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Li Y, Liu X. Effects of spatial accessibility of community health services on the activities of daily living among older adults in China: a propensity score matching study. Front Public Health 2024; 12:1335712. [PMID: 38932781 PMCID: PMC11199788 DOI: 10.3389/fpubh.2024.1335712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
Background The Chinese government proposes to establish a hierarchical diagnosis and treatment system, and attaches great importance to community health services. Under the background of population aging and the increase of older adults with disability, this study aimed to analyze the effect of spatial accessibility of community health services on the activities of daily living (ADL) among older adults in China. Methods A research sample of 7,922 older adults from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data in 2018 was adopted. There were 2,806 participants in the treatment group and 5,116 participants in the control group. The propensity score matching method was adopted to match the treatment and control groups to calculate the values of average treatment effects on treated (ATT). Results The results of kernel density matching method showed that the factual ADL score of the treatment group was 10.912, the counterfactual ADL score of the control group was 10.694, and the ATT value was 0.218 (p < 0.01). The spatial accessibility of community health services could significantly improve the activities of daily living among older adults in China. Meanwhile, there was urban-rural heterogeneity in the impact of spatial accessibility of community health services on the activities of daily living of older adults in China. The effect value in urban samples (ATT = 0.371, p < 0.01) was higher than that in rural samples (ATT = 0.180, p < 0.01). Conclusion Spatial accessibility of community health services could improve the activities of daily living among older adults in China. The Chinese government should take actions to improve the distribution of community health service resources.
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Zhu G. The effect of outdoor activities on the medical expenditure of older people: multiple chain mediating effects of health benefits. BMC Public Health 2024; 24:1227. [PMID: 38702631 PMCID: PMC11069142 DOI: 10.1186/s12889-024-18719-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 04/25/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND With the global aging population, attention to the health and medical issues of older adults is increasing. By analyzing the relationship between older people's participation in outdoor activities and medical expenditure, this study aims to provide a scientific basis for improving their quality of life and reducing the medical burden. METHODS Data on outdoor activity participation, medical expenditures, and relevant variables were collected through questionnaires and databases. A multi-chain mediation effect model was established to analyze the impact of outdoor activities on the medical expenditure of older people, considering mediation effects and heterogeneity. RESULTS Results revealed that increased participation in outdoor activities among older adults correlated with lower medical expenditures. Outdoor activities positively influenced their health by improving mental health, cognition, eating habits, and activities of daily living, resulting in reduced medical expenditures. Robustness tests confirmed the consistent effect of outdoor activities on older people's medical expenditure. CONCLUSION These findings contribute to understanding the relationship between outdoor activities, health, and medical expenditure in older people, guiding policy formulation and interventions. Encouraging and supporting older adults in outdoor activities can enhance their quality of life and alleviate medical resource strain. The study's conclusions can also inform health promotion measures for other populations and serve as a basis for future research in this area.
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Affiliation(s)
- Ge Zhu
- School of Economics, Trade and Management, Gansu University of Chinese Medicine, Lanzhou, Gansu, China.
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Liu H, Wang L, Hu T. The effect of city size on the disability rate of the older adults: empirical evidence from CHARLS data. Front Public Health 2024; 11:1227234. [PMID: 38249364 PMCID: PMC10796639 DOI: 10.3389/fpubh.2023.1227234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/09/2023] [Indexed: 01/23/2024] Open
Abstract
Background Exploring the value orientation of city development from the perspective of people's well-being is key to clarifying the current debate on city size strategies. Methods Based on the survey data of the China Health and Retirement Longitudinal Study in two phases, and by using the unbalanced panel-ordered logit model, stepwise analysis method, and KHB method, among others, we discuss the impact of city size on the disability rate of older adults. Results The study finds that city size significantly and positively affects the activities of daily living (ADL) of older adults, with odd ratios of 1.3286 (95% CI = [1.082243, 1.631089]), and exhibits significant group heterogeneity in terms of age, registered residence, income, and education level. City size has indeed played an mediation role through the health improvement effect, disease mitigation effect, emotional effect, and employment structure optimization effect, with a cumulative contribution rate of the mediation effect of 35.17%. In addition, the urban sprawl index has a significant moderation role. Discussion Robust urban sprawl is conducive to promoting the improvement of the regional health environment, the improvement of the medical security policy, the optimization of the family support policy, and the employment structure, thus helping to reduce the disability rate of older adults.
