[Determinants of disability free life expectancy in Chinese elderly: based on Multi-states Markov model]

objective: To understand and quantify the main influencing factors related to disability free life expectancy (DFLE) among Chinese elderly. Methods: Using publicly available data from the Chinese Longitudinal Healthy Longevity Survey (2011-2018), we fitted multi-states Markov model and microsimulation to estimate DFLE at age 65, life expectancy (LE) at age 65 and proportion of DFLE to LE (DFLE/LE) at age 65. We calculated 95%CI by Bootstrap. Result: DFLE of the Chinese elderly aged 65 was 14.27 (95%CI: 13.85-14.74) years, higher in female than male and higher in elderly with higher economic status. DFLE/LE at age 65 was 86.33% (95%CI: 85.52%-87.18%), higher in male than female and rural than urban. The risk factors of DFLE include not undergoing physical examination, inadequate fruit/vegetable intake, smoking, and feeling stress, leading to 0.74, 0.41, 0.62, 0.12 years of DFLE lost for male, and 0.82, 0.42, 0.19, 0.20 years of DFLE lost for female, respectively. Eliminating these risk factors can improve DFLE at age 65 by 1.73 years for male and 1.45 years for female. Conclusions: Policies targeting male elderly and the elderly with lower economic status, and measures promoting physical examination and adequate fruit/vegetable intake, relieving stress and banning smoking can substantially improve DFLE of Chinese elderly.