UK-China Health And Social Challenges Ageing Project: present and future burden of dementia, and policy responses
Lead Research Organisation:
University College London
Department Name: Epidemiology and Public Health
Abstract
There are 10.4M cases of dementia in China, and this number will rise. China's rapid ageing process is occurring at an earlier stage of economic development than UK and other countries, posing great demands on health and care services. Policy development in response to this situation would benefit from authoritative forecasts, to 2050, of the epidemiology and economics of China's older population in respect of disease burden, related costs of health and social care, and prospects for future prevention of cardiovascular disease, dementia and disability. The 65+ population of UK and China is 12.7 M and 173 M respectively. Thoughtful comparison of health and social care policy across the contrasting countries will be scientifically illuminating and valuable to policy makers. We propose to build a simulation model for the Chinese population, based on that recently developed for UK (BMJ 2017, Lancet Public Health 2017), for direct comparison of headline statistics and indicators to 2050. The model synthesises the major observed epidemiological and demographic trends, in order to forecast disease burden for dementia, disability and cardiovascular disease, and life expectancy (total life expectancy (LE), disabled LE, and disability-free LE) for the next three decades.
A key determinant of the future burden of dementia is its incidence trend. Our longitudinal analysis of the Chinese Longitudinal Healthy Longevity Study (CLHLS) shows age-adjusted dementia incidence declined 2.8% per year in the period 1998-2014, after accounting for non-random dropout and competing risks. Such rapid changes in disease occurrence, together with China's ageing demographic, mean that current forecasts are likely to be inaccurate. Scenario-modelling functions are built in to allow the user to simulate the impacts of health interventions and social trends in risk factors, such as smoking and obesity, on dementia and other age-related outcomes (Diabetologia 2019). The robustness of modelled estimates is tested with sensitivity analysis.
Our approach is to use repeat measures of cognitive and physical function in CLHLS and the China Health and Retirement Longitudinal Study Health (CHARLS) to identify DSM4-compliant dementia cases. We plan a validation study using a clinical neuropsychologist interview as point of reference. For the socioeconomic function of the model, health and social care costs, including indirect costs associated with caregiving, will draw on WHO-SAGE-China as well as CLHLS and CHARLS data. The project will use the modelled forecasts to examine the fit between projected dependency burden and policy responses, particularly Long-Term Care (LTC). This objective involves mixed methods, carried out by experienced policy analysts in both countries. The first step will be qualitative analysis of the policy development process for the current LTC pilot projects in China. Second, quantitative evaluation of the extent to which the stated policy intentions, and pilot projects, are likely to meet projected needs, will be conducted jointly by policy analysts and modelling teams along with assessment of relative economic costs. We plan a 'trans-positional' approach (Sen 1993), to consider both the internal view (CN researcher of CN system) and external view (UK researcher of CN system) thereby making explicit the cultural (or positional) dependence of observation. Reconciling divergent 'positional' observations leads to useful understanding, not otherwise achieved. Our interdisciplinary team will be led by epidemiologists from UCL and Sun Yat-Sen University (SYSU) together with economists (UCL/Institute for Fiscal Studies, SYSU, Guangzhou Medical University (GZMU)), statisticians and mathematician (SYSU), neuropsychologists (GZMU), clinicians (GZMU, UCL), policy analysts (Nuffield Trust, SYSU) and others. The study will make significant scientific and policy-relevant contributions in China, UK and internationally, beyond the three-year project.
A key determinant of the future burden of dementia is its incidence trend. Our longitudinal analysis of the Chinese Longitudinal Healthy Longevity Study (CLHLS) shows age-adjusted dementia incidence declined 2.8% per year in the period 1998-2014, after accounting for non-random dropout and competing risks. Such rapid changes in disease occurrence, together with China's ageing demographic, mean that current forecasts are likely to be inaccurate. Scenario-modelling functions are built in to allow the user to simulate the impacts of health interventions and social trends in risk factors, such as smoking and obesity, on dementia and other age-related outcomes (Diabetologia 2019). The robustness of modelled estimates is tested with sensitivity analysis.
