Health Inequality among Chinese Older Adults: The Role of Childhood Circumstances

The Role of Childhood Circumstances in Healthy Aging Inequalities Among Older Adults - China, 2011-2020

What is already known about this topic?

Addressing health disparities is a worldwide priority, with a well-established acknowledgment of the influence of childhood circumstances on these discrepancies. In China, particularly among the elderly, health inequalities are a notable concern.

What is added by this report?

The inequality in healthy aging has increased from 2011 to 2020, both in general and concerning childhood factors. Nevertheless, the impact of early-life healthcare access and parental health behaviors on healthy aging gaps has reduced among older adults in better health within the top segment of healthy aging.

What are the implications for public health practice?

Efforts towards reducing regional health disparities and improving healthcare access for children, along with promoting the health and well-being of parents, especially in economically disadvantaged households, are crucial policy considerations.

Place of Birth and Cognition among Older Americans: Findings from the Harmonized Cognitive Assessment Protocol

Objectives

Growing evidence suggests that place of birth (PoB) and related circumstances may have long-lasting and multiplicative contributions to various later-life outcomes. However, the specific contributions to different domains of cognitive function in late life remain less understood. This study aimed to investigate the extent to which PoB contribute to a wide range of later-life cognitive outcomes.

Methods

A nationally representative sample of Americans aged 65 and older (N=3,216) from the Health and Retirement Study (HRS) Harmonized Cognitive Assessment Protocol (HCAP) was utilized. Cognitive outcomes were assessed in HCAP and linked to HRS state-level PoB data to explore the contribution of birthplace to later-life cognitive disparities. Regression-based Shapley decompositions were employed to quantify this contribution.

Results

PoB significantly contributed to all assessed cognitive outcomes including memory, executive function, language and fluency, visuospatial function, orientation, global cognitive performance, cognitive impairment and dementia. Geographic disparities in cognitive outcomes were evident, with individuals born in US southern states and foreign-born individuals performing worse than those born in other states. PoB overall accounted for 2.4-13.9% of the total variance in cognition after adjusting for age and sex. This contribution reduced by half when adjusting for a rich set of sociodemographic and health factors over the life course, but PoB still independently explained 2.0-7.1% of the total variance in cognition.

Discussion

PoB has lasting contributions to later-life cognitive health, with significant geographic disparities observed. Addressing these disparities requires promoting more equalized place-based policies, resources, and early-life environments to improve health equities over the life course.

Comparing income-related inequality on health service utilisation between older rural-to-urban migrant workers and older rural residents in China: a cross-sectional study

OBJECTIVES

This study quantifies income-related inequalities in health service utilisation of older rural-to-urban migrant workers, by comparison with older rural residents, and identify with factors giving rise to the inequalities.

SETTING

Nationally representative survey conducted in 29 provinces, municipalities and autonomous regions of China.

PARTICIPANTS

952 older rural-to-urban migrant workers and 2676 older rural residents were identified for further analysis.

MAIN OUTCOME MEASURES

The probability of 2 weeks outpatient utilisation and inpatient utilisation.

DESIGN

Coarsened exact matching was used to control the confounding factors between older rural-to-urban migrant workers and their rural counterparts. Concentration index was used to depict the inequality in health service utilisation, and it can be decomposed proportionally into contributions.

RESULTS

The concentration indices of 2 weeks outpatient utilisation of two groups were -0.2061 (95% CI: 0.0193 to 0.1364) and -0.2041 (95% CI: 0.0594 to 0.1469), respectively. The concentration indices of inpatient of two groups were -0.0024 (95% CI: -0.0047 to 0.0639) and -0.1412 (95% CI: 0.0235 to 0.1125), respectively. The contributors of the inequality of 2 weeks outpatient utilisation of two groups were poor self-assessed health (SAH) status and richest group. The contributors of the inequality of inpatient utilisation of the rural elderly were poor SAH, fair SAH and sense of happiness. The horizontal inequality indices for 2 weeks outpatient of two groups were 0.1321 and -0.0.992, respectively. The horizontal inequality indices for the inpatient of two groups were -0.0032 and -0.0396, respectively.

CONCLUSIONS

The results illustrated the existence of a socioeconomic gradient in health service utilisation between older rural-to-urban migrant workers and older rural residents. Our studies provided evidences to take full account of the health service needs, contributing to more reliable understandings of inequalities in the health service utilisation. The results may be referential to identify policy priorities conducive to the health policy reform in the process of active ageing in China.

Early-Life Circumstances and Cross-Country Disparities in Cognition Among Older Populations - China, the US, and the EU, 2008-2018

What is already known about this topic?

Many health challenges have emerged due to rapid population aging, including declined cognitive ability among older adults.

What is added by this report?

