Studies that systematically examine the dynamics of task-specific ADL functioning and its associa... more Studies that systematically examine the dynamics of task-specific ADL functioning and its associates are very rare. Using the first three waves of the Chinese Longitudinal Healthy Longevity Survey, this study examines the dynamics of each of the six ADL tasks (bathing, dressing, toileting, indoor transferring, eating, and continence) and their sociodemographic correlates among the oldest-old by including the ADL information both at the follow-up wave for survivors and at the time prior to death for those who died during survey intervals. Effects of age, gender, urban/rural residence, ethnicity, education, primary lifetime occupation, primary source of daily expenses, living alone, and marital status are examined in both the absence and presence of other various confounders. Our results show that each sociodemographic factor still plays some limited role in the dynamics of ADL functioning across tasks.
In Western societies, the impact of air pollution on residents' health is higher in less wealthy ... more In Western societies, the impact of air pollution on residents' health is higher in less wealthy communities. However, it is not clear whether such an interaction effect applies to developing countries. The authors examine how the level of community development modifies the impact of air pollution on health outcomes of the Chinese elderly using data from the third wave of the Chinese Longitudinal Health Longevity Survey in 2002, which includes 7,358 elderly residents aged 65 or more years from 735 districts in 171 cities. The results show that, compared with a 1-point increase in the air pollution index in urban areas with a low gross domestic product, a similar increase in the air pollution index in areas with a high gross domestic product is associated with more difficulties in activities of daily living (odds ratio ¼ 1.41, 95% confidence interval (CI): 1.09, 1.83), instrumental activities of daily living (linear coefficient ¼ 0.98, 95% CI: 0.58, 1.37), and cognitive function (linear coefficient ¼ 2.67, 95% CI: 1.97, 3.36), as well as a higher level of self-rated poor health (odds ratio ¼ 2.20, 95% CI: 1.68, 2.86). Contrary to what has been found in the West, Chinese elderly who live in more developed urban areas are more susceptible to the effect of air pollution than are their counterparts living in less developed areas.
Background: Studies suggest that sleep quality and duration are significantly associated with mor... more Background: Studies suggest that sleep quality and duration are significantly associated with mortality risk and health conditions, yet such studies are seldom conducted among very old adults. The objective of this study was to examine associations between self-reported sleep quality/duration and subsequent mortality/health among very old adults in China. A second objective determines whether these associations vary by age and gender. Methods: This study used data of the 2005 and 2008 waves from a large, representative survey with a total of 12,671 individuals in 22 provinces in mainland China, in which 3158 respondents were aged 90-99 and 2293 were centenarians. Two self-reported questions about sleep quality and duration were examined while adjusting for numerous socio-demographic, family/social support, health practices, and baseline health factors. Results: Hazard regressions showed that, when demographic factors are controlled for, Chinese elders who report poor and fair quality of sleep have 26% and 10% higher risk of death over the next three years compared to those with good sleep quality; those who sleep either 6 h or less or 10 h or more per day have an 18-22% higher mortality risk as compared to those who sleep 8 h per day. The increased mortality risks of poorer sleep and too short or too long sleep duration are larger in men than in women and more robust in the oldest-old than in young elders. Logistic regressions show that poor sleep and daily sleep durations of 5 h or less or 10 h or more are also associated with worse health three years later. Conclusions: Poorer sleep quality and too short or too long sleep duration are associated with higher subsequent mortality risk and lower odds of being in a healthy state among very old Chinese.
Using a health economics framework, we examined how both individual level investments at differen... more Using a health economics framework, we examined how both individual level investments at different life stages and current community-level environmental factors affect individual health stock and flows at old ages. We used a nationwide dataset from the 2002 and 2005 waves of the Chinese Longitudinal Healthy Longevity Survey, which included more than 15,000 adults aged 65 and older from 22 provinces in mainland China. We measured health stock with a cumulative health deficit index, a measure developed in geriatrics and gerontology that reflects deficits, illnesses, and functional impairment in numerous domains of health. The cumulative health deficit index has not been used in health economics before, but is a significant contribution because it captures the health stock concept very well and overcomes the problems of inconsistency resulting from the use of different measures of health stock in research. Our results show that several proxy measures for individual health investments in both childhood (nutritional status and parental survival status) and adulthood (family financial condition and access to healthcare) yielded positive returns to health stock measured by the cumulative health deficit index. Investments in social connections and healthy behaviors (religious involvement, alcohol use, and exercise) also produced positive returns in health stock. Current community-level factors such as air quality and labor force participation rate were significantly associated with levels of health deficits in old age as well. Yet, most of these individual investment and community environment variables did not significantly affect short-term health flows (improvement or deterioration in health status over three years). Our findings have important implications for developing preventive health programs in the context of population aging by focusing on policy-relevant predictors and a comprehensive indicator of health status in later life.
