Studies have reported that elder adults are susceptible to the indoor pollution. However, evidenc... more Studies have reported that elder adults are susceptible to the indoor pollution. However, evidences on the mortality risk of household air pollution (HAP) on the elderly, especially on vulnerable oldest-old population, are scarce. We aimed to estimate the association between HAP exposure from solid fuel combustion and 7-years all-cause mortality using a nationally representative dataset of oldest-old population in China. We used data from wave 2011 to wave 2018 of Chinese Longitudinal Healthy Longevity Survey. Household cooking fuel were dichotomized as solid fuel (including kerosene, charcoal, coal, wood, and biomass) and clean fuel (including electricity, solar, natural gas, and coal gas). The cohort contained 6,167 participants, totaling 21,357 person-years. There were 3,836 deaths between 2011 and 2014. About half of the participants (53.8%) used solid fuel for cooking. In the fully adjusted model, the mortality hazard ratio (HR) for solid fuel users was 1.10 (95% CI: 1.03-1.18)...
Background Adequate access to healthcare is associated with lower risks of mortality at older age... more Background Adequate access to healthcare is associated with lower risks of mortality at older ages. However, it is largely unknown how many more years of life can be attributed to having adequate access to healthcare compared with having inadequate access to healthcare. Method A nationwide longitudinal survey of 27,794 older adults aged 65+ in mainland China from 2002 to 2014 was used for analysis. Multivariate hazard models and life table techniques were used to estimate differences in life expectancy associated with self-reported access to healthcare (adequate vs. inadequate). The findings were assessed after adjusting for a wide range of demographic factors, socioeconomic status, family/social support, health practices, and health conditions. Results At age 65, adequate access to healthcare increased life expectancy by approximately 2.0–2.5 years in men and women and across urban-rural areas compared with those who reported inadequate access to healthcare. At age 85, the correspo...
Background Urban-rural disparity in mortality at older ages is well documented in China. However,... more Background Urban-rural disparity in mortality at older ages is well documented in China. However, surprisingly few studies have systemically investigated factors that contribute to such disparity. This study examined the extent to which individual-level socioeconomic conditions, family/social support, health behaviors, and baseline health status contributed to the urban-rural difference in mortality among older adults in China. Methods This research used the five waves of the Chinese Longitudinal Healthy Longevity Survey from 2002 to 2014, a nationally representative sample of older adults aged 65 years or older in China (n = 28,235). A series of hazard regression models by gender and age group examined the association between urban-rural residence and mortality and how this association was modified by a wide range of individual-level factors. Results Older adults in urban areas had 11% (relative hazard ratio (HR) = 0.89, p 0.10) after adjusting for individual socioeconomic factors...
Based on the methods of the average period age ratio and the average cohort age ratio, this study... more Based on the methods of the average period age ratio and the average cohort age ratio, this study systematically assesses age heaping or digit preference in all population censuses of China. Our study finds that the overall age heaping was relatively low in the Chinese censuses; however, there was a notable preference for ages ending with zero after age 50 in the first two censuses, despite a weakening trend over time. Our study further shows that age heaping in China’s censuses is likely associated with age-related policies such as those on late marriage and retirement. As shown in the study, the average age ratio method can be an alternative of the Whipple’s Index and be improved if the size of birth cohort was taken into account when the number of births is generally reliable.
Objectives Solo-living has far-reaching implications for older adults’ well-being. The causal imp... more Objectives Solo-living has far-reaching implications for older adults’ well-being. The causal impacts and the pathways of solo-living on health and well-being of older adults are still unclear. This study examines the correlates of solo-living and subsequent health outcomes of solo-living among older adults in mainland China. Methods We draw data from four waves of a nationwide survey with a total of 9,714 older adults aged 65 or older who had at least three interviews in 2005–2014. A generalized structural equation modeling approach was applied to examine what factors are associated with solo-living status and whether and how the antecedent of solo-living status subsequently affects well-being and health. Results Owning a home, having no living child, and a preference to live independently are positively correlated with living alone, whereas living in a city, having economic independence, being educated, and having poor physical and cognitive functions are associated with lower odd...
