Socioeconomic differences in health among older adults in Mexico

Although the relationship between socioeconomic status (SES) and health is well-established in Western industrialized countries, few studies have examined this association in developing countries, particularly among older cohorts. We use the Mexican Health and Aging Study (MHAS), a nationally representative survey of Mexicans age 50 and older, to investigate the linkages between three indicators of SES (education, income, and wealth) and a set of health outcomes and behaviors in more and less urban areas of Mexico. We consider three measures of current health (self-rated health and two measures of physical functioning) and three behavioral indicators (obesity, smoking, and alcohol consumption). In urban areas, we find patterns similar to those in industrialized countries: higher SES individuals are more likely to report better health than their lower SES counterparts, regardless of the SES measure considered. In contrast, we find few significant SES-health associations in less urban areas. The results for health behaviors are generally similar between the two areas of residence. One exception is the education-obesity relationship. Our results suggest that education is a protective factor for obesity in urban areas and a risk factor in less urban areas. Contrary to patterns in the industrialized world, income is associated with higher rates of obesity, smoking, and excessive alcohol consumption. We also evaluate age and sex differences in the SES-health relationship among older Mexicans. The results suggest that further economic development in Mexico may lead to a widening of socioeconomic inequalities in health. The study also provides insight into why socioeconomic gradients in health are weak among Mexican-Americans and underscores the importance of understanding health inequalities in Latin America for research on Hispanic health patterns in the US.     

中国城市老年人自感健康与社会网络的关系研究

目的探讨中国城市老年人自感健康与社会网络的相关性,为制定有效的老年人健康促进策略提供参考依据。方法利用2008年开展的第四次国家卫生服务调查数据,从社会支持和社会参与两个方面,用最优尺度回归分析评估社会网络对城市老年人自感健康状况的影响。结果中国城市60岁及以上老年人自感健康评分均值为70.96±14.79分,最主要经济来源为自己或配偶的比例为83.53%;每周与邻居交往、参加亲戚朋友聚会、社会聚会和从事力所能及劳动的比例分别为76.08%、25.96%、10.94%和18.31%;对自感健康评分的影响重要性分别为0.039、0.070、0.023和0.022,仅次于身体健康状况。结论社会支持/参与是独立于身体健康状况之外的自感健康的风险因素。社会参与情况对自感健康的影响程度可能超过区域经济水平和来自配偶和子女的支持。社会网络内部不同构成要素对自感健康的影响程度存在差异。     

中国60岁及以上男性老年人参军经历与健康的关联研究

目的  分析中国男性老年人参军经历与其健康状况的关系,以期为今后政策的制定提供借鉴。方法  数据来源于中国家庭追踪调查(China Family Panel Studies, CFPS)2018年的调查数据。研究对象为3 706位≥60岁男性老年人。身体健康由是否患慢性病和自评健康测量,心理健康由流调中心抑郁量表(Center for Epidemiologic Studies Depression Scale, CES-D)测量,认知能力由自评记忆测量。利用Logistic回归分析模型、线性回归分析模型和倾向得分加权方法来分析参军经历与男性老年人健康的关系。结果  调整混杂因素后,在身体健康上,相较于非退役军人,退役军人患慢性病风险增加27%(OR=1.27, 95% CI: 1.01~1.59),自评健康较差的风险增加36%(OR=1.36, 95% CI: 1.09~1.69);在心理健康上,退役军人比非退役军人CES-D总分低0.26分,但差异不具有统计学意义(P=0.244);在认知能力上,相较于非退役军人,退役军人自评记忆较差的风险降低39%(OR=0.61, 95% CI: 0.45~0.82)。倾向得分加权后研究结果保持稳健。结论  男性老年人参军经历与其身体健康负相关而与认知能力正相关,与心理健康的关系不具有统计学意义。     

Trajectory of functional status among older Taiwanese: Gender and age variations

Current findings on gender and age differences in health trajectories in later life are equivocal and largely based upon data derived from Western developed nations. This study examines gender and age variations in the trajectory of functional status among older adults in Taiwan, a non-Western newly industrialized society. Data came from a sample of some 3500 Taiwanese aged 60 and over, initially surveyed in 1989 and subsequently followed in 1993, 1996, 1999, and 2003. Hierarchical linear models with time-varying covariates were employed in depicting the dynamics of functional status across gender and age. Women and the old–old experienced higher levels of disability and rates of increase than their male and young–old counterparts. Moreover, older women bore a disproportionately larger burden of disability. There are therefore significant gender and age variations in the trajectory of functional status among older Taiwanese. These findings provide evidence for the generalizability of prior observations to a non-Western society.     

