| ObjectiveWe explore the changes in years and differences in gender of health to comprehensively evaluate their health status by calculating the healthy life expectancy(HALE)among Chinese home-based elderly.In addition,establish mathematical model and construct influencing factor patterns in different groups by quantitatively evaluating influencing factors of health.Based on the above,we can provide scientific evidence for improving the health of Chinese home-based elderly and implementing more targeted,scientific and efficient health management for them.MethodsOn the one hand,we used the cross-sectional data of 2011 and 2014 from the Chinese Longitudinal Healthy Longevity Survey(CLHLS)to calculate the active life expectancy(ALE)and healthy life expectancy(HLE)and compare the changes in years and differences in gender of health.On the other hand,we took advantage of the longitudinal survey data of CLHLS from 2011 to 2014 to construct the influencing factor pattern.Each baseline variable in 2011 was taken as the independent variable.Activity of daily living(ADL),self-rated health and self-rated quality of life in 2014 were taken as dependent variables.On this basis,analyzing influencing factors of health in different dimensions is the first step.And then construct the structural equation models(SEMs)of health influencing factor among urban men,urban women,rural men and rural women.Results1.Healthy life expectancy of the subjectsIn 2011 and 2014,the limitation rate of ADL increased with age from less than 10%to about 45%,and the rate of self-rated unhealth slowly increased from about 40%to more than 60%.The limitation rate of ADL was 28.04%in 2011,and declined to 23.72%in 2014.The rate of self-rated unhealth was 58.32%in 2011,and rose to 58.43%in 2014.When the ADL was evaluated by 14 items,the limitation rate of was dramatically increased to about 65%.Before 75 years old,the ALE of subjects was longer than the HLE.The contrary is the case after 75 years old.2.The changes in years and differences in gender of healthIn both male and female subjects,the ALE among subjects only aged 65 to 69 in 2014 was longer than that in 2011(P<0.05).Before 90 years old,year of life lost(YLL)owing to limited ADL in 2014 was shorter than that in 2011(P<0.05).At each age group,the proportion of HALE in life expectancy in 2014 was higher than that in 2011.When the ADL was evaluated by 14 items,at the low age group,the proportion of healthy life expectancy in life expectancy in 2014 was higher than that in 2011.The contrary is the case at the high age group.At each age group before 80 years old,the ALE among female subjects was longer than that among male subjects.The ALE among female subjects was shorter than that among male subjects after 90 years old(P<0.05).YLL owing to limited ADL among female subjects at each age group was longer than that among male subjects(P<0.05).When the ADL was evaluated by 14 items,the ALE among female subjects was shorter than that among male subjects and YLL owing to limited ADL among female subject was longer than that among male subjects(P<0.05).The YLL owing to self-rated unhealth before 90 years old among female subject was longer than that among male subjects(P<0.05).The proportion of female HALE in life expectancy was smaller than that of male HALE in life expectancy.3.Influencing factor Patterns of healthThrough multivariate logistic regression analysis of multidimensional health,we knew that the risk factors of ADL were female,advanced age,living in the urban area and drinking(P<0.05)and the protective factors were regular physical exercise and taking part in leisure activities with high frequency(P<0.05).In terms of self-rated health,the risk factors of it were advanced age and drinking(P<0.05)and the protective factors were the adequate income,higher living standard,regular physical exercise and taking part in leisure activities with high frequency(P<0.05).On the self-rated quality of life,the risk factor was drinking(P<0.05)and the protective factors were the adequate income,higher living standard,frequently drinking tea,regular physical exercise and taking part in leisure activities with high frequency(P<0.05).In the SEMs on influencing factor of health for urban men,urban women,rural men and rural women,the effects of self-rated health and self-rated quality of life on health were larger,ranging from 0.62 to 0.84 and from 0.64 to 0.85,respectively.The direct influence of health-related behaviors and lifestyles on health was around 0.30.There was a strong positive correlation between socioeconomic status,external support and health-related behaviors and lifestyles.The correlation between health-related behaviors and lifestyles and external support was greater and the correlation index which was 0.44 among rural women,was more than 0.5.The factor loading of leisure activities on health-related behaviors and lifestyles was the largest,which was 0.60,0.63,0.59 and 0.69,respectively.It was larger than that of drinking tea and physical exercise.Among rural men,the factor loadings of smoking and drinking on health-related behaviors and lifestyles were-0.22 and-0.24.Among rural women,the factor loading of drinking on health-related behaviors and lifestyles was-0.12.Among rural and female subjects,there were higher factor loadings of life standard and adequate income on socioeconomic status,ranging from 0.68 to 0.75 and from 0.58 to 0.65,respectively.For urban subjects,the factor loadings of the main source of livelihood on external support were 0.68 and 0.71,respectively.In terms of rural subjects,marital status had the largest factor loading on external support(0.46 and 0.75,respectively).ConclusionWe think that self-rated health and self-rated quality of life can greatly reflect actual human health status.The quality of life of female home-based elderly is not as good as that of male home-based elderly.The ADL of the elderly is improving in recent years,but the improvement in the self-rated health status is not apparent.Based on the fact that physical health is more influenced by demographic factors and subjective health containing physical,mental and social health is more influenced by personal background,family structure and relative lifestyles,we should pay more attention to the health status of women and elderly at an advanced age(especially on the senile turning point).During the effective health education and targeted intervention guidance for home-based elderly,the significant role of social leisure activities on health should be focused on.We will improve government,social and family support systems to ensure adequate sources of income in the vulnerable elderly group.We also should intensify the guidance of changing their bad habits in the rural home-based elderly in order to make them own a healthy lifestyle.Last but not least,the importance of harmonious marital relationship should be realized in the improvement of the health status of home-based elderly. |
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