Chinese Longitudinal Health Longevity Survey Research Articles

Multimorbidity patterns, leisure activities, and cognitive function: A population-based longitudinal study

Abstract Background There is limited knowledge about the effect of leisure activities on cognitive decline related to different multimorbidity patterns. The study aimed to examine the role of leisure activities in the association between multimorbidity patterns and cognitive function. Methods We conducted a community-based cohort study based on the 2002-2018 Chinese Longitudinal Health Longevity Survey (CLHLS). Multimorbidity patterns were examined by exploratory factor analysis. Multivariable linear and logistic regression models were used to assess the associations between multimorbidity, leisure activities and cognitive function. Results The study included 14,093 older adults. Those with specific multimorbidity patterns had lower MMSE scores. Compared to individuals with cardio-metabolic and sensory patterns who frequently engaged in activities such as housework, garden work, and watching TV/listening to the radio, those who participated in these activities less regularly had lower MMSE scores. Furthermore, a higher frequency change of participation and a greater variety of leisure activities were associated with better cognitive function. Conclusions The older individuals with multimorbidity are associated with lower MMSE scores, while those who participated in more leisure activities had higher cognitive function. Diverse, and frequent leisure activities may help delay cognitive decline in Chinese older adults with different multimorbidities.

P013 EXPLORING THE BIDIRECTIONAL CAUSAL ASSOCIATION BETWEEN FRAILTY AND HYPERTENSION: FROM ASSOCIATION TO CAUSATION

Background: Studies have shown an association between frailty and hypertension. However, it remains uncertain whether this association reflects causality. We performed a Chinese Longitudinal Health Longevity Survey (CLHLS) analysis and a bidirectional Mendelian randomization (MR) study to assess the relationship between frailty and hypertension. Corroborative evidence for other heart diseases, including atrial fibrillation (AF), coronary artery disease (CAD), and heart failure (HF), was also analyzed. Methods: We performed the cross-sectional analysis based on CLHLS 2018 and used multivariable logistic regression to analyze the association between frailty and HTN. Then, we extracted independent single nucleotide polymorphisms for each phenotype at genome-wide significance levels from the latest genome-wide association summary data of European descent, including FI (N=175,226), HTN (N=462,933), AF (N=138,994), and HF (N= 977,323). The inverse variance weighted method was primarily used, followed by sensitivity and validation analyses. Results: In the cross-sectional study, compared to non-frail individuals, frail patients revealed a significantly higher risk of HTN (OR 5.32, 95% CI 3.46-8.17 P< 0.001) and heart disease (OR 13.50, 95% CI 8.18-22.28 P = 0.017) after full adjustment. In the MR study, higher FI significantly increased the risk of HTN (OR 1.12, 95% CI 1.07-1.16 P<0.001) and CAD (OR 2.57, 95% CI 1.72-3.84 P<0.001). FI suggestively increased the risk of AF (OR 1.83 95%CI 1.11-3.01 P<0.05). No association between FI and HF was observed (OR 1.30, 95% CI 1.00-1.71 P>0.05). In the reverse analysis, genetic predisposition to HTN (β 0.662, 95% CI 1.71, 2.19 P<0.001) and CAD (β 0.067, 95% CI 01.049-1.090 P<0.001) significantly increased FI. A suggestive causality from HF (β 0.088, 95% CI 1.000-1.192 P<0.05) to FI was also observed. No causality between AF to FI was observed (β 0.014, 95% CI 0.998-1.030 P>0.05). Conclusion: Our findings add new evidence to support the bidirectional causality between frailty and HTN. A deeper exploration of such associations is imperative to optimize the management of older patients.

Decomposition Analysis of Depressive Symptom Differences Among Older Adults With Hypertension Between Urban and Rural Areas: Cross-Sectional Study.