Health inputs and cumulative health deficits among the older Chinese

Using a health economics framework, we examined how both individual level investments at different life stages and current community-level environmental factors affect individual health stock and flows at old ages. We used a nationwide dataset from the 2002 and 2005 waves of the Chinese Longitudinal Healthy Longevity Survey, which included more than 15,000 adults aged 65 and older from 22 provinces in mainland China. We measured health stock with a cumulative health deficit index, a measure developed in geriatrics and gerontology that reflects deficits, illnesses, and functional impairment in numerous domains of health. The cumulative health deficit index has not been used in health economics before, but is a significant contribution because it captures the health stock concept very well and overcomes the problems of inconsistency resulting from the use of different measures of health stock in research. Our results show that several proxy measures for individual health investments in both childhood (nutritional status and parental survival status) and adulthood (family financial condition and access to healthcare) yielded positive returns to health stock measured by the cumulative health deficit index. Investments in social connections and healthy behaviors (religious involvement, alcohol use, and exercise) also produced positive returns in health stock. Current community-level factors such as air quality and labor force participation rate were significantly associated with levels of health deficits in old age as well. Yet, most of these individual investment and community environment variables did not significantly affect short-term health flows (improvement or deterioration in health status over three years). Our findings have important implications for developing preventive health programs in the context of population aging by focusing on policy-relevant predictors and a comprehensive indicator of health status in later life.     

健康本源学视角下心理一致感与老年心理健康关系研究的现状

随着人均期望寿命的提高, 提高老年人的幸福感和心理健康水平成为应对老龄化的重要方向。在众多心理健康促进理论中, 新兴的健康本源学理论受到学界关注。其从个体应对压力及刺激能力的角度去解释健康到疾病的发展过程, 强调如何利用资源增强该应对能力, 从而提高心理健康水平。本文通过整合国内外有关健康本源学的核心构件(心理一致感, 一般抗性资源)与心理健康关系的定量研究的文献, 归纳心理一致感、一般抗性资源对老年心理健康的关联性及影响路径, 为分析老年心理健康发展机制和制定干预策略提供研究基础。     

合肥市社区老年人久坐类型与抑郁关系的性别差异研究

目的 调查社区老年人久坐类型现状,分析不同类型久坐行为与抑郁的关系,并探讨两者之间关系在性别方面的差异。方法 自2021年11月至2022年4月,便利抽样法选择安徽省合肥市某3所社区的648名老年人为调查对象;采用量表的形式调查老年人的久坐类型及抑郁情况;使用二分类logistics回归分析探讨不同性别间久坐类型对抑郁的影响。结果 社区老年人每日总久坐时长为(6.05±1.43) h,被动思维久坐时长为(3.68±1.96) h,主动思维久坐时长为(2.36±1.61) h。主动思维久坐时长和被动思维久坐时长存在性别差异(P<0.05)。二分类logistics回归结果发现被动思维久坐会增加老年男性(OR=1.780,95%CI:1.392～2.277)和老年女性(OR=1.629,95%CI:1.377～1.927)抑郁的患病风险;而主动思维久坐会减少老年女性(OR=0.810,95%CI:0.678～0.968)抑郁的患病风险(P<0.05)。结论 社区老年人久坐类型以被动思维久坐为主;被动思维久坐延长与老年群体抑郁患病的上升有关,而主动思维久坐延长与老年女性抑郁患病的...     

Disability in instrumental activities of daily living among older adults: gender differences

OBJECTIVE

To analyze gender differences in the incidence and determinants of disability regarding instrumental activities of daily living among older adults.

