The association of childhood socioeconomic conditions with healthy longevity at the oldest-old ages in China

Based on unique data from the largest-ever sample of the Chinese oldest-old aged 80 and older, our multivariate logistic regression analyses show that either receiving adequate medical service during sickness in childhood or never/rarely suffering from serious illness during childhood significantly reduces the risk of being ADL (activities of daily living) impaired, being cognitively impaired, and self-reporting poor health by 18%-33% at the oldest-old ages. Estimates of effects for five other indicators of childhood conditions are similarly positive but mostly not statistically significant. Multivariate survival analysis shows that better childhood socioeconomic conditions in general tend to reduce the four-year period mortality risk among the oldest-old. But after additional controls for 14 covariates are put into the model, the effects are not statistically significant, thus suggesting that most of the effects of childhood conditions on oldest-old mortality are indirect-at least to the point of affecting current health status at the oldest-old ages, which itself is strongly associated with mortality. While acknowledging limitations of the present analyses due to a lack of information on childhood illness, the oldest-olds'recollection errors, and other data problems, we conclude, based on this and other studies, that policies that enhance childhood health care and children's socioeconomic well-being can have large and long-lasting benefits up to the oldest-old ages.     

A new method for correcting under-estimation of disabled life expectancy and an application to the chinese oldest-old

This article demonstrates that disabled life expectancies that are based on conventional multistate life-table methods are significantly underestimated because of the assumption of no changes in functional status between age x and death. We present a new method to correct the bias and apply it to data from a longitudinal survey of about 9,000 oldest-old Chinese aged 80-105 collected in 1998 and 2000. In our application, the age trajectories of disability (activities of daily living--ADL), status-specific death rates, and the probabilities of transitions between ADL states of the oldest-old were investigated for the first time in a developing country. In this article, we report estimates of bias-corrected disabled and active life expectancies of the Chinese oldest-old and demonstrate patterns of large differences associated with initial status, gender, and advances in ages. Using combined information on ADL disabilities and length of having been bedridden before dying, we analyze gender and age patterns of the extent of morbidity before dying among the oldest-old and their implications for debates on the hypothesis of compression of morbidity.     

城市高龄老年人的医疗问题调查——以湖南省长沙市310位高龄老年人为例

随着我国人口的高龄化,高龄老年人的医疗问题日益凸显。实地调查表明:他们的身体状况不好,医疗支持不够,对医疗的满意度不高。因此,依据城市高龄老年人的医疗现状及其对医疗的心理预期,改进和完善城市高龄老年人的医疗支持体系势在必行。     

儿子和女儿对高龄老人日常照料的比较研究

本文利用2002年中国老年人健康长寿调查数据,对比分析了在家庭中居住的高龄老人由儿子或女儿提供日常照料的可能性。研究发现,高龄老人的日常照料中存在明显的性别差异,高龄老年人有接受来自同性别子女帮助的倾向。     

Economic Stress, Quality of Life, and Mortality for the Oldest-Old in China

China??s oldest old population is estimated to quadruple by 2050. Yet, poverty rate for the oldest old has been the highest among all age groups in China. This paper investigates the relationship between economic stress, quality of life, and mortality among the oldest-old in China. Both objective economic hardships and perceived economic strain are examined. We base our investigation on data drawn from the Chinese Longitudinal Healthy Longevity Survey conducted between 2000 and 2005. Our sample includes 10,972 men and women between the ages of 80 and 105 in 2000. The data show that about 16% of these oldest-old lived under economic stress in 2000. The risk factors that make one vulnerable to economic stress include age, being male, being widowed or never married, being a minority member, having no education, having no living children, and not having children as main source of income, and having no pension. Economic stress is negatively associated with indicators of quality of life, such as the quality of medical care and mental well-being. The poor quality of life contributes to the higher mortality rate for the oldest old who are under economic stress. Results also show that perceived economic strain increases the risk of mortality by 42% in rural areas, even after controlling for basic demographic characteristics, life style factors, and major health events.?For the rural oldest-old, having children as a main source of income and having access to pension alleviates the negative impact of economic hardship on mortality hazard by 23 and 66% respectively. However, in urban areas, economic stress has no direct impact on the hazard of mortality.     

