The Future Dynamics of Long-Term Care Pressure in China’s Longevity Era: A Prediction Based on the Discrete-Time Markov Model

Abstract

Highlights: What are the main findings? The number of disabled older adults in China will peak at 160 million in 2070 and remain above 115 million by 2100, with the disability rate rising from 39.75% to 45.28%. Person-years with disability (PYD) will increase significantly among the oldest-old and women, highlighting sharp age and gender disparities in long-term care burdens. What are the implications of the main findings? China’s long-term care system will face sustained and structural pressure, demanding urgent adaptation to demographic aging. Timely policy interventions are needed to mitigate future health risks and avoid a care crisis in the longevity era. Background: In the era of longevity, many low- and middle-income countries (LMICs) still lack a comprehensive understanding of health deficits among older adults and the care burden associated with “unhealthy longevity”. This study aims to reveal future changes in care needs and pressure in China from 2030 to 2100. Method: This study develops a multistate demographic forecasting framework by integrating a Markov-based health state transition model with the conceptual logic of an age-shift algorithm. Transition probability matrices by age and gender are estimated using nationally representative microdata from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Baseline population data from the National Bureau of Statistics and WPP 2024 are then used to simulate the evolution of health status among older adults in China from 2030 to 2100. Finally, person-years with disability (PYD) are calculated to evaluate the projected magnitude, structure, and gender disparities of long-term care needs over time. Results: Between 2030 and 2100, the number of disabled older adults in China is projected to follow an inverted U-shaped trend—peaking at 160 million in 2070 and remaining above 115 million by 2100. The share of disabled individuals among older adults rises steadily, from 39.75% to 45.28%. Person-years with disability (PYD) show sustained growth, especially among the oldest-old and women. By 2100, adults aged 95 and older contribute over 20 million PYD—eight times the 2030 level. Gender disparities widen: in 2100, women aged 85–94 account for 53.94 million severe-disability PYD, exceeding men by 8.22 million. These trends reflect mounting structural pressures on China’s long-term care system, increasingly driven by age- and gender-specific disability burdens. Conclusions: If the current disability trend continues unchecked, health risks for older adults will grow over time. In the near future, China will face an extremely heavy care burden and pressure, which will severely impact its economic and social systems. Seizing this critical window for policy action and system improvement is crucial to reducing risks in the longevity era.