Health and life satisfaction of ethnic minority older adults in mainland China: effects of financial strain

Functional Disability Among Middle-Aged and Older Adults in China: The Intersecting Roles of Ethnicity, Social Class, and Urban/Rural Residency

This study explores how ethnicity, family income, and education level differentiate patterns of functional limitations among urban and rural Chinese (aged 45 ≥ years). Based on the 2018 China Family Panel Studies (CFPS) (n = 16,589), this nationwide study employed binary/multinomial logistic regression analyses, stratified by urban/rural residency, to estimate the likelihood of instrumental activities of daily living (IADLs) disability (0/1-2/≥3 limitations) by social determinants of health (SDoH). The estimated overall prevalence of IADLs disability was 14.3%. The multivariable analyses did not find significant ethnic disparity in IADLs disability in urban China, while in rural China, ethnic minorities were 44% more likely to have IADLs disability than Han Chinese. Among rural residents, Mongolians, Tibetans, and Yi minority more than tripled the odds of having ≥3 limitations than Han Chinese; and the intersections of ethnicity and social class were associated with functional limitations. Long-term care and anti-poverty programs should target minority aging populations in rural China.

Homeownership, Depression, and Life Satisfaction in China: The Gender and Urban-Rural Disparities

This study examines how depression and life satisfaction are associated with assets in the form of homeownership in China and whether their relationships differ between men and women, and between urban and rural areas. While the psychological benefits of homeownership are well-documented, how gender makes a difference in this relationship remains unclear. Given the dynamic housing market conditions characterized by the urban-rural divide and the notable gender gap in psychological well-being, China can provide a relevant context to address this knowledge gap. A series of linear regression analyses based on the China Family Panel Studies (CFPS) data show that homeownership is positively associated with life satisfaction and negatively related to depression, and this relationship is driven by men. While the homeownership-life satisfaction relation does not differ between urban and rural areas, the negative association between homeownership and depression is seen only among rural residents. The gender difference could be explained by the salient role of the financial security obtained from homeownership, whereas the regional difference seems to be supported by the social comparison theory. This study contributes to the knowledge of how a biological determinant, i.e., gender, interacts with a social determinant, i.e., homeownership, to affect psychological well-being.

Self-Rated Health and Subjective Economic Status in Life Satisfaction among Older Chinese Immigrants: A Cross-Sectional Study

This study examines the influence of self-rated health and subjective economic status on the life satisfaction of older Chinese immigrants in the United States. Data were obtained from a cross-sectional survey of 205 older Chinese immigrants aged 66 to 90 years living in Los Angeles and Honolulu. Ordinary Least Squares (OLS) regression analysis was employed to explore the independent effects of self-rated health and subjective economic status. The results demonstrated that self-rated health and subjective economic status were positively associated with life satisfaction. This cross-sectional study provides empirical evidence that self-rated health and subjective economic status are directly associated with subjective life satisfaction among older Chinese immigrants.

Behavioral factors associated with utilization of healthcare services among elderly in Pakistan: evidence from a nationally representative survey

BACKGROUND

In Pakistan, health system is facing unprecedented challenges to deal with the healthcare demand of the growing ageing population. Using conceptual framework, this study aims to analyze the factors associated with the utilization of healthcare services in private and public hospitals by the elderly population.

METHODS

This study used a sample of 5319 individuals aged 60 and above extracted from the Pakistan Social and Living Standards Measurement Survey 2014-15. We followed the Anderson's Behavioral model of healthcare utilization. The behavioral factors, including predisposing, enabling and need factors, associated with the use of healthcare care were analyzed using exploratory data analysis and binary logistic regressions. The utilization of healthcare service in the study refers to the visits to private and government hospital.