Hypertension is the most prevalent chronic disease among China's older population, which comprises a growing proportion of the overall demographic. Older individuals with chronic diseases have a higher risk of developing depressive symptoms than their healthy counterparts, as evidenced in China's older population, where patients with hypertension exhibit varying rates of depression depending on residing in urban or rural areas. This study aimed to investigate factors influencing and contributing to the disparities in depressive symptoms among older urban and rural patients with hypertension in China. We used a cross-sectional study design and derived data from the 8th Chinese Longitudinal Health Longevity Survey of 2018. The Fairlie model was applied to analyze the factors contributing to disparities in depressive symptoms between urban and rural older populations with hypertension. The sample size for this study was 5210, and 12.8% (n=669) of participants exhibited depressive symptoms. The proportions of depressive symptoms in rural and urban areas were 14.1% (n=468) and 10.7% (n=201), respectively. In rural areas, years of education (1-6 years: odds ratio [OR] 0.68, 95% CI 1.10-1.21; ≥7 years: OR 0.47, 95% CI 0.24-0.94), alcohol consumption (yes: OR 0.52, 95% CI 0.29-0.93), exercise (yes: OR 0.78, 95% CI 0.56-1.08), and sleep duration (6.0-7.9 hours: OR 0.29, 95% CI 0.17-0.52; 8.0-9.9 hours: OR 0.24, 95% CI 0.13-0.43; ≥10.0 hours: OR 0.22, 95% CI 0.11-0.41) were protective factors against depressive symptoms in older adults with hypertension, while gender (female: OR 1.94, 95% CI 1.33-2.81), self-reported income status (poor: OR 3.07, 95% CI 2.16-4.37), and activities of daily living (ADL) dysfunction (mild: OR 1.69, 95% CI 1.11-2.58; severe: OR 3.03, 95% CI 1.46-6.32) were risk factors. In urban areas, age (90-99 years: OR 0.37, 95% CI 0.16-0.81; ≥100 years: OR 0.19, 95% CI 0.06-0.66), exercise (yes: OR 0.33, 95% CI 0.22-0.51), and sleep duration (6.0-7.9 hours: OR 0.27, 95% CI 0.10-0.71; 8.0-9.9 hours: OR 0.16, 95% CI 0.06-0.44; ≥10.0 hours: OR 0.18, 95% CI 0.06-0.57) were protective factors, while years of education (1-6 years: OR 1.91, 95% CI 1.05-3.49), self-reported income status (poor: OR 2.94, 95% CI 1.43-6.08), and ADL dysfunction (mild: OR 2.38, 95% CI 1.39-4.06; severe: OR 3.26, 95% CI 1.21-8.76) were risk factors. The Fairlie model revealed that 91.61% of differences in depressive symptoms could be explained by covariates, including years of education (contribution 63.1%), self-reported income status (contribution 13.2%), exercise (contribution 45.7%), sleep duration (contribution 20.8%), ADL dysfunction (contribution -9.6%), and comorbidities (contribution -22.9%). Older patients with hypertension in rural areas had more depressive symptoms than their counterparts residing in urban areas, which could be explained by years of education, self-reported income status, exercise, sleep duration, ADL dysfunction, and comorbidities. Factors influencing depressive symptoms had similarities regarding exercise, sleep duration, self-reported income status, and ADL dysfunction as well as differences regarding age, gender, years of education, and alcohol consumption.

Neuropsychological and psychiatric outcomes among community-dwelling young Chinese older adults affected by falls in the past year with and without vision impairment.

This study was to investigate the differences between young older adults with and without vision impairment on neuropsychological and psychiatric outcomes following falls during the past year and to identify predictors of cognitive decline or mental distress. A secondary analysis of 668 young older Chinese adults aged 65 ∼ 79 years old with a history of falls was conducted from the cross-sectional survey data in the 2018 wave of the Chinese Longitudinal Health Longevity Survey (CLHLS). Participants with vision impairment scored significantly higher on anxiety and depression and lower on cognitive function and SWB than those without vision impairment. And vision impairment was a significant predictor of adverse outcomes for all four neuropsychological and psychiatric measures. Neurocognitive deficits, psychological problems, and decreased self-sufficiency are quite common among community-dwelling older adults with visual impairment who have a history of falls within a year.

