Objective To analyze the life expectancy (LE) and healthy life expectancy (HLE) of the elderly living in different ways in China, as well as gender and urban-rural differences, thus providing data support for optimizing the living arrangements and improving the HLE of the elderly in China.

Methods The data of 4 503 elderly people aged 65 years old and above in 2014 and 2018 of Chinese Longitudinal Healthy Longevity Survey (CLHLS) were collected. The LE, HLE, and HLE/LE ratio of the elderly living alone and living with their families were measured by the micro-simulation method and compared between different genders as well as between urban and rural areas.

Results The LE of 65–100 elderly living alone and living with their families in China were 20.12–4.72 years and 17.59–4.13 years, respectively. The HLE were 10.12–1.78 years and 9.26–1.70 years, respectively. The HLE/LE were 50.30%–37.71% and 52.24% –41.16 %, respectively. The LE of men living alone and living with their families for 65 years and 100 years old were 14.77–3.59 years, 16.61–4.12 years, respectively. The HLE were 7.04–1.10 years, 9.80–1.68 years, respectively. The HLE/LE were 47.66%–30.64%, 59.00%–40.78%, respectively. The LE of women living alone and living with their families for 65–100 years old were 23.93–5.21 years and 19.09–3.82 years, respectively. The HLE were 12.14–1.78 years and 8.96–1.29 years, respectively. The HLE/LE were 50.73%–34.17% and 46.96%–22.77%, respectively. The LE, HLE, HLE/LE of male elderly living alone and male elderly living with family were lower than those of female elderly. The HLE and HLE/LE of male elderly living with family were higher than those of female elderly. The LE, HLE and HLE/LE of male elderly living alone were lower than those of male elderly living with family. The LE, HLE and HLE/LE of female elderly living alone were higher than those of female elderly living with family. The LE of the elderly living alone in the city and living with their families for 65–100 years were 20.55–5.29 years and 18.52–5.13 years, respectively. The HLE were 10.02–2.85 years and 9.06–3.04 years, respectively. The HLE/LE were 48.76%–53.88% and 48.92–59.26%, respectively. The LE of the elderly living alone in rural areas and living with their families for 65–100 years were 20.13–4.53 years and 17.28–3.71 years, respectively. The HLE were 10.97–1.20 years and 9.67–0.92 years, respectively. The HLE/LE were 54.50%–26.49% and 55.96%–24.80%, respectively. The LE of the urban elderly at all ages was higher than that of the rural elderly. Except that the HLE of the urban elderly aged 65-68 and the elderly aged 65 and 66 living with their families was lower than that of the rural elderly, the HLE of the elderly at other ages was higher than that of the rural elderly. With the increase of age, the HLE/LE of the rural elderly gradually decreased, while the HLE/LE of the urban elderly gradually increased.

Conclusions The LE and HLE of the elderly living alone are generally higher than those living with their families, while the HLE/LE ratio demonstrates an opposite trend. Female elderly and the elderly living alone in urban areas have higher LE and HLE, while the male elderly living with their families have higher LE and HLE than the male elderly living alone.