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Abstract
Background: China has the largest number of aging people in need of long-term care, among whom 70% have chronic diseases. For policy planners, it is necessary to understand the different levels of needs of long-term care and provide long-term care insurance to ensure the long-term care needs of all people can be met. Methods: This study combines the 2013 wave of CHARLS survey and the Life Course Survey of 2014. The combination allows us to factor in both childhood and adulthood data to provide life-course analysis. We identified 7,734 older adults with chronic diseases for analysis. The need for long-term care is defined by the presence of functional limitations based on the performance of basic activities of daily living (ADLs) and of instrumental activities of daily living (IADLs). Two dummy variables, ADLs disability and IADLs disability, and two count variables, ADLs score and IADLs score, were defined to measure incidence and severity of long-term care need, respectively. The concentration index was used to capture the inequality in long-term care need, and a decomposition method based on Probit Regression and Negative Binomial Regression was exploited to identify the contribution of each determination. Results: At least a little difficulty was reported in ADLs and IADLs in 20.44% and 19.25% of respondents, respectively. The concentration index of ADLs disability, ADLs score, IADLs disability, IADLs score were −0.085, −0.109, −0.095 and −0.120, respectively, all of which were statistically significant, indicating the pro-poor inequality in the incidence and severity of long-term care need. Decomposition analyses revealed that family income, education attainment, aging, and childhood experience played a significant role in explaining the inequalities. Conclusions: The long-term care need among older adults with chronic disease is high in China and low socioeconomic groups had a higher probability of needing long-term care or need more long-term care. It is urgent to implement long-term care insurance, especially for the individuals from lower socioeconomic groups.
Highlights
According to the National Bureau of Statistics of China, 249 million people were over 60 or older in China at the end of 2019, accounting for 17.9% of the total population [1]
Before estimating inequality in long-term care need among older adults with chronic diseases by using the concentration index directly, we explored the distribution of long-term care need across quantiles of economic status
Substantial pro-poor income-related inequalities in long-term care need are identified among older adults with chronic diseases in China, indicating that low socioeconomic groups had a higher probability of needing long-term care or need more long-term care
Summary
According to the National Bureau of Statistics of China, 249 million people were over 60 or older in China at the end of 2019, accounting for 17.9% of the total population [1]. China has the largest number of aging people in need of long-term care, among whom 70% have chronic diseases. The concentration index was used to capture the inequality in long-term care need, and a decomposition method based on Probit Regression and Negative Binomial Regression was exploited to identify the contribution of each determination. The concentration index of ADLs disability, ADLs score, IADLs disability, IADLs score were −0.085, −0.109, −0.095 and −0.120, respectively, all of which were statistically significant, indicating the pro-poor inequality in the incidence and severity of long-term care need. Conclusions: The long-term care need among older adults with chronic disease is high in China and low socioeconomic groups had a higher probability of needing long-term care or need more long-term care. It is urgent to implement long-term care insurance, especially for the individuals from lower socioeconomic groups
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