Changes in functional limitation and survival among older Taiwanese, 1993, 1996, and 1999

Using data from the Survey of Health and Living Status of the Elderly in Taiwan, we investigate changes in difficulties in walking and climbing stairs, tasks that represent basic lower-body movements less likely to be influenced by changes in environment and social roles than are activities and instrumental activities of daily living. Results are shown for unadjusted prevalence rates and rates adjusted for changes in population composition. The findings indicate that Taiwan does not appear to be experiencing the improvements in functioning witnessed recently in the United States. Prevalence of functional limitation increased between 1993 and 1996 and between 1996 and 1999. One possible reason is the change in old-age survival, which appears to have benefited those who have functional limitations, especially in a severe form. The Universal Health Insurance programme, established in 1995, may have increased access to care and thus the survival of those in poorest health.     

Stalled Fertility Decline in Egypt,Why?

After experiencing rapid decline since the 1980s, fertility in Egypt seemed to be stalling during the second half of the 1990s. In an effort to identify the population segment(s) responsible for the stalling, this study considers fertility trends of women from three standard of living strata (low, middle, and high). Using data collected by the 1988, 1992, 1995, and the 2000 Egypt Demographic and Health Surveys, the study indicates that the reproductive behavior of women from high and middle standards households is largely responsible for stalling of the fertility decline during recent years, and that prospects for a lower fertility in the future is limited, once the gap between the three groups closes. This means that the expectation of achieving replacement fertility Egypt within the next 15 to 20 years is in doubt if the current trends in the both actual and desired fertility of the middle and high strata continued. The key for future decline in fertility is the decline in desired number of children below the current level of 3 children by at least one segment of the population. The fact none of the three population segments expressed a desired fertility below 3 children deprived the society of a vanguard group that leads the rest of the society to replacement level fertility.     

中国妇女生育意愿与生育行为的差异及其影响因素

生育行为与生育意愿背离现象广泛存在。在发达国家,普遍的情况是实际生育率大大低于意愿生育率。发展中国家同样出现了生育行为与生育意愿背离的现象,但更多呈现出与发达国家相反的规律。中国也出现了生育行为与生育意愿背离,且实际高于意愿的情况。根据中国2001年全国生殖健康调查,基本完成生育的40~49岁妇女,其平均理想子女数为1.8,而平均实际生育子女数为2.2。利用2001年全国生殖健康调查数据,考察中国妇女生育行为与生育意愿背离的特征和影响因素,并考察个体背景(个人特征和社会经济背景)、生育政策和生育孩子情况(包括孩子的性别结构和存活状况)对生育意愿与生育行为的差异产生的影响。结果表明,这些因素都对生育意愿与生育行为的差异产生显著影响,但性别偏好是造成生育行为大于生育意愿的主要因素。     

Women are key players in the economies of East and Southeast Asia

In 1996, the East-West Center's Program on Population investigated the links between population change and economic growth in Japan, South Korea, Taiwan, Singapore, Thailand, and Indonesia. This document discusses the findings pertaining to women's changing marriage and childbearing patterns, education attainment, and labor force participation as well as changes in family life. In eastern and southeastern Asia, women are delaying marriage and having fewer children as a result of their overwhelming acceptance of modern contraception. Concurrently, women's secondary school enrollment has increased dramatically since 1960, and women have accounted for steadily increasing proportions of total labor force growth. Economic development has led to fewer women employed in agriculture and more in clerical positions. Women continue to be marginalized in low-paying manufacturing jobs and to lose these jobs more frequently than do men. Women's labor force participation continues to be dependent upon their child care responsibilities, but women are beginning to combine both activities with the help of live-in grandparents. Women have made an important contribution to economic growth in Asia. Policies should address job discrimination against married women, wage discrimination, the problems faced by young women who leave home for employment in the manufacturing and service sectors, and the lack of child care facilities.     

Educational attainment and transitions in functional status among older Taiwanese

Despite considerable research examining the influence of socioeconomic status on health, few studies have considered this relationship as it pertains to older adults in non-Western societies. We attempt to ascertain the influence of education on changes in physical functioning in a rapidly developing country. Data come from the 1989 Survey of Health and Living Status of the Elderly in Taiwan and a follow-up interview in 1993 (N = 4,049, age = 60+). Individuals are conceptualized to be in a state of functional independence or functional limitation at the time of origin, based on their ability to perform three physical functioning tasks. The outcome at the follow-up interview is categorized as functionally independent, limited, or dead, allowing for six probabilities, one from each state of origin to each outcome. These are calculated using a multinomial logit model, controlling for other factors often thought to be associated with health transitions. High levels of educational attainment result in a decreased incidence of functional limitation for those originating in a state of independence. Contrary to expectations, however, education has little influence on those who originate functionally limited. Thus, higher education plays a substantial role in primary prevention of morbidity, delaying the onset of disability, but other factors are more important once limitations begin. We speculate on the reasons behind these findings, including that the results may be culturally dependent.     

