Parent-Child Relationship Typologies and Associated Health Status Among Older Adults in the United States and China: A Cross-Cultural Comparison

Background and Objectives

Cultural differences in intergenerational relationships have been well established in prior research. However, cross-national comparison evidence on the parent-child relationship and its health implications remains limited.

Research Design and Methods

Data from the 2014 U.S. Health and Retirement Study and the 2015 Health and Retirement Longitudinal Study in China were used (N US, non-Hispanic Whites only = 3,918; N China = 4,058). Relationship indicators included coresidence, living nearby, having weekly contact, receiving assistance with daily activities, providing grandchild care, and financial transfer to/from children. Latent class and regression analyses were conducted.

Results

Four classes were identified for non-Hispanic White older Americans: (1) distant and uninvolved (6.58%), (2) geographically proximate with frequent contact and downward support (47.04%), (3) coresident with frequent contact and upward support (13.1%), and (4) geographically proximate with frequent contact (33.28%). Three classes were identified among older Chinese: (1) coresident with frequent contact and upward support (37.46%), (2) coresident/interdependent (25.65%), and (3) geographically proximate with frequent contact and upward financial support (36.89%). For non-Hispanic White older Americans, providing downward support was associated with fewer functional limitations and better cognition. Receiving instrumental support from children was associated with more depressive symptoms, more functional limitations, and poorer cognition among older Chinese.

Discussion and Implications

Cultural contrasts were evident in parent-child relationship typologies and their health implications. Compared to the U.S. non-Hispanic Whites, parent-child relationships in China tended to be closer and associated with poorer health status. The findings call for culturally relevant strategies to improve parent-child relationships and ultimately promote the health of older adults.

Can adult children's education prevent parental health decline in the short term and long term? Evidence from rural China

This paper presents the first evidence of the causal relationship between adult children's schooling and changes in parental health in the short and long term. By using supply-side variation in schooling as an instrument for adult children's education and a representative dataset for rural China, we find that adult children' education has a positive influence on the long-term changes in parental health, with limited evidence of any short-term effect. Our results remain consistent after a variety of sensitivity tests. The heterogeneous analyses show differences in socio-economic status and gender, with low-educated parents and mothers being the primary beneficiaries of children's schooling. Potential mechanisms for the long-term effects of adult children's education on changes in parental health include better chronic disease management, improved access to health, sanitation, and clean fuel facilities, improved psychological well-being, and reduced smoking behaviours.

The impact of medical insurance on family financial support: evidence from CHARLS in China

BACKGROUND

In China, public medical insurance has expanded rapidly in the past 20 years. Many studies have discussed the benefits of medical insurance in improving residents' health and financial stability, and increasing the utilization of medical services. Less attention is paid to the effect of medical insurance on family support between parents and children. This study focuses on the effect of medical insurance on promoting family financial support in China.

METHOD

Fifty-five thousand sixty-two individual samples were obtained from four waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013, 2015 and 2018. Linear-regression model and propensity score matching are used to determine the relationship between medical insurance and family financial support. Then, mediation model is introduced to identify the mediation mechanisms. Also, moderation model is used to estimate the moderation effect of parental education and health.

RESULTS

Medical insurance has significantly increased family financial support between the insured parents and their children. Moreover, this positive effect is heterogeneous since only families living in rural areas were affected, and the direction of family financial support changed with the aging of the parents. The welfare of medical insurance on financial status have also been proven in this paper. The results indicate that medical insurance reduces the out-of-pocket ratio of medical expenses and increases health investment, which can perform as as two mediation mechanisms to affect family financial support. Besides, the education and health status of the insured parents play a role in moderating the effect of medical insurance.

Duration of Poverty and Subsequent Cognitive Function and Decline Among Older Adults in China, 2005-2018

OBJECTIVE

To investigate the relationship between late-life duration of poverty exposure and cognitive function and decline among older adults in China.

METHODS

Data were from 3,209 participants ≥64 years of age in the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Duration of poverty, defined according to urban and rural regional standards from the China Statistical Yearbook, was assessed according to annual household income from 2005 to 2011 (never in poverty; one-third of the period in poverty; two-thirds or more of the period in poverty). Cognitive function was measured by the Chinese Mini-Mental State Examination (CMMSE) from 2011 to 2018. We used attrition-weighted, multivariable mixed-effects Tobit regression to examine the association of duration of poverty with cognitive function and rate of decline.

RESULTS

A total of 1,162 individuals (36.21%) were never in poverty over the period from 2005 to 2011; 1,172 (36.52%) were in poverty one-third of the period; and 875 (27.27%) were in poverty two-thirds or more of the period. A longer poverty duration was associated with lower subsequent CMMSE scores with a dose-response relationship (one-third vs never in poverty: β = -0.98; 95% confidence interval -1.61 to -0.35; two-thirds or more vs never in poverty: β = -1.55; 95% confidence interval -2.29 to -0.81). However, a longer duration of poverty was associated with a slower rate of CMMSE score decline over time from 2011 to 2018.

CONCLUSION

These findings provide valuable evidence for the role of cumulative late-life poverty in relation to cognitive health among older adults in a rapidly urbanizing and aging middle-income country. Our findings may support a compensation hypothesis for cognitive reserve in this setting.