Childhood circumstances have significant and lasting impacts on cognition in old age. This study compared cognition data from China with both the United States (U.S.) and the European Union (EU) during 2008-2018, finding that childhood circumstances could respectively explain 65.4% [95% confidence interval (CI): 59.4%, 71.4%] (China vs. the U.S.) and 38.2% (95% CI: 35.1%, 41.2%) (China vs. the EU) of the overall differences in cognition among older adults. Family socioeconomic status explained the largest share of differences among all considered childhood circumstances.

What are the implications for public health practice?

Large disparities in cognition should be addressed by mitigating childhood disadvantages.

Measurement and Decomposition of the Health Poverty of Rural Residents in China

Narrowing the health gap and promoting health equality is the key to effectively blocking the intergenerational transmission of rural poverty. Previous studies have mainly focused on the relationship between health and poverty, but assessments of health poverty are lacking, especially with regard to the health poverty of rural residents. Based on China's large sample household survey data, this study uses the Alkire-Foster (AF) method to measure and decompose the health poverty of rural residents. The results show that the health poverty of Chinese rural residents greatly improved from 2016 to 2018. However, significant regional differences exist with regard to the level of health poverty. The marginal contribution of economic poverty alleviation is diminishing; the equalization of health services and security has shifted to a policy focus. Community environmental management has also become an important aspect of health poverty governance, and individual health literacy and behavior have played an important role in endogenous poverty alleviation. Ultimately, this paper offers some insightful policy implications. This study extends the multidimensional poverty measurement system and reveals the relationship between health poverty and regional economic and social development. The findings also enhance the understanding of the health poverty of rural residents in developing countries.

Trends in inequality of opportunity in health over the life cycle: The role of early-life conditions

This paper explores the evolution of inequality of opportunity in the prevalence of chronic diseases along the life cycle and across different birth cohorts for individuals aged 50 or older and residing in 13 European countries. We adopt an ex-ante parametric approach and rely on the dissimilarity index as our reference inequality metric. In addition to a commonly used set of circumstances, we pay particular attention to the role of adverse early-life conditions, such as the experience of harm and the quality of the relationship with parents. In order to quantify the relative importance of each circumstance, we apply the Shapley inequality decomposition method. Our results suggest that inequality of opportunity in health is not stable over the life cycle - it is generally lower at younger ages and then monotonically increases. Moreover, it varies between different birth cohorts and is generally higher for younger individuals than for older age groups. Finally, the contribution of adverse early life conditions ranges between 25% and 45%, which is comparable to the share of socio-economic circumstances but significantly higher than the relative contribution of other demographic characteristics, especially at younger ages.

Life-course risk factors are associated with activity of daily living disability in older adults

BACKGROUND

Multiple risk factors accumulate over the life-course and contribute to higher rates of disability at older ages. This study investigates whether three life-course risk factors (low educational attainment, poor health in childhood and multimorbidity) are associated with increased risk of disability [defined as any limitation in basic activities of daily living (BADL)] in older adults and whether this relationship is moderated by the national socioeconomic context, measured by the Human Development Index (HDI).

METHODS

Data include 100 062 adults (aged 50 and over) participating in longitudinal studies of aging conducted in 19 countries. Analyses include multivariable Poisson models with robust standard errors to assess the associations between HDI, life-course risk factors and other individual-level control variables (sex and age) with any BADL disability.

RESULTS

In country-specific analyses, both educational attainment and multimorbidity are independently associated with disability in nearly every country. The interaction between these risk factors further increases the magnitude of this association. In pooled regression analyses, the relationship between life-course risk factors and disability is moderated by a country's HDI. For individuals with all three life-course risk factors, the predicted probability of disability ranged from 36.7% in the lowest HDI country to 21.8% in the highest HDI country.

CONCLUSIONS

Social and health system policies directed toward reducing the development of life-course risk factors are essential to reduce disability in all countries, but are even more urgently needed in those with lower levels of socioeconomic development.

Growth and Weight Status in Chinese Children and Their Association with Family Environments

The growth status and weight status of Chinese children have experienced remarkable changes in the past decades. Using China Health and Nutrition Survey (CHNS) data, this paper examines the secular trends and disparity of the growth status and weight status in Chinese children and further investigates the impact of various family environments on children’s growth from 1991 to 2011. We found an increasing trend in standardized growth indicators (height, weight, and BMI), overweight, and obesity from 1991 to 2011. We also observed an increasing disparity in overweight and obesity over time. Family environments had a significant impact on children’s growth status and weight status. In particular, children that live in families with a small size, higher family income, better sanitary conditions, and with well-educated parents or overweight parents tended to be taller and heavier and have a higher BMI, lower risk of being underweight, and higher risk of exhibiting overweight and obesity. Further decomposition analysis showed that more than 70% of the disparity in standardized height, weight, and overweight and around 50% of the disparity in standardized BMI, underweight, and obesity could be attributed to heterogeneity in family environments. Moreover, the disparity associated with family environments tended to increase over time.

