China Health And Retirement Longitudinal Survey Research Articles

Instrumental activities of daily living function and cognitive status among Chinese older adults: a serial multiple mediation model.

This study aimed to develop and validate a serial multiple mediation model to investigate the association between instrumental activities of daily living (IADL) function and cognitive status among older adults while exploring the underlying mechanisms. This cross-sectional study involved 3,665 individuals aged 60 years and older who participated in the China Health and Retirement Longitudinal Survey (CHARLS). A serial multiple mediation model was utilized to explore the direct and indirect relationship between IADL function and cognitive status and whether sleep duration, social engagement, and depressive symptoms mediated this relationship. Decreased IADL function was associated with worse cognitive status [effect = -0.620, 95% CI: (-0.692, -0.540)]. Sleep duration, social participation (SP), and depressive symptoms all acted as mediators in the relationship between IADL function and cognitive status. This study found both direct and indirect associations between IADL function and cognitive status, providing new insights into the effective prevention and intervention of cognitive decline among older adults.

Decomposition analysis on the equity of health examination utilization for the middle-aged and elderly people in China: based on longitudinal CHARLS data from 2011 to 2018.

This study aimed to investigate the utilization rate and equity of health examination service among the middle-aged and elderly population in China from 2011 to 2018. The contribution of various determinants to the inequity in health examination service utilization was also examined. Data from the China Health and Retirement Longitudinal Survey (CHARLS) were analyzed to assess the health examination service utilization rate among the middle-aged and elderly population. A concentration curve and concentration index were employed to measure the equity of health examination service utilization and decomposed into its determining factors. Horizontal inequity index was applied to evaluate the trends in equity of health examination service. The health examination service utilization rates among the middle-aged and elderly population were 29.45%, 20.69%, 25.40%, and 32.05% in 2011, 2013, 2015, and 2018, respectively. The concentration indexes for health examination service utilization were 0.0080 (95% CI: - 0.0084, 0.0244), 0.0155 (95% CI: - 0.0054, 0.0363), 0.0095 (95% CI: - 0.0088, 0.0277), and - 0.0100 (95% CI: - 0.0254, 0.0054) from 2011 to 2018, respectively. The horizontal inequity index was positive from 2011 to 2018, evidencing a pro-rich inequity trend. Age, residence, education, region, and economic status were the major identified contributors influencing the equity of health examination service utilization. A pro-rich inequity existed in health examination service utilization among the middle-aged and elderly population in China. Reducing the wealth and regional gap, providing equal educational opportunities, and strengthening the capacity for chronic disease prevention and control are crucial for reducing the inequity in health examination service utilization.

Volunteer Participation and Loneliness in the Elderly: An Empirical Study Based on CHARLS 2018

Based on the empirical research data collected from the China Health and Retirement Longitudinal Survey (CHARLS) in 2018, this study examines the specific impacts of two types of volunteering on loneliness among elderly individuals in China. Additionally, it investigates various demographic, socioeconomic, physical health, and family intergenerational support factors that may influence the relationship between these variables. The findings of this investigation demonstrate that both group-driven volunteer service and individual active volunteer service significantly contribute to reducing loneliness among older adults. However, there exist four distinct demographic disparities: variations in age, differences in empty nest situations, disparities based on gender, and discrepancies in economic status. Consequently, to address the issue of elderly loneliness effectively, this study primarily proposes four key approaches: guiding the elderly towards embracing social participation as a concept; emphasizing the development of community social capital; enhancing volunteer service design; and increasing investment in volunteer services for the elderly. These measures aim to foster an inclusive environment that encourages active engagement among older adults while providing them with convenient avenues to participate in volunteer activities. This study empirically investigates the evolution of social engagement among elderly individuals in China, offering novel research perspectives on public involvement in addressing the challenges associated with elderly care services.

Abnormal sleep duration is associated with sarcopenia in older Chinese people: A large retrospective cross-sectional study.