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Affiliation(s)
- Huan Liu
- School of Social Society, Soochow University, Suzhou, Jiangsu Province, China
| | - Lianjie Wang
- School of Law, Jiangnan University, Suzhou, Jiangsu Province, China
| | - Tiantian Hu
- Shenzhen Futian District Economic Development Promotion Association, Shenzhen, China
- Qiaocheng Consulting (Shenzhen) Co., Ltd, Shenzhen, China
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Lin J, Zhang Y, Wang K, Xia H, Hua M, Lu K, Zheng W, Chen R. Long-term impact of PM 2.5 exposure on frailty, chronic diseases, and multimorbidity among middle-aged and older adults: insights from a national population-based longitudinal study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:4100-4110. [PMID: 38097844 DOI: 10.1007/s11356-023-31505-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/08/2023] [Indexed: 01/19/2024]
Abstract
Particulate Matter 2.5 (PM2.5) is a significant risk factor for frailty and chronic diseases. Studies on the associations between PM2.5 and frailty, chronic diseases, and multimorbidity are scarce, especially from large cohort studies. We aimed to explore the potential association between PM2.5 exposure and the risk of frailty, chronic diseases, and multimorbidity. We collected data from a national cohort (CHARLS) with a follow-up period of 11-18 years, totaling 13,366 participants. We obtained PM2.5 concentration data from the Atmospheric Composition Analysis Group at Dalhousie University. PM2.5 exposure is based on the average annual concentration in the prefecture-level city where residents live. We define frailty as the comprehensive manifestation of declining various body functions, characterized by a frailty index of 0.25 or greater, and multimorbidity as the presence of at least two or more chronic conditions. Cox proportional hazards regression was used to estimate the hazard ratio (HR) with its 95% confidence interval (95%CI). A 10-μg/m3 increase for PM2.5 was significantly associated with an increased risk of frailty (HR = 1.289, 95%CI = 1.257-1.322, P < 0.001). A 10-μg/m3 increase for PM2.5 was significantly associated with the elevated risk for most chronic diseases. Compared to those with no morbidity or only single morbidity, a 10-μg/m3 increase for PM2.5 was significantly associated with the elevated risk for multimorbidity (HR = 1.220, 95%CI = 1.181-1.260, P < 0.001). Ambient PM2.5 exposure is a significant risk factor for frailty, chronic diseases, and multimorbidity, and some measures need to be taken to reduce PM2.5 concentration and prevent frailty and chronic diseases.
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Affiliation(s)
- Junjie Lin
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Yu Zhang
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Kunyi Wang
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Huilin Xia
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Minxia Hua
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Kexin Lu
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Weijun Zheng
- Department of Medical Statistics, School of Public Health, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou City, 310053, Zhejiang Province, China
| | - Rucheng Chen
- Department of Medical Statistics, School of Public Health, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou City, 310053, Zhejiang Province, China.
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Li X, Lyu Y, Dong W, Xu A. Exploring the relationship between air quality and health shocks to the elderly: A retrospective cross-sectional study in China. Front Public Health 2023; 11:1087626. [PMID: 37050940 PMCID: PMC10084765 DOI: 10.3389/fpubh.2023.1087626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/06/2023] [Indexed: 03/29/2023] Open
Abstract
MethodsWe selected 5,172 microdata on individuals from the China Health and Retirement Longitudinal Study (CHARLS) 2018. The binary logit model, the ordered logit model, and the stepwise regression were employed to compare the effects of air pollution on self-rated health (SRH) and activities of daily living (ADL) in an elderly population. The effects on health shocks were explored in different age groups, different gender groups, different regions and different sources of pollutants, respectively.ResultsWe found that air pollution significantly increased the risk of health shocks in the elderly population, especially in the 60–69 year age group, and the eastern/central region, where NO2 and O3 were important pollutant sources.ConclusionTargeted management of the environment is necessary to improve the health status of China's elderly population. In addition, paying attention to the health status of vulnerable populations is needed to achieve social equity.
