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2008－2021年中国60岁及以上老年人死亡水平和变化趋势分析

Analysis on mortality level and change in elderly population aged ≥60 years in China, 2008−2021

    摘要
  • 摘要:
    目的 研究2008－2021年中国60岁及以上老年人死亡率水平和趋势变化特征，分析东、中、西部之间以及城市、农村之间的地区差异，为疾病防控提供依据。
    方法 利用《中国死因监测数据集（2008—2021）》中全国各地区60岁及以上人群分性别、年龄别死亡数和人口数，使用joinpoint回归模型分析我国东、中、西部地区之间以及城市、农村之间死亡率的变化趋势，计算平均年度变化百分比（AAPC），分析粗死亡率（CDR）与标化死亡率（ASDR）的地区差异及其趋势变化特征。
    结果 2008－2021年我国人群CDR从2008年5.74‰上升到2021年7.10‰（AAPC=1.64%，P<0.05）；ASDR从2008年8.76‰降低到2021年6.58‰（AAPC=−1.96%，P<0.05）。60岁及以上老年人CDR从2008年34.37‰降低到2021年28.91‰（AAPC=−1.22%，P<0.05）；ASDR从2008年37.61‰降低到2021年28.94‰（AAPC=−1.75%，P>0.05）。城市老年人ASDR从2008年32.31‰降低到2021年26.59‰（AAPC=−1.97%，P<0.05），而农村老年人ASDR从2008年41.26‰降低到2021年30.18‰（AAPC=−2.33%，P>0.05），研究期间农村老年人ASDR显著高于城市（WASDR=147，P<0.05）。东部、中部和西部地区老年人ASDR均呈现下降趋势（AAPC东=−2.61%，P<0.05；AAPC中=−3.25%，P<0.05；AAPC西=−1.78%，P<0.05）。东部、中部和西部ASDR差异有统计学意义（χ2=8.033，P<0.05），东部地区人群ASDR显著低于中部和西部（Z东−中=−2.542，P<0.05；Z东−西=−3.357，P<0.05），中部和西部ASDR差异无统计学意义（Z中−西=−0.185，P>0.05）。
    结论 2008－2021年我国60岁及以上老年人总体健康水平得到了显著提升，但仍存在明显的地区差异，老年人健康状况城市优于农村，东部地区优于中、西部。应切实加强中、西部地区和农村地区基层医疗投入和卫生服务能力，积极开展老年人慢性病防控和老年健康管理，构建多层次长期护理保障体系，扎实推进积极应对人口老龄化国家战略。

     

    Abstract:
    Objective  To understand the mortality level and its change in elderly population aged ≥60 years in China from 2008 to 2021, analyze its region specific differences among eastern, central, and western regions and between urban area and rural area, and provide evidence for the development of targeted disease prevention and control strategies.
    Methods The data, including age and gender specific death counts and population size of people aged ≥60 years were collected from China Cause of Death Surveillance Dataset (2008–2021). Joinpoint regression model was used to analyze the change trend of in the mortality levels in eastern, central and western regions and in urban and rural areas in China, the average annual percentage change (AAPC), crude death rate (CDR) and age-standardized death rate (ASDR) were calculated to evaluate the regional differences and temporal patterns.
    Results The results showed that the CDR increased from 5.74‰ in 2008 to 7.10‰ in 2021 (AAPC=1.64%, P<0.05) and the ASDR decreased from 8.76‰ in 2008 to 6.58‰ in 2021 (AAPC=−1.96%, P<0.05) in population in China. The CDR decreased from 34.37‰ in 2008 to 28.91‰ in 2021 (AAPC=−1.22%, P<0.05) and the ASDR decreased from 37.61‰ in 2008 to 28.94‰ in 2021 (AAPC=−1.75%, P>0.05) in the elderly aged ≥60 years. The ASDR in the elderly population in urban area decreased from 32.31‰ in 2008 to 26.59‰ in 2021 (AAPC=−1.97%, P<0.05), and the ASDR in the elderly population in rural area decreased from 41.26‰ in 2008 to 30.18‰ in 2021 (AAPC=−2.33%, P>0.05). During the study period, the ASDR in the elderly population in rural area was significantly higher than that in urban areas (WASDR=147, P<0.05). The ASDRs in the elderly population in eastern, central and western regions of China all showed significant downward trends (AAPCeast=−2.61%, P<0.05; AAPCcentral=−3.25%, P<0.05; AAPCwest=−1.78%, P<0.05). There was a significant difference in the ASDR among eastern, central and western regions (χ2=8.033, P<0.05), and the ASDR in eastern region was significantly lower than those in central and western regions (ZEast−Central=−2.542, P<0.05; Zeast−west=−3.357, P<0.05), and there was no significant difference in the ASDR between central and western regions (Zcentral -wWest=−0.185, P>0.05).
    Conclusion From 2008 to 2021, the health status of the elderly aged ≥60 years was significantly improved in China. However, obvious regional differences existed. The health status of the elderly population was better in urban area than in rural area and in eastern region than in central and western regions. It is necessary to increase the investment to primary medical care and improve the health services in central and western regions and in rural area, actively conduct the prevention and control of chronic diseases and health management in elderly population, establish a multi-level long-term care security system, and steadily implement the national strategy of active population aging response.

     

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