Unveiling health disparities and assessing wellbeing of older adults in China's aging society: The socioeconomic nexus

Abstract

With China's population aging rapidly, the challenge of preserving and enhancing the health of its older citizens has gained paramount importance. Leveraging data from the fourth wave of the China Health and Retirement Longitudinal Study, this study examines the relationship between socioeconomic status and well-being of older adults in the context of China's evolving demographic landscape. Empirical analysis reveals compelling statistical evidence that underscores the significant influence of socioeconomic status on the health outcomes of older adults. Notably, socioeconomic factors such as education level, place of residence, household registration (hukou [戶口]) type, and Communist Party of China membership significantly affect the mental and cognitive well-being of older adults, with a more pronounced impact on mental health. These findings emphasize the need for targeted policies to address disparities and promote holistic well-being as China grapples with an aging population.

Keywords

Older adults / Socioeconomic status / Health disparity / Health inequity / CHARLS / China

Acknowledgments

We thank April Siwon Lee for her contribution to our earlier draft. We are responsible for the published version of the manuscript.

Funding

None.

Conflict of interest

The authors declare no conflict of interest.

Author contributions

Conceptualization: All authors

Format analysis: All authors

Methodology: All authors

Writing - original draft: Kevin Yu-Ching Hsieh

Writing - review & drafting: Rikiya Matsukura

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Availability of data

Data used in this work are available from the fourth wave of the CHARLS (https://charls.pku.edu.cn/en/).

References

[1] Black D., Morris J., Smith C., & Townsend P. (1980). Inequalities in Health:Report of a Research Working Group. London: Department of Health and Social Security.

[2] Bloom D.E., & Williamson J.G. (1998). Demographic transitions and economic miracles in emerging Asia. World Bank Economic Review, 12(3):419-456. https://doi.org/10.1093/wber/12.3.419

[3] Brown B.M., Peiffer J.J., Sohrabi H.R., Mondal A., Gupta V.B.,Rainey-Smith, S.R., et al. ( 2012). Intense physical activity is associated with cognitive performance in the elderly. Translational Psychiatry, 2:e191. https://doi.org/10.1038/tp.2012.118

[4] Cai Y. (2010). China's below-replacement fertility: Government policy or socioeconomic development? Population Devilment Review, 36(3):419-440. https://doi.org/10.1111/j.1728-4457.2010.00341.x

[5] Chen E., & Miller G.E. (2013). Socioeconomic status and health: Mediating and moderating factors. Annual Review of Clinical Psychology, 9:723-749. https://doi.org/10.1146/annurev-clinpsy-050212-185634

[6] Chen E., Matthews K.A., & Boyce W.T. (2002). Socioeconomic differences in children's health: How and why do these relationships change with age? Psychological Bulletin, 128(2):295-329. https://doi.org/10.1037/0033-2909.128.2.295

[7] Cohen S., Janicki-Deverts D., Chen E., & Matthews K.A. (2010). Childhood Socioeconomic status and adult health. Annals of the New York Academy of Sciences, 1186(1):37-55. https://doi.org/10.1111/j.1749-6632.2009.05334.x

[8] Everson-Rose S.A., Skaruoski K.A., Bienias J.L., Wilson R.S., Evans D.A., & Mendes de Leon C.F. (2005). Do depressive symptoms predict declines in physical performance in an elderly, biracial population? Psychosomatic Medicine, 67(4):609-615. https://doi.org/10.1097/01.psy.0000170334.77508.35

[9] Fu H., Si L., & Guo R. (2022). What is the optimal cut-off point of the 10-item center for epidemiologic studies depression scale for screening depression among chinese individuals aged 45 and over? An exploration using latent profile analysis. Frontiers in Psychiatry, 13:820777. https://doi.org/10.3389/fpsyt.2022.820777

[10] Galobardes B., Lynch J.W., & Smith G.D. (2004). Childhood socioeconomic circumstances and cause-specific mortality in adulthood: Systematic review and interpretation. Epidemiologic Reviews, 26(1):7-21. https://doi.org/10.1093/epirev/mxh008