Association between Oral Health and Depressive Symptoms in Chinese Older Adults: The Mediating Role of Dietary Diversity.

Diet is a modifiable factor in healthy population aging. Additionally, oral health and diet are important factors affecting depressive symptoms. To assess the mediating role of dietary diversity (DD) in oral health and depressive symptoms in older adults, we selected 8442 participants aged ≥ 65 years from the 2018 Chinese Longitudinal Health Longevity Survey (CLHLS) for a cross-sectional study. Depressive symptoms were determined based on scores on the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). Dietary diversity scores (DDS) were established based on the frequency of intake of food groups. Oral health was measured by denture use and toothbrushing frequency. Stepwise multiple linear regression and PROCESS macros were used for mediated effects analysis and testing. The sample had a positive detection rate of 44.1% for depressive symptoms, 40.8% for denture use, and 41.9% for once-a-day toothbrushing. Denture use (ρ = -0.077, p < 0.01) and toothbrushing frequency (ρ = -0.115, p < 0.01) were negative predictors of depressive symptoms in older adults. DD significantly mediated the association between denture use (indirect effect -0.047; 95%CI: -0.068-0.028; p < 0.001), toothbrushing frequency (indirect effect -0.041; 95%CI: -0.054-0.030; p < 0.001), and depressive symptoms. Denture use and toothbrushing frequency not only directly reduce the risk of depressive symptoms in older adults, but also indirectly affect depressive symptoms through DD.

HAPPY LIFE EXPECTANCY AND REGIONAL AND GROUP HETEROGENEITY AMONG CHINESE OLDER ADULTS

Abstract A long, healthy and happy life is the aspiration of most people and an essential part of human well-being. However, longer life expectancy does not mean a higher quality of life. The measure of quality of life includes both objective and subjective indicators. Similar to healthy life expectancy, happy life expectancy is a measure that combines life expectancy with happiness indicators and can reflect both life length and quality of life. But at present, there is relatively little research on happy life expectancy. In China, there have been no studies using panel data to calculate happy life expectancy. We obtained longitudinal data from the Chinese Longitudinal Health Longevity Survey (CLHLS). We used the multistate life table approach to calculate the happy life expectancy of Chinese older adults, and analyzed the regional and group heterogeneity. A total of 13,807 participants aged 65 and older were included in this study. We found that the proportion of happy life expectancy to remaining life of Chinese older adults increased with age, which confirmed the “compression of unhappiness” hypothesis. In addition, older adults with more education had a higher proportion of happy life expectancy than those with less education. Finally, in terms of region, older adults in the more economically developed areas of eastern China have a higher proportion of happy life expectancy. Our findings provide a more comprehensive understanding of the quality of life of Chinese older adults and highlight the importance of education for the happiness of older adults in later life.

The structural characteristics of the lifestyle among older adults and its impact on the health in China.

Enhancing overall health remains a primary global objective, with lifestyle being a crucial factor impacting the health status among older adults. This study focuses on the lifestyle of Chinese older adults, systematically exploring the evolution and characteristics of their lifestyle and investigating its impact on their health. Utilizing panel data from the Chinese Longitudinal Health Longevity Survey (CLHLS) from 2008, 2011, 2014, and 2018, we adopted 15 indicators reflecting older adults' lifestyle. Latent class analysis and ordinary least square regression were used to uncover the structural nuances of the Chinese older adults' lifestyle and its effects on health. The study identifies three distinct lifestyle categories for the older adults: relatively positive, mixed, and relatively negative. It reveals that the Chinese older adults do not predominantly adopt a positive lifestyle, and this trend persisted from 2008 to 2018. Each improvement in lifestyle category significantly boosts the older adults' physical health, mental health, and self-assessed health by 11.2%, 3.6%, and 17.1%, respectively. To attain the strategic aim of healthy aging, efforts should prioritize encouraging the older adults to adopt a positive lifestyle, enhance the geriatric health service system, and promote an intelligent lifestyle management model.