Abnormalities in sleep patterns are a common health problem for the older adults. The relationship between sarcopenia and sleep duration in older people is controversial. This research is to examine the association between sleep duration and sarcopenia. We drew 21,095 adults from the China Health and Retirement Longitudinal Survey (CHARLS). Not only we explore the relationship between sleep duration and sarcopenia, but also compare sleep duration to three sarcopenia subcomponents. Moreover, the sensitivity analysis was conducted by the gender and residence area to ascertain the discrepancy, separately. Finally, using restricted cubic spline to find the non-linear association between them. Among 7,342 community older adults engaged by CHARLS in 2015, the incidence of possible sarcopenia and sarcopenia was 23.14 and 11.30%, separately. Sleep duration (≤6 h) [OR(95%CI) = 1.30(1.03-1.65), p < 0.05] and (≥8 h) [OR(95%CI) = 1.33(1.05-1.69), p < 0.05] were significantly linked with possible sarcopenia, while long sleep duration (≥8 h) [OR(95%CI) = 1.41(1.01-2.02), p < 0.05] was correlated strongly with sarcopenia. A non-linear relationship (U-shaped) between sarcopenia risk and sleep duration was found (p for non-linear = 0.009). Our findings highlight the importance of sleep duration in the onset of sarcopenia and might assist older persons to maintain good sleeping habits.

The association between dual sensory loss and healthcare expenditure: Mediating effect of depression

BackgroundPrevious studies have suggested the dual sensory loss (DSL) is linked to depression, and that they are associated with higher healthcare expenditures, respectively. However, the association between DSL, depression and healthcare expenditures remains ambiguous. ObjectivesThe current study aims to examine the association between DSL, depression and healthcare expenditures as well as catastrophic health expenditures (CHE) among Chinese people aged 45 and above. MethodsWe first utilized the China Health and Retirement Longitudinal Survey (CHARLS) 2018 to obtain data from a total of 13,412 Chinese individuals aged 45 and above to conduct a cross-sectional study. DSL was defined as a combined variable of self-reported vision loss and hearing loss. Depression was measured using The Center for Epidemiologic Studies Depression Scale (CESD-10). The healthcare expenditures, including outpatient out-of-pocket cost and inpatient out-of-pocket cost, were obtained from the Harmonized CHARLS section. CHE were defined as out-of-pocket (OOP) health spending equal to or higher than 40 % of a household's capacity to pay. A Tobit linear regression with three models and a path analysis were conducted to estimate the association between DSL, depression and healthcare expenditures and CHE. Then we utilized 2011CHARLS and 2018CHARLS to present a longitudinal analysis. A path analysis was conducted to estimate the association between 2011DSL, 2018depression and 2018healthcare expenditures and CHE. ResultsDepression has a significant mediating effect between DSL and healthcare expenditures. (For outpatient OOP cost: a = 0.453, b = 23.559, c = 25.257, the proportion of mediating effect in total effect = 29.71 %; for inpatient OOP cost: a = 0.453, b = 13.606, c = 15.463, the proportion of mediating effect in total effect = 28.50 %; all P < 0.05). The mediating effect of depression also exists in the association between DSL and CHE (a = 0.453, b = 0.018, c = 0.043, the proportion of mediating effect in total effect = 15.90 %; P < 0.05). The mediation effect of depression on healthcare expenditures and CHE also exists in the longitudinal analysis using CHARLS 2011 and CHARLS 2018 (all P < 0.05). LimitationsThe DSL status were based on self-report and we used 2018CHARLS to conduct the study, which may cause some bias. ConclusionSignificant mediating effect of depression exists between DSL and higher healthcare expenditures and CHE. The mental health of elder people with DSL should be focused on, and we should have an overall viewpoint on the topic of healthcare expenditures and CHE.

MIGRATE OR STAY? PSYCHOLOGICAL WELL-BEING AMONG MIGRANT AND LEFT-BEHIND OLDER ADULTS IN CHINA

Abstract When adult children migrate from households, older parents face two options: migrate with children or remain in place (“left behind”). However, it remains unclear which option is better for older adults’ psychological well-being. With the data from China Health and Retirement Longitudinal Survey (CHARLS) at the wave of 2015 and 2018 (N = 4989), this study examined the longitudinal changes in depression and life satisfaction among older locals (those who did not migrate and lived with their children), migrants and left-behinds, and the impacts of children support and social support on the well-being of older parents. Results showed that there was an increase in depression level among the left-behind older adults from 2015 to 2018, but this was not found among the migration group or the local group. Furthermore, the left-behind group reported a higher level of depression than the local group and migration group, and this difference was accounted by the time of living with children, but not social activities. In addition, the time of living with children was positively associated with life satisfaction among the left-behind group, and this association was not observed among the migration group or the local group, suggesting the salutary effect of children’s support among the left-behind group. These results highlight the adverse effect of being left behind among older adults and the importance of children’s support for left-behind older adults.

