Aging with Disabilities: Navigating the Dual Challenge of Aging and Disability in a Rapidly Aging Society with a Focus on China

Binbin Su^1,&; Jincheng Chen^2,&; Chen Chen¹; Yu Wu¹; Yuling Li¹; Xinran Shen¹; Xiaoying Zheng^1,3#

1. School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.

2. Department of Stomatology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan City, Hubei Province, China

3. APEC Health Science Academy (HeSAy), Beijing, China.

^& Joint first authors.

^# Corresponding authors: Xiaoying Zheng, zhengxiaoying@sph.pumc.edu.cn.

China faces the dual challenge of population aging and rising disability rates, creating an "aging-disability overlap" that places unprecedented pressure on the nation's healthcare system. This paper analyzes the complex mechanisms underlying the intersection of aging and disability, revealing that chronic and degenerative diseases are primary contributors to disability among older adults, with disability rates significantly increasing with age and comorbidities. Despite China's implementation of long-term care insurance pilot programs and community-based elderly care services, multiple challenges persist: insufficient financing sustainability, inconsistent assessment standards, regional development imbalances, professional talent shortages, and social-cultural prejudices. In response, this paper proposes a comprehensive strategy framework aligned with "Healthy China 2030"’s goals of strengthening disability prevention and early intervention mechanisms; enhancing long-term care services with diversified security systems; fostering professional talent development in geriatric and rehabilitation medicine; promoting research and application of intelligent assistive technologies; and creating barrier-free communities within an inclusive social environment. Through these coordinated approaches, we aim to improve the quality of life for older adults with disabilities and facilitate dignified and high-quality healthy aging.

老龄化与残障共存：基于中国的视角在快速老龄化社会中应对人口老龄化和残疾的双重挑战

苏彬彬^1,&；陈锦程^2,&；陈晨¹；武昱¹；李宇玲¹；沈欣然¹；郑晓瑛^1,3,#

1. 群医学及公共卫生学院，中国医学科学院北京协和医学院，北京，中国；

2. 口腔科，武汉儿童医院（武汉市妇幼保健院）同济医学院附属医院，华中科技大学，武汉市，湖北省，中国；

3. 亚太经合组织健康科学研究院（APEC-HeSAy），北京，中国。

^& 共同第一作者。

^# 通信作者：郑晓瑛，zhengxiaoying@sph.pumc.edu.cn。

中国正面临人口快速老龄化与残疾率上升的双重挑战，这种"老-残共存"现象，给国家的医疗与社会服务体系带来了巨大压力。本文深入剖析中国老龄化与残疾问题的交织机制，揭示慢性疾病与退行性疾病是导致老年人残疾的主要因素，且残疾率随年龄增长和共病数量而显著攀升。尽管我国已推行长期护理保险试点计划并大力发展社区居家养老服务体系，但仍面临融资可持续性不足、评估标准不统一、区域发展不平衡、专业人才匮乏及社会文化偏见等多重困境。基于此，本文提出符合"健康中国2030"战略框架的系统应对方案：强化残疾预防与早期干预机制；完善长期护理服务与多元化保障体系；加强老年医学与康复医学专业人才培养；推动智能辅助技术研发与普及应用；构建无障碍社区与包容性社会环境。通过这些协同策略，旨在提升残疾老年人生活质量，实现其有尊严、高质量的健康老龄化。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.121

Application of Global Activity Limitation Indicator on Measuring Disability — China, 2019–2022

Yue Cai^1,&; Xiang Cui^2,3,&; Xiaoxu Wang¹; Shiyong Wu^1,#; Dongfeng Gu^2,3,4,#

1. Center for Health Statistics and Information, National Health Commission, Beijing, China.

2. Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

3. Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing, China.

4. School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen City, Guangdong Province, China.

^& Joint first authors

^# Corresponding author: Shiyong Wu, wusy99@126.com; Dongfeng Gu, gudongfeng@cashq.ac.cn.

The Global Activity Limitation Indicator (GALI) offers a simpler and more efficient approach to measuring disability compared to traditional instruments. While GALI's reliability has been validated across different regions, its effectiveness is influenced by cultural differences. This study aims to assess GALI's applicability in China and examine the relationships between GALI and mortality rates, as well as health human resources. We analyzed data from the Resident Health and Health Service Monitoring survey, a nationally representative cross-sectional survey conducted annually from 2019-2022. Multivariate and multinomial logistic regression models were employed to estimate odds ratios and activity limitation probabilities. Mixed effect models were used to explore county-level associations. GALI demonstrated high response rates and reliability throughout the survey period. Significant associations were observed between GALI and traditional disability instruments, as well as disease prevalence. At the county level, GALI showed positive associations with mortality rates and negative associations with the number of physicians per thousand residents. GALI represents a reliable measure of disability for Chinese mainland's population and could serve as a potential predictor for cardiovascular diseases, respiratory system diseases, and unintentional injuries. Our findings suggest that increasing the number of physicians per thousand residents may be associated with reduced activity limitation, though additional research is needed to validate this relationship.

