《保险研究》20250601-《中国与日本、美国的健康预期寿命差距分解与原因探析》（金玥明、王晓军）

［摘   要］健康预期寿命显著提高是健康中国建设的重要目标。目前，中国的健康预期寿命已超过美国等发达国家，但与全球领先的日本相比仍有明显差距。为深入研究中国的健康优势和短板，本文采用健康预期寿命差距逐步分解法，对中日和中美的健康预期寿命差距进行年龄别、死因别、伤害和疾病类别、风险类别等多层次交叉分解分析。研究结果显示：中国与日本的健康差距主要体现在婴儿和老年人群死亡率偏高，尤其是心血管疾病、慢性阻塞性肺病、某些肿瘤的死亡水平显著高于日本，主要原因是中国的空气污染、吸烟、饮食风险和职业风险高于日本。相比之下，中国在与美国的比较中，展现出全年龄段患病率较低的优势，特别是在肌肉骨骼疾病、精神疾病、物质使用障碍、糖尿病等方面，中国的患病水平远低于美国。因此，未来中国提升健康预期寿命的关键是降低相关风险水平，降低婴幼儿和老年人群的死亡水平，同时继续维持较低的各类疾病的患病水平。

［关键词］健康预期寿命；差距分解；死亡效应；疾病效应；风险归因

［基金项目］本文受到教育部哲学社会科学研究重大课题攻关项目“健康中国 2030 背景下的健康老龄化体系优化研究”的支持。

［作者简介］金玥明，中国人民大学统计学院博士研究生；王晓军(通讯作者)，中国人民大学应用统计科学研究中心、统计学院教授。

The Gap in Healthy Life Expectancy Between China and both Japan and the United States： Decomposition and Cause Analysis

JIN Yue-ming，WANG Xiao-jun

Abstract：Significantly improving healthy life expectancy is an important goal of building a healthy China.At present，China′s healthy life expectancy has exceeded that of some developed countries such as the United States，but there is still a significant gap compared with Japan，which is the world leader.In order to further study China′s health advantages and disadvantages，the step-by-step decomposition method of healthy life expectancy gap is adopted to conduct multi-level cross-decomposition analysis of the healthy life expectancy gap between China and both Japan and the United States，in terms of ages，causes of death，injuries and diseases，and risk factors.The results of the study show that the health gap between China and Japan is mainly reflected in the high mortality rates of infants and the elderly，especially the significantly higher mortality level of cardiovascular diseases，chronic obstructive pulmonary disease，and certain tumors than Japan，due to China′s severe air pollution，higher smoking level，dietary risks，and occupational risks，etc.In contrast，China has the advantage of lower morbidity rates in all age groups compared with the United States，especially in musculoskeletal diseases，mental illness，substance use disorders，diabetes，etc.，where the morbidity levels in China are much lower.Therefore，the key to improving China′s healthy life expectancy in the future is to reduce the level of related risks，reduce the mortality level of infants and the elderly，and continue to maintain a low morbidity level of various diseases.

Key words：healthy life expectancy;gap decomposition;death effect;disease effect;risk attribution