Grandparent Caregiving and Self-Rated Health among Rural Chinese Older Adults: A Longitudinal Study Using Latent Difference Score Analysis

Abstract BackgroundRural-urban inequalities in health among older adults in China have not been extensively studied from the national perspective. In particular, studies have not taken into account combinations of Hukou (household registration system in China) and actual residence, which may be important so as not to underestimate rural-urban differences. This study investigates rural-urban inequalities in prevalence of poor self-rated health, self-reported functional disabilities and depression among Chinese older adults in 2011 and 2015, and analyses sociodemographic determinants of rural-urban inequalities in self-reported health outcomes. MethodsData from the nationwide China Health and Retirement Longitudinal Study (CHARLS), on older adults aged 60 years and above in CHARLS 2011 and CHARLS 2015 were used. Only rural residents with rural Hukou and urban residents with urban Hukou were included. Sociodemographic factors, including age, sex, marital status, living arrangement, living near children, educational level and income were studied. Self-Rated Health (SRH) was assessed with a single question. Basic Activities of Daily Living (BADLs) and Instrumental Activities of Daily Living (IADLs) were used to measure self-reported functional abilities. The 10-item version of the Center for Epidemiologic Studies Depression Scale was used to measure self-reported depression. ResultsRural respondents had poorer socioeconomic status and higher prevalence of poor SRH, functional disabilities and depression than urban respondents. The levels of functional disabilities, both BADLs and IADLs, were similar in 2011 and 2015, while the prevalence of poor SRH and self-reported depression was lower in 2015, both among rural and urban respondents. Impairments increased with age and appeared at younger age among rural respondents compared to urban respondents. Being female, unmarried, with low educational level and low income increased the odds ratios of reporting poor SRH, functional disabilities and depression. Sensitivity analyses using only Hukou registration resulted in underestimation of rural-urban differences. ConclusionsThere were large rural-urban inequalities in poor SRH, self-reported functional disabilities and depression that were closely related to rural-urban differences in educational level and income. Key words : China; depression; functional ability; health inequalities; household registration system; older adults; rural-urban; self-rated health; social determinants of health

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Rural-urban inequalities in poor self-rated health, functional disabilities and depression among Chinese older adults: Evidence from the China Health and Retirement Longitudinal Study 2011 and 2015

10.21203/rs.2.23207/v1 ◽

2020 ◽

Author(s):

Haiting Jiang ◽

Bo Burström ◽

Jiaying Chen ◽

Kristina Burström

Keyword(s):

Older Adults ◽

Longitudinal Study ◽

Health Outcomes ◽

Activities Of Daily Living ◽

Educational Level ◽

Daily Living ◽

Living Arrangement ◽

Chinese Older Adults ◽

Self Rated Health ◽

Functional Disabilities

Abstract Background: The demand for healthcare and social services increases with the aging of the population and functional disabilities among older adults. Rural-urban inequalities in health have not been extensively studied previously from the national perspective, especially after classifying the effects of Hukou (household registration system in China) and residence. This study investigates rural-urban inequalities in prevalence of poor self-rated health, functional disabilities and self-reported depression among Chinese older adults and analyses determinants of rural-urban inequalities in self-reported health outcomes. Methods: The data originate from the China Health and Retirement Longitudinal Study (CHARLS), which started in 2011 and collects data every two years, a representative sample in 28 provinces in China. Older adults aged 60 years and above in CHARLS 2011 and CHARLS 2015 were studied. Sociodemographic factors were studied, including age, sex, marital status, living arrangement, living near children, educational level and income. Self-Rated Health (SRH) was assessed with a single question. Basic Activities of Daily Living (BADLs) and Instrumental Activities of Daily Living (IADLs) were used to measure self-reported functional abilities. The 10-item version of the Center for Epidemiologic Studies Depression Scale was used to measure self-reported depression. Results: Rural respondents had poor socioeconomic status and higher prevalence of poor SRH, functional disabilities and depression than urban respondents. The levels of functional disabilities, both BADLs and IADLs, were similar in 2011 and 2015, while the prevalence of poor SRH and self-reported depression were lower in 2015, both among rural and urban respondents. Impairments increased with age, and appeared at younger age among rural respondents compared to urban respondents. Being female, unmarried, with low educational level and low income increased the odds ratios of reporting poor SRH, functional disabilities and depression. Living arrangement and living near children did not have significant impacts on health outcomes. Conclusions: Rural-urban inequalities in poor SRH, functional disabilities and depression were mainly related to educational level and income.

