Aging in Asia Findings from New and Emerging Data Initiatives (2012) / Chapter Skim
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17 Aging, Health, and Chronic Conditions in China and India: Results from the Multinational Study on Global AGEing and Adult Health (SAGE)--Paul Kowal, Sharon Williams, Yong Jiang, Wu Fan, P. Arokiasamy, and Somnath Chatterji
17 Aging, Health, and Chronic Conditions in China and India: Results from the Multinational Study on Global AGEing and Adult Health (SAGE)--Paul Kowal, Sharon Williams, Yong Jiang, Wu Fan, P. Arokiasamy, and Somnath Chatterji
Pages 415-437
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Population aging in China and India will likely be accompanied by an increase in chronic disease burden. An estimated 66% of the Chinese health burden and 45% of the Indian health burden are expected to be in older adults by 2030 (Chatterji et al., 2008)
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In comparison to HALE at 60 years for both sexes combined of 14.6 years in China and 11.5 years in India, older people living in Indonesia can expect 11.9 years of healthy life remaining at age 60; in the United States, 17.3 years; and in Japan, 20.2 years. Recent Global Burden of Disease estimates show a higher agestandardized overall disease burden in India than China, but with a higher proportion of noncommunicable disease (NCD)
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TABLE 17-1 Population Aged 60 and Older, Life Expectancy (LE) at Birth and Age 60, China and India, 2010 and 2030 2010 2030 LE at LE at Median birth LE at 60 Median birth LE at 60 Country Total, N*
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NOTE: DALY is a health gap measure that combines the time lived with disability and the time lost due to premature mortality. SOURCE: Data from World Health Organization (2008)
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The SAGE survey instruments cover a broad range of topics, including health and its determinants, disability, subjective well-being, emotional and financial well-being, health care utilization, and health sys tems responsiveness. SAGE has included methodologies to improve cross-population comparability of self-reported health and well-being data through the inclusion of biomarkers, performance tests, anchoring vignettes, and additional validation studies.
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In addition, objectively observed performance tests (including grip strength and a fourmeter timed walk) and anthropometric measurements (including weight, 2 More information, survey materials and results for SAGE are available at http://www.
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" with a five-point response scale from very good to very bad. A single general health question has been shown to be a good predictor of numerous health outcomes, but raises concerns about comparability and inconsistency of results, which is why a multidimensional approach to measuring health state, combined with vignette methodologies, is also used in SAGE (Bowling, 2005; Fayers and Sprangers, 2002; Salomon et al., 2009; Sen, 2002; Subramanian et al., 2009)
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For the single overall general health question, an ordered logistic regression produced proportional odds ratios. A composite health state score in SAGE was generated using the 16 questions asked in eight
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BiHOPIT is computationally more efficient than CHOPIT, but provides similar results. The prevalence of each condition was estimated separately and was generated using probability weights based on WHO's World Standard Population and the UN Statistical Division (Ahmad et al., 2001; United Nations, 2009)
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Using the continuous composite health state measure, a decline in health state with increasing age is seen in both countries; however, the level of health is higher at all age points in China as compared to India (see Figure 17-2)
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SOURCE: Data from SAGE Wave 1. 100 80 Adjusted Health 60 40 20 0 20 40 60 80 100 Age China Male China Female India Male India Female FIGURE 17-2 Vignette-adjusted health scores by age, gender, and country.
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An analysis of the contributions of the different domains to the overall health state score may help to better understand the determinants and drivers of health between the genders and at different ages. Chronic Conditions Overall, 33% of Chinese and 49% of Indian respondents aged 50 and older reported at least one chronic condition.
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Women hadeditable of angina than men at all vectors, higher rates age groups. Current and longer-term treatment levels were similar in men scaled for portrait above, landscape below and women and increased with age.
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and older (70-plus) women in China reported lower levels of asthma compared to men in the same age groups.
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Diabetes The percentage reporting diabetes was similar in China (6.6%) and India (6.9%)
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For example, 5.7% of Chinese men and 11.9% of Chinese women aged 60–69 reported multiple chronic diseases, compared to 23.3%
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A striking result is that health state scores for women aged 50–59 were similar to men aged 60–69, and women aged 60–-69 similar to men aged 70+ in both countries. This finding suggests a decade difference in health levels for women as compared to men.
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India currently has much higher levels of people with multiple chronic conditions than China; however, China's underreporting of conditions, particularly mental health conditions, is well documented. China's levels of treatment for the different chronic health conditions were generally higher than India, with the highest levels of treatment for
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held in September 2011. SAGE has many strengths, including nationally representative samples with large numbers in different older age groups, a method for measuring health and related techniques for improving cross-national comparability, and assessment of angina, arthritis, asthma, and depression through self-report and validated symptom-reporting methods (Moussavi et al., 2007; Tandon, Murray, and Shengalia, 2004)
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. Study on the relationship between self-rated health situation and health status in the elderly -- an 8-year follow-up study from the Multidimensional Longitudinal Study of Aging in Beijing.
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. Depression, chronic diseases, and decrements in health: Results from the World Health Surveys.
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. Preventing chronic diseases in China.
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First Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control. Available: http:// www.who.int/nmh/events/moscow_ncds_2011/conference_documents/moscow_ declaration_en.pdf.
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