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Changes in total and disability-free life expectancy among older adults in China: Do they portend a compression of morbidity?

morbidity, is suggested for the following sub-groups: urban males with lower education,
urban females with lower education, and rural females with lower education. No change,
either favorable or unfavorable, is detected for the following sub-groups: urban males with
higher education, rural males with lower education, and rural males with higher education.
Some evidence of improvement is found among urban females with higher education and
rural females with higher education, but small sample sizes make these estimates unstable
and uncertain. On balance then, favorable changes were experienced more so by females
than males and more so in urban than in rural areas. Furthermore, across all sub-groups,
changes are most likely to be robust and statistically significant for older-old, around the
ages 75 to 90.

4 Conclusions
Like many developing countries around the world, the demographic changes occurring in
China mean its population is rapidly getting older and its older population is living to more
advanced ages. Given the inextricable link between aging and disability, such changes may
ominously signify persistently growing numbers and proportions disabled. However, the
extent to which population-wide disability rates are affected by these demographic trends
depends upon whether and how disability changes in concert with increases in longevity. A
status quo scenario whereby the likelihood of being disabled at older ages remains un-
changed surely leads to more disabled. A more sanguine scenario is one that is implicated
by a compression of morbidity (Nusselder, 2003). While this concept means that life spent
with morbidity is condensed to a very small time preceding death, given increasing lon-
gevity it translates into a greater proportion of life lived disability-free. In such a scenario,
increases in DFLE would be outpacing TLE.
To address the issue in the current analysis, changes in DFLE and TLE were compared
among Chinese 65 years and older over from the period 2002–05 to the period 2008–11
with emphasis on the ratio of DFLE/TLE. Portending a compression of morbidity would
be an increasing DFLE/TLE ratio. In order to assess whether the same scenario is consis-
tent across the population or whether a compression may be occurring for some and not
others, a situation we refer to as a heterogeneous compression, the study sample was di-
vided into groups by sex, rural/urban residence and level of education.
The main conclusions are:
(i) There are striking increases in TLE and DFLE over this period of observation, sug-
gesting consequential changes between 2002 and 2011. The TLE estimates in this study
are not unreasonable, given World Health Organization (2012) reports of life expectancy
increases at age 65 from 2000 to 2009 of about half a year for males and a year for females.
One possible reason for the sharp rise in TLE and DFLE is that China witnessed rapid
changes in socioeconomic conditions, access to health care, growth in urban areas, and
higher levels of education, all of which are related to health outcomes (Meng et al., 2013;
Siciliano, 2012; Chan, 2012; Meng et al., 2012).
(ii) Across the total population there is evidence of a compression of morbidity, with in-
creasing ratios of DFLE/TLE. However, the compression tends to be robust and statisti-
cally significant for females more so than males, for urbanites more so than rural residents,
and for older-old more so than younger-old. Some of these findings correspond to those
presented by Liu et al. (2009), especially with respect to outcomes among the older-old.
More improvement for females supports disability trend research by Zimmer et al. (2014).
However, results contrast from those of Feng et al. (2013) who reported more favorable
changes in ADL from 1998 to 2008 in Shanghai for females, and Gu et al. (2009) who
showed generally similar improvements across sexes.

International Journal of Population Studies | 2015, Volume 1, Issue 1 14