Socioeconomic inequalities and healthy life expectancy among the oldest-old in China: a comparison of two cohorts across two decades

BACKGROUND: The global rise of the oldest-old (≥80 years) presents a critical challenge to healthcare systems. OBJECTIVES: To evaluate 10-year changes in healthy life expectancy (HLE) among this population in China, assessing trends in morbidity compression and expansion by socioeconomic status (SES) and sex. METHODS: We analyzed two community-based cohorts (1998-2008, n = 7160; 2008-2018, n = 7945) from the Chinese Longitudinal Healthy Longevity Survey. Using a Markov multi-state model, we estimated HLE at age 80 across four health dimensions: physical performance, activities of daily living (ADL), cognitive function, and self-perceived health (SPH). SES was assessed by education background, financial status, and occupation. RESULTS: Women consistently lived longer but with more unhealthy years. Between the two decades, we observed a compression of cognitive impairment across most SES and sex groups. Conversely, an expansion of poor SPH was observed across different SES and sex groups. Trends in physical performance and ADL disability were more heterogeneous, varying significantly by sex and SES, with socioeconomically advantaged groups and women generally experiencing better health spans. CONCLUSIONS: Extended lifespan in China's oldest-old over the past two decades coincides with improved cognitive health but an expansion of morbidity in other domains. These findings underscore the need for sex-specific and SES-tailored strategies to address the growing long-term care needs of this population.