The Effect of Veteran Status on Mortality among Older Americans and its Pathways

This research examines excess mortality among American veterans age 70 years or older during a two-to-three year interval from 1993/94 to the end of 1995. Using a structural hazard rate model, we analyzed data on a sample of respondents age 70 or over from the Survey of Asset and Health Dynamics among the Oldest Old (AHEAD). We found that at age 70, older veterans have a slightly higher death rate than their nonveteran counterparts, implying a mortality crossover right before this age. Such excess mortality among veterans increases considerably with age, when other factors are held equal. The direct and indirect effects of veteran status on mortality by means of physical and mental health mostly perform in opposite directions, and such effects vary greatly in magnitude and direction as a function of age. The intervening effects of physical and mental health status decrease substantially with increasing age. Many of the mechanisms inherent in the excess mortality among older veterans are not captured by variations in their health status, especially among the oldest-old. A more extensive study on this topic is urgently needed.     

Association of late childbearing with healthy longevity among the oldest-old in China

Statistical analysis of a large and unique longitudinal data-set demonstrates that childbearing after age 35 or 40 is associated with survival and healthy survival among very old Chinese women and men. The association is stronger for women than for men. The estimates are adjusted for a variety of confounding factors: demographic characteristics, family support, social connections, health practices, and health conditions. Further analysis based on an extension of the Fixed-Attributes Dynamics method shows that late childbearing is positively associated with long-term survival and healthy survival from ages 80-85 to 90-95 and 100-105. This association exists among oldest-old women and men, but, again, the effects are substantially stronger for women than for men. We discuss four possible factors that may explain why late childbearing affects healthy longevity at advanced ages: (1) social factors; (2) biological changes caused by late pregnancy and delivery; (3) genetic and other biological characteristics; and (4) selection.     

中国高龄老年人精神失调状况及其影响因素分析

为分析中国高龄老年人的精神失调状况,探讨中国高龄老年人是否健康的度过晚年,本文利用了2000年中国长寿老年人的健康状况的调查数据,从中随机抽取了1006个样本,用logistic回归方法进行了分析。结果显示中国高龄老年人表现出精神失调症状的占48.9%,老年人的心态,人格,婚姻状况,经济状况对老年人精神失调症状都有显著影响,并且发现年龄,性别,对精神失调的影响不显著。中国长寿老年人的精神健康状况需要引起重视。负向心态,离婚,独居和跟家人在一起对精神失调症状影响非常显著;正向心态,自评健康状况好,有偶,住养老机构相比较而言更有利于缓解长寿老人的精神失调症状。     

Life Satisfaction of Middle-Aged and Older Chinese: The Role of Health and Health Insurance

The Chinese government has launched a series of health reforms to establish universal health insurance coverage, particularly for vulnerable groups, including middle-aged and older adults. However, the current public health insurance system is highly fragmented, consisting of different programs with different levels of premiums and benefits. We analyse whether the universal health insurance system increases the life satisfaction of middle-aged and older Chinese people and to what extent the type of health insurance affects the life satisfaction of this group. Our study is based on data from the China Health and Retirement Longitudinal Study, a nationally representative longitudinal survey of Chinese aged 45 and above, in 2011, 2013, and 2015. We find that the life satisfaction of middle-aged and older adults does not depend on having any health insurance coverage but varies with the type of health insurance coverage, controlling for potential confounding variables such as health status, occupation, hukou status, and other demographic variables. Individuals covered by the most generous program, the Government Medical Insurance, reported a higher life satisfaction. In comparison, individuals covered by the Urban Employee Medical Insurance, the Urban Resident Medical Insurance, and the New Rural Cooperative Scheme reported a lower life satisfaction by 0.155, 0.106, and 0.112 standard deviations, respectively. Our results suggest that establishing a more equitable health insurance system should be the next step in health reforms in China.