Dietary factors in relation to the risk of cognitive impairment and physical frailty in Chinese older adults: a prospective cohort study.

The study aimed to investigate the independent associations of dietary factors with cognitive impairment (CI) and physical frailty (PF) among Chinese older adults. This study included 10,734 participants (mean age = 78.7years) free of CI and PF at baseline from the Chinese Longitudinal Health Longevity Survey. Dietary intake was collected using a simplified food frequency questionnaire every 3-4years. The Chinese version Mini-Mental State Examination was used to assess cognition function, participants with a score below 18 were defined as CI. PF was defined using the activities of daily living, instrumental activities of daily living, and functional limitation-related questions. The outcome was defined as the first onset of either CI or PF. Competing risk models were used to estimate the corresponding hazard ratios (HRs) and the 95% confidence intervals (95% CIs). During the study follow-up (mean = 8.1years), a total of 1220 CI cases and 1451 PF cases were newly identified. Higher frequency of fruits intake was associated with a lower hazard of CI (HR = 0.75, 95% CI 0.58-0.97), whereas higher intake of preserved vegetables demonstrated an opposite association (HR = 1.23, 95% CI 1.07-1.42). In terms of PF, we observed a lower risk associated with higher meat and poultry intake (HR = 0.72, 95% CI 0.61-0.88). In particular, a significant protective association of fish and aquatic products intake with PF was observed among participants with ≥ 28 natural teeth (HR = 0.52, 95% CI 0.27-0.99). Our findings suggest divergent roles of major dietary factors in the development of CI and PF among Chinese older adults.

Gender differences in depressive symptoms among Chinese older adults based on fairlie decomposition analysis

This study aimed to investigate the factors influencing depressive symptoms among Chinese older adults based on gender differences. Data from the eighth wave of Chinese Longitudinal Health Longevity Survey were used. We analyzed the influencing factors of depressive symptoms reported by older adults using the chi-squared test and logistic model. Fairlie decomposition analysis was performed to quantify the contribution level of each influencing factor. We found that 11.71 % of older adults met the CES-D-10 criteria for depressive symptoms. Females (13.89 %) reported a significantly higher level of depressive symptoms than males (9.24 %). Age, residence, sleeping time, exercise, activities of daily living functional disability, instrumental activity of daily living functional disability, and living status influenced depressive symptoms in older adults. Higher education and lower body mass index were only significant in male, whereas middle annual income and exercising were significant only in female. The Fairlie decomposition model explained the reasons for 75.64 % of the gender differences in depressive symptoms, with instrumental activity of daily living functional disability (33.60 %), age (−17.79 %), and education level (17.41 %) being major factors affecting gender differences in depressive symptoms. This is the first nationwide study to examine gender differences in depressive symptoms among older adults. These results provide a basis for relevant Chinese government departments to formulate policies to prevent and control depressive symptoms.

Decomposition and comparative analysis of depressive symptoms between older adults living alone and with others in China.

This research dealt with investigating and measuring the contribution of the factors that impact depression in older adults living alone vs. those living with others (hereafter referred to as "not alone") in China. This investigation adopts a cross-sectional research design. The dataset employed for this study comprises data from 2018 the Chinese Longitudinal Health Longevity Survey (CLHLS). The research involved data sourced from China, specifically from 23 of its provinces. From the 8th CLHLS, 12,197 older adults were selected who met the study requirements. Binary logistic regression models were established to delve into the primary factors impacting the depressive symptoms of the individuals. Furthermore, Fairlie models were employed to assess these factors between older adults living alone and those not living alone. This approach facilitated an in-depth analysis of their respective contributions. It was observed that the demographic of Chinese older adults exhibited depressive symptoms at a rate of 11.92%. Older adults who resided alone (15.76%) exhibited a higher prevalence of depressive symptoms in comparison to their counterparts living in not-alone settings (11.15%). Employing Fairlie decomposition analysis, it was determined that this observed disparity in depressive symptoms, amounting to 55.33% of the overall difference, could be primarily attributed to distinct factors. This encompassed variance in marital status (20.55%), years of school (4.63%), self-reported local income status (7.25%), self-reported sleep status (17.56%), and self-reported health status (4.24%). The resulting data indicated that depressive symptoms exhibited an elevated prevalence in older adults living alone than in those living not alone. This discrepancy was predominantly attributed to variance in socioeconomic marital status, years of school, self-reported local income status, self-reported sleep status, and self-reported health status by living alone vs. not alone. Mitigating these influential factors could help develop targeted and meticulous intervention strategies, precisely tailored to improve the mental well-being of older adults at high risk.