总体活动受限指数在衡量残疾中的应用 — 中国，2019–2022年

蔡玥^1,&；崔翔^2,3,&；王晓旭¹；吴士勇^1,#；顾东风^2,3,4,#

1. 国家卫生健康委统计信息中心，北京，中国；

2. 流行病研究部，国家心血管病中心，阜外医院，中国医学科学院，北京协和医学院，北京，中国；

3.心血管疾病全国重点实验室，中国医学科学院，北京，中国；

4. 南方科技大学公共卫生及应急管理学院，深圳市，广东省，中国。

^& 共同第一作者。

^# 通信作者：吴士勇，wusy99@126.com；顾东风，gudongfeng@cashq.ac.cn。

总体活动受限指数（GALI）是一个比传统残疾量表更加简单方便的衡量残疾的工具。该量表的可靠性已经在不同区域得以验证，但同时也受到文化差异的影响。本研究旨在评估中国人群中GALI的适用性，并进一步探索GALI与死亡率和卫生人力资源的关联。本研究的数据来源于2019-2022年居民健康与卫生服务监测数据，该调查逐年收集具有全国代表性的居民健康相关信息。本研究分别使用多因素logistic回归模型估计优势比（odds ratio）、多项式logistic回归模型估计活动受限概率。混合效应模型被用来探索县区层面的关联。GALI在调查中展现出高度的应答率和可靠性，与传统的活动受限量表和疾病患病情况显著相关。在区县层面，GALI与死亡率呈显著正相关，而与每千人医师数呈显著负相关。GALI可以作为测量中国人群残疾状态的可靠指标。它可能成为心血管疾病、呼吸系统疾病和意外伤害的潜在预测因子。本研究还发现更多的每千人医师数与活动受限率的降低有关，该结论需要更多的研究予以证实。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.118

Utilization of Rehabilitation Services, Economic Participation, and Subjective Relative Deprivation Among Persons with Disabilities — China, 2023

Lei Zhang^1,&,#; Deshan Chen^1,2,&; Niuniu Cui¹; Zixin Zhou¹; Xiaodong Zhang¹; Caimao Li³

1. Institute of Population Research, Peking University, Beijing, China;

2. China Research Center for Disability and Development, Peking University, Beijing, China;

3. China Disabled Persons’ Federation (CDPF), Beijing, China.

^& Joint first authors.

^# Corresponding author: Lei Zhang, zhang.lei@pku.edu.cn.

Research on the well-being of persons with disabilities (PWDs) has predominantly focused on objective living conditions and physical improvements, with insufficient attention to subjective experiences. This study addresses this gap by examining how rehabilitation service utilization enhances economic participation, thereby alleviating subjective relative deprivation (SRD). Data from 5,288 certified PWDs were analyzed using the National Survey on Subjective Perceptions and Evaluation of Persons with Disabilities Protection and Development (2023) in China. Linear regression and the Karlson, Holm, and Breen (KHB) method were employed. A heterogeneity analysis was conducted to evaluate subgroup variations. Rehabilitation service utilization is negatively associated with SRD (β=-0.532, 95% confidence interval (CI): -0.832, -0.231, P<0.001], with economic participation serving as a mediator in this relationship. The SRD-reducing effect of rehabilitation services is stronger among individuals with mild to moderate disabilities (β=-0.634，95% CI: -1.070,-0.197 , P<0.01), those with at least a middle school education (β=-0.850，95% CI: -1.250,-0.450, P<0.001), and urban residents (β=-0.803，95% CI: -1.370,-0.236, P<0.01). The mediating effects are also more pronounced within these subgroups. Policies should prioritize enhancing rehabilitation services and employment support for PWDs, with particular focus on groups with mild to moderate disabilities, higher education backgrounds, and urban residents. Psychological interventions should also be implemented to mitigate SRD-related mental health.