We estimate trends and racial differentials in marriage, cohabitation, union formation and dissol... more We estimate trends and racial differentials in marriage, cohabitation, union formation and dissolution (union regimes) for the period 1970-2002 in the United States. These estimates are based on an innovative application of multistate life table analysis to pooled survey data. Our analysis demonstrates (1) a dramatic increase in the lifetime proportions of transitions from nevermarried, divorced or widowed to cohabiting; (2) a substantial decrease in the stability of cohabiting unions; (3) a dramatic increase in mean ages at cohabiting after divorce and widowhood; (4) a substantial decrease in direct transition from never-married to married; (5) a significant decrease in the overall lifetime proportion of ever marrying and re-marrying in the 1970s to 1980s but a relatively stable pattern in the 1990s to 2000-2002; and (6) a substantial decrease in the lifetime proportion of transition from cohabiting to marriage. We also present, for the first time, comparable evidence on differentials in union regimes between four racial groups.
The classic headship-rate method for demographic projections of households is not linked to demog... more The classic headship-rate method for demographic projections of households is not linked to demographic rates, projects a few household types without size, and does not deal with household members other than heads. By comparison, the ProFamy method uses demographic rates as input and projects more detailed household types, sizes, and living arrangements for all members of the population. Tests of projections from 1990 to 2000 using ProFamy and based on observed U.S. demographic rates before 1991 show that discrepancies between our projections and census observations in 2000 are reasonably small, validating the new method. Using data from national surveys and vital statistics, census microfiles, and the ProFamy method, we prepare projections of U.S. households from 2000 to 2050. Medium projections as well as projections based on smaller and larger family scenarios with corresponding combinations of assumptions of marriage/union formation and dissolution, fertility, mortality, and international migration are performed to analyze future trends of U.S. households and their possible higher and lower bounds, as well as enormous racial differentials. To our knowledge, the household projections reported in this article are the first to have found empirical evidence of family household momentum and to have provided informative low and high bounds of various indices of projected future households and living arrangements distributions based on possible changes in demographic parameters.
This study is based on an unique dataset of birth records of 11,693 persons born in Beijing, Chin... more This study is based on an unique dataset of birth records of 11,693 persons born in Beijing, China from 1921–54 and from clinical examinations (May 2003–April 2005) of 2,085 tracked surviving cohort members (aged 50–82) to diagnose seven major chronic diseases. Data were analyzed using the extended Fixed Attribute Dynamics (FAD) method and multivariate regressions. The results of our FAD analysis have shown that, as compared to the persons with low birth weight (<2,500 g), the probability of survival from age 0 to ages 50–56, 63–67 and 68–82 for persons with higher birth weight (2,500–2,999 g, 3,000–3499 g, or ≥3,500 g) was 16–31, 62–104, and 52–108% higher respectively. These estimates display similar patterns for both genders, with somewhat stronger effects in men. Of the 27 estimates of the Odds Ratio of Survival in the FAD analysis, 21 are statistically significant. Controlling for 14 confounding factors, multivariate binary logistic regressions have demonstrated that the risk of having cardiovascular disease and diabetes is negatively associated birth weight; ordinal logit regressions have shown that the number of major chronic diseases at ages 50–82 is significantly associated with birth weight: the lower the birth weight, the higher the risk of having more chronic diseases. We conclude that low birth weight is negatively associated with 1) long-term survival probability from age 0 to ages 50–82, and 2) overall health at middle and old ages. Further research is needed to understand the mechanisms of these effects.