Plant-based dietary pattern and low muscle mass: a nation-wide cohort analysis of Chinese older adults

BackgroundIt remains unclear whether plant-based or animal-based dietary patterns are more beneficial for older adults more in maintaining muscle mass. Using a prospective cohort with nationwide sample of China older adults in this study, we aimed to examine the relationship between adhering to plant-based diet patterns or animal-based diet patterns and muscle loss.MethodsWe included 2771 older adults (≥ 65 years) from the Chinese Longitudinal Health Longevity Survey (CLHLS) with normal muscle mass at baseline (2011 and 2014 waves), which followed up into 2018. Plant-based dietary pattern scores and preference subgroups were constructed using 16 common animal-based and plant-based food frequencies. We used the corrected appendicular skeletal muscle mass (ASM) prediction formula to assess muscle mass. We applied the Cox proportional hazard risk regression to explore associations between dietary patterns and low muscle mass (LMM).ResultsDuring a mean of 4.1 years follow-up, 234 (8.4%) participants with normal muscle mass at baseline showed LMM. The plant-based dietary pattern reduced the risk of LMM by 5% (Hazard Ratios [HR]: 0.95, 95% confidence intervals [95%CI]: 0.92–0.97). In addition, a high plant-based food company with a high animal-based food intake pattern reduced the risk of LMM by 60% (HR: 0.40, 95% CI: 0.240–0.661) and 73% (HR: 0.27, 95% CI: 0.11–0.61) in the BADL disability and IADL disability population compared with a low plant-based food and high animal-based food intake, whereas a high plant-based food and low animal-based food intake was more beneficial in reducing the risk of LMM in the normal BADL functioning (HR: 0.57, 95% CI: 0.35–0.90) and IADL functioning (HR: 0.51, 95% CI: 0.28–0.91) population.ConclusionsWhen it comes to maintaining muscle mass in older Chinese people with functional independence, a plant-based diet pattern is more beneficial and effective than the animal-based one. People with functional dependence may profit from a combination of plant-based and animal-based diets to minimize muscle loss.

Hearing Loss and Subjective Well-Being Among Older Adults: Mediating Effect of Social Activity and Cognitive Function

ABSTRACT Objectives To examine the relationship between hearing loss and subjective well-being (SWB) and to investigate the mediating roles of social activity and cognitive function in the link between hearing loss and SWB. Methods An analysis of 11,949 older Chinese adults was conducted from the 2018 wave of the Chinese Longitudinal Health Longevity Survey. Multiple linear regression and mediation analysis were conducted. Results Hearing loss had a significant negative association with SWB (B = -0.787; 95% CI: −0.961, −0.613). Hearing loss influenced older adults’ SWB in the following three ways: first, via the partial mediating effect of social activity (B = -0.021, 95% CI: −0.036, −0.009); second, via the partial mediating effect of cognitive function (B = -0.275, 95% CI: −0.347, −0.252); and third, via the serial mediating effects of social activity and cognitive function (−0.016, 95% CI: −0.021, −0.011). Conclusions Social activity and cognitive function play a serial intermediary role in the relationship between hearing loss and SWB among older Chinese adults. Clinical implications Multidimensional health and social interventions aimed at improving mental health and social inclusion among adults with hearing loss should be recommended.

