Gender and ethnic health disparities among the elderly in rural Guangxi, China: estimating quality-adjusted life expectancy.
BACKGROUND
Ethnic health inequalities for males and females among the elderly have not yet been verified in multicultural societies in developing countries. The aim of this study was to assess the extent of disparities in health expectancy among the elderly from different ethnic groups using quality-adjusted life expectancy.


METHODS
A cross-sectional community-based survey was conducted. A total of 6,511 rural elderly individuals aged ≥60 years were selected from eight different ethnic groups in the Guangxi Zhuang Autonomous Region of China and assessed for health-related quality of life (HRQoL). The HRQoL utility value was combined with life expectancy at age 60 years (LE60) data by using Sullivan's method to estimate quality-adjusted life expectancy at age 60 years (QALE60) and loss in quality-adjusted life years (QALYs) for each group.


RESULTS
Overall, LE60and QALE60for all ethnic groups were 20.9 and 18.0 years in men, respectively, and 24.2 and 20.3 years in women. The maximum gap in QALE60between ethnic groups was 3.3 years in males and 4.6 years in females. The average loss in QALY was 2.9 years for men and 3.8 years for women. The correlation coefficient between LE60and QALY lost was -0.53 in males and 0.12 in females.


CONCLUSIONS
Women live longer than men, but they suffer more; men have a shorter life expectancy, but those who live longer are healthier. Attempts should be made to reduce suffering in the female elderly and improve longevity for men. Certain ethnic groups had low levels of QALE, needing special attention to improve their lifestyle and access to health care.
Epidemiology and Biostatistics Unit, Faculty of Public Health, Dali University, Dali, China.|Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Tai
T
Zhang
Health Management Unit, Faculty of Humanities and Management, Guilin Medical University, Guilin, China.
Wuxiang
W
Shi
Health Management Unit, Faculty of Humanities and Management, Guilin Medical University, Guilin, China.
Zhaoquan
Z
Huang
Health Management Unit, Faculty of Humanities and Management, Guilin Medical University, Guilin, China.
Dong
D
Gao
Health Management Unit, Faculty of Humanities and Management, Guilin Medical University, Guilin, China.
Zhenyou
Z
Guo
Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand; cvirasak@medicine.psu.ac.th.
Virasakdi
V
Chongsuvivatwong
ethnicity; gender; inequality in health; quality-adjusted life expectancy; rural elderly