Based on a unique data set on the event history of marriage and divorce collected in the In-Depth... more Based on a unique data set on the event history of marriage and divorce collected in the In-Depth Fertility Surveys conducted in Shanghai, Shaanxi, and Hebei in 1985 and a multivariate hazards model, this paper investigates the association between divorce risk and socio-demographic factors in China. Controlling for several other sociodemographic factors, we demonstrate that the risk of divorce for women who married before age 18 is twice as high as that of those married after age 20; the risk of divorce of arranged marriages is about 2.6 times as high as that of not-arranged ones. The number of children is highly and negatively correlated with risk of divorce; the traditional son preference does not seem having substantial effects on divorce among women who have one or two children; but the risk of divorce of women who have three or more daughters without a son was 2.2 times as high as that of those women who have three or more
This article demonstrates that the widely used disabled life expectancies based on conventional m... more This article demonstrates that the widely used disabled life expectancies based on conventional methods are significantly underestimated due to assuming no functional status changes between age
By pooling the data from the three waves (1998, 2000, and 2002) of the Chinese Longitudinal Healt... more By pooling the data from the three waves (1998, 2000, and 2002) of the Chinese Longitudinal Health and Longevity Survey, this study examines the association of sociodemographic factors with the onset and recovery of ADL disability including changes in functional status before dying. The results show that the sociodemographic factors play some specific roles in disability dynamics at very high ages even after controlling for a rich set of confounders. Our results also point out that the conventional method, which excludes the information of ADL changes before dying due to unavailability of the data, overestimates the effects of age, gender, ethnicity, and living alone on disability transitions whereas it underestimates the effects of SES, although such discrepancies are not very big compared with the results including information of ADL changes before dying. 1
Based on a unique data set on the event history of marriage and divorce collected in the In-Depth... more Based on a unique data set on the event history of marriage and divorce collected in the In-Depth Fertility Surveys conducted in Shanghai, Shaanxi, and Hebei in 1985 and a multivariate hazards model, this paper investigates the association between divorce risk and socio-demographic factors in China. Controlling for several other sociodemographic factors, we demonstrate that the risk of divorce for women who married before age 18 is twice as high as that of those married after age 20; the risk of divorce of arranged marriages is about 2.6 times as high as that of not-arranged ones. The number of children is highly and negatively correlated with risk of divorce; the traditional son preference does not seem having substantial effects on divorce among women who have one or two children; but the risk of divorce of women who have three or more daughters without a son was 2.2 times as high as that of those women who have three or more
Numerous studies document improvements in health status and health expectancies among older adult... more Numerous studies document improvements in health status and health expectancies among older adults over time. However, most evidence is from developed nations and gender differences in health trends are often inconsistent. It remains unknown whether changes in health in developing countries resemble Western trends or whether patterns of health improvement are unique to the country's epidemiologic transition and gender norms. Using two nationally representative samples of noninstitutionalized adults in China ages 65 and older, this study investigates gender differences in the improvements in disability, chronic disease prevalence, and self-rated health from 1992 to 2002. Results from multivariate logistic regression models show that all three indicators of health improved over the 10-year period, with the largest improvement in self-rated health. With the exception of disability, the health of women improved more than men. Using Sullivan's decomposition methods, we also show that active life expectancy, disease-free life expectancy, and healthy life expectancy increased over this decade and were patterned differently according to gender. Overall, the findings demonstrate that China experienced broad health-improvements during its early stages of the epidemiologic transition and that these changes were not uniform by gender. We discuss the public health implications of the findings in the context of China's rapidly aging population.
Objective: This study examines the factors associated with the enrollment, satisfaction, and sust... more Objective: This study examines the factors associated with the enrollment, satisfaction, and sustainability of the New Cooperative Medical Scheme (NCMS) program in six study areas in rural Beijing. Methods: Data come from a sample of 890 persons aged 15-88 from 890 households who were randomly interviewed from six rural counties/districts in Beijing. Results: Findings from multi-level models indicate that gender, socioeconomic status, adequate knowledge about the policy, subjective premium contribution, subjective co-payment rates, and need are significantly associated with enrollment. We further find that the sustainability of the NCMS program is only significantly related to knowledge about the policy and satisfaction with the overall performance of the program. Conclusion: The NCMS program should be further promoted through different media avenues. It is also necessary to expand the types of services to include basic medical care and other specialized services to meet the different needs of the rural population. In addition, supervision of the system's performance should be enhanced and characteristics of the local community should be considered in the implementation of the NCMS.