Factors influencing the demands for home and community-based care services among older adults living alone in China

ABSTRACT The number of older adults living alone in China is rising sharply. This study aimed to explore the demand for home and community-based care services (HCBS) and related influencing factors of older adults living alone. The data were extracted from the 2018 Chinese Longitudinal Health Longevity Survey (CLHLS). Guided by the Andersen model, binary logistic regressions were used to analyze the influencing factors of HCBS demand from the aspect of predisposing, enabling and need variables. Results show that there were significant differences between urban and rural areas for provision of HCBS. HCBS demand of older adults living alone was influenced by distinct factors including age, residence, income source, economic status, availability of services, loneliness, physical function and number of chronic diseases. Implications for HCBS developments are discussed.

Interaction between home and community-based services and PM2.5 on cognition: A prospective cohort study of Chinese elderly

PM2.5 and home and community-based services (HCBSs) had been shown to affect cognition, but the evidence on their joint effects was limited. Aimed to study the joint effects of HCBSs and PM2.5 on cognition, we utilized the follow-up data of participants in the Chinese Longitudinal Health Longevity Survey (CLHLS) who were 65 years of age or older and had normal cognitive function at baseline for the 2008–2018, 2011–2018, and 2014–2018 waves. 16,954, 9,765, and 7192 participants from each of these three waves were initially recruited, respectively. The PM2.5 concentration data of each province in China from 2008 to 2018 was obtained from the Atmospheric Composition Analysis Group. Participants were asked what kind of HCBSs were available in their community. The cognitive status of the participants was evaluated by the Chinese version of Mini-Mental State Examination (CMMSE). We applied the Cox proportional hazard regression model to investigate the joint effects of HCBSs and PM2.5 on cognition and further stratified the analysis according to HCBSs. Hazard ratio (HR) and 95% confidence interval (95% CI) were calculated based on Cox models. During a median follow-up period of 5.2 years, 911 (8.8%) participants with normal baseline cognitive function developed cognitive impairment. Compared to participants without HCBSs and exposed to the highest level of PM2.5, those with HCBSs and exposed to the lowest level of PM2.5 had a significantly reduced risk of developing cognitive impairment (HR = 0.428, 95% CI: 0.303–0.605). The results from the stratified analysis revealed that the detrimental effect of PM2.5 on cognition was more pronounced in participants without HCBSs (HR = 3.44, 95% CI: 2.18–5.41) compared with those with HCBSs (HR = 1.42, 95% CI: 0.77–2.61). HCBSs may attenuate the harmful impact of PM2.5 on cognitive status in the elderly Chinese and the government should further promote the application of HCBSs.

Waist-to-calf circumstance ratio and cognitive function among Chinese older adults: Mediating roles of physical performance and social activity.

In light of the potentially detrimental effects of central fat and decreased muscle mass on cognitive function, it would be beneficial to learn more about the mediating mechanisms underpinning the association between the two. The purpose of this study is to determine the association between waist-to-calf circumstance ratio (WCR) and cognitive function, as well as to investigate whether physical performance and social activity mediate the relationship between WCR and cognitive function among older Chinese adults. An analysis of 9,652 older Chinese adults was conducted during the 2018 wave of the Chinese Longitudinal Health Longevity Survey (CLHLS). The Mini-Mental State Examination (MMSE) and a self-reported scale were used to measure cognitive function, physical performance, and social activity, respectively. Multiple linear regression and mediation analyses were conducted. The findings suggest that a high WCR had a significant negative association with cognitive function (B = -0.535, 95% CI: -0.754, -0.317). Mediation analysis revealed that a high WCR influenced old adults' cognitive function in three ways: first, through the partial mediating effect of physical performance (B = -0.270; 95% CI: -0.340, -0.203); second, through the partial mediating effect of social activity (B = -0.035; 95% CI: -0.055, -0.017); and third, through the serial mediating effects of physical performance and social activity (B = -0.021, 95% CI: -0.029, -0.015). The study results suggest the adverse impact of a high WCR on older adults' cognitive function, and the possible mechanisms of physical performance and social activity by which the association takes place. Multidimensional health and social interventions aimed at improving physical, social, and cognitive functioning among older adults with sarcopenic obesity are recommended.

