the workshop on “determinants of health longevity in china” (mpidr), rostock, germany august...
TRANSCRIPT
The workshop on “Determinants of Health Longevity in China”
(MPIDR), Rostock, Germany August 2-4, 2004
Lengthening of life and emergence of the oldest old: can we extend the healthy longevity
survey in Hong Kong?
By CHEUNG, S.L. Karen[1] YIP S. F. Paul[2], CHI Iris[3] and ROBINE Jean-Marie[4]
[1] Department of Demography, University of Rome “La Sapienza”[2] Department of Statistics and Actuary Science, The University of Hong Kong [3] Sau Po Ageing Centre, The University of Hong Kong [4] INSERM and Health and Demography team, Department of Biostatistics, University of Montpellier 1
Life expectancy at birth Vs
Modal length of life
Increase in life expectancy at birth and modal length of life, males and females
after the 1960s
55
65
75
85
95
1950 1960 1970 1980 1990 2000 2010
F_Mode
M_Mode
F_e0
M_e0
Increase in life expectancy at age 80, males and females, from 1971 to 2001
4
6
8
10
12
1965 1970 1975 1980 1985 1990 1995 2000 2005
Females
Males
Compression of mortality with normal indicators, males and females, 1976 and 2001
0
1000
2000
3000
4000
5000
0 20 40 60 80 100 120 140
1976
2001
Males
Infant mortality
Premature mortality
Highest value indicated by M+4SDM+
M
Lowest value indicated by M-4SDM+
0
1000
2000
3000
4000
5000
0 20 40 60 80 100 120 140
1976
2001
Females
Infant mortality
Premature mortality
M
Highest value indicated by M+4SDM+
Lowest value indicated by M-4SDM+
Three dimensions on the rectangularization of survival curve, males and females,
1976 and 2001
0.0
0.2
0.4
0.6
0.8
1.0
1.2
0 0.5 1 1.5 2
Normalized age
1976 Actual lx
1976 Theoretical lx
2001Actual lx
2001 Theoretical lx
Females
Max accelerationsymmetric to max deceleration
M
Maxdeceleration
M+4SD(M+)
M-4SD(M+)
lxlx
0.0
0.2
0.4
0.6
0.8
1.0
1.2
0 0.5 1 1.5 2
Normalized age
1976 Actual lx
1976 Theoretical lx
2001Actual lx
2001 Theoretical lx
Males
M-4SD(M+)
Max accelerationsymmetric to max deceleration
M
Maxdeceleration
M+4SD(M+)
lxlx
Objectives
1. Describe and monitor the change in oldest-old and centenarians in HK2. Collect, review and synthesize Health surveys since 1980s3. Explore the possibility to launch a Longitudinal Survey on Healthy Longevity in HK
Data sources
1. Micro Known Mortality dataset, 1976-20012. Census estimated and projected populations
Increase in the absolute number of deaths of oldest old by single age for both sexes,
from 1976 to 2001
0
200
400
600
800
1000
1200
1975 1980 1985 1990 1995 2000
80818283848586878889909192939495969798
Rate of increase in deaths of oldest old (logarithmic scale) by single age for both sexes,
from 1976 to 2001
10
100
1000
10000
1975 1980 1985 1990 1995 2000
80818283848586878889909192939495969798
Increase in the absolute number of deaths at age 99+, males and females,
from 1976 to 2001
0
50
100
150
200
250
300
1970 1975 1980 1985 1990 1995 2000 2005
Females
Males
Increase in the proportion of 65+, 75+ and 85+ for both sexes,
1961-2001, and prospects up to 2031
0
5
10
15
20
25
30
1961 1971 1981 1991 2001 2011 2021 2031 2041
%
65+
75+
85+
Increase in the absolute number of oldest old for both sexes, 1981-2001 (census years)
0
5
10
15
20
25
1981 1986 1991 1996 2001
Thousands
8081828384858687888990919293949596979899
Increase in the absolute number of oldest-old (aged 80+), males and females,
1981-2001 (census years)
0
20
40
60
80
100
1981 1986 1991 1996 2001
Thousands
Females
Males
Increase in the absolute number of centenarian (aged 100+), males and females,
1981-2001 (census years)
0
100
200
300
400
500
600
700
1981 1986 1991 1996 2001
Females
Males
Since the 1980s several studies conducted locally on various topics
among elderly populations…
…can we extend the Chinese Longitudinal Survey on Healthy
Longevity in Hong Kong?
