背景：改善人群健康不只意味着延长寿命，而反映死亡水平的指标（例如：死亡率、出生时平均期望寿命等）并不能完全反映人们生命质量状况，因此考虑使用健康调整期望寿命（Health-adjusted Life Expectancy, HALE）作为衡量标准。本研究的目的是以潍坊市数据为例，采用Sullivan法、GOM模型法及综合法三种方法，构建基于健康相关生命质量核心量表（Health Related Quality of Life-4, HRQOL-4）的健康日调整期望寿命（Healthy Days-adjusted Life Expectancy, HDALE，HDALE是指经过不健康日比例调整后的健康存活的年数。对三种方法构建的HDALE进行比较，判断不同方法的在估算HDALE上的优劣，从而为构建新的疾病负担汇总指标奠定基础，为疾病负担方法新方法学的建立提供新的思路。

方法：采用2018-2019年山东省潍坊市开展的多阶段分层整群抽样的人群健康状态及行为危险因素横断面调查数据库，获得基于HRQOL-4量表的居民健康状况数据。采用Sullivan法、GOM模型及综合法，估算通过HRQOL-4量表获得不同等级健康等级下的健康状态权重 （Health Status Weight, HSW），结合潍坊市的死因监测系统的2010-2017年死亡数据，估算以上三种方法计算的HDALE及其在期望寿命中的占比。

结果：

1）2010年-2017年潍坊市的粗死亡率总体呈现上升趋势；但是，7年间标化死亡率无论男性还是女性均呈下降趋势。从2017年来看，除5-10岁外，其余各年龄组男性死亡率明显高于女性。

2）现场调查对象共 26614人，其中男性占51.58%。“自评健康”、“心理不健康日”、“身体不健康日”、“总不健康日”、“日常活动受限”和“自理能力受限”这六个指标健康的比例分别为70.9%、95.0%、92.6%、91.3%、97.2%和98.5%，且这六项指标在不同性别上的表现类似，均在不同年龄、文化程度收入和城乡分布上呈现了统计学差异，即年龄越大，文化程度越低，收入越低和居住在城市的人，健康状况更差。而其他人口学特征，如吸烟、饮酒、体力活动或婚姻状况的人群在健康状况分布之间的差异无统计学意义。

3）采用了Sullivan法、GOM模型法及综合法三种方法计算的HSW值略有不同，但是总体上在不同年龄别上的趋势是一致的，除个别年龄组（15-25岁组）外，其余各年龄组，随着年龄的增长，HSW值逐渐增大，且不同年龄别女性的HSW值普遍高于男性。 Sullivan法计算的HSW值相对来说最小，GOM模型法计算的三类权重值加和最大，而综合法居中。对于80岁以上人群组，Sullivan法、GOM模型法和综合法计算的HSW值分别为6.20%、12.02%和7.99%，其中GOM模型计算的轻、中和重度的HSW值分别为6.55%、2.02%和3.45%。

4）2017年，Sullivan法、GOM模型法和综合法计算的65-70岁人群的健康日调整期望寿命分别为13.55岁（95%CI: 13.34-13.75）、12.59岁（95%CI: 12.53-12.65） 和13.29岁（95%CI: 12.98-13.60），分别占期望寿命（14.51岁）的93.38%、86.77%和91.59%，其中Sullivan法和综合法差异无统计学意义，而GOM模型法与另外两种方法计算的结果差异有统计学意义。从不同年代来看，三种方法计算的趋势基本一致。其中Sullivan法和综合法计算的健康日调整期望寿命较为稳定，除了2010年较低外，其余各年代差异无统计学意义。GOM模型法的结果2010年及2013年明显低于其他各年代。

结论： Sullivan法及综合法计算的HSW与HDALE结果接近，差异无统计学意义，GOM法估算的HSW较高，HDALE明显低于另外两种方法计算的结果，且差异有统计学意义。本研究提出的健康日调整期望寿命这一疾病负担的汇总指标，所包含的问题数少，操作简便，可以为构建新的疾病负担汇总指标提供新的思路。