Trends in the availability of community-based psychological counselling services for oldest-old in China, 2005 to 2018

BackgroundCommunity-based psychological counselling services (CPCS) is crucial for the oldest-old who often faces challenges or are reluctant to seek care at the healthcare settings. This study aims to examine trends in availability of CPCS over time and rural-urban disparities in service availability among nationwide oldest-old in China. MethodsMultiple cross-sectional data were derived from the 2005–2018 Chinese Longitudinal Health Longevity Survey. Service availability was reported by each oldest-old participant or their next-of-kins as having CPCS in one's neighborhood. We used Cochran-Armitage tests to estimate service availability trends and applied sample-weighted logistic regression models to examine its rural-urban disparities. ResultsOf 38,032 oldest-old, CPCS availability decreased from 6.7 % in 2005 to 4.8 % in 2008/2009, followed by continual increases to 13.6 % in 2017/2018. In 2017/2018, rural oldest-old's neighborhoods had no greater service availability. Oldest-old residing in the Central (6.7 %), Western (13.4 %) and Northeast China (8.1 %) were less likely to report having services locally than their Eastern counterparts (17.8 %). Oldest-old having any disability or living in the nursing homes reported having greater service availability than those without disability or living at home. LimitationService availability might have been disrupted during the COVID-19 pandemic. ConclusionsDespite the increasing service availability, as of 2017/2018, only 13.6 % oldest-old in China had reported CPCS availability. It raises concerns on the disproportionate access to and continuity of mental health care, especially for those living the Central, Western China and those living at home. Policy efforts are needed to incentivize service expansion and eliminate disparities in the service availability.

Decomposition and comparative analysis of differences in depressive symptoms between urban and rural older adults: Evidence from a national survey.

The aim of this study was to investigate the factors influencing urban-rural differences in depressive symptoms among old people in China and to measure the contribution of relevant influencing factors. A cross-sectional research. The 2018 data from The Chinese Longitudinal Health Longevity Survey (CLHLS). Twenty-three provinces in China. From the 8th CLHLS, 11,245 elderly participants were selected who met the requirements of the study. We established binary logistic regression models to explore the main influencing factors of their depressive symptoms and used Fairlie models to analyze the influencing factors of the differences in depressive symptoms between the urban and rural elderly and their contribution. The percentage of depressive symptoms among Chinese older adults was 11.72%, and the results showed that rural older adults (12.41%) had higher rates of depressive symptoms than urban (10.13%). The Fairlie decomposition analysis revealed that 73.96% of the difference in depressive symptoms could be explained, which was primarily associated with differences in annual income (31.51%), education level (28.05%), sleep time ( - 25.67%), self-reported health (24.18%), instrumental activities of daily living dysfunction (20.73%), exercise (17.72%), living status ( - 8.31%), age ( - 3.84%), activities of daily living dysfunction ( - 3.29%), and social activity (2.44%). The prevalence of depressive symptoms was higher in rural than in urban older adults, which was primarily associated with differences in socioeconomic status, personal lifestyle, and health status factors between the urban and rural residents. If these factors were addressed, we could make targeted and precise intervention strategies to improve the mental health of high-risk elderly.

Association of rurality, type of primary caregiver and place of death with end-of-life medical expenditures among the oldest-old population in China