Health Status survey in Hong Kong since 1980s by General Household Survey or government agenciesSURVEY YEARS AGE LIMITS INCLUDE POP
IN INSTITUTIONS (YES/NO)
Doctor Consultation (GHS-STR#1, 2, 6, 7, 10, 15 and SSS-THSR#3, 8, 12)
(Nov/1982-Jan/1983), (July1982, (Jan/1983 and Sept/1983), (Jan/1989), (July/1990), (Aug-Sept/1992), (May-June/1996), (Sept-Nov/1999), (Jan-May/2001), (May-July/2002)
No restriction
No
Hospitalization (GHS-STR#7, 8, 13, 21) (SSS-THSR#3, 8, 12)
(May-July/1982), (Nov/1982-Jan/1983), (Oct-Dec/1984), (Oct- Dec/1989), (July- Sept/1991), (April-Aug/1995), (April-June/1998), (Sept-Nov/1999), (Jan-May/2001), (May-July/2002)
No restriction
No
Health Status of the population in HK (GHS-STR#10, 15, SSS-THSR#3, 8, 12)
(July/1992), (May-June/1996), (Sept-Nov/1999), (Jan-May/2001), (May-July/2002)
No restriction
No
Socio-demographic, health and economic profiles of elderly people and soon-to-be old (GHS-STR#27)
(July-Sept/2000) Elderly people = 60+ Soon to be old people =45-59
No
Persons with disabilities and chronic diseases (GHS-STR#28)
(Jan-Dec/2000) (mid-June to mid-July/2000) for institutions survey
No Yes
Major Health Status survey among elderly populations in Hong Kong since 1980s by Universities
HKU SURVEY YEARS AGE
LIMITS SAMPLE SOURCE
A Health Survey of the Elderly in Hong Kong by Iris Chi and Lee
Conducted in Summer 1988
55+ Sampling frame of households formulated from the 1986 By-Census
An Evaluation Study of the Health Promotion Program for the Elderly in HK by Iris Chi and Leung
Conducted in Dec/1991-March/ 1992
55+ Recruited from the Adult Health Promotion Program of St James’ Settlement
Validation of Measuring Instruments of Mental Health Status of the Elderly in Hong Kong By Chi, Iris and K. W. Boey
Published in 1992
60+ (60-69; 70-79; 80+)
Either normal elderly of the adult Service Division or patients of the Psychogeriatric Assessment Clinic in St James’ Settlement.
A Mental Health and Social Support Study of the Old-Old in Hong Kong, by Chi, Iris and K. W. Boey
Conducted in Feb-April/ 1992, published in 1994
70-74; 75-79; 80-84; 85+
Drawn from the recipients of Special Needs Allowance, Old Age Allowance and Disability Allowance
Baptist College SURVEY YEARS AGE
LIMITS SAMPLE SOURCE
Health Status, Cognitive Functioning and Dementia Among Elderly Community Population in Hong Kong, by William Liu, et al
Conducted in 1991 Cooperated with Department’s General Household Survey.
65+ (65-74; 75+)
Frames of quarters
City University and Lingnan University SURVEY YEARS AGE
LIMITS SAMPLE SOURCE
A study of the long-term care needs, patterns and impact of the elderly in HK by Raymond Ngan et al
Conducted in March-August/1994
60+ From St. James Settlement and United Christian Hospital
A study of family support, friendship, and psychological well-being among older women in HK by Siu and Phillips
Conducted in Feb 1999
Women aged 60-85
Recruited from three social service centers for the elderly (i.e. Kwai Chung, Lei Muk Shue, and Shek Lei
Quality of life of the Chinese elderly in HK: preliminary findings from two focus groups studies by Alfred Chan, Cheng and Phillips
Started in August 1999
60+
Recruited through multi-service centers for the elderly
CU SURVEY YEARS AGE
LIMITS SAMPLE SOURCE
A cross-sectional survey of the residents of homes for the elderly By Suzanne Ho, Jean Woo, et al
Published in 1989
60-69; 70-79; 80-89; 90+
Shatin and Tai Po Districts only Included populations in institutions
A survey of functional status and chronic diseases among elderly Hong Kong Chinese By Suzanne Ho, Jean Woo, et al
A baseline survey conducted in July 1991 – July 1992, longitudinal 18-month & 36-month follow-up
Young old = 70-79 Old-old =80 years +
Recruited by random sampling of the Old Age and Disability Allowance Schemes Included populations in institutions
From regional community geriatric assessment teams in eight ha hospital clusters
(Chu and Pei, 1997)
A specified hospital (e.g. Tuen Mun Hospital) (Mok et al, 1997) Family medicine clinics (Lam, 2000) Government outpatient clinics (Wun, Lee, Chan, 1998)
Other surveys among elderly populations also
found in Hong Kong BUT…
Problem of existing survey data by GHS or Universities
1. Cross-sectional surveys2. No raw dataset available to public, only population estimates provided on request3. Selectively analyzed and presented results4. Datasets are underused5. District and/ or hospital – restricted/driven6. Bias – sample source7. Mainly cross-sectional surveys, only one longitudinal
by CU, but not available for public8. Proportional sampling design – insufficient sample sizes – especially, 90-99 and 100+ and suppress the heterogeneity of the oldest-old9. Grouped 85+, 80+, or even 75+ as one category
Research Niches
• No research explain why the proliferation of oldest-old and centenarians
• No research on how different factors (i.e. socio-economic, behavioral, environmental and biological factors) influence the healthy longevity to oldest old and centenarians
• Research on their needs (i.e. social, health, care and welfare needs) is rare
• Little research shows whether a longer life with a worsening health
Thank you!