Existing research on the institutionalized population of older adults is primarily limited to Wes... more Existing research on the institutionalized population of older adults is primarily limited to Western countries. This study is the first to use nationally representative data to examine differences in the institutionalized and community-residing population of the oldest-old (ages 80+) in China. Using three waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) (1998, 2000, and 2002), we examine differences in sociodemographic characteristics, family caregiving resources, health practices, religious activity, chronic conditions, and mortality risk. The results indicate that the institutionalized oldest-old are younger, male, reside in urban areas, have lower family-care resources, and exhibit poorer health compared to those living in the community. We also find that the 2-year mortality risk for institutionalized elders is 1.35 times greater than for those residing in the community. However, the mortality differential is eliminated once the sociodemographic, family caregiving, and health characteristics of the oldest-old are taken into account. The implications of these findings are discussed. r
Objective To examine the association between frailty and type of death among the world's largest ... more Objective To examine the association between frailty and type of death among the world's largest oldest-old population in China. Design Prospective cohort study. Setting 2002 and 2005 waves of the Chinese longitudinal healthy longevity survey carried out in 22 provinces throughout China. Participants 13 717 older adults (aged ≥65).
This chapter assesses the reliability of mortality and self-reported morbidity in the first three... more This chapter assesses the reliability of mortality and self-reported morbidity in the first three waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Results indicate that the observed rates of all-cause mortality reported in the CLHLS are underestimated by 15–20 percent between 1998 and 2000 and by 5–20 percent for ages 80–90 when based on hazard-model estimates; however, no such differences are found between the 2000 and 2002 waves. Our analyses further show that mortality rates over age 90 in the CLHLS are more reliable than those obtained from the census. The quality of self-reported morbidity and its population prevalence is generally quite good compared to other national data sets. However, the analyses suggest that information collected from next-of-kin should be interpreted with caution. We find that cause-specific mortality rates estimated from reports by the next-of-kin are substantially biased and that the prevalence of the decedents’ morbidity reported by the next-of-kin is somewhat underestimated.
Studies that systematically examine the dynamics of task-specific ADL functioning and its associa... more Studies that systematically examine the dynamics of task-specific ADL functioning and its associates are very rare. Using the first three waves of the Chinese Longitudinal Healthy Longevity Survey, this study examines the dynamics of each of the six ADL tasks (bathing, dressing, toileting, indoor transferring, eating, and continence) and their sociodemographic correlates among the oldest-old by including the ADL information both at the follow-up wave for survivors and at the time prior to death for those who died during survey intervals. Effects of age, gender, urban/rural residence, ethnicity, education, primary lifetime occupation, primary source of daily expenses, living alone, and marital status are examined in both the absence and presence of other various confounders. Our results show that each sociodemographic factor still plays some limited role in the dynamics of ADL functioning across tasks.
In Western societies, the impact of air pollution on residents' health is higher in less wealthy ... more In Western societies, the impact of air pollution on residents' health is higher in less wealthy communities. However, it is not clear whether such an interaction effect applies to developing countries. The authors examine how the level of community development modifies the impact of air pollution on health outcomes of the Chinese elderly using data from the third wave of the Chinese Longitudinal Health Longevity Survey in 2002, which includes 7,358 elderly residents aged 65 or more years from 735 districts in 171 cities. The results show that, compared with a 1-point increase in the air pollution index in urban areas with a low gross domestic product, a similar increase in the air pollution index in areas with a high gross domestic product is associated with more difficulties in activities of daily living (odds ratio ¼ 1.41, 95% confidence interval (CI): 1.09, 1.83), instrumental activities of daily living (linear coefficient ¼ 0.98, 95% CI: 0.58, 1.37), and cognitive function (linear coefficient ¼ 2.67, 95% CI: 1.97, 3.36), as well as a higher level of self-rated poor health (odds ratio ¼ 2.20, 95% CI: 1.68, 2.86). Contrary to what has been found in the West, Chinese elderly who live in more developed urban areas are more susceptible to the effect of air pollution than are their counterparts living in less developed areas.