Association between cognitive function and dusty weather: a propensity score matching study

BackgroundWith a rapidly aging global population, the health of older adults is a national priority for countries across the world. Dusty weather has been demonstrated to be a potential risk factor of cognitive function among the elderly population. However, there is a paucity of studies exploring the associations between dusty weather and cognitive function among the older in China.MethodsData on individual characteristics were obtained from the China Health and Retirement Longitudinal Survey (CHARLS) 2018, whereas data on air pollution were sourced from environmental monitoring stations in China. Cognitive function, including general cognitive function, episodic memory, and linguistic competence, was assessed by self- or informant-questionnaires. We used propensity score matching and linear regression to investigate the relationship between dusty weather and cognitive function. Sensitivity analyses were conducted to test the robustness of the results.ResultsThis study included 8,604 participants older than 60 years old. After controlling air pollutant weather, dusty weather was demonstrated to be positively associated with a decline in cognitive function (Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), 4.0, 95% confidence interval (CI): 3.11, 4.89; Mini‐Mental State Exam (MMSE), 0.63, 95% CI: 0.34, 0.92). Results of sensitivity analysis showed that our research findings are robust.ConclusionOlder adults living in dusty weather regions suffered a higher level of cognitive impairment, and such adverse effects were more substantial among females compared with their male counterparts. Targeted health interventions to help older adults living in regions where dusty weather occurs frequently are suggested to be proposed.

Links between life-course SES and frailty trajectory moderated by community environment resources: Person-environment Fit perspective

IntroductionDrawing from the life course and person-environment fit perspectives, this study examined whether life-course SES disadvantages during childhood, adulthood and old- age influence frailty development in late- life and how community environment resources moderated the association between life-course SES disadvantages and frailty trajectories over a seven-year follow-up period. MethodsData from 11,675 participants aged ≥ 50 years at baseline who participated in the four waves (2011-2018) of the China Health and Retirement Longitudinal Survey (CHARLS) were used. Life-course SES disadvantages were self-reported, and community environment resources (basic infrastructure and voluntary organizations) were ascertained from informed officials in the community. Frailty development was measured at each wave by the Frailty Index (FI) based on 39 potential deficits. Multilevel growth modeling was used to examine the interactive effect of life-course SES disadvantages and community environment resources on frailty development. ResultsLife-course SES disadvantage exerted cumulatively negative effects on frailty trajectory, and individuals with SES disadvantages in two or three life stages reported higher initial levels of and faster increases in frailty scores. Community environmental resources (basic infrastructure and voluntary organizations) had a protective effect on frailty development and buffered the negative effects of SES vulnerability experiences accumulated over the life course. Community basic infrastructure resources played an important role in slowing the progression of frailty for individuals with cumulative SES disadvantage and downward mobility. DiscussionOur findings provided new evidence of person-environmental docility among older adults, documenting the role of community resources in buffering SES disparities in health during later-life.

Does home and community-based services use reduce hospital utilization and hospital expenditure among disabled elders? Evidence from China.

