Productivity-adjusted life year loss among the late middle-aged adults in China

Productivity-adjusted life years (PALYs) measure the impact of health conditions on an individual's ability to contribute productively to the economy. However, they have not been evaluated for the Chinese population. We aim to estimate PALYs for the Chinese population aged 50 to 64 years.

We applied the China Aging and Retirement Simulation (CHARISMA) model, a validated microsimulation model, to calculate PALYs for three age cohorts (50-54, 55-59, 60-64). PALYs were calculated by integrating workforce participation, absenteeism, and death. A probabilistic sensitivity analysis was conducted to address parameter uncertainties. PALY losses due to specific conditions were estimated by nullifying each health condition's risk separately. The results were stratified by sociodemographic factors and adjusted using 2018 population data to estimate total PALYs accrued by 2032.

Here we show that the average PALYs before age 65 are 6.80, 4.35, and 1.50 years for the 50-54, 55-59, and 60-64 age groups, respectively. Significant PALY variations are observed among subgroups, with males, rural residents, and individuals with lower education exhibiting higher PALYs. From 2018 to 2032, total accrued PALYs for the cohort initially aged 50-64 in 2018 are approximately 1.24 billion years. The primary conditions contributing to PALY loss are dyslipidemia, hypertension, heart disease, diabetes, and stroke.

This study reveals substantial sociodemographic variations in PALYs and identifies major health conditions impacting productivity. Our results can guide targeted health interventions and policies to sustain workforce productivity and social security amid China's aging demographics.