By P.K.Balachandran
Colombo, December 22: Life expectancy goes up in China but gender and provincial gaps remain and that pattern will continue till 2035, says a paper published by Chinese researchers Ruhai Bai, Yunning Liu, Lei Zhang, Wanyue Dong, Zhenggang Bai, and Maigeng Zhou in the British medical journal Lancet.
In 2019, life expectancy at birth in mainland China was 77·7 years (81·0 years for women and 74·8 years for men). It is expected to rise steadily and reach 81·3 years by 2035 (85·1 years for women and 78·1 years for men), says the study dated March 2023.
“Our projections indicate a 96% probability that life expectancy at birth in mainland China in 2030 will reach 79 years (the goal of the Healthy China 2030 Plan) and a 93% probability that life expectancy at birth will surpass 80 years in 2035 (the goal of the 14th Five-Year National Health Plan).
While China’s national goals for 2030 and 2035 will be realised, women will continue to have a higher life expectancy than men and the richer East China provinces like Beijing and Shanghai will continue to have a higher life expectancy than the poorer Western provinces like Tibet and Xinjiang, the study says.
Life expectancy for women 90 in Beijing
The study shows that at the Provincial level, women in Beijing will have the highest projected life expectancy in 2035 with an 81% probability of reaching 90 years. Beijing women will be followed by women in Guangdong, Zhejiang, and Shanghai, with probabilities of reaching 90 being 78%, 62%, and 54% respectively.
Men in Shanghai are projected to have the highest life expectancy at birth, with a 98% probability that life expectancy will surpass 80 years in 2035 and a 77% probability of life expectancy surpassing 83 years. Men in Beijing, Zhejiang, Guangdong, Jiangsu, and Fujian have a probability of more than 50% for surpassing a life expectancy of 80 years.
Provincial Differences
While China has improved the health status of more than one billion citizens, mortality and life expectancy “vary widely” among its provinces. The study stresses the need for life expectancy forecasts at the sub-national or provincial levels to help fashion health policies and programmes achieve national goals.
Provinces with the largest projected gains in women’s life expectancy are Guangdong, Beijing, Zhejiang, and Fujian, with at least a 53% probability of an increase of more than 5 years.
Men in Tibet, Fujian, Guangdong, and Jilin are projected to have the largest gains in life expectancy, with at least a 53% probability of an increase of more than 4 years.
The difference in life expectancy between females and males is projected to increase from 6·2 years in 2019 to 7·0 years in 2035 in the country as a whole.
In 2019, Guangxi, Liaoning, Guangdong, and Beijing had the largest sex differences in life expectancy with 7·7, 7·4, 7·3, and 7·1 years, respectively. Jilin had the lowest at 2·7 years.
“Our projections indicate that the sex differences will increase by 2035 in all provinces except Tibet, Jilin, and Guizhou, where the life expectancy of men is projected to increase at a faster pace compared with women,” the authors said.
Role of Generations
In most Chinese provinces, more than half of the projected gains in life expectancy at birth for women are due to improvements in longevity among older individuals (aged ≥65 years), except in Xinjiang, Tibet, Qinghai, Yunnan, and Guizhou.
In Qinghai, Yunnan, and Guizhou, more than one-third of the projected increase in life expectancy at birth in women is due to improvement in longevity among older individuals.
But in Xinjiang and Tibet, the projected gains in life expectancy at birth for women are mainly due to younger (Xinjiang) and middle-aged individuals (Tibet).
The projections for the life expectancy of both sexes in mainland China are broadly similar to a previous study (80·7 years for both sexes) and those of the UN (81·1 years for both sexes and 78·9 years for men).
Key Factors
China has made tremendous progress in improving health over the past few decades. Increases in life expectancy might be associated with declines in fertility and reductions in infant mortality. Recent increases might be associated with declines in mortality from cardiovascular disease, chronic respiratory disease, and tumours, although they remain the leading causes of death in China, the study says.
These declines in mortality might be linked to recent public health developments, such as increased public funding for health, improved access to health care and decreased health inequality, increased education level, and improvements in nutritional status.
This study indicated that life expectancy varies between provinces in mainland China. There are large variations in social development level and disease burden within the country.
The social development level of some provinces is similar to that of high-income countries, and the life expectancy has recently exceeded that of South Korea and the USA. However, some provinces have characteristics of low-income countries, with a high burden of infectious diseases and neonatal mortality, as well as high levels of cerebrovascular disease, gastric cancer, and road injuries.
In addition, the urbanisation rate also varies among provinces, with some Western provinces having lower rates of urbanisation. Urban populations have higher incomes and access to better health services and education. These disparities have led to regional differences in life expectancy in the past.
Reassuringly, life expectancy is catching up quickly in some Western provinces and is expected to continue to increase in the future (eg, the life expectancy of men in Tibet is expected to increase substantially). These increases could help reduce inequalities in life expectancy across regions.
It is expected that life expectancy in some wealthier Eastern provinces will continue to lead countrywide (eg, Beijing and Shanghai). These provinces have better medical resources, and the burden of disease is also lower than in other provinces.
The projected gap in life expectancy between men and women in most provinces is increasing, which is consistent with historical data.
Non-communicable Diseases
The current sex differences in life expectancy are mainly due to differences in deaths from non-communicable diseases (eg.,respiratory diseases and circulatory diseases), cancer (eg., lung cancer, liver cancer, and gastric cancer), and external causes (eg., traffic accidents and suicide).
Risk factors for these disorders (eg., smoking) trended differently among men and women in China.
Increases in life expectancy will require healthcare and social service resources. Moreover, non-healthy life expectancy (ie., years lived with disability) might also increase.
Healthy Ageing
Some effective health education or economic measures should be taken to promote healthy ageing—eg., by reducing the use of tobacco and alcohol, improving the diet and physical activity, and controlling obesity, the study recommends.
Long-term care for an increasing number of older adults affected by multiple conditions and mobility limitations also needs to be considered.
Integrated care in community settings or even at home should be considered, along with appropriate changes to the built environment and transportation services.
More Spending on Social Security
The study draws attention to the fact that an increase in life expectancy will lead to an increase in social security and pensions, which also means that advance planning is needed.
Source: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(22)00338-3/fulltext#%20 (dated March 30, 2023).
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