichester, England: John Wiley and Sons.Google Scholar
  64. Scott, W.K., C.A. Macera, C.B. Cornman, and P.A. Sharp. 1997. “Functional Health Status as a Predictor of Mortality in Men and Women Over 65.” Journal of Clinical Epidemiology 50:291–96.CrossRefGoogle Scholar
  65. Schoen, R. 1988. Modeling Multi-Group Population. New York: Plenum Press.Google Scholar
  66. Seeman, I. 1992. “National Mortality Followback Survey: 1986 Summary, United States.” Vital Health Statistics 20 (19). Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention.Google Scholar
  67. Steinhauser, K.E., N.A. Christakis, E.C. Clipp, M. McNeilly, L. McIntyre, and J. Tulsky. 2000. “Factors Considered Important at the End of Life by Patients, Family, Physicians, and Other Care Providers.” Journal of American Medical Association 284:2476–82.CrossRefGoogle Scholar
  68. Thatcher, A.R., V. Kannisto, and J.W. Vaupel. 1998. The Force of Mortality at Ages 80 to 120. Odense, Denmark: Odense University Press.Google Scholar
  69. Tu, E.J.-C. and K.-J. Chen. 1994. “Changes in Active Life Expectancy in Taiwan: Compression or Expansion?” Social Science and Medicine 39:1657–65.CrossRefGoogle Scholar
  70. United Nations, Population Division. 2001. World Population Prospects: The 2000 Revision. New York: United Nations.Google Scholar
  71. Üstün, T.B., S. Chatterji, M. Villanueva, L. Bendib, C. Çelik, R. Sadana, N. Valentine, J. Ortiz, A. Tandon, J. Salomon, Y. Cao, W. Xie, E. Özaltin, C. Mathers, and C.J.L. Murray. 2001. “WHO Multi-Country Household Survey Study on Health and Responsiveness, 2000–2001.” GPE Discussion Paper No. 37. Geneva: World Health Organization. Available on-line at http://www.who.int/evidence.Google Scholar
  72. Wang, M. 1993. Long life Is Not Equal to Healthy Life. Beijing: China Economic Press.Google Scholar
  73. Wang, Z.L., Y. Zeng, J.W. Vaupel, and B. Jeune. 1998. “Age Validation of Han Chinese Centenarians.” Genus 54(1–2):123–41.Google Scholar
  74. Wolf, D.A. and S.B. Laditka. 1997. “Stochastic Modeling of Active Life and Its Expectancy.” Papers in Microsimulation Series Paper No. 4. Syracuse, NY: Maxwell Center for Demography and Economics of Aging, Syracuse University.Google Scholar
  75. Wolinsky, F.D., C.M. Callahan, J.F. Fitzgerald, and R.J. Johnson. 1993. “Changes in Functional Status and the Risk of Subsequent Nursing Home Placement and Death.” Journal of Gerontology 48:S94-S101.Google Scholar
  76. Zeng, Yi and J.W. Vaupel. 2002. “Functional Capacity and Self-evaluation of Health and Life of the Oldest Old in China.” Journal of Social Issues 58: No. 4.Google Scholar
  77. Zeng, Yi and J.W. Vaupel. 2003. “Mortality Trajectory of the Oldest Old in China.” Demographic Research 8: No.7.Google Scholar
  78. —. 2004. “Association of Late Childbearing With Healthy Longevity Among The Oldest-Old in China.” Population Studies 58(1):37–53.CrossRefGoogle Scholar
  79. Zeng, Yi, J.W. Vaupel, Z.Y. Xiao, C.Y. Zhang, and Y.Z. Liu. 2001. “The Healthy Longevity Survey and the Active Life Expectancy of the Oldest Old in China.” Population 13(1):95–116.Google Scholar
  80. Zeng, Yi, J.W. Vaupel, Z.Y. Xiao, C.Y. Zhang, and Y.Z. Liu. 2002. “Sociodemographic and Health Profiles of Oldest Old in China.” Population and Development Review 28:251–73.CrossRefGoogle Scholar

Copyright information

© Population Association of America 2004

Authors and Affiliations

  1. 1.Center for Demographic StudiesDuke UniversityDurham
  2. 2.Peking UniversityUSA
  3. 3.Max Planck Institute for Demographic ResearchUSA
  4. 4.Sanford Institute for Public PolicyDuke UniversityUSA

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