Background: Improving people's health does not only mean prolonging life expectancy. The indicators reflecting the level of death (such as mortality, life expectancy at birth, etc.) cannot fully reflect the quality of life of people, therefore, we consider using Health-adjusted Life Expectancy (HALE) as a measurement. The purpose of this study is to take the data from Weifang City of Shandong Province as an example and adopt three methods, namely Sullivan method, GOM model method and synthetic method. To construct the Healthy Days-adjusted Life Expectancy (HDALE) based on the Health Related Quality of Life version 4 (HRQOL-4). In this study, we compared and judged the advantages and disadvantages of various methods, thus to lay a foundation for the construction of new burden of disease summary indicators and to provide new ideas for burden of disease methodology.

Methods: The health status data of residents based on HRQOL-4 scale were obtained by using the cross-sectional survey database of health status and behavioral risk factors of multi-stage stratified cluster sampling in Weifang City from 2018 to 2019. Sullivan method, GOM model and synthetic method were used to estimate the Health Status Weight (HSW) of different levels of health status obtained by HRQOL-4 scale. Combined with the death data of Weifang cause of death surveillance system from 2010 to 2017, the HDALE calculated by the above three methods and its proportion in life expectancy were estimated.

Results:

1) The crude mortality rate in Weifang City showed an overall upward trend from 2010 to 2017. The standardized mortality rate decreased overall in the past seven years in both male and female. In 2017, the crude mortality of men in all age groups was higher than that of women except 5-10 age-group.

2) The total number of the subjects surveyed was 26614, among whom 51.58% were male. The proportions of “Health” among six indicators, namely "self-rated health", "mentally unhealthy days", "physically unhealthy days", "total unhealthy days", "daily activities limited" and "self-care ability limited", were 70.9%, 95.0%, 92.6%, 91.3%, 97.2% and 98.5%, respectively. The performance of these six indicators was similar in different genders. There were statistical differences between distributions in income, urban, rural, age, education levels. The results showed that the older the people, the lower the education level, the lower the income, and the people living in the city, the worse the health status. Other demographic characteristics, such as smoking, alcohol consumption, physical activity, or marital status, were not statistically significant related to health status.

3) The HSW calculated by Sullivan method, GOM model method and synthetic method were slightly different, but the overall trend in different age groups is consistent. Except for special age groups (15-25 years old group), the HSW values of other age groups gradually increased with the increase of age, and the HSW values of women in different age groups were generally higher than men. The HSW value calculated by Sullivan method was relatively the smallest, the sum of three kinds of weight values calculated by GOM model method was the largest, and the synthetic method was in the middle. For people over 80 years old, the HSW values calculated by Sullivan method, GOM model method and synthetic method were 6.20%, 12.02% and 7.99% respectively, and the HSW values calculated by GOM model for mild, moderate and severe were 6.55%, 2.02% and 3.45% respectively.

4) In 2017, the HDALE calculated by Sullivan method, GOM model method and synthetic method of 65-70 years old people were 13.55 years old (95% CI: 13.34-13.75), 12.59 years old (95%CI: 12.53-12.65) and 13.29 years old (95%CI: 12.98-13.60), which accounted for 93.38%, 86.77% and 91.59% of life expectancy (14.51 years old), respectively. There was no significant difference between Sullivan method and synthetic method. The results of GOM model and the other two methods were statistically significant. From different years, the trend of the three methods was basically the same. Among them, HDALE calculated by Sullivan method and the synthetic method were stable, and there was no statistical significance in other years except 2010, which was lower. The results of GOM model in 2010 and 2013 were significantly lower than those of other years.

Conclusions: The HSW and HDALE calculated by Sullivan method and synthetic method were similar, and the difference between these two methods was not statistically significant. The HSW estimated by GOM method was higher, and the HDALE was significantly lower. The HDALE proposed in this study is simple and easy to operate, which can provide a new idea for the construction of new disease burden index.