We examined whether exposure to urban environments was linked with mortality in a longitudinal su... more We examined whether exposure to urban environments was linked with mortality in a longitudinal survey dataset of nearly 28,000 Chinese adults who were 65 years of age or older in the years 2002–2014. Urban life exposure was measured by residential status at birth, current residential status, and urban-related primary lifetime occupation, which generated eight different categories of urban life exposure: no exposure, mid-life-only exposure, late-life-only exposure, mid-late-life exposure, early-life-only exposure, early-mid-life exposure, early- & late-life exposure, and full life exposure. We also included a measure of migration, whether the respondent lived in the same county/city at birth and at first interview, to further classify these eight categories. Overall, we found that when demographics were controlled for, compared to those with no urban life exposure and no migration, mortality risk was lower for older adults with mid-late life exposure with or without migration and for...
Journal of the American Heart Association, Jan 16, 2017
Prior studies have documented racial and ethnic disparities in hospitalization among patients wit... more Prior studies have documented racial and ethnic disparities in hospitalization among patients with heart failure (HF). However, racial/ethnic differences in trajectories of hospitalization following the diagnosis of HF have not been well characterized. This study examined racial/ethnic differences in individual-level trajectories of hospitalization in older adults with diagnosed HF. Data from a nationally representative prospective cohort of US men and women aged 45 years and older were used to examine the number of hospitalizations reported every 24 months. Participants who were non-Hispanic white, non-Hispanic black, and Hispanic with a reported diagnosis of HF (n=3011) were followed from 1998 to 2014. Results showed a quadratic change in the number of reported hospitalizations following HF diagnosis, with an average of 2.36 (95% confidence interval [CI], 2.19-2.53; P<0.001) hospitalizations within 24 months that decreased by 0.35 (95% CI, -0.45 to -0.25; P<0.001) every 24 m...
ABSTRACT The unmet needs of persons needing long-term care have recently drawn attention in China... more ABSTRACT The unmet needs of persons needing long-term care have recently drawn attention in China, the nation with the world’s largest elderly population. Using national panel data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), we examined the 3-year mortality of 3,089 Chinese adults above the age of 65 years who required long-term care. Long-term care needs were measured by the inability to perform any of the following six activities of daily living for 3 months: eating, dressing, bathing, getting in/out of the bed, indoor transferring, and toileting. Exponential parametric hazard models were used to investigate the association between unmet care needs on subsequent mortality. Results showed that older adults with unmet needs had an approximately 10% increased risk of mortality compared with those whose needs were met when demographics were under control. The risks were particularly elevated among older women and among urban older adults. We conclude by discussing these findings and the importance of a national social insurance program (or additional programs) specialized for the provision of long-term care in China.
American journal of medical research (New York, N.Y.), 2016
This study analyzes the unique datasets of the Chinese Longitudinal Healthy Longevity Survey usin... more This study analyzes the unique datasets of the Chinese Longitudinal Healthy Longevity Survey using logistic regression and controlling for various covariates. Our analyses clearly demonstrate that disabled older parents are more satisfied with care provided by daughters than sons and that older parents enjoy greater filial piety from and better relationships with daughters than sons. The daughter-advantages of enjoying greater filial piety from and better relationships with children are stronger among the oldest-old aged 80+ than the young-old aged 65-79, and surprisingly more profound in rural areas than urban areas, while son-preference is much more prevalent among rural residents. We also discuss why China's rigorous fertility policy until October-2015 and much less-developed pension system in rural areas substantially contribute to sustaining traditional son-preference and a high sex ratio at birth (SRB) when fertility is low. We recommend China take integrative public healt...
Residential status has been linked to numerous determinants of health and well-being. However, th... more Residential status has been linked to numerous determinants of health and well-being. However, the influence of residential status on cognitive decline remains unclear. The purpose of this research was to assess the changes of cognitive function among older adults with different residential status (urban residents, rural-to-urban residents, rural residents, and urban-to-rural residents), over a 12-year period. We used five waves of data (2002, 2005, 2008/2009, 2011/2012, and 2014) from the Chinese Longitudinal Healthy Longevity Survey with 17,333 older adults age 65 and over who were interviewed up to five times. Cognitive function was measured by the Mini Mental State Examination (MMSE). Multilevel models were used regarding the effects of residential status after adjusting for demographic characteristics, socioeconomic factors, family support, health behaviors, and health status. After controlling for covariates, significant differences in cognitive function were found across the ...
