Spatial variations and influencing factors of Cumulative Health Deficit Index of elderly in China.

BACKGROUND: With the acceleration of aging and urbanization, how to make cities more age-friendly has become a hot topic. During the long-term demographic transition, the health of the elderly has become an important consideration in urban planning and management. The health of the elderly is a complex issue. However, previous studies have mainly focused on the health defects related to disease incidence, loss of function, mortality, etc., yet a comprehensive evaluation of health status is lacking. The Cumulative Health Deficit Index (CHDI) is a composite index that combines psychological and physiological indicators. Health deficits can reduce the quality of life of the elderly and increase the burden on families, cities and even society, so it is indispensable to understand the individual factors and regional factors that affect CHDI. The research on the spatial differentiation of CHDI and its driving factors can provide scientific geographic information basis for the construction of age-friendly cities and healthy city planning. It also has great significance in narrowing the differences in the health status among regions and reducing the overall burden of the country. METHODS: This research analyzed a nationwide dataset, the China Longitudinal Aging Social Survey in 2018 conducted by the Renmin University of China, which contained 11,418 elderly aged 60 years and older from 28 provinces/municipalities/autonomous regions that represent 95% of the population in mainland China. The Cumulative Health Deficit Index (CHDI) was the first time constructed using the entropy-TOPSIS method to evaluate the health status of the elderly. Entropy-TOPSIS is to quantify the importance of each indicator by calculating the entropy value to improve the reliability and accuracy of the results and avoid the influence of previous researchers' subjective assignments and model assumptions on the results. The selected variables include physical health 27 indicators (self-rated health, basic mobility assessment, daily activity ability, disease and treatment) and mental health 36 indicators (cognitive ability, depression and loneliness, social adjustment, and filial piety concept). The research used the Geodetector methods (factor detection and interaction detection) that combined individual and regional indicators to analyze the spatial variation characters and reveal the driving factors of CHDI. RESULTS: The weight of mental health indicators (75.73) is three times that of physical health indicators (24.27), and its composition formula is: CHDI value = (14.77% disease and treatment + 5.54% daily activity ability + 2.14% health self-assessment + 1.81% basic mobility assessment) + (33.37% depression and loneliness + 25.21% cognitive ability + 12.46% social adjustment + 4.7% filial piety). Individual CHDI was more associated with age and was more evident in females than males. CHDI average values show the distribution trend of Hu Line (HL) in the geographic information graph that the CHDI in West HL regions are lower than in the East HL regions. The highest CHDI cities are in Shanxi, Jiangsu, and Hubei, whereas the lowest CHDI cities are Inner Mongolia, Hunan and Anhui. The geographical distribution maps of the 5-levels of CHDI levels show very different CHDI classification levels among the elderly in the same region. Further, the top three influential factors are personal income, empty nest, aged 80+, and regional factors also obviously affect CHDI values, such as the proportion participating in insurance, population density, and GDP. The two different factors in individual and regional factors all show a two-factor interaction effect, and enhancement or nonlinear enhancement. The top three ranks are personal income ∩ quality of air (0.94), personal income ∩ GDP (0.94), and personal income ∩ urbanization rate (0.87). CONCLUSIONS: CHDI is a subjective and objective comprehensive index, and mental indicators are primary factors. Thus attaching importance to the psychological care of the elderly is the key to building a healthy aging society. The large individual heterogeneity and spatial differentiation of CHDI in the elderly were demonstrated by map visualization. The analysis of the influencing factors of CHDI by the Geodetector method proves that spatial differentiation is mainly affected by individual economic and social security factors, but also by the interaction with regional factors such as quality of air, GDP, and urbanization rate. This research fills a gap in the elderly health status in the field of spatial geography. The results can provide empirical evidence for policymakers to take measures according to local conditions to improve the health status of the elderly according to regional differences in physical and mental conditions. It also plays a guiding role for the country in balancing regional economic development, promoting healthy and sustainable urban development, and creating age-friendly cities.

Current situation and progress toward the 2030 health-related Sustainable Development Goals in China: A systematic analysis.

BACKGROUND: The Sustainable Development Goals (SDGs), adopted by all United Nations (UN) member states in 2015, established a set of bold and ambitious health-related targets to achieve by 2030. Understanding China's progress toward these targets is critical to improving population health for its 1.4 billion people. METHODS AND FINDINGS: We used estimates from the Global Burden of Disease (GBD) Study 2016, national surveys and surveillance data from China, and qualitative data. Twenty-eight of the 37 indicators included in the GBD Study 2016 were analyzed. We developed an attainment index of health-related SDGs, a scale of 0-100 based on the values of indicators. The projection model is adjusted based on the one developed by the GBD Study 2016 SDG collaborators. We found that China has achieved several health-related SDG targets, including decreasing neonatal and under-5 mortality rates and the maternal mortality ratios and reducing wasting and stunting for children. However, China may only achieve 12 out of the 28 health-related SDG targets by 2030. The number of target indicators achieved varies among provinces and municipalities. In 2016, among the seven measured health domains, China performed best in child nutrition and maternal and child health and reproductive health, with the attainment index scores of 93.0 and 91.8, respectively, followed by noncommunicable diseases (NCDs) (69.4), road injuries (63.6), infectious diseases (63.0), environmental health (62.9), and universal health coverage (UHC) (54.4). There are daunting challenges to achieve the targets for child overweight, infectious diseases, NCD risk factors, and environmental exposure factors. China will also have a formidable challenge in achieving UHC, particularly in ensuring access to essential healthcare for all and providing adequate financial protection. The attainment index of child nutrition is projected to drop to 80.5 by 2025 because of worsening child overweight. The index of NCD risk factors is projected to drop to 38.8 by 2025. Regional disparities are substantial, with eastern provinces generally performing better than central and western provinces. Sex disparities are clear, with men at higher risk of excess mortality than women. The primary limitations of this study are the limited data availability and quality for several indicators and the adoption of "business-as-usual" projection methods. CONCLUSION: The study found that China has made good progress in improving population health, but challenges lie ahead. China has substantially improved the health of children and women and will continue to make good progress, although geographic disparities remain a great challenge. Meanwhile, China faced challenges in NCDs, mental health, and some infectious diseases. Poor control of health risk factors and worsening environmental threats have posed difficulties in further health improvement. Meanwhile, an inefficient health system is a barrier to tackling these challenges among such a rapidly aging population. The eastern provinces are predicted to perform better than the central and western provinces, and women are predicted to be more likely than men to achieve these targets by 2030. In order to make good progress, China must take a series of concerted actions, including more investments in public goods and services for health and redressing the intracountry inequities.