[11] Greenfield E.A., & Moorman S.M. (2019). Childhood socioeconomic status and later life cognition: Evidence from the Wisconsin longitudinal study. Journal of Aging and Health, 31(9):1589-1615. https://doi.org/10.1177/0898264318783489

[12] Groot C., Hooghiemstra A.M., Raijmakers P.G.H.M., Van Berckel B.N.M., Scheltens P., Scherder E.J.A.,Van der Flier, W.M., et al. ( 2016). The effect of physical activity on cognitive function in patients with dementia: A metaanalysis of randomized control trials. Ageing Research Reviews, 25:13-23. https://doi.org/10.1016/j.arr.2015.11.005

[13] Gu D., & Dupre M.E. ( 2008). Assessment of reliability of mortality and morbidity in the 1998- 2002 CLHLS waves. In: Healthy Longevity in China:Demographic, Socioeconomic, and Psychological Dimensions. Dordrecht, Netherlands: Springer Publisher, p. 99-115.

[14] Guralnik J.M., Butterworth S., Wadsworth M.E.J., & Kuh D. (2006). Childhood socioeconomic status predicts physical functioning a half century later. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 61(7):694-701. https://doi.org/10.1093/gerona/61.7.694

[15] Harman D. (1981). The aging process. Proceedings of the National Academy of Sciences, 78(11):7124-7178. https://doi.org/10.1073/pnas.78.11.7124

[16] Hayward M.D., & Gorman B.K. (2004). The long arm of childhood: The influence of early-life social conditions on men's mortality. Demography, 41(1):87-107. https://doi.org/10.1353/dem.2004.0005

[17] Jiang H., Burström B., Chen J., & Burström K. (2021). Ruralurban inequalities in poor self-rated health, self-reported functional disabilities, and depression among Chinese older adults: Evidence from the China health and retirement longitudinal study 2011 and 2015. International Journal of Environmental Research and Public Health, 18(12):6657. https://doi.org/10.3390/ijerph18126557

[18] Jiang Q., & Sánchez-Barricarte J.J. (2011). The 4-2-1 Family structure in China: A survival analysis based on life tables. European Journal of Ageing, 8:119-127. https://doi.org/10.1007/s10433-011-0189-1

[19] Jiang Q., Zhang C., Zhuang Y., Jiang Y., & Zhang X. (2023). Rising trend of childlessness in China: Analysis of social and regional disparities with 2010 and 2020 Census Data. BMJ Open, 13(5):1-12. https://doi.org/10.1136/bmjopen-2022-070553

[20] Lee R., & Mason A. (2010). Fertility, human capital, and economic growth over the demographic transition. European Journal of Population, 26(2):159-182. https://doi.org/10.1007/s10680-009-9186-x

[21] Lee R., & Mason A. (2011). Population Aging and the Generational Economy: A Global Perspective. Cheltenham, Northampton, Ottawa: Edward Elgar and International Development Research Centre.

[22] Link B.G., & Phelan J.C. (1995). Social Conditions as Fundamental Causes of Disease. Journal of Health and Social Behavior, 35:80-94.

[23] Livingston G., Huntley J., Sommerlad A., Ames D., Ballard C., & Banerjee S., et al. (2020). Dementia prevention, intervention, and care:2020 report of the lancet commission. The Lancet, 396:413-446. https://doi.org/10.1016/S0140-6736(20)30367-6

[24] Livingston G., Sommerlad A., Orgeta V., Costafreda S.G., Huntley J.,Ames, D., et al. ( 2017). Dementia prevention, intervention, and care. The Lancet, 390:2673-2734. https://doi.org/10.1016/S0140-6736(17)31363-6

[25] Lowry D., & Xie, Y. ( 2009). Socioeconomic Status and Health Differentials in China: Convergence or Divergence at Older Ages? Population Studies Research Center Report 09-690. Michigan: University of Michigan.