Self-perception of uselessness is associated with increased mortality risk in older adults. Howev... more Self-perception of uselessness is associated with increased mortality risk in older adults. However, it is unknown whether and to what extent changes in perceived uselessness are associated with mortality risk. Using four waves of national longitudinal data of older adults from China (2005, 2008, 2011, and 2014), this study examines the association between changes in perceived uselessness and risk of subsequent mortality. Perceived uselessness is classified into three major categories: high levels (always/often), moderate levels (sometimes), and low levels (seldom/never). Five categories are used to measure change over three-year intervals: (1) persistently high levels, (2) increases to moderate/high levels, (3) persistent moderate levels, (4) decreases to moderate/low levels, and (5) persistently low levels. Cox proportional hazard models were used to estimate mortality risk associated with changes in levels of perceived uselessness. Compared to those with persistently low levels o...
Mechanisms of ageing and development, Jan 28, 2016
After a brief introduction to the background, significance and unique features of the centenarian... more After a brief introduction to the background, significance and unique features of the centenarian population in China, we describe the Chinese Longitudinal Healthy Longevity Study (CLHLS), which is the world's largest study of centenarians, nonagenarians, octogenarians, and compatible young-old aged 65-79. Based on the CLHLS data and other relevant studies, we summarize demographic and socioeconomic characteristics as well as self-reported and objectively-tested health indicators of centenarians in China, with an emphasis on gender differences and rural/urban disparities. We then compare five-year-age-specific trajectories of physical and cognitive functions, self-reported health, and life satisfactions from ages 65-69 to 100+, concluding that good psychological resilience and optimism are keys to the exceptional longevity enjoyed by centenarians. We discuss recent findings of novel loci and pathways that are significantly associated with longevity based on the genome-wide assoc...
The journals of gerontology. Series B, Psychological sciences and social sciences, Jan 7, 2016
To investigate subtypes of successful aging (SA) based on concordance and discordance between sel... more To investigate subtypes of successful aging (SA) based on concordance and discordance between self-rated and researcher-defined measures and their associations with demographic, psychosocial, and life satisfaction factors. We used multinomial logistic regression models to analyze 2013 cross-sectional survey data from 1,962 persons aged 65 and older in Shanghai that measured self-rated successful aging (SSA) with a single global assessment and researcher-defined successful aging (RSA) with a cumulative deficit index reflecting physical, physiological, cognitive, psychological, and social engagement domains. We generated four subtypes based on these two dichotomous variables: nonsuccessful aging (non-SA; meeting neither the criterion of RSA nor the criterion of SSA), RSA-only (meeting the criterion of RSA-only but not the criterion of SSA), SSA-only (meeting the criterion of SSA-only but not the criterion of RSA), and both-successful aging (both-SA; meeting both criteria of RSA and SS...
We have presented in the database (in Excel file format) as part of the ProFamy package the race-... more We have presented in the database (in Excel file format) as part of the ProFamy package the race-sex-age-specific o/e rates of marital/union status transitions and race- age-parity-marital status-specific fertility o/e rates in the 1990s, based on a large data set which pools several relevant variables (age, sex, race, events history information on dates of marital/union status changes and births) from
Archives of gerontology and geriatrics, Jan 12, 2016
This study aims to examine the relationship between frailty and life satisfaction and the roles o... more This study aims to examine the relationship between frailty and life satisfaction and the roles of age and social vulnerability underlying the links in Chinese older adults. Using a cross-sectional sample of 1970 adults aged 65 and older in 2013 in Shanghai, we employed regression analyses to investigate the interaction between frailty and age on life satisfaction in the whole sample and in different social vulnerability groups. Life satisfaction was measured using a sum score of satisfaction with thirteen domains. Using a cumulative deficit approach, frailty was constructed from fifty-two variables and social vulnerability was derived from thirty-five variables. Frailty was negatively associated with life satisfaction. The interaction between frailty and age was significant for life satisfaction, such that the negative association between frailty and life satisfaction was stronger among the young-old aged 65-79 than among the old-old aged 80+. Moreover, frailty's stronger assoc...