China has faster pace than Japan in population aging in next 25 years

The aging of a population structure is an inevitable path of demographic transition, as an inescapable result of decline in fertility rate and extension in life expectancy. Although demographic transition occurred earlier in Japan than in China, the two countries had similar patterns, both of which took a much shorter period of time than Western countries to complete demographic transition, as well as have been aging at a rapid speed that has rarely been seen in the world. Japan has the highest level of population aging in the world, and China has been experiencing a very fast pace of the population aging process and has the largest older population. Drawing upon data from World Population Prospects (2019), this paper compares changes in population aging in both China and Japan. Findings show that Japan's aging process is 30 years ahead of China, but China has been changing in a similar way as Japan. To be specific, both countries experienced four phases of the population aging process: accelerated development period, rapid development period, slow down period and high-level maintained period. In addition, both countries had a quick growing rate of population aging. It will take China 23 years and 10 years respectively for the aging rate increasing from 7% to 14% and then to 20%, while Japan took 24 and 11 years respectively, which is much shorter than developed countries in the West. Furthermore, China has a faster pace than Japan in population aging in the next 25 years. We found that from 2019-2044, China's aging rate, elderly dependency ratio, oldest-old coefficient and median age of population will increase 13.24 percent points, 24.21 percent points, 8.33 percent points, and 8.47 years, while the four indicators of Japan will increase 8.38 percent points, 22.52 percent points, 8.29 percent points, and 6.20 years, respectively.

Objective and subjective financial status and mortality among older adults in China

The association between financial status and mortality in older adults is well documented. However, it is unclear whether the association may vary by objective and subjective indicators of financial status. To examine this issue, we used the latest four waves (2005, 2008/2009, 2011/2012, and 2014) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) of community-residing adults aged 65 and older (n = 25,954). Financial status was assessed using eight objective, subjective, and culturally-oriented measures to capture various dimensions of financial resources at older ages. Multivariate hazard models were used to examine how different indicators of financial status were associated with subsequent mortality in all older adults and by age, gender, and urban-rural residence. Results showed that higher financial status-either objective or subjective-was associated with lower risks of mortality. Subjective assessments of financial status had stronger associations with mortality than objective assessments. The patterns were generally similar between young-old (aged 65-79) and the oldest-old (aged 80+), between women and men, and between rural and urban areas. Together, the findings offer new evidence to help improve the socioeconomic gradient in mortality among older adults in China.

Children's education and their financial transfers to ageing parents in rural China: mothers and fathers’ strategic advantages in enforcing reciprocity

This investigation examined the impact of children's education on their financial support to older parents in rural China based on a theoretical framework that regards financial transfers from adult children as motivated by parents’ earlier investments on children's education, and mothers and fathers having different strategic advantages to enforce reciprocity. The sample derived from six waves of panel data from the Longitudinal Study of Older Adults in Anhui Province, China, from 2001 to 2015, based on which we constructed five stacked intervals (2001–2003, 2003–2006, 2006–2009, 2009–2012, 2012–2015). The random-effects models showed that the highest educated child provided more financial support than other children and that the amount was conditional on the actual educational attainment of the highest educated child. Our results also suggested that fathers and mothers have different strategic advantages in the process. Mothers’ emotional bonds with their highest educated children enforced financial returns. In contrast, fathers’ stronger identification with traditional filial norms was more consequential for receiving financial support from the highest educated children. We discuss these findings in the context of the patrilineal family system and social changes, including rapid population ageing and the decline of fertility rates.

Internal migration and regional differences of population aging: An empirical study of 287 cities in China

In addition to birth and death, migration is also an important factor that determines the level of population aging in different regions, especially under the current context of low fertility and low mortality in China. Drawing upon data from the fifth and sixth national population census of 287 prefecture-level cities in China, this study explored the spatial patterns of population aging and its trends from 2000 to 2010 in China. We further examined how the large-scale internal migration was related to the spatial differences and the changes of aging by using multivariate quantitative models. Findings showed that the percentage of elder cities (i.e. proportion of individuals aged 65 and above to total population is higher than 7%) increased from 50% to 90% in the total 287 cities within the decade. We also found that regional imbalances of population aging have changed since 2000 in China. The gap of aging level between East zone and the other three zones (i.e. West, Central, and North-east) has considerably narrowed down. In 2000, Eastern region had the greatest number (65) of and the largest proportion (74.7%) of elder cities among all four regions. By 2010, the proportion (87.4%) of elder cities in the eastern region was slightly lower than Central (91.4%), Western (88.2%) and North-east sectors (91.2%). Results from multivariate quantitative models showed that the regional differences of population aging appear to be affected much more by the large-scale internal migration with clear age selectivity and orientation preference than by the impact of fertility and mortality. Population aging is expected to continue in China, which will in turn exacerbate regional imbalances. Policies and implications are discussed to face the challenges that the divergent aging population may present in China.

Buying out of Familial Obligation: The Tradeoff between Financially Supporting versus Living with Elderly Parents in Urban China

For Chinese families, coresidence with elderly parents is both a form of support and a moderator of financial support. Previous literature on intergenerational support in Chinese societies has studied either coresidence or financial support independently, but not these two forms of support jointly. Using data from the 1999 "Study of Family Life in Urban China" in Shanghai, Wuhan, and Xi'an, we examined whether or not adult children, especially sons, buy out of the obligation to live with their parents by providing greater financial support. To account for the potential selection bias associated with coresidence, we treated coresidence and financial transfer as joint outcomes by using endogenous switching regression models. The results showed that children who coreside with their parents would have provided more financial support had they lived away, and children who live away from their parents would have provided more financial support had they coresided. These findings suggest a self-selection mechanism that maximizes children's interests rather than parents'.