     

An Exploratory Study on the Quality of Life of older Chinese People Living alone in Hong Kong

This study successfully interviewed 109 randomly selected Chinese people aged 60 and over living alone in two public housing estates in an urban area of Hong Kong. The results show that mental health status, number of days staying in hospital, life satisfaction, age, and self-esteem are significant factors in predicting the life quality of older Chinese respondents living alone. The explanatory power of this model is 56.4. The results of this study are consistent with previous findings reported in the west and in Hong Kong. A subgroup analysis of those older Chinese respondents living alone who have offspring also living in Hong Kong shows that belief in childrens’ support in old age, good walking ability, and better self-reported health status via life satisfaction as the mediating variable, better self-reported health status and satisfactory self-reported financial status via self-esteem as the mediating variable, are crucial predictors of quality of life. This model explains 64.2% of the variance in quality of life from a subset of the predictor variables.     

An Exploratory Study on the Quality of Life of older Chinese People Living alone in Hong Kong

This study successfully interviewed 109 randomly selected Chinese people aged 60 and over living alone in two public housing estates in an urban area of Hong Kong. The results show that mental health status, number of days staying in hospital, life satisfaction, age, and self-esteem are significant factors in predicting the life quality of older Chinese respondents living alone. The explanatory power of this model is 56.4. The results of this study are consistent with previous findings reported in the west and in Hong Kong. A subgroup analysis of those older Chinese respondents living alone who have offspring also living in Hong Kong shows that belief in childrens support in old age, good walking ability, and better self-reported health status via life satisfaction as the mediating variable, better self-reported health status and satisfactory self-reported financial status via self-esteem as the mediating variable, are crucial predictors of quality of life. This model explains 64.2% of the variance in quality of life from a subset of the predictor variables.     

Adolescent Health in Hong Kong: Disturbing Socio-Demographic Correlates

Relationships between self-assessed health status and socio-demographic variables were examined among 4,502 Chinese adolescent secondary school students in Hong Kong, a modern society with traditional Chinese ethno-cultural origin. Health status was self-rated in four aspects: overall health, physical health, mental health, and health effects on usual activities. In both the bivariate and multivariate analyses, there was health advantage for adolescent males relative to females, and there were inverse relationships between health level and age/level of study, in all four health aspects. Family structure was an important risk factor for all health aspects. Two-parent family was associated with significantly higher health levels than those living with father only, or with no parent/single parent and other adults, but not those living with mother only. Mainland-born adolescents had higher risks of low health level than the local-born in the aspect of overall health status. Finally economically well-being was associated with lower level of mental health.     

中国老年人口健康预期寿命延长还是缩短？——基于Sullivan方法的实证研究

随着老年人口数量在总人口中不断增长,中国人口的总体健康水平。特别是老年人的健康预期寿命将会发生新的变化。中国老年人口的健康预期寿命是在增长还是在缩短？老年人口的健康预期寿命在总预期寿命中的比例是在增大还是在缩小？搞清楚这个问题对于我们合理地制定老龄政策至关重要。本文尝试应用国际上最为流行的Sullivan方法回答上述问题。     

与收入相关的老人健康不平等及其分解——基于中国城镇和农村的经验研究

本文使用“中国老年人健康长寿影响因素调查”（CLHLS）数据,测度了中国老人健康不平等程度,重点计算了收入、婚姻状况、居住安排等因素对健康不平等的贡献。回归基础上的集中系数及其分解结果显示：我国存在亲富人的健康不平等,高收入人群的健康状况更好;城镇地区,健康不平等主要的贡献因素为收入、婚姻状况、医疗保险、经常锻炼,居住安排对健康不平等的贡献为负。农村地区,收入因素对于健康不平等的贡献最大,这就意味着消除农村健康不平等的关键是要降低收入不平等。在城镇和农村地区医疗保险的不平等程度更甚,进一步强化了健康不平等。因此如果政策想要降低健康不平等,首先要降低穷人获得医疗保险的经济门槛,增加医疗保健服务的可及性。     