Background: Studies suggest that sleep quality and duration are significantly associated with mor... more Background: Studies suggest that sleep quality and duration are significantly associated with mortality risk and health conditions, yet such studies are seldom conducted among very old adults. The objective of this study was to examine associations between self-reported sleep quality/duration and subsequent mortality/health among very old adults in China. A second objective determines whether these associations vary by age and gender. Methods: This study used data of the 2005 and 2008 waves from a large, representative survey with a total of 12,671 individuals in 22 provinces in mainland China, in which 3158 respondents were aged 90-99 and 2293 were centenarians. Two self-reported questions about sleep quality and duration were examined while adjusting for numerous socio-demographic, family/social support, health practices, and baseline health factors. Results: Hazard regressions showed that, when demographic factors are controlled for, Chinese elders who report poor and fair quality of sleep have 26% and 10% higher risk of death over the next three years compared to those with good sleep quality; those who sleep either 6 h or less or 10 h or more per day have an 18-22% higher mortality risk as compared to those who sleep 8 h per day. The increased mortality risks of poorer sleep and too short or too long sleep duration are larger in men than in women and more robust in the oldest-old than in young elders. Logistic regressions show that poor sleep and daily sleep durations of 5 h or less or 10 h or more are also associated with worse health three years later. Conclusions: Poorer sleep quality and too short or too long sleep duration are associated with higher subsequent mortality risk and lower odds of being in a healthy state among very old Chinese.
Using a health economics framework, we examined how both individual level investments at differen... more Using a health economics framework, we examined how both individual level investments at different life stages and current community-level environmental factors affect individual health stock and flows at old ages. We used a nationwide dataset from the 2002 and 2005 waves of the Chinese Longitudinal Healthy Longevity Survey, which included more than 15,000 adults aged 65 and older from 22 provinces in mainland China. We measured health stock with a cumulative health deficit index, a measure developed in geriatrics and gerontology that reflects deficits, illnesses, and functional impairment in numerous domains of health. The cumulative health deficit index has not been used in health economics before, but is a significant contribution because it captures the health stock concept very well and overcomes the problems of inconsistency resulting from the use of different measures of health stock in research. Our results show that several proxy measures for individual health investments in both childhood (nutritional status and parental survival status) and adulthood (family financial condition and access to healthcare) yielded positive returns to health stock measured by the cumulative health deficit index. Investments in social connections and healthy behaviors (religious involvement, alcohol use, and exercise) also produced positive returns in health stock. Current community-level factors such as air quality and labor force participation rate were significantly associated with levels of health deficits in old age as well. Yet, most of these individual investment and community environment variables did not significantly affect short-term health flows (improvement or deterioration in health status over three years). Our findings have important implications for developing preventive health programs in the context of population aging by focusing on policy-relevant predictors and a comprehensive indicator of health status in later life.
We estimate trends and racial differentials in marriage, cohabitation, union formation and dissol... more We estimate trends and racial differentials in marriage, cohabitation, union formation and dissolution (union regimes) for the period 1970-2002 in the United States. These estimates are based on an innovative application of multistate life table analysis to pooled survey data. Our analysis demonstrates (1) a dramatic increase in the lifetime proportions of transitions from nevermarried, divorced or widowed to cohabiting; (2) a substantial decrease in the stability of cohabiting unions; (3) a dramatic increase in mean ages at cohabiting after divorce and widowhood; (4) a substantial decrease in direct transition from never-married to married; (5) a significant decrease in the overall lifetime proportion of ever marrying and re-marrying in the 1970s to 1980s but a relatively stable pattern in the 1990s to 2000-2002; and (6) a substantial decrease in the lifetime proportion of transition from cohabiting to marriage. We also present, for the first time, comparable evidence on differentials in union regimes between four racial groups.
The classic headship-rate method for demographic projections of households is not linked to demog... more The classic headship-rate method for demographic projections of households is not linked to demographic rates, projects a few household types without size, and does not deal with household members other than heads. By comparison, the ProFamy method uses demographic rates as input and projects more detailed household types, sizes, and living arrangements for all members of the population. Tests of projections from 1990 to 2000 using ProFamy and based on observed U.S. demographic rates before 1991 show that discrepancies between our projections and census observations in 2000 are reasonably small, validating the new method. Using data from national surveys and vital statistics, census microfiles, and the ProFamy method, we prepare projections of U.S. households from 2000 to 2050. Medium projections as well as projections based on smaller and larger family scenarios with corresponding combinations of assumptions of marriage/union formation and dissolution, fertility, mortality, and international migration are performed to analyze future trends of U.S. households and their possible higher and lower bounds, as well as enormous racial differentials. To our knowledge, the household projections reported in this article are the first to have found empirical evidence of family household momentum and to have provided informative low and high bounds of various indices of projected future households and living arrangements distributions based on possible changes in demographic parameters.