Factors Associated With Positive Self-Rated Health: Comparing Older Adults in Brazil and in Portugal

Introduction: Self-rated health is a multidimensional health indicator and a predictor of adverse events in old age. Answers to this assessment are influenced by social, cultural and personality factors. Aim: Exploring common and distinctive characteristics of Brazilian and Portuguese older adults aged 70 and over regarding positive self-rated health according to sociodemographic variables, to functional capacity, to independent performance of basic activities of daily living and to neuroticism, as well as analyzing associations between positive self-rated health and these variables. Methods: The present paper is a comparative and cross-sectional study based on secondary data contained in the databases of the FIBRA (Frailty in Brazilian Older Adults) follow-up study, with 418 Brazilian older adults, and of the DIA (From Disability to Activity: The Challenge of Aging) study, with 380 Portuguese older adults. Both samples had higher percentages of women: 68.4% for Portugal and 69.9% for Brazil. The Brazilian sample had a higher average age (80.31 ± 4.67) than the Portuguese sample (76.80 ± 5.28). Results: The Portuguese older adults had better overall cognition scores, higher handgrip strength and higher neuroticism values than the Brazilian older adults. In the simple and multiple logistic regression analyses, it was found that among Brazilian older adults, subjects with higher scores in the MMSE (OR 1.16; 95% CI 1.08-1.24), regardless of ADL performance (OR 2.13; 95% CI 1.31-3.47) and with scores 24-29 (OR 1.92; 95% CI 1.07-3.43) or 11-23 (OR 2.09; 95% CI 1.15-3.79) in neuroticism were more likely to assess their health as very good/good. On the other hand, the Portuguese older adults with intermediate 24-9 (OR 2.38; 95% CI 1.31-4.33) or low 11-23 (OR 5.31; 95% CI 2.69-10.45) scores in neuroticism were more likely to evaluate their health as very good/good. Conclusion: Based on the findings of the present study and on the existing literature, it may be said that it is possible for people to age while keeping a positive perception of their own health, even in advanced old age; comparisons between the above-mentioned countries, however, point to the need for investments in healthcare systems so that older adults may enjoy greater physical independence and improved mental health.

Understanding Health and Social Challenges for Aging and Long-Term Care in China

The second King's College London Symposium on Ageing and Long-term Care in China was convened from 4 to 5th July 2019 at King's College London in London. The aim of the Symposium was to have a better understanding of health and social challenges for aging and long-term care in China. This symposium draws research insights from a wide range of disciplines, including economics, public policy, demography, gerontology, public health and sociology. A total of 20 participants from eight countries, seek to identify the key issues and research priorities in the area of aging and long-term care in China. The results published here are a synthesis of the top four research areas that represent the perspectives from some of the leading researchers in the field.

The Effects of Childhood Circumstances on Health in Middle and Later Life: Evidence From China

Background: This study examined the relationship between childhood circumstances and health in middle and later life. We quantified how childhood circumstances contribute to health in later life, both directly and indirectly, through their effects on potential mediators.

Methods: This study used three waves of data from the national longitudinal survey of the China Health and Retirement Longitudinal Study (CHARLS). The final model in this study included 7,476 eligible respondents aged 45 years and above. We constructed a simple health status measure based on the first principal component of CHARLS survey responses with 25 health-related information. It is a multi-dimensional measurement that comprehensively reflects the individual's healthy aging. We formulated childhood circumstances factors into five domains: childhood health and nutrition, childhood socioeconomic status, access to health care, parental genetics, and adverse childhood experiences. Ordered logit regression was conducted to analyze the relationship between health in middle and later life and childhood circumstances, with other explanatory variables controlled.

Results: Controlling for educational attainment, personal income, and health status in the last wave, adults who experience good childhood health (poor as the base, coefficient 0.448, p < 0.01), and better family financial status (worse as the base, coefficient 0.173, p < 0.01) have significantly better health during their middle and later life, in comparison, being inconvenient to visit a doctor (coefficient −0.178, p < 0.01), and having two or three adverse childhood experiences (0 as the base, coefficient −0.148, p < 0.01) are significantly associated with poorer health. Childhood circumstances appear to act both through a lasting effect of initial health and financial status in childhood and through their impact on achievements in adulthood.

Conclusion: Our findings suggest that investments in health during childhood not only contribute to health in later life but also dynamically improve an individual's educational attainment and personal income, as well as other life prospects. All these returns may extend far beyond childhood and continue throughout the lifespan.