Studies have reported that elder adults are susceptible to the indoor pollution. However, evidenc... more Studies have reported that elder adults are susceptible to the indoor pollution. However, evidences on the mortality risk of household air pollution (HAP) on the elderly, especially on vulnerable oldest-old population, are scarce. We aimed to estimate the association between HAP exposure from solid fuel combustion and 7-years all-cause mortality using a nationally representative dataset of oldest-old population in China. We used data from wave 2011 to wave 2018 of Chinese Longitudinal Healthy Longevity Survey. Household cooking fuel were dichotomized as solid fuel (including kerosene, charcoal, coal, wood, and biomass) and clean fuel (including electricity, solar, natural gas, and coal gas). The cohort contained 6,167 participants, totaling 21,357 person-years. There were 3,836 deaths between 2011 and 2014. About half of the participants (53.8%) used solid fuel for cooking. In the fully adjusted model, the mortality hazard ratio (HR) for solid fuel users was 1.10 (95% CI: 1.03-1.18)...
Background Adequate access to healthcare is associated with lower risks of mortality at older age... more Background Adequate access to healthcare is associated with lower risks of mortality at older ages. However, it is largely unknown how many more years of life can be attributed to having adequate access to healthcare compared with having inadequate access to healthcare. Method A nationwide longitudinal survey of 27,794 older adults aged 65+ in mainland China from 2002 to 2014 was used for analysis. Multivariate hazard models and life table techniques were used to estimate differences in life expectancy associated with self-reported access to healthcare (adequate vs. inadequate). The findings were assessed after adjusting for a wide range of demographic factors, socioeconomic status, family/social support, health practices, and health conditions. Results At age 65, adequate access to healthcare increased life expectancy by approximately 2.0–2.5 years in men and women and across urban-rural areas compared with those who reported inadequate access to healthcare. At age 85, the correspo...
Background Urban-rural disparity in mortality at older ages is well documented in China. However,... more Background Urban-rural disparity in mortality at older ages is well documented in China. However, surprisingly few studies have systemically investigated factors that contribute to such disparity. This study examined the extent to which individual-level socioeconomic conditions, family/social support, health behaviors, and baseline health status contributed to the urban-rural difference in mortality among older adults in China. Methods This research used the five waves of the Chinese Longitudinal Healthy Longevity Survey from 2002 to 2014, a nationally representative sample of older adults aged 65 years or older in China (n = 28,235). A series of hazard regression models by gender and age group examined the association between urban-rural residence and mortality and how this association was modified by a wide range of individual-level factors. Results Older adults in urban areas had 11% (relative hazard ratio (HR) = 0.89, p 0.10) after adjusting for individual socioeconomic factors...
Based on the methods of the average period age ratio and the average cohort age ratio, this study... more Based on the methods of the average period age ratio and the average cohort age ratio, this study systematically assesses age heaping or digit preference in all population censuses of China. Our study finds that the overall age heaping was relatively low in the Chinese censuses; however, there was a notable preference for ages ending with zero after age 50 in the first two censuses, despite a weakening trend over time. Our study further shows that age heaping in China’s censuses is likely associated with age-related policies such as those on late marriage and retirement. As shown in the study, the average age ratio method can be an alternative of the Whipple’s Index and be improved if the size of birth cohort was taken into account when the number of births is generally reliable.
Objectives Solo-living has far-reaching implications for older adults’ well-being. The causal imp... more Objectives Solo-living has far-reaching implications for older adults’ well-being. The causal impacts and the pathways of solo-living on health and well-being of older adults are still unclear. This study examines the correlates of solo-living and subsequent health outcomes of solo-living among older adults in mainland China. Methods We draw data from four waves of a nationwide survey with a total of 9,714 older adults aged 65 or older who had at least three interviews in 2005–2014. A generalized structural equation modeling approach was applied to examine what factors are associated with solo-living status and whether and how the antecedent of solo-living status subsequently affects well-being and health. Results Owning a home, having no living child, and a preference to live independently are positively correlated with living alone, whereas living in a city, having economic independence, being educated, and having poor physical and cognitive functions are associated with lower odd...