In the background of aging in place, home and community-based services (HCBS) have been playing an increasingly important role in long-term care (LTC) security systems. However, it is still uncertain whether and how HCBS use affects hospital utilization and the corresponding expenditures. Using data from the China Health and Retirement Longitudinal Survey (CHARLS) and the China City Statistical Yearbook, the instrumental variable (IV) approach is applied to identify the causal effects of HCBS use on hospital utilization and hospital expenditure among disabled elders. We find that HCBS use significantly reduces the probability of being hospitalized, the times of hospitalization, and the length of inpatient stay, as well as the total, out-of-pocket and reimbursement inpatient expenditures, demonstrating not only the substitution impact of HCBS for hospital care but also the effectiveness of medical expenditure control in LTC security systems. Heterogeneity analysis shows that the impacts of HCBS use on hospital utilization and hospital expenditure concentrate on disabled elders who are younger, male, living in urban areas, or from higher-income households; both healthcare and spiritual consolation services have significant negative effects, while the anticipated effects of daily care service use are not supported. The possible mechanisms are the substitution of HCBS for hospital care and the improvements in both the physical and psychological health of disabled elders. However, the mechanism of adverse events decrease is not verified, which needs to be investigated further with more proxy variables. This study provides empirical evidence that HCBS use can not only reduce hospital utilization and hospital expenditure among disabled elders but also improve their physical and psychological health. Policy designs should emphasize the orientation of HCBS, ensure the fundamental and central position of HCBS in the formal care service system, pay more attention to the accessibility and affordability of HCBS for fragile groups, and diversify and optimize the development of the health service and the spiritual consolation service.

Health effects of long-term care insurance on spouses of disabled people: a quasi-experimental study

BackgroundIt is still uncertain whether and how formal long-term care (LTC) systems affect the health status of family members. This paper examines the health effects of long-term care insurance (LTCI) on spouses of disabled people in China.MethodsThe data is from China Health and Retirement Longitudinal Survey (CHARLS), a longitudinal survey of a nationally representative sample of Chinese residents aged 45 or older and their spouses, and China City Statistical Yearbook. Exploiting the regional variation in the implementation of LTCI in the first round of pilot cities in China, a difference-in-difference (DID) strategy is applied to identify the causal effects of LTCI on the health status of spouses of disabled people. We carefully identify the causal effects by controlling for city-level covariates, testing common trends between the treatment and control groups, combining propensity score matching (PSM) with DID, selecting the second round of pilot cities as the control group, controlling for city fixed effects (FE) instead of individual FE, and evaluating selection bias from omitted observable and unobservable factors.ResultsThe introduction of LTCI in China reduces the number of painful body parts and the self-reported health score significantly, indicating that spouses of disabled people get physical health benefits from LTCI coverage. However, the impact of LTCI on the depression index remains ambiguous and needs to be analyzed further. LTCI improves the physical health status of spouses of disabled individuals mainly through the time reallocation channel, while the impact of the consumption promotion channel has not been verified. Furthermore, the beneficial effects of LTCI on physical health are stronger for spouse caregivers and spouses with lower-level education and lower household income.ConclusionThese findings demonstrate that LTCI not only improves the health status of family caregivers by reducing their caregiving burden but also has beneficial health effects on non-caregiver family members. Policy designs of LTCI should emphasize the orientation of home and community-based care services (HCBS), which can not only satisfy the care preferences of disabled individuals, reduce the care burden on family caregivers, promote the health of all family members, but also prevent a large number of disabled individuals from choosing high-cost institutional care and reduce the financial burden of the LTCI Fund.

Living with particles: Disclosure of pollution information, individual responses, and health consequences

Drawing on a panel dataset—the China Health and Retirement Longitudinal Survey (CHARLS)—and other city- and individual-level datasets, this study examines the causal impact of pollution information disclosure on individual outdoor activities and the health status of the middle-aged and elderly. Using city-level variations in disclosure timing, we found that the adoption of pollution information disclosure (PID) significantly reduces the probability of outdoor exercise, especially for those living in more polluted cities. This occurs mainly through enhanced awareness of environmental pollution, particularly for those who are more educated. However, the adoption of PID does not lead to an improvement in health status.

Economic insecurity exposure and cognitive function in late life

ObjectivesThis study took the State-owned Enterprises (SOE) reform from 1996 to 2002 in China as a natural experiment to explore the consequences of economic insecurity exposure during early-adulthood and mid-adulthood...