社交活动对老年人口健康状况影响的量化分析

人口老龄化已成为中国社会的常态,老年人口健康及其相关问题研究日益成为政府、社会和学者共同关注的焦点。本文基于中国健康与养老追踪调查2015年数据,针对老年人口社交活动难以量化的问题,构建"社交活跃度"指标,利用OLS回归和IV-regress二阶段回归模型分析社交活动对中国老年人口健康状况的影响。实证结果表明:第一,我国老年人社交活动水平整体呈现低活跃型特征,社交形式比较单一。第二,社交活动确实会对中国老年人口的健康状况产生影响,老年人健康状况在各影响因素不同水平下表现出显著差异,尤其受教育程度较高、经济状况较好以及较高的社交活跃度会对老年人健康产生积极正向影响。第三,老年人积极参与社交活动能够显著改善其健康状况,参与多项社交活动且参与活动频率高对老年人口健康状况的优化作用尤其明显。因此,我们应提升中国老年人口的社交活跃度。老年人应积极主动参与丰富多彩的社交活动,社区、基层政府及社会企业应构建并完善与老年人社交活动及健康保障相配套的产品和服务体系,国家层面则应更加积极地完善相关的老龄化政策、制度。     

对我国育龄妇女生育健康状况的分析——个体指标的应用实例

本文利用 1997年全国人口与生殖健康调查数据 ,应用作者提出的育龄妇女生育健康个体指标 ,从人口、社会、经济几个方面对我国育龄妇女生育健康状况的部分影响因素进行了定量分析。分析结果显示 ,我国育龄妇女的生育健康状况及存在主要问题与妇女年龄、文化程度、居住地及社区环境密切相关。文章最后根据分析结果 ,对改善我国育龄妇女生育健康状况提出了几点建议     

家庭迁移决策分析——基于中国农村的证据

本文利用中国健康与营养状况调查数据,以家庭为单位分析了农村劳动力迁移的影响因素。结果表明,有无子女、子女年龄是影响家庭迁移的重要因素。与无子女的家庭相比,有子女家庭中夫妻二人至少一人外出打工的概率会大大降低,且子女年龄越小,影响越大。老人健康因素对一个家庭中夫妻二人是否至少有一人外出打工的影响不大,但家中男性老人健康较差会大大减少已婚子女夫妻共同外出打工的概率。     

中国社区安老服务的需求和供给研究

根据中国老人健康长寿追踪调查2005年数据,描述和分析了我国社区安老服务的需求和供给情况。结果发现由于受健康状况和家庭功能弱化等因素的影响,老人对社区安老服务有强烈的需求;但是,受文化、制度和经济条件的限制,我国社区安老服务的供给还远远不能满足老人的需求。因此,大力发展社区安老服务是一项重要而紧迫的任务。     

Health Implications of Socioeconomic Characteristics,Subjective Social Status,and Perceptions of Inequality: An Empirical Study of China

This study explores how health is associated with socioeconomic status, subjective social status, and perceptions of inequality simultaneously. Two health outcomes (self-reported health and psychological distress) are examined, and the subtlety of their relationships with each of the three dimensions of inequality is probed. Data used come from a nationally representative sample survey conducted in China. Several findings emerge from empirical analyses: (1) Overall, the three dimensions of social inequality are associated with self-reported health and psychological distress net of each other and other control variables; (2) among focal socioeconomic characteristics, income and Chinese Communist Party membership are significantly associated with both health outcomes, education exhibits a robust effect on self-reported health, and rural and migrant statuses are linked to less distress; (3) subjective social status in comparisons with both socially proximal and broad referents is associated with both health outcomes, and the association with downward comparisons is more salient than with upward comparisons; and (4) perceived degree and perceived sources of inequality in society show varying relationships with the two health outcomes. These findings add to our understanding of the multidimensionality and complexity of social inequality in relation to health.     

基于医疗保险视角的老年人医疗费用研究

在"全国老年人口健康状况调查"2008年数据集基础上,应用Tobit多元嵌套模型考察不同类型医疗保险身份对老年人医疗费用的作用。结果表明,老年人的经济状况以及健康状况等因素(而不是医疗保险身份因素)对其医疗费用存在显著作用,当前医疗保险尚且不能满足我国老年人群医疗健康需求,老年人医疗费用主要还是以子女支付为主,其医疗保险身份呈现出典型"不足论"的特征。老年人医疗健康需求处于被压抑状态,医疗保险的覆盖率和保险额度都有待进一步提高,以增强老年人的医疗费用支付能力。