RESULTS

Out of total 5319 participants around three-fourth or 72.4% of participants visited private hospitals for their healthcare needs. Multivariate analysis showed that older age-group (80 years and above) and participants from urban were 1.35 and 1.53 times more likely to avail healthcare service in private hospitals, respectively. The elderly persons from Khyber Pakhtunkhwa were three times (AOR: 3.29, 95%CI 2.5-4.8) more likely to visit government hospitals than their peers in Punjab. Participants who attended school (AOR: 1.21, 95%CI 0.82-1.31) were more likely to utilize healthcare service in private hospitals. Elders from rich (AOR: 1.04, 95%CI 0.84-1.13) and richest (AOR: 1.29, 95%CI 0.89-1.87) wealth quintiles were more likely to use healthcare in private hospitals. The likelihood of the utilization of healthcare service in private hospitals was 1.7 times higher for three or more consulting visits than the single visit, and 1.5 times higher in the public hospital.

CONCLUSIONS

Our findings underscore a dire need for expanding the outreach of healthcare services for the elderly population. It calls for effective implementation of policies which aim at improving equitable access to private healthcare services, and upgrading of government hospitals Moreover, the knowledge generated through this research may be employed to make social protection programs more responsive to age-related healthcare needs, and focused on caregiving for elderly living without spouse.

The Reciprocal Relationship between Instrumental Support from Children and Self-Rated Health among Older Adults over Time in Rural China

Objective: To investigate the dynamic interplay between instrumental support from children and self-rated health (SRH) among older adults over time in rural China. Methods: Data came from a regional representative, longitudinal study The Well-Being of Older People in Anhui Province collected in 2001, 2003, 2006, 2009, and 2012. At baseline, 1636 respondents reported having at least one child. Bivariate latent change score modeling was conducted, and sequential model comparison was used to assess the directionality of the reciprocal association. Results: Older adults who received higher levels of help with household chores from children tended to experience improvement in subsequent SRH, irrespective of gender. There is no evidence to support the influence of SRH on subsequent changes in instrumental support. Discussion: This study sheds light on the sequence of changes between support and health processes using population-based data within a specific sociocultural context.

Social Support and Life Satisfaction of Ethnic Minority Elderly in China

Previous studies indicate that Han and ethnic minority groups in China are not homogeneous. However, little research has examined potential heterogeneity in the association between social support and life satisfaction across Han and ethnic minority elderly. Based on data from the 2014 China Longitudinal Aging Social Survey, this study uses ordered logit models with interaction terms to examine the relationship between social support and the life satisfaction of ethnic minority elderly and of elderly Han Chinese. We find that support from families and friends has a stronger association with the life satisfaction of ethnic minority elderly than their Han peers. For ethnic minority elderly, the patterns of family support varied according to rural or urban residence, with family support being less important to the life satisfaction of ethnic minority elderly living in urban communities than in rural areas. Our findings suggest that social policy should take this heterogeneity between ethnic groups into account.

Chinese Urban Hui Muslims' Access to and Evaluation of Cardiovascular Diseases-Related Health Information from Different Sources

This research aims to identify the sources that urban Hui Muslims access to get health information related to cardiovascular diseases (CVD) and how they evaluate the information from different sources. This paper focuses on health information related to cardiovascular diseases among Hui Muslims. The data was gathered by means of an online survey administered on mobile devices. To put the answers given by Hui Muslims into perspective and make a comparison between Hui Muslims and the Han people, we also gathered information from Han—the dominant group in China. The results showed that Chinese Hui Muslims mostly used mediated sources, while Han people mainly used interpersonal sources. Both Hui Muslims and Han people trusted and preferred health information about cardiovascular diseases provided by health organizations, doctors, and healthcare providers. The information given by religious leaders was trusted the least, although Hui Muslims were significantly more positive about religious authority than the Han people. The current results are relevant for Chinese health information promoters and can help them diffuse CVD health information more effectively to urban Hui Muslims.

Is outpatient care benefit distribution of government healthcare subsidies equitable in rural ethnic minority areas of China? Results from cross-sectional studies in 2010 and 2013

OBJECTIVES

Government healthcare subsidies for healthcare facilities play a significant role in providing more extensive healthcare access to patients, especially poor ones. However, equitable distribution of these subsidies continues to pose a challenge in rural ethnic minority areas of China. This study aimed to evaluate the benefits distribution of outpatient services across different socioeconomic populations in China's rural ethnic minority areas.

SETTING

Inner Mongolia Autonomous Region, Xinjiang Autonomous Region and Qinghai Province.

DESIGN

Two rounds of cross-sectional study.