Long-term exposure to ambient ozone and cardiovascular diseases: Evidence from two national cohort studies in China

IntroductionThe health effects of ambient ozone have been investigated in many previous studies. However, the effects of long-term exposure to ambient ozone on the incidence of cardiovascular disease (CVD) remain inconclusive. ObjectivesTo estimate the associations of long-term exposure to maximum daily 8-hours average ozone (MDA8 O3) with the incidence of total CVD, heart disease, hypertension, and stroke. MethodsThis was a prospective cohort study, and the data was obtained from the China Health and Retirement Longitudinal Survey (CHARLS) implemented during 2011–2018 and the China Family Panel Studies (CFPS) implemented during 2010–2018. We applied a Cox proportional hazards regression model to evaluate the associations of MDA8 O3 with total CVD, heart disease, hypertension, and stroke risks, and the corresponding population-attributable fractions (PAF) attributable to MDA8 O3 were also calculated. All analyses were conducted by R software. ResultsThe mean MDA8 O3 concertation of all included participants in the CHARLS and CFPS were 51.03 part per billion (ppb) and 51.15 ppb, respectively. In the CHARLS including 18,177 participants, each 10 ppb increment in MDA8 O3 concentration was associated with a 31% increase [hazard ratio (HR) = 1.31, 95% confidence interval (CI): 1.22–1.42] in the risk of incident heart disease, and the corresponding population-attributable fractions (PAF) was 13.79% [10.12%-17.32%]. In the CFPS including 30,226 participants, each 10 ppb increment in MDA8 O3 concentration was associated with an increase in the risk of incident total CVD (1.07 [1.02–1.13]), and hypertension (1.10 [1.03–1.18]). The PAFs of total CVD, and hypertension attributable to MDA8 O3 were 3.53% [0.82%-6.16%], and 5.11% [1.73%-8.38%], respectively. Stratified analyses showed greater associations in males, urban areas, and Southern China. ConclusionsLong-term exposure to MDA8 O3 may increase the incidence of CVD. Therefore, the policies that control O3 and related precursors are persistently needed.

Association between uric acid and risk of venous thromboembolism in East Asian populations: a cohort and Mendelian randomization study

Serum uric acid (SUA) levels have been associated with an increased risk and recurrence of venous thromboembolism (VTE) in European populations, but the potential causal relationship remains unclear. Large-scale studies on the association between SUA and VTE in East Asian populations are lacking, despite the high prevalence of hyperuricemia in this region. To address this, we conducted a cohort analysis and a two-sample Mendelian randomization (MR) study in East Asian populations. We collected data on VTE patients from the China Pulmonary Thromboembolism Registry Study (CURES) and compared them to controls obtained from the China Health and Retirement Longitudinal Survey (CHARLS). Propensity score matching (PSM) and cubic-spline models were applied to assess the effect of SUA on VTE risk while adjusting for multiple covariates. We also performed two-sample MR analyses to infer potential causality based on summary statistics from Genome-wide Association Studies (GWAS) of SUA and VTE in the East Asian population. We found that the SUA levels were higher in VTE patients (317.95mmol/L) compared to the general population (295.75mmol/L), and SUA ≥ 325mmol/L was associated with an increased risk of VTE recurrence (P-value=0.0001). The univariable MR suggested a causal relationship between elevated SUA and higher VTE risk (Pinverse variance weighted < 0.05), and multivariable MR showed that elevated SUA levels continued to promote the development of VTE after adjusting for multiple covariates (Pmultivariable residual < 0.05). Sensitivity analyses produced similar results for these estimations. Our study provides evidence supporting a robust positive association between SUA and VTE in the East Asian population, and MR analyses suggest that this association is likely to be causal. Our findings underscore the importance of monitoring SUA levels in VTE prevention and call for urgent action to address the growing burden of hyperuricemia in the Asia-Pacific region. This research was funded by Beijing Nova Program (No. Z211100002121057), National Natural Science Foundation of China (No. 82100065 and No. 62350004), CAMS Innovation Fund for Medical Sciences (No. 2021-I2M-1-061 and No. 2021-1-I2M-001), Elite Medical Professionals project of China-Japan Friendship Hospital (No. ZRJY2021-QM12), National Key Research and Development Project (No. 2021YFF1201200 and No. 2022YFC3341004).

Education level as a predictor of the onset of health problems among China's middle-aged population: Cox regression analysis.

