Effects of multimorbidity coexistence on the risk of mortality in the older adult population in China.

Background: Multimorbidity coexistence is a serious public health issue affecting a significant number of older adults worldwide. However, associations between multimorbidity and mortality are rarely studied in China. We assessed the effects of multimorbidity coexistence on mortality among a nationwide sample of older adults from China. Objective: We analyzed 10-year (2008-2018) longitudinal data of 12,337 individuals who took part in China, a nationwide survey of people aged 65 years and above. We used the Cox proportional hazard model to determine the effects of multimorbidity on the all-cause mortality risk. We also examined mortality risk between sex and age obtained through differential analysis. Results: At baseline, 30.2, 29.9, and 39.9% of participants had 0, 1, and 2 or more diseases, respectively. The cumulative follow-up of this study was 27,428 person-years (median follow-up = 2.7 years; range, 0.01-11.3 years), with 8297 deaths. The HRs (95% CIs) for all-cause mortality in participants with 1, and 2 or more conditions compared with those with none were 1.04 (0.98, 1.10) and 1.12 (1.06, 1.18), respectively. The heterogeneity analysis indicated that, the mortality risk for 80-94 years and 95-104 years group with multimorbidity coexistence is 1.12 (1.05-1.21) and 1.11 (1.01-1.23), respectively, but the mortality risk for 65-79 years group with multimorbidity coexistence was not statistically significant. The heterogeneity analysis indicated that, the mortality risk for men and women in older adults with multimorbidity coexistence is 1.15 (1.06, 1.25) and 1.08 (1.01, 1.17), respectively. Conclusion: Multimorbidity coexistence is associated with an increase in an increased risk of death in older individuals, with the effect being relatively significant in those aged 80-94 years.

Are there gender differences in the trajectories of self-rated health among chinese older adults? an analysis of the Chinese Longitudinal Healthy Longevity Survey (CLHLS).

BACKGROUND: Self-rated health (SRH) is a good predictor of morbidity and mortality. Extensive research has shown that females generally report poorer SRH than males but still tend to live longer. Previous studies used cross-sectional or pooled data for their analyses while ignoring the dynamic changes in males' and females' SRH statuses over time. Furthermore, longitudinal studies, especially those that focus on older adults, typically suffer from the incompleteness of data. As such, the effect of dropout data on the trajectories of SRH is still unknown. Our objective is to examine whether there are any gender differences in the trajectories of SRH statuses in Chinese older adults. METHODS: The trajectories of SRH were estimated using the pattern-mixture model (PMM), a special latent growth model, under non-ignorable dropout data assumption. We analyzed the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data of 15,613 older adults aged 65 years and above, collected from 2005 to 2014. RESULTS: The results demonstrated the effect of non-ignorable dropout data assumptions in this study. The previous SRH score was negatively associated with the likelihood of dropping out of the study at the next follow-up survey. Our results showed that both males and females in China perceive their SRH as decreasing over time. A significant gender difference was found in the average SRH score (female SRH was lower than male SRH) in this study. Nonetheless, based on the results obtained using the PMM, there are no gender differences in the trajectories of SRH at baseline as well as in the rate of decline among the total sample. The results also show that males and females respond to SRH predictors similarly, except that current drinking has a more pronounced positive effect on males and healthcare accessibility has a more pronounced positive effect on females. CONCLUSIONS: Our results suggest that missing data have an impact on the trajectory of SRH among Chinese older adults. Under the non-ignorable dropout data assumptions, no gender differences were found in trajectories of SRH among Chinese older adults. Males and females respond to SRH predictors similarly, except for current drinking habit and healthcare accessibility.

Longitudinal association between home and community-based services provision and cognitive function in Chinese older adults: Evidence from the Chinese Longitudinal Healthy Longevity Survey.

Few studies have assessed the impact of home and community-based services (HCBSs) provision on cognitive function among older adults over time. This study examined the longitudinal association between HCBSs provision and cognitive function in Chinese older adults. The study included 5,134 participants aged 65 years and older in the Chinese Longitudinal Healthy Longevity Survey from 2008 to 2014. The Mini-Mental State Examination (MMSE) was used to evaluate cognitive function over the same time period. Participants were asked what kind of HCBSs were provided in his or her community. However, they were not asked whether services were utilised. The study used the number of HCBSs provided each wave to represent the strength of HCBSs, and used the MMSE score of each wave to represent the older adults' cognitive function status. A latent growth model was used to explore the relationship between HCBSs provision and cognitive function of older adults. The number of HCBSs provided was positively associated with older adults' cognitive function (2008: ß = 0.03, p = 0.031; 2011: ß = 0.06, p < 0.001; 2014: ß = 0.06, p < 0.001) after controlling for gender, age, residence, education, income, medical insurance, activities of daily living disability, instrumental activities of daily living disability, serious illness, living arrangement and marital status. Results provided longitudinal evidence that an increase in HCBSs provision at a national level can result in better cognitive function in Chinese older adults.

Income-related health inequality of migrant workers in China and its decomposition: An analysis based on the 2012 China Labor-force Dynamics Survey data.

BACKGROUND: Although migrant workers are a vulnerable group in China, they demonstrably contribute to the country's economic growth and prosperity. This study aimed to describe and assess the inequality of migrant worker health in China and its association with socioeconomic determinants. METHODS: The data utilized in this study were obtained from the 2012 China Labor-force Dynamics Survey conducted in 29 Chinese provinces. This study converted the self-rated health of these migrant workers into a general cardinal ill-health score. Determinants associated with migrant worker health included but were not limited to age, marital status, income, and education, among other factors. Concentration index, concentration curve, and decomposition of the concentration index were employed to measure socioeconomic inequality in migrant workers' health. RESULTS: Prorich inequality was found in the health of migrant workers. The concentration index was -0.0866, as a score indicator of ill health. Decomposition of the concentration index revealed that the factors most contributing to the observed inequality were income, followed by gender, age, marital status, and smoking history. CONCLUSION: It is generally known that there is an unequal socioeconomic distribution of migrant worker health in China. In order to reduce the health inequality, the government should make a substantial effort to strengthen policy implementation in improving the income distribution for vulnerable groups. After this investigation, it is apparent that the findings we have made warrant further investigation.