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Rural–Urban Inequalities in Poor Self-Rated Health, Self-Reported Functional Disabilities, and Depression among Chinese Older Adults: Evidence from the China Health and Retirement Longitudinal Study 2011 and 2015

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18126557 ◽

2021 ◽

Vol 18 (12) ◽

pp. 6557

Author(s):

Haiting Jiang ◽

Bo Burström ◽

Jiaying Chen ◽

Kristina Burström

Keyword(s):

Older Adults ◽

Longitudinal Study ◽

Activities Of Daily Living ◽

Social Services ◽

Daily Living ◽

Depression Scale ◽

Registration System ◽

Chinese Older Adults ◽

Self Rated Health ◽

Functional Disabilities

The household registration system (Hukou) in China classifies persons into rural or urban citizens and determines eligibility for state-provided services and welfare. Not taking actual residence into account may underestimate rural–urban differences. This study investigates rural–urban inequalities in self-reported health outcomes among older adults aged 60+, taking into account both Hukou and actual residence, adjusting for sociodemographic determinants, based on the China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 2015. Self-Rated Health (SRH) was assessed with a single question, functional abilities were assessed with the Basic Activities of Daily Living (BADLs) and Instrumental Activities of Daily Living (IADLs) scales, and depression was assessed with the 10-item version of the Center for Epidemiologic Studies Depression Scale. Rural respondents had poorer socioeconomic status and higher prevalence of poor SRH, functional disabilities, and depression than urban respondents in both years, which were closely related to rural–urban differences in educational level and income. Impairments appeared at a younger age among rural respondents. Analyses using only Hukou registration and not actual residence resulted in underestimation of rural–urban differences. This study may serve as a basis for interventions to address rural–urban differences in health and social services and reduce health inequalities among Chinese older adults.

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Social isolation, rather than loneliness, is associated with cognitive decline in older adults: the China Health and Retirement Longitudinal Study

Psychological Medicine ◽

10.1017/s0033291720001026 ◽

2021 ◽

pp. 1-8

Author(s):

Bin Yu ◽

Andrew Steptoe ◽

Yongjie Chen ◽

Xiaohua Jia

Keyword(s):

Older Adults ◽

Longitudinal Study ◽

Cognitive Function ◽

Episodic Memory ◽

Cognitive Decline ◽

Social Isolation ◽

Mental Status ◽

Chinese Older Adults ◽

Confounding Variables

Abstract Background Social isolation and loneliness have each been associated with cognitive decline, but most previous research is limited to Western populations. This study examined the relationships of social isolation and loneliness on cognitive function among Chinese older adults. Methods This study used two waves of data (2011 and 2015) from the China Health and Retirement Longitudinal Study and analyses were restricted to those respondents aged 50 and older. Social isolation, loneliness, and cognitive function were measured at baseline. Follow-up measures on cognitive function were obtained for 7761 participants (mean age = 60.97, s.d. = 7.31; male, 50.8%). Lagged dependent variable models adjusted for confounding factors were used to evaluate the association between baseline isolation, loneliness, and cognitive function at follow-up. Results Loneliness was significantly associated with the cognitive decline at follow-up (episodic memory: β = −0.03, p < 0.01; mental status: β = −0.03, p < 0.01) in the partially adjusted models. These associations became insignificant after additional confounding variables (chronic diseases, health behaviors, disabilities, and depressive symptoms) were taken into account (all p > 0.05). By contrast, social isolation was significantly associated with decreases in all cognitive function measures at follow-up (episodic memory: β = −0.05, p < 0.001; mental status: β = −0.03, p < 0.01) even after controlling for loneliness and all confounding variables. Conclusions Social isolation is associated with cognitive decline in Chinese older adults, and the relationships are independent of loneliness. These findings expand our knowledge about the links between social relationships and the cognitive function in non-Western populations.

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