METHODS

The data were extracted from the Saúde, Bem-Estar e Envelhecimento (SABE – Health, Wellbeing and Ageing) study. In 2000, 1,034 older adults without difficulty in regarding instrumental activities of daily living were selected. The following characteristics were evaluated at the baseline: sociodemographic and behavioral variables, health status, falls, fractures, hospitalizations, depressive symptoms, cognition, strength, mobility, balance and perception of vision and hearing. Instrumental activities of daily living such as shopping and managing own money and medication, using transportation and using the telephone were reassessed in 2006, with incident cases of disability considered as the outcome.

RESULTS

The incidence density of disability in instrumental activities of daily living was 44.7/1,000 person/years for women and 25.2/1,000 person/years for men. The incidence rate ratio between women and men was 1.77 (95%CI 1.75;1.80). After controlling for socioeconomic status and clinical conditions, the incidence rate ratio was 1.81 (95%CI 1.77;1.84), demonstrating that women with chronic disease and greater social vulnerability have a greater incidence density of disability in instrumental activities of daily living. The following were determinants of the incidence of disability: age ≥ 80 and worse perception of hearing in both genders; stroke in men; and being aged 70 to 79 in women. Better cognitive performance was a protective factor in both genders and better balance was a protective factor in women.

CONCLUSIONS

The higher incidence density of disability in older women remained even after controlling for adverse social and clinical conditions. In addition to age, poorer cognitive performance and conditions that adversely affect communication disable both genders. Acute events, such as a stroke, disables elderly men more, whereas early deficits regarding balance disable women more.     

Disability and self-rated health among older women and men in rural Guatemala: The role of obesity and chronic conditions

Unprecedented population aging in poorer settings is coinciding with the rapid spread of obesity and other chronic conditions. These conditions predict disability and poor self-rated health and often are more prevalent in women than men. Thus, gender gaps in obesity and other chronic conditions may account for older women’s greater disability and worse self-rated health in poor, rural populations, where aging, obesity, and chronic conditions are rapidly emerging. In a survey of 604 adults 50 years and older in rural Guatemala, we assessed whether gender gaps in obesity and other chronic conditions accounted for gender gaps in disability and self-rated health. Obesity strongly predicted gross mobility (GM) disability, and the number of chronic conditions strongly predicted all outcomes, especially in women. Controlling for gender gaps in body-mass index (BMI) and especially the number of chronic conditions eliminated gender gaps in GM disability, and controlling for gender gaps in the number of chronic conditions eliminated gender gaps in self-rated health. We recommend conducting longitudinal cohort studies to explore interventions that may mitigate adult obesity and chronic conditions among poor, rural older adults. Such interventions also may reduce gender gaps in later-life disability and self-rated health.     

Older adult social participation and its relationship with health: Rural-urban differences

In an aging world, there is increased need to identify places and characteristics of places that promote health among older adults. This study examines whether there are rural-urban differences in older adult social participation and its relationship with health. Using the 2003 and 2011 waves of the Wisconsin Longitudinal Study (n=3006), I find that older adults living in rural counties are less socially active than their counterparts in more-urban counties. I also find that relationships between social participation and health vary by the type of activity and rural-urban context.     

Income inequality, social capital and self-rated health and dental status in older Japanese

The erosion of social capital in more unequal societies is one mechanism for the association between income inequality and health. However, there are relatively few multi-level studies on the relation between income inequality, social capital and health outcomes. Existing studies have not used different types of health outcomes, such as dental status, a life-course measure of dental disease reflecting physical function in older adults, and self-rated health, which reflects current health status. The objective of this study was to assess whether individual and community social capital attenuated the associations between income inequality and two disparate health outcomes, self-rated health and dental status in Japan. Self-administered questionnaires were mailed to subjects in an ongoing Japanese prospective cohort study, the Aichi Gerontological Evaluation Study Project in 2003. Responses in Aichi, Japan, obtained from 5715 subjects and 3451 were included in the final analysis. The Gini coefficient was used as a measure of income inequality. Trust and volunteering were used as cognitive and structural individual-level social capital measures. Rates of subjects reporting mistrust and non-volunteering in each local district were used as cognitive and structural community-level social capital variables respectively. The covariates were sex, age, marital status, education, individual- and community-level equivalent income and smoking status. Dichotomized responses of self-rated health and number of remaining teeth were used as outcomes in multi-level logistic regression models. Income inequality was significantly associated with poor dental status and marginally significantly associated with poor self-rated health. Community-level structural social capital attenuated the covariate-adjusted odds ratio of income inequality for self-rated health by 16% whereas the association between income inequality and dental status was not substantially changed by any social capital variables. Social capital partially accounted for the association between income inequality and self-rated health but did not affect the strong association of income inequality and dental status.     