Below-replacement fertility and prospects for labour force growth in Taiwan

Fertility in Taiwan had declined to replacement level in 1983. In 1986–1997, the total fertility rate dropped to 1.7–1.8, with continuing decreases observed in 1997–2001. Fertility will probably be sustained at the 2001 level of 1.48 or even decline further in the future. If the current fertility and labour-force participation rates persist, the size of the labour force will increase only slightly in the next 15 years and begin to shrink soon after 2015. After 2034, the labour force will fall below the current level and Taiwan will face a labour shortage. Though efficient, the policy option of importing more foreign workers is fraught with political sensitivities, especially given the current economic downturn and rising unemployment. Another policy approach, to increase the participation rates for women and mature men, would lead to growth in the labour supply sometime after 2030 and, combined with a modest increase in fertility, would prevent the labour force from falling below its current size in the next 50 years. Notwithstanding that any increase in fertility will have a delayed effect on labour supply, strong incentives are still required to affect fertility behaviour.     

Income and “Outcomes” for Elderly: DO the Poor have A Poorer Life?

The objective of this paper is to analyze the relationship between income and living conditions and well-being of elderly. The best from two worlds is used for this purpose: a Danish survey covering 1440 elderly aged 72 and 77 from 1997, connected to reliable register information on income, 1988–1996. Indicators of physical activity, social and solitary activities, social contact, functional capability, loneliness and psychological well-being are constructed from the survey. Ordered logistic models are estimated controlling for demographics, education, previous occupation and whether the elderly are still working. It is found that elderly with low income levels have poorer functional capability, lower physical activity and poorer psychological well-being whereas social contact and social activities show no relationship with income. The relationship with income vanishes for solitary activities and loneliness when adding control variables. Having established that robust relations exist between income and some measures of well-being of elderly, we turn to an investigation of causality. Simultaneous models are estimated to assess whether the income relationship can be causally interpreted for functional capability and physical activity. The results show that it cannot be rejected that the income effects are causal, although care should be taken when interpreting results. We finally address our findings in the light of current and future changes regarding the size and economic well-being of the elderly population.     

Why the rise in adolescent fertility rates in the Dominican Republic in the 1990s?

Despite concern over high pregnancy rates and levels of risk for sexually transmittedinfections, adolescent fertility rates in the Dominican Republic have not changed substantially since the early 1980's, and actually increased during the early to mid 1990s. The present study was undertaken to assess the factors contributing to the recent rise in fertility among Dominican adolescents. The findings suggest that although contraceptive use among adolescents and young adults has increased, this has been more than offset by ominous trends on other determinants of fertility. Among these are declines in mean age at first sex and first marriage/union without a commensurate decline in mean age at first contraceptive use, and stubbornly high discontinuation rates for oral contraceptives andcondoms. There is also some evidence that rates of induced abortion among adolescents may have increased, without which adolescent fertility rates would have been even higher. Demand for children among Dominican adolescents remains strong, suggesting that efforts to reduce the current high prevalence of risky sexual behaviors need to influence social norms in order to be successful.     

Some roots of preference: Roles,activities and familial values

This paper examines some of the connecting links between modernization in a developing society, particularly urbanization and increased education for women, and preferences for number of children. Using 1973 Taiwan data, preferences for smaller families are found to be consistently related to modern attitudes and behavior in the three domains examined: intrafamilial husband-wife role relationships, extrafamilial activities of the wife, and familial and religious values relating the family to the larger institutional setting. Modernization of these attitudes, behaviors, and values has an impact on reproductive goals independent of their association with structural variables. The wife's outside activities and exposure to modern influences through the mass media are especially important linkages, having a particularly strong mediating effect in the education effect on preferences. Intrafamilial relations appear to be of less importance. Modernization of familial and religious values mediates between urbanization and family size preferences. The measure of preference used is a scale value which has been found in other research to be more predictive of reproductive behavior than the conventional single-valued statement of number of children wanted. As the level of contraceptive use rises in developing societies, family size preferences increasingly become a factor in birth rates, and understanding the sources of change in these preferences takes on added importance. The policy implications of these findings are discussed.     