We examined whether exposure to urban environments was linked with mortality in a longitudinal su... more We examined whether exposure to urban environments was linked with mortality in a longitudinal survey dataset of nearly 28,000 Chinese adults who were 65 years of age or older in the years 2002–2014. Urban life exposure was measured by residential status at birth, current residential status, and urban-related primary lifetime occupation, which generated eight different categories of urban life exposure: no exposure, mid-life-only exposure, late-life-only exposure, mid-late-life exposure, early-life-only exposure, early-mid-life exposure, early- & late-life exposure, and full life exposure. We also included a measure of migration, whether the respondent lived in the same county/city at birth and at first interview, to further classify these eight categories. Overall, we found that when demographics were controlled for, compared to those with no urban life exposure and no migration, mortality risk was lower for older adults with mid-late life exposure with or without migration and for...
Journal of the American Heart Association, Jan 16, 2017
Prior studies have documented racial and ethnic disparities in hospitalization among patients wit... more Prior studies have documented racial and ethnic disparities in hospitalization among patients with heart failure (HF). However, racial/ethnic differences in trajectories of hospitalization following the diagnosis of HF have not been well characterized. This study examined racial/ethnic differences in individual-level trajectories of hospitalization in older adults with diagnosed HF. Data from a nationally representative prospective cohort of US men and women aged 45 years and older were used to examine the number of hospitalizations reported every 24 months. Participants who were non-Hispanic white, non-Hispanic black, and Hispanic with a reported diagnosis of HF (n=3011) were followed from 1998 to 2014. Results showed a quadratic change in the number of reported hospitalizations following HF diagnosis, with an average of 2.36 (95% confidence interval [CI], 2.19-2.53; P<0.001) hospitalizations within 24 months that decreased by 0.35 (95% CI, -0.45 to -0.25; P<0.001) every 24 m...
ABSTRACT The unmet needs of persons needing long-term care have recently drawn attention in China... more ABSTRACT The unmet needs of persons needing long-term care have recently drawn attention in China, the nation with the world’s largest elderly population. Using national panel data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), we examined the 3-year mortality of 3,089 Chinese adults above the age of 65 years who required long-term care. Long-term care needs were measured by the inability to perform any of the following six activities of daily living for 3 months: eating, dressing, bathing, getting in/out of the bed, indoor transferring, and toileting. Exponential parametric hazard models were used to investigate the association between unmet care needs on subsequent mortality. Results showed that older adults with unmet needs had an approximately 10% increased risk of mortality compared with those whose needs were met when demographics were under control. The risks were particularly elevated among older women and among urban older adults. We conclude by discussing these findings and the importance of a national social insurance program (or additional programs) specialized for the provision of long-term care in China.
American journal of medical research (New York, N.Y.), 2016
This study analyzes the unique datasets of the Chinese Longitudinal Healthy Longevity Survey usin... more This study analyzes the unique datasets of the Chinese Longitudinal Healthy Longevity Survey using logistic regression and controlling for various covariates. Our analyses clearly demonstrate that disabled older parents are more satisfied with care provided by daughters than sons and that older parents enjoy greater filial piety from and better relationships with daughters than sons. The daughter-advantages of enjoying greater filial piety from and better relationships with children are stronger among the oldest-old aged 80+ than the young-old aged 65-79, and surprisingly more profound in rural areas than urban areas, while son-preference is much more prevalent among rural residents. We also discuss why China's rigorous fertility policy until October-2015 and much less-developed pension system in rural areas substantially contribute to sustaining traditional son-preference and a high sex ratio at birth (SRB) when fertility is low. We recommend China take integrative public healt...
Residential status has been linked to numerous determinants of health and well-being. However, th... more Residential status has been linked to numerous determinants of health and well-being. However, the influence of residential status on cognitive decline remains unclear. The purpose of this research was to assess the changes of cognitive function among older adults with different residential status (urban residents, rural-to-urban residents, rural residents, and urban-to-rural residents), over a 12-year period. We used five waves of data (2002, 2005, 2008/2009, 2011/2012, and 2014) from the Chinese Longitudinal Healthy Longevity Survey with 17,333 older adults age 65 and over who were interviewed up to five times. Cognitive function was measured by the Mini Mental State Examination (MMSE). Multilevel models were used regarding the effects of residential status after adjusting for demographic characteristics, socioeconomic factors, family support, health behaviors, and health status. After controlling for covariates, significant differences in cognitive function were found across the ...