Despite the importance of midlife with reference to one's health, educational inequalities in midlife health have attracted little attention in China. Using Cox proportional hazards regression analysis, this study examined the association between educational attainment and the onset of midlife health problems and investigated the potential mediating effects of socioeconomic position (SEP) other than educational attainment, depression, and health behavior. Data were extracted from the China Health and Retirement Longitudinal Survey (CHALRS) from 2011 (baseline) to 2018 (latest data). Participants aged 45-59 years at baseline were studied (N = 8,050). Health outcomes included the onset of poor self-rated health (SRH), limitation in activities of daily living (ADL) and instrumental ADL (IADL), multimorbidity, hypertension, dyslipidemia, heart diseases, and stroke over the 7-year follow-up period. Cox proportional hazard models were used to examine the associations of the outcomes with educational attainment, while controlling for potential mediators (other SEP, depression, and health behaviors). Lower educational level was associated with increased incidences of poor SRH and ADL/IADL limitations, but with decreased incidences of dyslipidemia and heart disease. After adjusting for baseline covariates, the RII was 2.17 (95% confidence interval [CI]: 1.74, 2.70) for poor SRH, 2.15 (95% CI: 1.42, 3.26) for ADL limitation, 3.84 (95% CI: 2.98, 4.94) for IADL limitation, 0.52 (95% CI: 0.40, 0.68) for dyslipidemia, and 0.55 (95% CI: 0.40, 0.74) for heart disease. Significant proportions (2.1 to 27.0%) of the RII were explained by the mediators. No sex or urban-rural differences were found in this study. Our findings suggest that educational attainment is an important predictor of the incidences of key midlife health problems, with significant mediating effects exerted by other indicators of SEP, depression, and health behavior.

Relationships between the Physical Activity Intensity and the Medical Expenditure of Middle-Aged and Elderly People: Parsing from the CHARLS Database.

There are many studies on the impact of physical activity on health but few studies on the relationship between physical activity and medical expenditure among the elderly. Based on the China Health and Retirement Longitudinal Survey (CHARLS) database and selected 4456 valid samples, this paper used a two-part model to analyze the effects of high, moderate, and low physical activity intensity on medical expenditure. It is found that the intensity of physical activity was negatively correlated with medical expenditure, and the medical expenditure of the high physical activity intensity group was significantly lower than that of the low physical activity intensity group. For example, compared to people with no physical activity, the total medical expenditure decreased by 22.4%, 40.4%, and 62.5% per week in those with low, moderate, and high physical activity intensity. Thus, the government should provide more places for the elderly to exercise, planning special exercise areas for the elderly in community playgrounds, such as a dancing square, which will also help the elderly to increase their amount of exercise per week and develop a daily exercise habit.

Can Land Circulation Improve the Health of Middle-Aged and Older Farmers in China?

Compared with the urban aging population, the rural aging population in China is larger, and is subject to a lower per capita income, lower social security coverage, and insufficient security capacity. Therefore, ensuring the health of middle-aged and older farmers is an inevitable requirement for maintaining the stability of rural areas and society. This study uses data from the China Health and Retirement Longitudinal Survey (CHARLS) 2018, an ordered probit model and instrumental variable approach to empirically analyze the effect of land circulation out on the physical health of middle-aged and older farmers over 45. The results indicate that land circulation out positively and significantly affects farmers’ health. Again, farmer’s non-agricultural work and household income play a significant role in this positive relationship between land circulation out and farmers’ health. Thus, the promotion of non-agricultural work for farmers and household income enhancement could alleviate household budget constraints while increasing health investment. The findings provide policies advocating for rural health development from land circulation perspectives.

Impacts of combined childhood exposures to poor neighborhood quality, peer friendships and family relationships on adult depression: A seven-year longitudinal study