This study is based on an unique dataset of birth records of 11,693 persons born in Beijing, Chin... more This study is based on an unique dataset of birth records of 11,693 persons born in Beijing, China from 1921–54 and from clinical examinations (May 2003–April 2005) of 2,085 tracked surviving cohort members (aged 50–82) to diagnose seven major chronic diseases. Data were analyzed using the extended Fixed Attribute Dynamics (FAD) method and multivariate regressions. The results of our FAD analysis have shown that, as compared to the persons with low birth weight (<2,500 g), the probability of survival from age 0 to ages 50–56, 63–67 and 68–82 for persons with higher birth weight (2,500–2,999 g, 3,000–3499 g, or ≥3,500 g) was 16–31, 62–104, and 52–108% higher respectively. These estimates display similar patterns for both genders, with somewhat stronger effects in men. Of the 27 estimates of the Odds Ratio of Survival in the FAD analysis, 21 are statistically significant. Controlling for 14 confounding factors, multivariate binary logistic regressions have demonstrated that the risk of having cardiovascular disease and diabetes is negatively associated birth weight; ordinal logit regressions have shown that the number of major chronic diseases at ages 50–82 is significantly associated with birth weight: the lower the birth weight, the higher the risk of having more chronic diseases. We conclude that low birth weight is negatively associated with 1) long-term survival probability from age 0 to ages 50–82, and 2) overall health at middle and old ages. Further research is needed to understand the mechanisms of these effects.
Based on a unique data set on the event history of marriage and divorce collected in the In-Depth... more Based on a unique data set on the event history of marriage and divorce collected in the In-Depth Fertility Surveys conducted in Shanghai, Shaanxi, and Hebei in 1985 and a multivariate hazards model, this paper investigates the association between divorce risk and socio-demographic factors in China. Controlling for several other sociodemographic factors, we demonstrate that the risk of divorce for women who married before age 18 is twice as high as that of those married after age 20; the risk of divorce of arranged marriages is about 2.6 times as high as that of not-arranged ones. The number of children is highly and negatively correlated with risk of divorce; the traditional son preference does not seem having substantial effects on divorce among women who have one or two children; but the risk of divorce of women who have three or more daughters without a son was 2.2 times as high as that of those women who have three or more
This article demonstrates that the widely used disabled life expectancies based on conventional m... more This article demonstrates that the widely used disabled life expectancies based on conventional methods are significantly underestimated due to assuming no functional status changes between age
By pooling the data from the three waves (1998, 2000, and 2002) of the Chinese Longitudinal Healt... more By pooling the data from the three waves (1998, 2000, and 2002) of the Chinese Longitudinal Health and Longevity Survey, this study examines the association of sociodemographic factors with the onset and recovery of ADL disability including changes in functional status before dying. The results show that the sociodemographic factors play some specific roles in disability dynamics at very high ages even after controlling for a rich set of confounders. Our results also point out that the conventional method, which excludes the information of ADL changes before dying due to unavailability of the data, overestimates the effects of age, gender, ethnicity, and living alone on disability transitions whereas it underestimates the effects of SES, although such discrepancies are not very big compared with the results including information of ADL changes before dying. 1
Based on a unique data set on the event history of marriage and divorce collected in the In-Depth... more Based on a unique data set on the event history of marriage and divorce collected in the In-Depth Fertility Surveys conducted in Shanghai, Shaanxi, and Hebei in 1985 and a multivariate hazards model, this paper investigates the association between divorce risk and socio-demographic factors in China. Controlling for several other sociodemographic factors, we demonstrate that the risk of divorce for women who married before age 18 is twice as high as that of those married after age 20; the risk of divorce of arranged marriages is about 2.6 times as high as that of not-arranged ones. The number of children is highly and negatively correlated with risk of divorce; the traditional son preference does not seem having substantial effects on divorce among women who have one or two children; but the risk of divorce of women who have three or more daughters without a son was 2.2 times as high as that of those women who have three or more
Numerous studies document improvements in health status and health expectancies among older adult... more Numerous studies document improvements in health status and health expectancies among older adults over time. However, most evidence is from developed nations and gender differences in health trends are often inconsistent. It remains unknown whether changes in health in developing countries resemble Western trends or whether patterns of health improvement are unique to the country's epidemiologic transition and gender norms. Using two nationally representative samples of noninstitutionalized adults in China ages 65 and older, this study investigates gender differences in the improvements in disability, chronic disease prevalence, and self-rated health from 1992 to 2002. Results from multivariate logistic regression models show that all three indicators of health improved over the 10-year period, with the largest improvement in self-rated health. With the exception of disability, the health of women improved more than men. Using Sullivan's decomposition methods, we also show that active life expectancy, disease-free life expectancy, and healthy life expectancy increased over this decade and were patterned differently according to gender. Overall, the findings demonstrate that China experienced broad health-improvements during its early stages of the epidemiologic transition and that these changes were not uniform by gender. We discuss the public health implications of the findings in the context of China's rapidly aging population.
