Risk factors and economic impacts of chronic disease for middle-aged and older people in China

Chronic disease, from cardiovascular disease to respiratory disease, diabetes and cancer, is a public health challenge with impacts on economic and social progress in China and worldwide. Morbidity of chronic disease in the Chinese population is rising quickly, reaching 34.3% in 2018, the latest available data, from a low of 12.3% in 2003. China's rapid population ageing makes this growth in morbidity an acute challenge. We estimate that almost two-thirds (64.1%) of increases in the morbidity of chronic disease from 2003 to 2018 can be explained by the changes in the age structure of the population. Chronic disease morbidity could increase further without significant action.

Our research, in Chinese and English, finds that early-life health, quality of environment and lifestyle choices are the biggest risk factors for chronic disease morbidity in the middle-aged and older people in China, our study of longitudinal surveys finds. Our statistical model finds that individuals who are physically healthier when aged up to 15 years old have a 5.6 percentage points (ppt) lower probability of chronic disease after the age of 45. People who live near better-managed waste disposal facilities are less vulnerable (-3.4 ppts) to chronic disease from middle age. Smoking, drinking alcohol, and overuse of the Internet for work or socialising are further risk factors, estimated to increase chronic disease morbidity by 2.2-4.9 ppts, 1.8 ppts, and 1.5-1.8 ppts respectively. Smoking, drinking alcohol, and physical activity have bigger morbidity impacts on lower-income groups, while internet overuse affects middle- and upper-income groups more. While our findings are statistically significant, they are estimated from statistical modelling of broad-based survey data and have certain limitations, such as they are not comparable with medical results.

The morbidity of chronic diseases in older adults has large economic consequences. For people aged from 45 to 59, suffering from a chronic disease can reduce labour participation by 3.3 ppts, resulting in a decline in working hours by 27.9% and the working income of 23.6%. We estimate that suffering from a chronic disease from middle age onward increases a person's total consumption expenditure by 2.0%, with health expenditure affected the most, up by 13.7%. Financial transfers from adult child(ren) rise by an estimated 6.8%, and the time length of care support from adult children increases by 34.8%, due to chronic disease. Malignant tumours cause the largest economic impact of the four major chronic diseases.

Chronic disease prevention and management need coordination between the public and private sectors to provide health support and encourage the adoption of lifelong healthy lifestyles. We propose a detailed protection concept for tackling chronic disease in China based on our research findings. The “Zero-One-Two-Three-Four” policy framework describes five levels of interventions to improve prevention and management of chronic disease in middle aged and older people. "Zero-level prevention” advocates action from pre-birth and intervention to support healthy early years; “One bottom line” encourages governments and employers to create healthier environments for home and work; “Two-way action” advises on healthy adult lifestyle choices; “Three classifications” suggest tailoring healthcare actions to different specific needs, and “Four-layer protections” looks at how the insurance industry can complement social health insurance schemes.