残疾人康复服务利用、经济参与和主观相对剥夺感 — 中国，2023年

张蕾^1,&,#；陈德山^1,2,&；崔牛牛¹；周子欣¹；张孝栋¹；厉才茂³

1.  北京大学人口研究所，北京，中国。

2.  北京大学中国残疾人事业发展研究中心，北京，中国。

3 .中国残疾人联合会（CDPF），北京，中国。

^& 共同第一作者。

^# 通讯作者: 张蕾，zhang.lei@pku.edu.cn。

现有关于残障群体福祉的研究多集中于客观生活条件和身体改善，对其主观感受的关注仍较有限。本文旨在探讨康复服务的利用如何提升残障群体的经济参与度，进而缓解其主观相对剥夺感，以补充现有研究的不足。本研究基于《中国残疾人保障与发展主观感受与评价抽样调查》（2023），分析了5,288名持证残疾人的数据。研究采用线性回归和 Karlson-Holm-Breen（KHB）方法，并开展异质性分析以评估不同亚组间的影响差异。康复服务利用与主观相对剥夺感呈显著负相关（β=-0.532, 95% CI： -0.832, -0.231, P<0.001），且经济参与在其中起中介作用（KHB：β=−0.044, 95% CI: −0.087, −0.001， P < 0.05）。对于轻度至中度残疾者（β=-0.634, 95% CI：-1.070, -0.197, P<0.01）、具有初中及以上学历者（β=-0.850, 95% CI：-1.250, -0.450, P<0.001），以及城镇地区居民（β=-0.803, 95% CI： -1.370, -0.236, P<0.01），康复服务对主观相对剥夺感的缓解效果更为显著，中介作用亦更加突出。政策应优先强化对残障人士的康复服务与就业支持，重点关注轻中度残障者、高教育水平者以及居住在城镇地区的残障群体；同时，应实施心理干预，以预防与相对剥夺感相关的心理健康问题。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.119

Spatiotemporal Evolution of the Prevalence of Depressive Symptoms Among Older Adults — China, 2013–2020

Kexin Li¹;  Peihan Wang^2,3;  Li Wang⁴;  Zhenbo Wang^2,3,#;  Chengdong Xu^3,5;  Xueying Zhao^2,6; Huimin Zhang^2,6;  Yuehua Hu^7,#

1. Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China;

2. Key Laboratory of Regional Chinese Center for Disease Control and Prevention Sustainable Development Modeling, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China;

3. University of Chinese Academy of Sciences, Beijing, China;

4. College of Geography and Environmental Science, Henan University, Kaifeng City, Henan Province, China;

5. State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China;

6. School of Architecture and Urban Planning, Lanzhou Jiaotong University, Lanzhou City, Gansu Province, China;

7. Office of Epidemiology, Chinese Center for Disease Control and Prevention, Beijing, China;

^# Corresponding author: Zhenbo Wang, wangzb@igsnrr.ac.cn; YuehuaHu, huyh@chinacdc.cn.

Depression has emerged as a critical public health concern among older adults in China. Previous research has demonstrated spatial heterogeneity in the prevalence of depressive symptoms across China's elderly population. However, a comprehensive understanding of its spatiotemporal patterns remains limited. This study aimed to estimate city-level prevalence of depressive symptoms among elderly Chinese residents from 2013 to 2020 and analyze its spatial-temporal evolution. Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS). The sandwich estimation method was employed to estimate prevalence rates, while global autocorrelation analysis was conducted to assess spatial patterns of depressive symptom prevalence. Throughout the study period, the average prevalence of depressive symptoms among China's elderly population showed a consistent upward trend. The prevalence rates in 2013, 2015, 2018, and 2020 were 30.27% (95% CI: 24.53, 36.02%), 33.17% (95% CI: 27.21, 39.12%), 34.75% (95% CI: 28.20, 41.31%), and 37.79% (95% CI: 31.01, 44.56%), respectively. Cities in Southwest, Northwest, and Central China reported relatively higher prevalence rates, although no significant spatial aggregation was observed. These findings indicate the need for enhanced mental health initiatives targeting China's elderly population, particularly in western and central regions.