Obesity, disease, and functional limitation in later life

Little is known about the effects of obesity late in life. Using data from the Longitudinal Study of Aging and the Assets and Health Dynamics of the Oldest Old Survey, this study finds an increased prevalence of obesity, over time, among those 70 and older. Obesity is related most strongly to limitations in activities of daily living (ADLs) for women and to activities related to mobility. One ADL, eating, has a negative association to obesity. Obesity is associated with an increased prevalence of arthritis, diabetes, and hypertension. These results are cross-sectional and are based on self-reports of height and weight; they must be interpreted cautiously.     

Latest-Late Fertility? Decline and Resurgence of Late Parenthood Across the Low-Fertility Countries

After decades of fertility postponement, we investigate recent changes in late parenthood across low-fertility countries in the light of observations from the past. We use long series of age-specific fertility rates from the Human Fertility Database (1950–2016) for women, and new data covering the period 1990–2016 for men. In 1950, the contribution of births at age 40 and over to female fertility rates ranged from 2.5 to 9 percent, but then fell sharply until the 1980s. From the 1990s, however, the prevalence of late first births increased rapidly, especially so in countries where it was initially lowest. This has produced a late fertility rebound in the last two decades, occurring much faster for women than for men. Comparisons between recent and past extremely late (age 48+) fertility levels confirm that people are now challenging the natural fertility barriers, particularly for a first child.     

Trends in late-life disability in Taiwan, 1989-2007: the roles of education, environment, and technology

This analysis offers the first strong evidence of trends in late-life disability in an emerging economy. For the population of Taiwan aged 65 and older, consistent measures of limitations in seeing, hearing, physical functions, instrumental activities of daily living (IADLs), and activities of daily living (ADLs) were available for three to six survey waves, depending on the outcome, from 1989 to 2007. Limitations in seeing, hearing, and IADLs declined substantially, but trends were mixed for physical functions and flat for ADLs. The remarkable reduction in difficulty telephoning, an IADL, may reflect changes in telecommunications infrastructure and highlights the roles of environment and technology in disability outcomes. Trends for urban residents were more advantageous than those for rural residents for seeing and hearing, but less so for physical functions and IADLs. Were it not for the substantial increase in educational attainment, trends in all outcomes would have been less favourable.     

Determinants of infant and child mortality in Kenya: an analysis controlling for frailty effects

In this paper, Weibull unobserved heterogeneity (frailty) survival models are utilized to analyze the determinants of infant and child mortality in Kenya. The results of these models are compared to those of standard Weibull survival models. The study particularly examines the extent to which child survival risks continue to vary net of observed factors and the extent to which nonfrailty models are biased due to the violation of the statistical assumption of independence. The data came from the 1998 Kenya Demographic and Health Survey. The results of the standard Weibull survival models clearly show that biodemographic factors are more important in explaining infant mortality, while socioeconomic, sociocultural and hygienic factors are more important in explaining child mortality. Frailty effects are substantial and highly significant both in infancy and in childhood, but the conclusions remain the same as in the nonfrailty models.     

The roles of child support enforcement and welfare in non-marital childbearing

This paper examines the effects of stronger child support enforcement and declines in welfare benefits on changes in non-marital childbearing between 1980 and 1996. Economic theory suggests that stricter child support enforcement will increase the costs of children for unwed fathers, making them less likely to have a child outside marriage. Reductions in welfare benefits also are expected to increase the costs of non-marital childbearing for both mothers and fathers. We examine these hypotheses, using aggregate state-level data and fixed effects regression models to identify the effects of policies on non-marital birth rates. We find that both stricter child support enforcement and declines in welfare benefits deter non-marital births. However, the estimated effects of child support enforcement are more robust and larger than those of welfare. The estimates imply that in the 1980–1996 period, increases in child support enforcement led to a decline in non-marital birth rates in the range of 6% to 9%, whereas decreases in welfare benefits led to a decline in the range of 2% to 4%. Received: 28 June 2000/Accepted: 17 September 2001     

Fertility trends in Taiwan: Tradition and change

Fertility rates have been falling In Taiwan for several years. The declines appear to be general throughout the island, and are occurring mainly in the age groups above 50, as would be expected if there are beginnings of family limitation. There are indications that the fertility rates are negatively correlated with indices of modernization In local areas. Several pilot studies indicate a consensus in the population on the desirability of a moderate number of children, the desirability of the Idea of family planning, a positive valuation of such traditional Chinese values as the joint family and support of parents by their children In old age. In one urban area studied, a substantial minority of wives 25–29 years old have used a family planning method already. The “pre-pregnancy health program” of the Provincial Health Department has been quite successful in providing service to interested couples, and among these couples the programme is demonstrably effective in reducing birth rates. Data from the various sources are consistent with the speculation that Taiwanese couples want to use modern family planning methods to maintain elements of the traditional Chinese family in a modern setting.     