Self-perception of uselessness is associated with increased mortality risk in older adults. Howev... more Self-perception of uselessness is associated with increased mortality risk in older adults. However, it is unknown whether and to what extent changes in perceived uselessness are associated with mortality risk. Using four waves of national longitudinal data of older adults from China (2005, 2008, 2011, and 2014), this study examines the association between changes in perceived uselessness and risk of subsequent mortality. Perceived uselessness is classified into three major categories: high levels (always/often), moderate levels (sometimes), and low levels (seldom/never). Five categories are used to measure change over three-year intervals: (1) persistently high levels, (2) increases to moderate/high levels, (3) persistent moderate levels, (4) decreases to moderate/low levels, and (5) persistently low levels. Cox proportional hazard models were used to estimate mortality risk associated with changes in levels of perceived uselessness. Compared to those with persistently low levels o...
Mechanisms of ageing and development, Jan 28, 2016
After a brief introduction to the background, significance and unique features of the centenarian... more After a brief introduction to the background, significance and unique features of the centenarian population in China, we describe the Chinese Longitudinal Healthy Longevity Study (CLHLS), which is the world's largest study of centenarians, nonagenarians, octogenarians, and compatible young-old aged 65-79. Based on the CLHLS data and other relevant studies, we summarize demographic and socioeconomic characteristics as well as self-reported and objectively-tested health indicators of centenarians in China, with an emphasis on gender differences and rural/urban disparities. We then compare five-year-age-specific trajectories of physical and cognitive functions, self-reported health, and life satisfactions from ages 65-69 to 100+, concluding that good psychological resilience and optimism are keys to the exceptional longevity enjoyed by centenarians. We discuss recent findings of novel loci and pathways that are significantly associated with longevity based on the genome-wide assoc...
The journals of gerontology. Series B, Psychological sciences and social sciences, Jan 7, 2016
To investigate subtypes of successful aging (SA) based on concordance and discordance between sel... more To investigate subtypes of successful aging (SA) based on concordance and discordance between self-rated and researcher-defined measures and their associations with demographic, psychosocial, and life satisfaction factors. We used multinomial logistic regression models to analyze 2013 cross-sectional survey data from 1,962 persons aged 65 and older in Shanghai that measured self-rated successful aging (SSA) with a single global assessment and researcher-defined successful aging (RSA) with a cumulative deficit index reflecting physical, physiological, cognitive, psychological, and social engagement domains. We generated four subtypes based on these two dichotomous variables: nonsuccessful aging (non-SA; meeting neither the criterion of RSA nor the criterion of SSA), RSA-only (meeting the criterion of RSA-only but not the criterion of SSA), SSA-only (meeting the criterion of SSA-only but not the criterion of RSA), and both-successful aging (both-SA; meeting both criteria of RSA and SS...
We have presented in the database (in Excel file format) as part of the ProFamy package the race-... more We have presented in the database (in Excel file format) as part of the ProFamy package the race-sex-age-specific o/e rates of marital/union status transitions and race- age-parity-marital status-specific fertility o/e rates in the 1990s, based on a large data set which pools several relevant variables (age, sex, race, events history information on dates of marital/union status changes and births) from
Archives of gerontology and geriatrics, Jan 12, 2016
This study aims to examine the relationship between frailty and life satisfaction and the roles o... more This study aims to examine the relationship between frailty and life satisfaction and the roles of age and social vulnerability underlying the links in Chinese older adults. Using a cross-sectional sample of 1970 adults aged 65 and older in 2013 in Shanghai, we employed regression analyses to investigate the interaction between frailty and age on life satisfaction in the whole sample and in different social vulnerability groups. Life satisfaction was measured using a sum score of satisfaction with thirteen domains. Using a cumulative deficit approach, frailty was constructed from fifty-two variables and social vulnerability was derived from thirty-five variables. Frailty was negatively associated with life satisfaction. The interaction between frailty and age was significant for life satisfaction, such that the negative association between frailty and life satisfaction was stronger among the young-old aged 65-79 than among the old-old aged 80+. Moreover, frailty's stronger assoc...
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