老年人抑郁症状患病率的时空演化特征 — 中国，2013–2020年

李可欣¹；王培涵^2,3；王丽⁴；王振波^2,3,#；徐成东^3,5；招雪影^2,6；张慧敏^2,6；胡跃华^7,#

1.  中国科学院地理科学与资源研究所陆地表层格局与模拟院重点实验室，北京，中国；

2.  中国科学院地理科学与资源研究所区域可持续发展分析与模拟院重点实验室，北京，中国；

3.  中国科学院大学，北京，中国；

4.  河南大学地理与环境学院，河南省开封市，中国；

5.  中国科学院地理科学与资源研究所资源与环境信息系统国家重点实验室，北京，中国；

6.  兰州交通大学建筑与城市规划学院，甘肃省兰州市，中国；

7.  中国疾病预防控制中心流行病学办公室，北京，中国。

^# 通信作者: 王振波，wangzb@igsnrr.ac.cn；胡跃华，huyh@chinacdc.cn。

在我国，老年人抑郁症已然成为一个不可忽视的关键公共卫生问题。已有研究表明，中国老年人抑郁症状的患病率存在空间异质性，然而目前仍缺乏对其时空演化特征的全面认识。本研究旨在估算2013年至2020年中国市级老年人抑郁症状的患病率，探讨其时空演化特征。研究数据来源于中国健康与养老追踪调查（CHARLS）。采用三明治模型计算城市老年人抑郁症状的患病率，进一步利用全局自相关分析评估患病率的空间分布特征。研究结果表明，中国老年人抑郁症状患病率从2013年至2020年呈上升趋势。2013年、2015年、2018年和2020年的患病率分别为30.27%（95% CI：24.53, 36.02%）、33.17%（95% CI：27.21, 39.12%）、34.75%（95% CI：28.20, 41.31%）和37.79%（95% CI：31.01, 44.56%）。老年人抑郁症状患病率较高的城市主要分布在中国西南、西北和中部地区，但并未发现患病率呈现明显的空间聚集性。本研究提示在我国西南、西北等老年人抑郁症状高发地区，有必要加大相关防控措施的力度，从而改善中国老年人群的心理健康状况。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.120

Legislative Status of Public-Access Cardiopulmonary Resuscitation — China, 2024

Lei Hou^1,#; Guixiu Chen²; Haowen Kan²; Jiaxin Liu²; Junyao Ma¹; Keyi Quan¹; Xuefei Feng¹

1 National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China

2 School of Public Health, Inner Mongolia Medical University, Hohhot City, Inner Mongolia Autonomous Region, China.

^# Corresponding authors: Lei Hou, houlei@ncncd.chinacdc.cn.

Chinese patients who have experienced out-of-hospital cardiac arrest (OHCA) are reported to have a survival rate at discharge of only 0.35%. Public-access cardiopulmonary resuscitation (CPR) ranks first in the “Prevention and Control of Major Diseases” section of the Healthy China 2030 Initiative. This study compared the legislative status between China and other major economies worldwide, namely, the USA, China, Germany, and Japan, and provided scientific basis and legislative path for saving lives through international experience reference and analysis of domestic pre-hospital emergency regulations. All four countries have laws supporting life-saving out-of-hospital interventions. However, unlike in the other three countries, no national laws in China mention CPR, defibrillators, or cardiac arrest. China has only 23 local regulations in 67 provincial regions or major cities and no national regulations on pre-hospital emergency care. Among the 23 existing regulations, one mention cardiac arrest, nine mention CPR, 17 mention defibrillators, and none mention telecommunicator CPR. Moreover, four of these 23 regulations do not include any of the legislative points appearing in the national laws of the three comparator countries. It is necessary to integrate decentralized policies and improve the efficiency of OHCA care through the legislation of the National Public-Access Cardiopulmonary Resuscitation Law of the People's Republic of China.

公众心肺复苏相关立法现状 — 中国，2024年

厚磊^1,#；陈桂秀²；阚浩文²；刘佳欣²；马君瑶¹；权可伊¹；冯雪菲¹

1. 慢性非传染性疾病预防控制中心，中国疾病预防控制中心，北京，中国；

2. 公共卫生学院，内蒙古医科大学，呼和浩特市，内蒙古自治区，中国。

^# 通信作者：厚磊，houlei@ncncd.chinacdc.cn。

我国院外心脏骤停患者出院生存率仅为0.35%，“引导居民学习掌握心肺复苏等自救互救知识技能”位居《国务院关于实施健康中国行动的意见》“防控重大疾病”的首位。本研究比较了我国与美国、德国和日本等其他世界主要经济体的立法情况，通过国际经验借鉴与国内院前急救条例分析，为挽救生命提供科学依据与立法路径。与其他三国相比，我国尽管也有支持院外挽救生命措施的法律，但没有国家法律提及院外心肺复苏、除颤器或心脏骤停。在我国的67个省级行政区及主要城市中只颁布了23个院前急救地方条例，且无关于院前急救的国家条例。在有限的23个院前急救条例中，只有1个提及心脏骤停，9个提及心肺复苏，17个提及除颤器，且均未提及急救中心调度员指导的心肺复苏；其中4个院前急救条例甚至不包括三个比较国国家法律提及的任何立法要点。启动并加快《中华人民共和国国民心肺复苏法》专项立法对整合分散政策和提高院外心脏骤停急救效率非常必要。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.122