Knowledge,attitudes and practices related to the influenza virus and vaccine among older adults in Eastern China

BackgroundThis study aims to assess the association between socio-demographic and health characteristics of older adults in Eastern China and knowledge, attitudes, and practices (KAP) about the influenza virus and vaccine.MethodsA prospective cohort of 1506 older adults (aged ≥60 years) was enrolled from November to December 2015 in Jiangsu Province. We examined the association between demographics, health and functional status, and cognitive impairment at enrollment with awareness of influenza virus and vaccine and KAP items focused on five Health Belief Model domains. At a 12-month follow-up interview we assessed change in awareness and readiness to be vaccinated.ResultsOne in five older adults was aware of the influenza virus (21%) or vaccine (20%); even fewer reported having at least “a little” knowledge of the virus and vaccine (7% and 4%, respectively); less than 1% reported ever receiving an influenza vaccine. Retirement, higher education and income, and normal cognitive status were consistently associated with both awareness and knowledge of influenza virus. The odds of having at least “a little” knowledge of the vaccine was 2.9-fold (95% CI = 1.6–5.3) higher among older adults with at least some secondary schooling. Among the 108 with knowledge of the virus, 55% said they “worry about getting the flu this season.” Among the 73 with knowledge of the vaccine, 92% believed the vaccine was at least somewhat effective and less than half (43%) thought that influenza vaccination was safe. At a 12-month follow-up interview, 33% (442/1333) increased from no knowledge to at least “a little”.ConclusionsIf and when influenza vaccines become widely available to older adults in China, our results indicate that influenza vaccination campaigns with basic information on the virus and vaccine could be beneficial for all older adults, especially those with less education and/or more cognitive impairment.     

Self-rated health disparities among disadvantaged older adults in ethnically diverse urban neighborhoods in a Middle Eastern country

Objectives: This paper examines differentials in self-rated health (SRH) among older adults (aged 60+ years) across three impoverished and ethnically diverse neighborhoods in post-conflict Lebanon and assesses whether variations are explained by social and economic factors.

Design: Data were drawn from the Older Adult Component (n?=?740) of the Urban Health Survey, a population-based cross-sectional study conducted in 2003 in a formal community (Nabaa), an informal settlement (Hey El-Sellom), and a refugee camp for Palestinians (Burj El-Barajneh) in Beirut, Lebanon. The role of the social capital and economic security constructs in offsetting poor SRH was assessed using multivariate ordinal logistic regression analyses.

Results: Older adults in Nabaa fared better in SRH compared to those in Hey El-Sellom and Burj El-Barajneh, with a prevalence of good, average, and poor SRH being respectively, 41.5%, 37.0%, and 21.5% in Nabaa, 33.3%, 23.9%, and 42.7% in Hey El-Sellom, and 25.2%, 31.3%, and 43.5% in Burj El-Barajneh. The economic security construct attenuated the odds of poorer SRH in Burj El-Barajneh as compared to Nabaa from 2.57 (95% confidence interval, CI: 1.89–3.79) to 1.42 (95% CI: 0.96–2.08), but had no impact on this association in Hey El-Sellom (odds ratio, OR: 2.12, 95% CI: 1.39–3.24). The incorporation of the social capital construct in the fully adjusted model rendered this association insignificant in Hey El-Sellom (OR: 1.49, 95% CI: 0.96–2.32), and led to further reductions in the magnitude of the association in Burj El-Barajneh camp (OR: 1.18, 95% CI: 0.80–1.76).