PARTICIPANTS

One thousand and seventy patients in 2010 and 907 patients in 2013, who sought outpatient services prior to completing the household surveys, were interviewed.

METHODS

Benefits incidence analysis was performed to measure the benefits distribution of government healthcare subsidies across socioeconomic groups. The concentration index (CI) for outpatient care at different healthcare facility levels in rural ethnic minority areas was calculated. Two rounds of household surveys using multistage stratified samples were conducted.

FINDINGS

The overall CI for outpatient care was -0.0146 (P>0.05) in 2010 and -0.0992 (P<0.01) in 2013. In 2010, the CI was -0.0537 (P<0.01), -0.0085 (P>0.05) and -0.0034 (P>0.05) at levels of village clinics (VCs), township health centres (THCs) and county hospitals (CHs), respectively. In 2013, the CI was -0.1353 (P<0.05), -0.0695 (P>0.05) and -0.1633 (P<0.01) at the levels of VCs, THCs and CHs, respectively.

CONCLUSION

Implementation of the gatekeeper mechanism helped improve the benefits distribution of government healthcare subsidies in rural Chinese ethnic minority areas. Equitable distribution of government healthcare subsidies for VCs was improved by increasing financial input and ensuring the performance of primary healthcare facilities. Equitable distribution of subsidies for CHs was improved by policies that rationally guided patients' care-seeking behaviour. In addition, highly qualified physicians were also a key factor in ensuring equitable benefits distribution.

Trajectories of Life Satisfaction and their Predictors among Korean Older Adults

BACKGROUND

Among older adults, life satisfaction (LS) correlates with health, mortality, and successful ageing. As various potential threats to LS tend to increase with advancing years, patterns of age-related changes in LS among older adults remain inconsistent. This study aimed to identify LS trajectories in older adults and the characteristics of individuals who experience them.

METHODS

Large-scale, nationally representative, longitudinal data collected from 2005 to 2013 were analyzed for this study. The outcome measure was a summary of multidimensional domains influencing LS: health, finance, housing, neighbor relationships, and family relationships. Latent class growth models and logistic regression models were used to identify trajectory groups and their predictors, respectively.

RESULTS

Within 3517 individuals aged 65 or older, five trajectories were identified across eight follow-up years: "low-stable" (TG1; n = 282; 8%), "middle-stable" (TG2; n = 1146; 32.6%), "improving" (TG3; n = 75; 2.1%), "upper middle-stable" (TG4; n = 1653; 47%), and "high" (TG5; n = 361; 10.3%). High trajectory individuals more frequently had higher education, financial security, good physical health, and good mental health than those in the stable, but less satisfied, groups. Similarly, compared to the largest group (upper middle-stable trajectory), individuals in the low-stable or middle-stable trajectory group not only had poorer physical and mental health but were more likely to be living alone, financially stressed, and residing in urban locations. Individuals with improving trajectory were younger and in poorer mental health at baseline compared to the upper middle-stable trajectory group.

CONCLUSION

Life satisfaction in the older follows distinct trajectories. For older adults, trajectories are stable over time and predictable, in part, from individual characteristics. Knowledge of these patterns is important for effective policy and program development.

Effect of socio-economic factors in utilization of different healthcare services among older adult men and women in Ghana

BACKGROUND

The older adult population is increasing all over the world. In sub-Saharan Africa, due to poverty and low policy coverage, older adults are not well catered for. The effect of socio-economic inequality in the use of healthcare services among older adult men and women in Ghana was investigated in this paper.

METHODS

The data employed in the study were drawn from Global Ageing and Adult Health survey SAGE Wave 1 Ghana and was based on the design for the World Health Survey 2003, SAGE Wave 0, Ghana. The survey was conducted in 2007-2008 and collected data on socio-economic characteristics and other variables of the 5573 individuals interviewed.