Estimates of Survival of Diabetics from Repeated, Independent Sample Surveys

Little is known about death rates among diabetic populations. The few prior estimates have used two data systems, usually a registry or a survey to identify diabetics and death certificates to identify deaths. In this research, the diabetic population aged 18–94 in 1996–1998 and those surviving in 2001–2003 were estimated from repeated cross-sectional surveys, the Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention. Forward survival ratios were computed using a method developed for successive censuses and these were used to compute death rates. Nonlinear regression models for age-sex specific survival ratios were used to estimate parametric rates and thereby increase the accuracy of estimates. About 81.4 % (SE = 1.3 %) of diabetics survived 5 years, for an annual death rate of 41.1 per thousand (SE = 3.2). Among men survival was 84.7 % (SE = 2.1 %) with an annual death rate of 33.8 (SE = 4.9) per thousand; among women survival was 78.5 % (SE = 2.2 %) with an annual death rate of 48.1 (SE = 4.1) per thousand. Model estimates of mortality rates showed an odds ratio of 3.17 (95 % CI 2.64, 3.82) for each 10 year age interval and of 1.35 (95 % CI 1.02, 1.79) for women compared with men. Pooled annual samples, longer time intervals for survival, and parametric estimates of rates all help overcome the small numbers and large sampling variation of survey estimates of survival and mortality. Useful estimates of survival rates can be made from a single data system, a sample survey of the general population. This can be done for any condition where a respondent’s status at the earlier survey time is obtained at the later survey time. It could also be used to make estimates from periodic surveys for nations with limited information systems.     

Age structure,growth, attrition and accession: A new synthesis

This paper shows that each equation describing relationships among demographic parameters in a stable population is a special case of a similar and equally simple equation that applies to any closed population and demonstrates some implications of these new equations for demographic theory and practice. Much of formal demography deals with functions that pertain to individuals passing through life, or to a stationary population in which births of individuals are evenly distributed over time. These functions include life expectancy, probabilities of survival, net and gross reproduction rates, expected years spent in various states and the probability that certain events will occur in the course of life. The stable population model permits the translation of population structure or processes in a more general type of population, with constant growth rates, back into equivalent populations for a stationary population. The method for translation developed in this paper, requiring only a set of age-specific growth rates is even more general, applying to any population. Age specific growth rates may also be useful for performing reverse translations, between a population's life table and its birth rate or its age distribution. Tables of numbers of females by single years of age in Sweden are used to illustrate applications. Tables summarize the basic relations among certain functions in a stationary population, a stable population and any population. Applications of new equations, particularly to demographic estimation of mortality, fertility and migration, from incomplete data, are described. Some other applications include; the 2 sex problem, increment decrement tables, convergence of population to its stable form, and cyclical changes in vital rates. Stable population models will continue to demonstrate long term implications of changes in mortality and fertility. However, in demographic estimation and measurement, new procedures will support most of those based on stable assumptions.     

Female fertility history and mid-late-life health: Findings from China

China’s middle-aged and older women suffer from poorer health than men. Using national baseline data from the China Health and Retirement Longitudinal Study (CHARLS), a survey conducted from 2011 to 2012, this article applies logistic models to investigate the association between female fertility history (parity, early childbearing, late childbearing) and middle-aged and late-life health. We find that parity is related to the mid-late-life health of women. Women with four children or more are more likely to suffer from activities of daily living (ADL) impairment and poorer self-rated health than those with one to three children. Early childbearing is associated with ADL impairment; however, the correlation is mediated by socioeconomic status. Early childbearing is related to self-rated health in later life by an indirect-only mediation effect via educational attainment and personal income.     

The limited effect of increasing educational attainment on childlessness trends in twentieth-century Europe,women born 1916–65

During the twentieth century, trends in childlessness varied strongly across European countries while educational attainment grew continuously across them. Using census and large-scale survey data from 13 European countries, we investigated the relationship between these two factors among women born between 1916 and 1965. Up to the 1940 birth cohort, the share of women childless at age 40+ decreased universally. Afterwards, the trends diverged across countries. The results suggest that the overall trends were related mainly to changing rates of childlessness within educational groups and only marginally to changes in the educational composition of the population. Over time, childlessness levels of the medium-educated and high-educated became closer to those of the low-educated, but the difference in level between the two better educated groups remained stable in Western and Southern Europe and increased slightly in the East.