BackgroundLittle is known about how multisystemic childhood exposures predict adult depression. This study aims to examine the effects of multisystemic childhood exposures on the onset and remission of adult depression. MethodsData were drawn from the China Health and Retirement Longitudinal Survey (CHARLS) (wave 1–4), which is a nationally representative longitudinal survey of people 45 years of age or older in China. Childhood family relationships (CFR), childhood peer friendships (CPF), and childhood neighborhood quality (CNQ) scores were recoded into binary (No = 0, Yes = 1) according to the first quantile value. Participants were divided into four groups based on the total number of poor childhood exposures (group 0–3). The generalized linear mixed model was used to test the longitudinal relationship between combined poor childhood exposures and adult depression. ResultsOf the 4696 participants (55.1 % males), 22.5 % suffered from depression at baseline. The incidence of depression increased from group0 to group3 in four waves, reaching the peak in wave 2018 (incidence of group0 to group3: 14.1 %, 18.5 %, 22.8 %, 27.4 %, p < 0.001), with declining remission rates that reached its lowest in wave 2018 (50.8 %, 41.3 %, 34.3 %, 31.7 %, p < 0.001). The persistent depression rate increased from group0 to group3 (2.7 %, 5.0 %, 8.1 %, 13.0 %, p < 0.001). The risk of depression in group1 (AOR = 1.50, 95%CI: 1.27–1.77), group2 (AOR = 2.43, 95%CI: 2.01–2.94) and group3 (AOR = 4.24, 95%CI: 3.25–5.54) were significantly higher than that in group0. LimitationsChildhood histories were collected via self-reported questionnaires, and thus recall bias was inevitable. ConclusionsMultisystem poor childhood exposures jointly increased the onset and persistence of adult depression, as well as reduced the remission rate of depression.

Direct economic burden attributable to age-related diseases in China: An econometric modelling study.

Aging is a strong risk factor for many chronic diseases. However, the economic burden attributable to age-related diseases remains unclear. We aimed to calculate the economic burden attributable to age-related diseases in China. We used an econometric modelling approach from the China Health and Retirement Longitudinal Survey (CHARLS), which is based on a longitudinal observational data set from middle-aged and older adults aged 45+ in 2011, 2013, and 2015. We calculated the total direct economic burden attributable to age-related diseases for outpatient and inpatient services among adults aged 45 and above in China, which was approximately 288.368 billion US dollars (US$), US$379.901 billion, and US$616.809 billion in 2011, 2013, and 2015, respectively, taking up 19.48%, 21.11% and 32.03% of the overall health care expenses in the same year. The proportion of dyslipidemia was the largest, followed by hypertension in all the three years; hearing problems accounted for the lowest proportion. The alarming upward trend in age-related economic burden in China calls for urgent interventions to prevent or slow down the accumulation of damage associated with age-related diseases.

The shattered "Iron Rice Bowl": effects of Chinese state-owned enterprise reformon depressive symptoms in later life.

The SOE reform was the first time that economic insecurity was introduced since 1949 in China, with hundreds of million employees affected by the laid off. This study took the State-Owned Enterprises (SOE) reform in China as a natural experiment to explore the impact of economic insecurity on depressive symptoms in later life. Data were obtained from the China Health and Retirement Longitudinal Survey (CHARLS), 2014 and 2015. CHARLS is a nationally representative survey covering 28 provinces in China. CHARLS used the probabilities proportional to size (PPS) sampling method and involved 450 villages/resident committees, 150 counties/districts and 12,400 households. A total of 5113 urban dwellers born earlier than 1971 (aged 25years old and above at the start of the SOE reform, 1995) were involved. Using the province-level economic loss from the layoffs, we examined the impact of economic insecurity exposure on the score of depressive symptoms using a difference-in-differences model (DID). Individuals with economic insecurity exposure had a significantly increased risk of higher depressive symptoms scores, in which a 1 percentage point increase in expected economic loss would increase the CESD-10 score by 0.10. For an individual at the median distribution (CESD-10 = 5), this implies a shift to the 58th percentile (CESD-10 = 6). Given that the average intensity of expected economic loss is 10.22% and the mean CESD-10 is 6.92, exposure to the SOE reform led to an average increase in the CESD-10 score by 1.02 and by at least 14.74%. The heterogeneity analyses showed that the role of SOE reform in depressive symptoms scores was robust in both female and male groups and groups with different educational attainment. Economic insecurity exposure increased the depressive symptoms score later in life in the context of China. Programs, such as adequate unemployment insurance benefits, can protect individuals against the risk of financial loss, thereby reducing their negative impact on depressive symptoms. Providing mental symptoms surveillance and psychological counseling to those experienced at a time of great uncertainty is important for preventing depression in times of economic insecurity.