How Chronic Diseases Shape Subjective Life Expectancy: The Role of Pain

Objectives Chronic diseases are a global health concern, and subjective life expectancy (SLE) is a novel concept increasingly linked to health outcomes. However, the relationship between chronic disease patterns and SLE remains unclear. This study aimed to examine these associations and to explore whether pain mediates them. Design Longitudinal study. Setting and Participants Data were drawn from 4 waves of the China Health and Retirement Longitudinal Study (CHARLS), including 4774 participants aged 45 and older. Methods Chronic disease patterns were classified as none, preexisting, or new-onset based on reports across 2 consecutive waves. SLE was dichotomized as lower or higher. Weighted mixed-effects logistic regression models with nested random intercepts for communities and individuals were used to examine the association between chronic disease patterns and SLE, adjusting for baseline SLE. The delta method assessed whether pain mediated these associations. Results Most chronic diseases were significantly associated with lower SLE compared with those without such conditions, with exceptions of dyslipidemia, emotional/nervous/psychiatric diseases, and memory-related diseases. For several conditions including diabetes/high blood sugar, cancer, heart disease, kidney disease, chronic lung disease, and arthritis/rheumatism, new-onset conditions showed stronger associations with lower SLE than preexisting conditions. For stroke [odds ratio (OR), 0.54; 95% CI, 0.36–0.81 vs OR, 0.51; 95% CI, 0.34–0.76], preexisting conditions showed slightly stronger associations. Conversely, only preexisting conditions were significantly associated with lower SLE for hypertension, liver disease, stomach/digestive disease, and asthma. Pain served as a partial mediator in these associations. Conclusions and Implications These findings offer new insights for policymakers and health care practitioners, highlighting the importance of implementing interventions during the early stages following diagnosis. Reducing and managing pain at this critical period may help prevent declines in SLE and support individuals’ long-term well-being.