Our approach is to use repeat measures of cognitive and physical function in CLHLS and the China Health and Retirement Longitudinal Study Health (CHARLS) to identify DSM4-compliant dementia cases. We plan a validation study using a clinical neuropsychologist interview as point of reference. For the socioeconomic function of the model, health and social care costs, including indirect costs associated with caregiving, will draw on WHO-SAGE-China as well as CLHLS and CHARLS data. The project will use the modelled forecasts to examine the fit between projected dependency burden and policy responses, particularly Long-Term Care (LTC). This objective involves mixed methods, carried out by experienced policy analysts in both countries. The first step will be qualitative analysis of the policy development process for the current LTC pilot projects in China. Second, quantitative evaluation of the extent to which the stated policy intentions, and pilot projects, are likely to meet projected needs, will be conducted jointly by policy analysts and modelling teams along with assessment of relative economic costs. We plan a 'trans-positional' approach (Sen 1993), to consider both the internal view (CN researcher of CN system) and external view (UK researcher of CN system) thereby making explicit the cultural (or positional) dependence of observation. Reconciling divergent 'positional' observations leads to useful understanding, not otherwise achieved. Our interdisciplinary team will be led by epidemiologists from UCL and Sun Yat-Sen University (SYSU) together with economists (UCL/Institute for Fiscal Studies, SYSU, Guangzhou Medical University (GZMU)), statisticians and mathematician (SYSU), neuropsychologists (GZMU), clinicians (GZMU, UCL), policy analysts (Nuffield Trust, SYSU) and others. The study will make significant scientific and policy-relevant contributions in China, UK and internationally, beyond the three-year project.
Planned Impact
Over the course of three years, UKCHASCAP will have epidemiologic, economic and policy outputs with implications for China, UK and international policy making. The 2014 launched Institute of State Governance (ISG) at SYSU and Chinese Aging Well Association (CAWA) aims to conduct strategic research in social governance. This project will address network of health and social care policy makers, and others. See Pathways to Impact for detail.
Ageing and health policy in China is not in place to address the complex needs of the older population, their families and carers adequately, in part because evidence to formulate such policies is limited. This project will provide forecasts for the incidence and prevalence of CVD, disabilities, and dementia in the UK and China, to 2050. Comparative cost-benefit analyses on health and social care in the two countries based on scenarios of potential policy intervention will be produced. These outputs, referencing the provision of long-term care in China will help direct the formation of relevant social care policy in the UK. Our forecasts will be a point of reference for formulation and revision of ageing policies both in the UK and China into the future, generating medium- and long-term social impact. IMPACT-BAM & IMPACT-CAM are robust, sharable platforms, able to handle changes in input parameters as demographic and mortality forecasts evolve. Thus, the social and economic impact of our work has the potential to continue for years beyond the 3-year project.
Beneficiaries of the Research: This research will offer benefits to both academic and non-academic audiences. In academia, the innovative project will interest those working in a number of fields including demography, epidemiology, geriatrics, gerontology, social policy, and sociology. It will also contribute to further developments in the areas of economic and predictive modelling as set out in the Case for Support.
Anticipated social impact will be delivered. Activity will include an inclusive meeting in year 3 to discuss implications of our comparative study with other 3rd sector organisations such as ILC-UK, Centre for Ageing Better, Kings Fund as well as civil servants and others.
Conventional and social media channels will be used to ensure recognition of the research findings.
Ageing and health policy in China is not in place to address the complex needs of the older population, their families and carers adequately, in part because evidence to formulate such policies is limited. This project will provide forecasts for the incidence and prevalence of CVD, disabilities, and dementia in the UK and China, to 2050. Comparative cost-benefit analyses on health and social care in the two countries based on scenarios of potential policy intervention will be produced. These outputs, referencing the provision of long-term care in China will help direct the formation of relevant social care policy in the UK. Our forecasts will be a point of reference for formulation and revision of ageing policies both in the UK and China into the future, generating medium- and long-term social impact. IMPACT-BAM & IMPACT-CAM are robust, sharable platforms, able to handle changes in input parameters as demographic and mortality forecasts evolve. Thus, the social and economic impact of our work has the potential to continue for years beyond the 3-year project.
Beneficiaries of the Research: This research will offer benefits to both academic and non-academic audiences. In academia, the innovative project will interest those working in a number of fields including demography, epidemiology, geriatrics, gerontology, social policy, and sociology. It will also contribute to further developments in the areas of economic and predictive modelling as set out in the Case for Support.
Anticipated social impact will be delivered. Activity will include an inclusive meeting in year 3 to discuss implications of our comparative study with other 3rd sector organisations such as ILC-UK, Centre for Ageing Better, Kings Fund as well as civil servants and others.
Conventional and social media channels will be used to ensure recognition of the research findings.
Publications
Araghi M
(2021)
Serum transthyretin and risk of cognitive decline and dementia: 22-year longitudinal study.
in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Arapakis K
(2021)
Dementia and disadvantage in the USA and England: population-based comparative study.
in BMJ open
Bloomberg M
(2021)
Sex differences and the role of education in cognitive ageing: analysis of two UK-based prospective cohort studies.
in The Lancet. Public health
Brunner E
(2021)
Appetite disinhibition rather than hunger explains genetic effects on adult BMI trajectory
in International Journal of Obesity
Chen Y
(2023)
Dementia incidence trend in England and Wales, 2002-19, and projection for dementia burden to 2040: analysis of data from the English Longitudinal Study of Ageing.