BackgroundUnderstanding whether the type of primary caregiver and end-of-life (EOL) care location are associated with EOL medical expenditures is crucial to inform global debates on policies for efficient and effective EOL care. This study aims to assess trends in the type of primary caregiver and place of death stratified by rural‒urban status among the oldest-old population from 1998–2018 in China. A secondary objective is to determine the associations between rurality, the type of primary caregiver, place of death and EOL medical expenditures. MethodsA total of 20,149 deaths of people aged 80 years or older were derived from the Chinese Longitudinal Health Longevity Survey (CLHLS). Cochran-Armitage tests and Cuzick’s tests were used to test trends in the type of primary caregiver and place of death over time, respectively. Tobit models were used to estimate the marginal associations of rurality, type of primary caregiver, and place of death with EOL medical expenditures because CLHLS sets 100,000 Chinese yuan (approximately US$15,286) as the upper limit of the outcome variable. ResultsOf the 20,149 oldest-old people, the median age at death was 97 years old, 12,490 (weighted, 58.6%, hereafter) were female, and 8,235 lived in urban areas. From 1998–2018, the prevalence of informal caregivers significantly increased from 94.3% to 96.2%, and home death significantly increased from 86.0% to 89.5%. The proportion of people receiving help from informal caregivers significantly increased in urban decedents (16.5%) but decreased in rural decedents (-4.0%), while home death rates significantly increased among both urban (15.3%) and rural (1.8%) decedents. In the adjusted models, rural decedents spent less than urban decedents did (marginal difference [95% CI]: $-229 [$-378, $-80]). Those who died in hospitals spent more than those who died at home ($798 [$518, $1077]). No difference in medical expenditures by type of primary caregiver was observed.ConclusionsOver the past two decades, the increases in informal caregiver utilization and home deaths were unequal, leading to substantially higher EOL medical expenditures among urban decedents and deceased individuals who died at hospitals than among their counterparts who lived in rural areas and died at home.

Decomposition analysis of health inequalities between the urban and rural oldest-old populations in China: Evidence from a national survey

The number of Chinese oldest-old (aged 80+) is growing rapidly and some studies have shown that the health status is unequal among older persons in different regions. However, to the best of our knowledge, no study to date has analyzed health inequalities among the oldest-old in urban and rural areas in China. This study therefore aimed to examine the correlation between health inequalities among the oldest-old in urban and rural areas of China. From the 8th wave of the Chinese Longitudinal Health Longevity Survey (CLHLS), we selected 8124 oldest-old participants who met the requirements of the study. Chi-square tests were used to analyze the distribution characteristics of indicators and a logistic model was performed to determine the factors associated with different self-rated health (SRH). The Fairlie model was adopted to decompose the causes and related contributions to health inequality. Our results found that of the Chinese oldest-old, 46.57% were in good health. Urban residents reported significantly better SRH than rural residents (50.17% vs. 45.13%). Variables associated with good and poor SRH had different distribution characteristics. The logistic model suggested that marital status, alcohol consumption, and annual income were important factors underlying the SRH differences. Our decomposition analysis indicated that 76.64% of the SRH differences were caused by observational factors, and validated that the difference in SRH between urban and rural areas was significantly (P<0.05) associated with exercise status (45.44%), annual income (37.64%), social activity status (3.75%), age (-5.27%), and alcohol consumption (-2.66%). Therefore, socioeconomic status and individual lifestyle status were the main factors underlying the health inequality between urban and rural Chinese oldest-old.

Research on Mortality Risk of Chinese Older Adults from the Perspective of Social Health

In response to the increasing aging problem that China is facing, this study aimed to investigate the impact of social health on the mortality risk of the Chinese older adult population. In this paper, we used the data from “The Chinese Longitudinal Health Longevity Survey (CLHLS)-Longitudinal Data (2008–2018)” and applied the Cox proportional hazard model to investigate the effects of three dimensions of social health on the risk of death among older adults in China. The study found that: (1) The three dimensions of social health have a positive effect on the mortality risk of older adults. (2) Among those three dimensions, social activities had the most significant effect on older adults. The effect of social support and social network on the mortality risk of older adults are basically similar. Moreover, social activity, social support, and the social network had no significant effect on the young-old’s mortality risk. (3) In order to address the problem of data censoring, the Cox proportional hazard model can be used, whereas demographic characteristics, health status, and health behavior components are selective to society. This study enriches social health research in China and promotes the development of social health research from theory to practice. Moreover, it has obvious advantages in terms of economics and feasibility for achieving mortality risk reduction through improving the social health of older adults and building a healthy aging society.