[26] Lynch, J.W., Kaplan, G.A., Cohen, R.D., Kauhanen, J., Wilson, T.W., & Smith, N.L., et al. (1994). Childhood and adult socioeconomic status as predictors of mortality in Finland. The Lancet, 343:524-527. https://doi.org/10.1016/s0140-6736(94)91468-0

[27] Marin, M.F., Lord, C., Andrews, J., Juster, R.P., Sindi, S., Arsenault-Lapierre, G., et al. (2011). Chronic stress, cognitive functioning and mental health. Neurobiology of Learning and Memory, 96(4):583-595. https://doi.org/10.1016/j.nlm.2011.02.016

[28] McAuley, E., Blissmer, B., Marquez, D.X., Jerome, G.J., Kramer, A.F., & Katula, J. (2000). Social relations, physical activity, and well-being in older adults. Preventive Medicine, 31(5):608-617. https://doi.org/10.1006/pmed.2000.0740

[29] Milanović Z., Pantelić S., Trajković N., Sporiš G., Kostić R., & James, N. (2013). Age-related decrease in physical activity and functional fitness among elderly men and women. Clinical Interventions in Aging, 8:549-556. https://doi.org/10.2147/CIA.S44112

[30] Schuch, F.B., Vancampfort, D., Firth, J., Rosenbaum, S., Ward, P.B., Silva, E.S., et al. (2018). Physical activity and incident depression: A meta-analysis of prospective cohort studies. American Journal of Psychiatry, 175(7):587-685. https://doi.org/10.1176/appi.ajp.2018.17111194

[31] United Nations. (1956). The Aging of Populations and its Economic and Social Implications. Population Studies No. 26. New York: United Nations.

[32] United Nations. (2013). National Transfer Accounts Manual: Measuring and Analyzing the Generational Economy. New York: United Nations. https://ntaccounts.org/web/nta/show/Methodology

[33] Van de Mheen, H., Stronks, K., Looman, C.W., Mackenbach, J.P., et al. (1998). Does Childhood Socioeconomic Status Influence Adult Health through Behavioural Factors? International Journal of Epidemiology, 27(3):431-437. https://doi.org/10.1093/ije/27.3.431

[34] Van den Berg, G.J., Deeg, D.J.H., Lindeboom, M., & Portrait, F. (2010). The role of early-life conditions in the cognitive decline due to adverse events later in life. The Economic Journal, 120(548):411-428. https://doi.org/10.1111/j.1468-0297.2010.02396.x

[35] Van Gelder, B.M., Tijhuis, M.A.R., Kalmijn, S., Giampaoli, S., Nissinen, A., & Kromhout, D. (2004). Physical activity in relation to cognitive decline in elderly men. Neurology, 63(12):2316-2321. https://doi.org/10.1212/01.wnl.0000147474.29994.35

[36] Wallace, J., & O'Hara, M.W. (1992). Increases in depressive symptomatology in the rural elderly: Results from a crosssectional and longitudinal study. Journal of Abnormal Psychology, 101(3):398-404. https://doi.org/10.1037//0021-843x.101.3.398

[37] Williams, D.R. (1990). Socioeconomic differentials in health: A review and redirection. Social Psychology Quarterly, 53(2):81-99. https://doi.org/10.2307/2786672

[38] Wu, C. (1991). The Aging of Population in China. The International Institute on Aging. Malta: United Nations.

[39] Zeng, Y., Gu, D., & Land K.C. (2007). The association of childhood socioeconomic conditions with healthy longevity at the oldest-old ages in China. Demography, 44(3):497-518. https://doi.org/10.1353/dem.2007.0033

[40] Zhao, Y., Hu, Y., Smith J., Strauss J., & Yang, G. (2014). Cohort Profile: The China Health and Retirement Longitudinal Study (CHARLS). International Journal of Epidemiology, 43(1):61-68. https://doi.org/10.1093/ije/dys203

[41] Zhu, H., & Xie, Y. (2007). Socioeconomic differentials in mortality among the oldest old in China. Research on Aging, 29(2):125-143. https://doi.org/10.1177/0164027506296758