RESULTS

Using generalized logit model, the study found that health status is a very strong determinant of the type of healthcare services preferred by older adults Ghanaians. Men with higher income preferred the private health facilities, while those who completed tertiary education, those with health insurance and those who self-rated their health as very bad, bad or moderate preferred public facility. Self-employed men and those in informal employment, preferred other health facilities outside the formal public health service. Women with primary and secondary education, preferred the private health facilities. Women with health insurance, those in middle and upper class income quintiles or those with self-rated bad and moderate health status or being relatively younger preferred the public facility to other health services. Self-employed women and those in informal employment preferred traditional treatment. In Ghana, there are important socio-economic gradients in the use of some healthcare services. In both sexes, those without insurance and rural residents preferred the pharmacy and traditional treatment.

CONCLUSION

These differences may be due to socio-economic inequities but could also indicate that the existing health facilities are not always used in an optimal way. Patient factors may be equally important as supply factors in explaining the differential use of health services. The public health systems in Ghana still have a major role in improving the health of older adults. National commitments in providing basic essential infrastructure and personnel to health centres for the citizenry is imperative. Policy readjustment of the national health insurance scheme to make it truly accessible to the aged is essential.

Effect of occupational mobility and health status on life satisfaction of Chinese residents of different occupations: logistic diagonal mobility models analysis of cross-sectional data on eight Chinese provinces

Background

Life satisfaction research in China is in development, requiring new perspectives for enrichment. In China, occupational mobility is accompanied by changes in economic liberalization and the emergence of occupational stratification. On the whole, however, occupational mobility has rarely been used as an independent variable. Health status is always used as the observed or dependent variable in studies of the phenomenon and its influencing factors. A research gap still exists for enriching this field.

Methods

The data used in this study were obtained from the China Health and Nutrition Survey (CHNS). The study included nine provinces in China. The survey was conducted from 1989 to 2009.Every survey involved approximately 4400 families or 19,000 individual samples and parts of community data.

Results

First, we built a 5 × 5 social mobility table and calculated life satisfaction of Chinese residents of different occupations in each table. Second, gender, age, marital status, education level, annual income and hukou, health status, occupational mobility were used as independent variables. Lastly, we used logistic diagonal mobility models to analyze the relationship between life satisfaction and the variables. Model 1 was the basic model, which consisted of the standard model and controlled variables and excluded drift variables. Model 2 was the total model, which consisted of all variables of interest in this study. Model 3 was the screening model, which excluded the insignificant drift effect index in Model 2.

Conclusion

From the perspective of the analysis of controlled variables, health conditions, direction, and distance of occupational mobility significantly affected life satisfaction of Chinese residents of different occupations. (1) From the perspective of health status, respondents who have not been sick or injured had better life satisfaction than those who had been sick or injured. (2) From the perspective of occupational mobility direction, the coefficients of occupational mobility in the models are less than 0, which means that upward mobility negatively affects life satisfaction. (3) From the perspective of distance, when analyzing mobility distance in Models 2 and 3, a greater distance indicates better life satisfaction.

Correlates of life satisfaction among older people in China: an examination of two cultural variables

This article examines the relationships between the two cultural variables of having mianzi in social interactions and Chinese cultural beliefs of adversity and life satisfaction among older people in a coastal city in mainland China. The mediating effect of having mianzi in social interactions on the relationship between Chinese cultural beliefs of adversity and life satisfaction is also examined. The study applies a non-probability sampling and adopts a face-to-face interview approach using a questionnaire composed of close-ended questions. A total of 532 valid questionnaires are obtained. Multiple regression analysis is used to test the hypotheses. Findings indicate that the two cultural variables are associated significantly with life satisfaction, while controlling for socio-demographic variables. The variable of Chinese cultural beliefs of adversity is also indirectly associated with life satisfaction through its effect on having mianzi in social interactions. Older people with higher endorsement of positive Chinese cultural beliefs of adversity and higher degree of having mianzi in social interactions tend to have higher life satisfaction. Professionals working with older people should be sensitive to cultural variables that exert impacts on older people's life satisfaction.