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Affiliation(s)
- Xinyu Li
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yanxia Lyu
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Wanyue Dong
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Aijun Xu
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Research Center for Major Health Risk Management and TCM Control Policy, Nanjing University of Chinese Medicine, Nanjing, China
- *Correspondence: Aijun Xu
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Jia Z, Gao Y, Zhao L, Han S. Effects of pain and depression on the relationship between household solid fuel use and disability among middle-aged and older adults. Sci Rep 2022; 12:21270. [PMID: 36481918 PMCID: PMC9732289 DOI: 10.1038/s41598-022-25825-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
Household air pollution (HAP) is suggested to increases people's risk of disability, but mediating mechanisms between HAP and disability remains under-investigated. The aim of this study was to investigate the underlying mechanisms between household air pollution and disability in middle-aged and older adults (i.e., older than 45 years) using a nationally representative prospective cohort. In total, 3754 middle-aged and older adults were selected from the China Health and Retirement Longitudinal Study. Correlation analysis and logistic regression analysis were employed to estimate the association between HAP, pain, depression and disability. Finally, three significant mediation pathways through which HAP directly impacts disability were found: (1) pain (B = 0.09, 95% CI 0.01, 0.02), accounting for 15.25% of the total effect; (2) depression (B = 0.07, 95% CI 0.004, 0.02), accounting for 11.86% of the total effect; (3) pain and depression (B = 0.04, 95% CI 0.003, 0.01), accounting for 6.78% of the total effect. The total mediating effect was 33.89%. This study clarified that HAP can indirectly affect disability through the respective and serial mediating roles of pain and depression. These findings potentially have important implications for national strategies concerning the widespread use of clean fuels by citizens.
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Affiliation(s)
- Zhihao Jia
- grid.27255.370000 0004 1761 1174School of Physical Education, Shandong University, Jinan, 250061 China
| | - Yan Gao
- grid.27255.370000 0004 1761 1174School of Physical Education, Shandong University, Jinan, 250061 China
| | - Liangyu Zhao
- grid.27255.370000 0004 1761 1174School of Physical Education, Shandong University, Jinan, 250061 China
| | - Suyue Han
- grid.27255.370000 0004 1761 1174School of Physical Education, Shandong University, Jinan, 250061 China
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Jin X, He J, Liang Y, Sun X, Yan S, Wu Y, Li Y, Mei L, Song J, Pan R, Yi W, Tao J, Xu Z, Cheng J, Su H. Associations between household solid fuel use and activities of daily living trajectories: A nationwide longitudinal study of middle and older adults in China. ENVIRONMENT INTERNATIONAL 2022; 170:107605. [PMID: 36323064 DOI: 10.1016/j.envint.2022.107605] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/13/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND More studies focus on reporting the effects of ambient air pollution on physical activity while ignoring the hazards of indoor air pollution caused by household solid fuel use. Moreover, the impact of individual cognitive and depressive status on the health effects of air pollution is often overlooked. OBJECTIVE We examined the association between household solid fuel and activities of daily living (ADL) trajectories, and further examined this association in homogeneous subgroups of cognitive or depressive trajectories. METHODS Participants were from the China Health and Retirement Longitudinal Study, which conducted four waves of surveys from 2011 to 2018. We collected information on participants' household fuel use, then the ADL, cognitive and depressive performances were assessed in each wave. The latent growth mixture model (LGMM) was used to identify the optimal trajectory class for ADL, cognition, and depression. Then, the multinomial logistic regression was used to assess the association between solid fuel use and ADL trajectories in total population, as well as subgroups with different cognitive or depression trajectories. Furthermore, we examined the association between switching household fuel types and ADL trajectories across the four-wave survey. RESULTS The study sample included 7052 participants. We identified three ADL trajectory classes in total population: "Low-stable", "Moderate-anterior rise", and "Moderate-posterior rise". The multinomial logistic regression results showed that solid fuel use was associated with elevated odds for the adverse ADL trajectories, and this association was still shown in homogeneous subgroups of cognitive or depressive trajectories, while some effects were less significant. In addition, the risk of adverse ADL trajectories generally increases with the times of solid fuel use across the four-wave survey. CONCLUSIONS For middle and older adults in China, household solid fuel use was not conducive to physical activity development, which inspires that a further transformation to cleaner fuels is an important intervention.
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Affiliation(s)
- Xiaoyu Jin
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Jun He
- Sanlian Street Community Health Service Center, Shushan District, Hefei City, Anhui Province, China
| | - Yunfeng Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Xiaoni Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Shuangshuang Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Yudong Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Yuxuan Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Lu Mei
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Jian Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Rubing Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Weizhuo Yi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Junwen Tao
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Zhiwei Xu
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Jian Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China.
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