Chinese Medical Journal · 9 authors, 7 centres
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Life expectancy in Shaanxi Province increased from 74.66 years in 2015 to 77.19 years in 2019, with health-adjusted life expectancy also improving. However, unhealthy years increased when considering ten major chronic disease systems, indicating that while people live longer, they spend more years with disease. These findings highlight the need for targeted preventive measures and improved public health services to address the growing burden of non-communicable diseases.
**Background:** Measuring population health is crucial for regional development. Life expectancy (LE) and health-adjusted life expectancy (HALE) are key indicators. While eastern Chinese regions have been studied, data on quality of life in western China, specifically Shaanxi Province, are scarce. This study aimed to estimate LE, HALE, and unhealthy years in Shaanxi from 2015 to 2019 to inform health policy.
**Methods:** Data were obtained from the Full Population Database (FPD) maintained by the Health Commission of Shaanxi Province, with coverage rates of 93.48% to 94.49% from 2015 to 2019. Birth numbers came from the Shaanxi Statistical Yearbook 2020. Prevalence data were derived from the Home Page of Inpatient Medical Record (HPIMR) from all hospitals except traditional Chinese medicine hospitals. Age-specific mortality rates were calculated after adjusting population data and using multiple imputation for missing death data (2018-2019). The Kannisto extrapolation model corrected mortality rates for those over 80 years old. Prevalence of ten major disease systems (tumors; endocrinology, nutrition and metabolism; mental and behavioral disorders; nervous system; sensory diseases; circulatory system; respiratory system; digestive system; genitourinary system; musculoskeletal system and connective tissue) was extracted using ICD-10 codes. Total disease/injury prevalence was estimated by adjusting the proportion of these ten systems in the entire HPIMR. Life expectancy was calculated using life tables, and HALE was estimated using the Sullivan method. Unhealthy years were the difference between LE and HALE.
**Key Results:** The total population grew by 2.17% over five years, with the proportion of those over 65 increasing from 9.45% to 13.62%. Mortality rates improved, especially in children under five. Life expectancy at birth increased from 74.66 years in 2015 to 77.19 years in 2019 (a gain of 2.54 years). Men increased from 74.04 to 76.61 years, women from 75.32 to 77.83 years. HALE considering total diseases and injuries (HALE-TDIs) at birth rose from 67.85 to 69.76 years (increase of 1.91 years). HALE considering ten major disease systems (HALE-TENDs) at birth increased from 70.55 to 72.30 years (increase of 1.75 years). At age 65, LE increased from 16.61 to 18.50 years, HALE-TDIs from 9.30 to 10.84 years, and HALE-TENDs from 12.20 to 13.46 years. Unhealthy years under total diseases/injuries increased by 0.62 years over five years, and under the ten major disease systems increased by 0.78 years. Urban areas showed greater improvements than rural areas; for example, HALE-TDIs at birth increased by about 3.02 years in urban areas versus 0.51 years in rural areas. Regional disparities were noted: Guanzhong area had higher LE and HALE than northern and southern Shaanxi.
**Clinical Implications:** The study demonstrates that while Shaanxi Province has made progress in increasing life expectancy and controlling chronic diseases, the quality of life gains are modest. The increase in unhealthy years, particularly from non-communicable diseases (NCDs), indicates that extended lifespan is accompanied by more years lived with disease. This underscores the need for continued focus on NCD prevention and management, especially cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes. The findings highlight disparities between urban and rural areas and between sexes, suggesting that targeted interventions are needed. Improving basic public health services, such as health management for NCD patients, elderly care, and vaccination programs, is essential. The study also notes the challenge of population aging, with the elderly dependency ratio increasing, which will strain healthcare resources. Policymakers should consider strategies to reduce risk factors like smoking and unhealthy lifestyles, and enhance health education and early detection programs to compress morbidity and improve quality of life in the aging population.