Conclusions: The social context in which older adults live and their financial security are key in explaining disparities in SRH in marginalized communities. Social capital and economic security, often overlooked in policy and public health interventions, need to be integrated in dimensions of well-being of older adults, especially in post-conflict settings.     

Perceived social position and health in older adults in Taiwan

We examined whether perceived social position predicted mental and physical health outcomes (depressive symptoms, cognitive impairment, mobility restrictions, and self-assessed health) in a prospective study based on a nationally representative sample of older persons in Taiwan. Cross-sectional and longitudinal models were used to demonstrate the relationship between perceived social position and health, as reported by participants in the Social Environment and Biomarkers of Aging Study in Taiwan (SEBAS). Lower perceived social position predicted declining health beyond what was accounted for by objective indicators of socioeconomic position. As predicted, the effect was substantially reduced for all health outcomes in the presence of controls for baseline health. After including these controls, perceived social position was significantly related only to depressive symptoms. The findings suggest that the strength of the association between perceived social position and health may have been overstated in cross-sectional studies.     

A multi-level analysis of urban/rural and socioeconomic differences in functional health status transition among older Chinese

The main purpose of the study is to assess urban versus rural differences in functional status transitions among older Chinese, aged 55+, and to examine how individual and community level socioeconomic indicators alter the rural/urban effects and themselves influence transitions. The study uses a hierarchical linear modeling approach that considers individual responses to be embedded within communities. Data come from the 2004 and 2006 rounds of the Chinese Health and Nutrition Survey. The study considers the functional transitions of 2944 individuals living across 209 communities in nine Chinese provinces. Functioning is measured at baseline as being able or not being able to conduct all of the following: walking, standing, climbing stairs, lifting, kneeling. Outcomes include having or not having a functional limitation, measured the same way, dying, or not responding. Outcomes are modeled adjusted for baseline functional status. Findings indicate urbanites have substantial advantages. They are less likely to have a limitation at follow-up and less likely to die over the study period. Some of this is explained by socioeconomic indicators measured at two levels. Cross-level interactions suggest education and having insurance operate differently in urban and rural areas. Community-level indicators are somewhat less predictive, and much of the urban advantage is unexplained. In conclusion, the study suggests differences in the influences of socioeconomic indicators in China versus what has been found in the past, and that place of residence in China is a particularly robust predictor of functional health transitions.     

Socioeconomic influences at different life stages on health in Guangzhou, China

In long-term developed countries socioeconomic position across the life course is positively associated with health. We examined these associations in a developing country with a history of efforts to reorganize the social hierarchy. Taking a life course perspective, we used multi-variable logistic regression to assess the association of socioeconomic disadvantage at four life stages (measured by parental possessions, education, longest-held occupation and current household income) with self-rated health, chronic obstructive pulmonary disease (COPD) and metabolic syndrome in 20,086 Chinese adults aged ≥50 years from the Guangzhou Biobank Cohort Study (2005-2008). Model comparisons were used to determine whether the number of exposures to disadvantage (accumulation of risk) was more important than the life stage of exposure (critical periods). Socioeconomic disadvantage across the life course was associated with poor self-rated health, COPD and, in women only, with metabolic syndrome. Adjusting for adult health-related behavior (smoking, alcohol use and physical exercise) altered these associations very little. Associations between socioeconomic disadvantage and health in this Southern Chinese population were broadly similar to those found in Western countries in terms of the accumulation of disadvantage across the life course. However, longest-held occupation was not independently associated with adult health and socioeconomic disadvantage was not associated with metabolic syndrome in men. This suggests that the mechanisms linking socioeconomic position to health in China may be different from those in Western populations and may require context-specific policy interventions.     

中国老年人多病共存情况下肥胖状态与死亡关系的队列研究

目的:探索不同多病共存状态下,中国老年人肥胖状态与死亡的关系。方法:采用2011-2018年中国老年人健康长寿影响因素调查数据,纳入基线≥65岁的老年人为研究对象,利用探索性因子分析探索多病共存模式,分别基于基线疾病数量和多病共存模式定义研究对象的多病共存状态。肥胖状态采用基线BMI和腰围进行定义分组。采用Cox比例风...