Aging well socially through engagement with life: adapting Rowe and Kahn's model of successful aging to Chinese cultural context

Although aging well socially (engagement with life) is as important as aging well personally (illness avoidance and functioning) (Rowe & Kahn, 1998), it has received less research attention. A caring (CE) and a productive (PE) form of engagement were derived from an analysis of Chinese cultural meanings of engagement, and combined with illness avoidance and functioning to form a 4-factor model. Confirmatory factor analysis based on 2970 Hong Kong Chinese (40 to 74 years) showed a good model fit that was replicated a year later with 2120 of the original sample. Further analysis led to a more parsimonious model where illness avoidance and functioning converged into a single second-order factor whereas CE and PE remained as distinct first-order factors. The results supported the differentiation of Rowe and Kahn's engagement with life component into caring and productive engagements.

Economic strain and well-being in late life: findings from an 18-year population-based Longitudinal Study of older Taiwanese adults

BACKGROUND

This study estimates the concurrent and longitudinal effects of perceived economic strain and socioeconomic status (SES) on well-being of older adults in Taiwan.

METHODS

This study uses data from the Taiwan Longitudinal Study on Aging, a nationally representative sample (n= 3602) of older adults aged 60 and above. Participants were interviewed and followed for 18 years. Individual well-being is measured by self-reported life satisfaction, psychological distress and perceived health status. Generalized linear modeling with the generalized estimating equation estimates is used to predict the relationships between perceived economic strain, SES and well-being cross-sectionally and longitudinally, controlling for individual background characteristics, physical health and survival status.

RESULTS

Older adults who experienced economic strain had significantly poorer well-being in comparison to older adults without strain, both cross-sectionally and longitudinally, controlling for SES and other covariates. In contrast, SES indicators did not consistently predict well-being in the cross-sectional and longitudinal analyses.

CONCLUSIONS

These findings suggest a strong, cumulative, negative effect of perceived economic strain on well-being among older adults. Health-care initiatives aiming at promoting well-being among older adults should consider the impact of economic strain, which may increase at the end of the life course and threaten health and functioning.

Examining alternative measures of social disadvantage among Asian Americans: the relevance of economic opportunity, subjective social status, and financial strain for health

Socioeconomic position is often operationalized as education, occupation, and income. However, these measures may not fully capture the process of socioeconomic disadvantage that may be related to morbidity. Economic opportunity, subjective social status, and financial strain may also place individuals at risk for poor health outcomes. Data come from the Asian subsample of the 2003 National Latino and Asian American Study (n = 2095). Regression models were used to examine the associations between economic opportunity, subjective social status, and financial strain and the outcomes of self-rated health, body mass index, and smoking status. Education, occupation, and income were also investigated as correlates of these outcomes. Low correlations were observed between all measures of socioeconomic status. Economic opportunity was robustly negatively associated with poor self-rated health, higher body mass index, and smoking, followed by financial strain, then subjective social status. Findings show that markers of socioeconomic position beyond education, occupation, and income are related to morbidity among Asian Americans. This suggests that potential contributions of social disadvantage to poor health may be understated if only conventional measures are considered among immigrant and minority populations.

Perceived need and actual usage of the family support agreement in rural China: results from a nationally representative survey

PURPOSE

The Family Support Agreement (FSA) is a voluntary but legal contract between older parents and adult children on parental support in China. As the first comprehensive empirical study on the FSA, this study aims to understand the prevalence and covariates of older parents' perceived need and actual use of this agreement.

DESIGN AND METHODS

Using logistic regression analyses, t-tests and chi-square tests, this study analyzed data from a nationally representative sample of 9,587 rural parents aged 60 years and above from the 2006 Sample Survey on Aged Population in Urban/Rural China, which had a 99% response rate.

RESULTS

More than 11% of the subjects regarded the FSA as necessary, and more than 6% have signed it, respectively, representing 160 million and 30.7 million older Chinese. Perceiving the need for the FSA was associated with living arrangement, number of daughters-in-law, care needs, filial piety assessment and concerns, family harmony, sociodemographics, individual characteristics related to rights protection, and the existence of rights protection-related local community organizations. Having signed the FSA was associated with the above last 3 factors, traditional old-age support strategy, and FSA need assessment.

IMPLICATIONS

Individuals regarding the FSA as necessary or using it are characterized by personal, familial, and sociocultural factors that render them more in need of parental support but less likely to receive it. They are also better informed about their rights, are more willing to take actions to protect their rights, and have more exposure to rights protection--related community organizations.