in The Lancet. Public health
Hiyoshi A
(2023)
Trends in health and health inequality during the Japanese economic stagnation: Implications for a healthy planet.
in SSM - population health
Jansen MG
(2022)
Association of cerebral small vessel disease burden with brain structure and cognitive and vascular risk trajectories in mid-to-late life.
in Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism
Kimenai DM
(2023)
Trajectories of cardiac troponin in the decades before cardiovascular death: a longitudinal cohort study.
in BMC medicine
Description | UKCHASCAP has built an epidemiological model to predict burden of dementia and disability in older people in UK and China We estimate the cost of dementia in China currently and in future years. |
Exploitation Route | The epidemiological model is available to the research community. |
Sectors | Communities and Social Services/Policy,Healthcare,Government, Democracy and Justice |
URL | https://www.ucl.ac.uk/epidemiology-health-care/research/epidemiology-and-public-health/research/uk-china-health-and-social-challenges-ageing |
Description | Our health burden estimates add to the evidence for UK and Chinese policy makers focused on the needs of the ageing population. |
First Year Of Impact | 2023 |
Sector | Communities and Social Services/Policy,Healthcare,Government, Democracy and Justice |
Impact Types | Policy & public services |
Description | UK-China Health And Social Challenges Ageing Project: present and future burden of dementia, and policy responses |
Amount | £792,098 (GBP) |
Funding ID | ES/T014377/1 |
Organisation | Economic and Social Research Council |
Sector | Public |
Country | United Kingdom |
Start | 08/2020 |
End | 08/2024 |
Description | Collaboration with Prof. Eric French at IFS and University of Cambridge |
Organisation | University of Cambridge |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Working with Sun Yat-Sen University colleagues on calculating the healthcare costs of disability and dementia in China and UK populations. |
Collaborator Contribution | Support from Eric French on calculating the healthcare costs in UK model and Chinese models of dementia and disability in ageing populations. |
Impact | In progress. |
Start Year | 2020 |
Description | Collaboration with Sun Yat-Sen University (China) School of Public Health Epidemiological forecasting model for dementia and disability IMPACT-CAM |
Organisation | Sun Yat-Sen University |
Country | China |
Sector | Academic/University |
PI Contribution | Probabilistic Markov modelling for China based on established UK model Policy analysis |
Collaborator Contribution | Chinese epidemiological data, data analysis and model building, Original research papers |
Impact | Manuscripts submitted/under review (March 2022) |
Start Year | 2020 |
Description | Markov modelling of health state transitions to predict burden of dementia, disability in ageing China and UK populations. |
Organisation | Medical University of Gdansk |
Country | Poland |
Sector | Academic/University |
PI Contribution | Working with Piotr Bandosz at Gdansk Medical University to build a model of projected burden of dementia and disability in China and UK, and coordinating with work at SYSU. |
Collaborator Contribution | See above |
Impact | In progress. |
Start Year | 2020 |
Description | Nuffield Trust partnership looking at policy development of ageing social care in China |
Organisation | Nuffield Trust |
Country | United Kingdom |
Sector | Charity/Non Profit |
PI Contribution | Nuffield Trust supporting on literature review of long-term care in China, to facilitate progress of Objective 4 of our project. UCL research team supporting the Nuffield Trust on literature review, policy analysis and working on qualitative interview framework. |
Collaborator Contribution | In progress. |
Impact | In progress. |
Start Year | 2020 |
Description | Osaka University-UCL capacity-building collaboration 2019-22 |
Organisation | Osaka University |
Country | Japan |
Sector | Academic/University |
PI Contribution | Expertise in social epidemiology, epidemiological study design and analysis, and project management. |
Collaborator Contribution | Prof Iso, HOD Public Health Osaka University (OU) awarded OU grant of approx. £450,000 2019-2022 to fund collaboration with us and others at UCL (Livingston, Psychiatry; Steptoe, ELSA study; Tyler, Civil Engineering) with aim to increase research capacity and build the case for a new Dementia Research Centre at Osaka University. |
Impact | Several projects in progress Collaboration is multi-disciplinary: epidemiology, psychiatry, robotics, old-age nursing |
Start Year | 2019 |
Title | Markov model for dementia and disability |
Description | 10 state probabilistic Markov model using population and epidemiological input data |
Type Of Technology | Software |
Year Produced | 2017 |
Open Source License? | Yes |
Impact | Led to major project to build model for Chinese population funded by UKRI and Chinese National Science Foundation |
Description | Lecture delivered at Japan & China online seminar on Supporting community-dwelling older adults and their families in times of pandemics: strengthening triadic relationships of elderly patients, families and health professionals by science and technology |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Other audiences |
Results and Impact | Delivered a lecture on Dementia Trend and Care Burden in Japan, China & UK |
Year(s) Of Engagement Activity | 2021 |