Objective: This study examines the factors associated with the enrollment, satisfaction, and sust... more Objective: This study examines the factors associated with the enrollment, satisfaction, and sustainability of the New Cooperative Medical Scheme (NCMS) program in six study areas in rural Beijing. Methods: Data come from a sample of 890 persons aged 15-88 from 890 households who were randomly interviewed from six rural counties/districts in Beijing. Results: Findings from multi-level models indicate that gender, socioeconomic status, adequate knowledge about the policy, subjective premium contribution, subjective co-payment rates, and need are significantly associated with enrollment. We further find that the sustainability of the NCMS program is only significantly related to knowledge about the policy and satisfaction with the overall performance of the program. Conclusion: The NCMS program should be further promoted through different media avenues. It is also necessary to expand the types of services to include basic medical care and other specialized services to meet the different needs of the rural population. In addition, supervision of the system's performance should be enhanced and characteristics of the local community should be considered in the implementation of the NCMS.
Existing research on the institutionalized population of older adults is primarily limited to Wes... more Existing research on the institutionalized population of older adults is primarily limited to Western countries. This study is the first to use nationally representative data to examine differences in the institutionalized and community-residing population of the oldest-old (ages 80+) in China. Using three waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) (1998, 2000, and 2002), we examine differences in sociodemographic characteristics, family caregiving resources, health practices, religious activity, chronic conditions, and mortality risk. The results indicate that the institutionalized oldest-old are younger, male, reside in urban areas, have lower family-care resources, and exhibit poorer health compared to those living in the community. We also find that the 2-year mortality risk for institutionalized elders is 1.35 times greater than for those residing in the community. However, the mortality differential is eliminated once the sociodemographic, family caregiving, and health characteristics of the oldest-old are taken into account. The implications of these findings are discussed. r
Objective To examine the association between frailty and type of death among the world's largest ... more Objective To examine the association between frailty and type of death among the world's largest oldest-old population in China. Design Prospective cohort study. Setting 2002 and 2005 waves of the Chinese longitudinal healthy longevity survey carried out in 22 provinces throughout China. Participants 13 717 older adults (aged ≥65).
This chapter assesses the reliability of mortality and self-reported morbidity in the first three... more This chapter assesses the reliability of mortality and self-reported morbidity in the first three waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Results indicate that the observed rates of all-cause mortality reported in the CLHLS are underestimated by 15–20 percent between 1998 and 2000 and by 5–20 percent for ages 80–90 when based on hazard-model estimates; however, no such differences are found between the 2000 and 2002 waves. Our analyses further show that mortality rates over age 90 in the CLHLS are more reliable than those obtained from the census. The quality of self-reported morbidity and its population prevalence is generally quite good compared to other national data sets. However, the analyses suggest that information collected from next-of-kin should be interpreted with caution. We find that cause-specific mortality rates estimated from reports by the next-of-kin are substantially biased and that the prevalence of the decedents’ morbidity reported by the next-of-kin is somewhat underestimated.
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