Longitudinal change of intrinsic capacity and associated factors in older Chinese adults: China Health and Retirement Longitudinal Study.

BACKGROUND: Although intrinsic capacity (IC) has been constructed in older populations, whether IC retains the same structure over time has not been formally examined, nor have the factors associated with the changes in IC over time been thoroughly investigated. This study aimed to establish that the structure of IC remains unchanged over time by testing its longitudinal measurement invariance and to investigate factors that influence the longitudinal change of IC over time. METHODS: Data came from 7,271 participants aged 60 and older from the China Health and Retirement Longitudinal Study in 2011 (Wave 1) and 2015 (Wave 3). Bifactor confirmatory factor analysis (CFA) was used to construct IC with its domains, and the longitudinal measurement invariance of IC between Waves was tested. RESULTS: Bifactor CFA fitted the data well at both Waves and showed good construct validity. Partial scalar invariance was supported with non-invariant intercepts for delayed word recall, math, and close vision. Decreases in IC were associated with increasing age, being female (-0.030, 95% CI: -0.045, -0.016), living in rural areas (-0.019, 95% CI: -0.030, -0.009), BMI < 18.5 (-0.019, 95% CI: -0.035, -0.003), and hypertension (-0.012, 95% CI: -0.022, -0.001). Increases in IC were associated with higher education (primary school: 0.012, 95% CI: 0.001, 0.024; lower secondary school: 0.023, 95% CI: 0.005, 0.041) and drinking ≥4/week (0.019, 95% CI: 0.003, 0.034). Stratifying the sample by gender, the protective effect of education was observed only in women. CONCLUSIONS: The bifactor structure of the IC construct was valid and retained its meaning over time. Longitudinal changes in IC were associated with various sociodemographic factors, lifestyle, and health conditions, confirming the need to monitor IC for timely intervention, particularly in those with risk factors for IC decline.

Trajectories of antidepressant use before and after union dissolution and re-partnering in later life: a prospective total population register-based cohort study.

BACKGROUND: Grey divorce and later remarriage have become increasingly common in high-income countries, but previous evidence on their impacts on mental health is scarce. Even less is known about the effects of non-marital separation and re-partnering in later life. METHODS: Using Finnish registry data from 1996 to 2018 on 228 644 individuals aged 50-70 in 2000-2014, trajectories of antidepressant (AD) use 4 years before and 4 years after divorce, non-marital separation, bereavement and subsequent re-partnering were examined using individual fixed-effects (FE) linear probability models. RESULTS: In adjusted FE models, for both genders AD use increased during the 4 years before divorce (men: 5.00 percentage points (95% CI 4.50 to 5.50); women: 6.96 (95% CI 6.34 to 7.59)), non-marital separation (men: 3.20 (95% CI 2.72 to 3.69); women: 5.98 (95% CI 5.30 to 6.66)) and bereavement (men: 4.53 (95% CI 3.97 to 5.09); women: 5.64 (95% CI 5.25 to 6.04)), with the increase accelerating immediately before the event. AD use gradually declined after union dissolution, after which it stabilised on a persistently higher level compared with pre-dissolution. Re-partnering was only associated with a small and transitory reduction in AD use (0.1-1.5 percentage points). The increases in AD use associated with union dissolution were larger in women than in men, whereas the small reductions in AD use associated with re-partnering were particularly short-lived among women. CONCLUSIONS: Our results suggest that union dissolution in later life is associated with large and persistent increases in AD use, whereas the reductions associated with re-partnering are limited both in magnitude and duration.

The influence of social participation and depressive symptoms on cognition among middle-aged and older adults.

Background: The global aging phenomenon has raised concerns about the cognitive abilities of older individuals. This study aimed to explore the relationship between social participation, depressive symptoms, and cognitive function among middle-aged and older adults. Methods: This study utilized data from the China Longitudinal Study of Health and Retirement (CHARLS) from wave 1 to wave 4. We used linear regression and generalized estimation equations to investigate the correlation between social participation, depressive symptoms, and cognitive function. Moreover, three models were constructed by adjusting covariates, and we used the sobel test and bootstrap method to analyze the mediating effects of depressive symptoms on social activities and cognitive function. Results: The results of both linear regression and generalized estimation equation showed that social participation had a positive correlation with cognitive function (P < 0.05), and the impact of social participation on cognition increased with the number of social activity types. Meanwhile, depressive symptoms had a negative association with cognitive function (P < 0.05). Furthermore, there was no interaction between social participation and depressive symptoms on cognitive function. Finally, after adjusting the model, social participation could affect cognitive function by affecting depressive symptoms (P < 0.05). Conclusion: The study emphasizes the mediating role of depressive symptoms in the relationship between social participation and cognitive function. Notably, no interaction was observed between social participation and depressive symptoms. These findings highlight the potential of active social participation in reducing depressive symptoms and enhancing cognitive function in middle-aged and older adults.

Life Course Socioeconomic Position and Cognitive Aging Trajectories: A Cross-National Cohort Study in China and England.

Background and Objectives: Cross-national research on cognitive aging inequality has largely concentrated on Western countries. It is unclear whether socioeconomic position (SEP) has similar effects on cognitive decline in emerging economies. We compared the association between life course SEP and cognitive function trajectories between China and England, the largest nation under state socialism and one of the oldest capitalist countries. Research Design and Methods: This cross-cohort study examined participants aged 50 years and older from the China Health and Retirement Longitudinal Study (n = 12,832) and the English Longitudinal Study of aging (n = 8,875). Cognition z-scores were derived using comparable measures of memory and time orientation on 4 occasions. Life course SEP was self-reported by participants at baseline. Seven- to 8-year trajectories of cognition z-scores were estimated using latent growth curve modeling. Country- and gender-specific associations between childhood/adolescent deprivation, education, material wealth, and home ownership were evaluated in relation to model intercept (baseline level) and linear slope (annual rate of change) of cognition. Results: After multivariable adjustment, education was positively associated with the greatest differences in baseline cognition across country and gender. Education was further linked to a slower rate of cognitive decline (z-score units per year); but compared with those with low education, Chinese men (b = 0.032) and women (b = 0.065) with high education had significantly slower declines than English men (b = -0.004) and women (b = 0.010) with high education. Discussion and Implications: Despite substantial between-cohort differences in downstream and upstream determinants of dementia, education provided the greatest benefits to cognitive aging in England but particularly in China.

Relationship between social support and 7-year trajectories of cognitive decline: results from the China Health and Retirement Longitudinal Study.

BACKGROUND: Social support is associated with cognitive function at an older age, but how distinct dimensions of social support affect trajectories of cognitive decline in older Chinese adults remains unclear. METHODS: Using longitudinal data (waves 1-4) from the China Health and Retirement Longitudinal Study, 7-year trajectories of cognitive decline by various social support markers, including family support, financial support, public support and perceived support, were estimated using latent growth curve modelling for adults aged 60 and over (N=6795). RESULTS: After adjusting for baseline sociodemographics, behaviours, body mass index and health conditions, all social support markers were associated with baseline cognitive function, except for living with spouse. Participants living with spouse experienced a slower cognitive decline (0.069 per year, 95% CI 0.006, 0.133) than those who were not. A faster cognitive decline was associated with co-residing with children (-0.053 per year, 95% CI -0.104, -0.003), receiving ≥¥5000 from children (-0.095 per year, 95% CI -0.179, -0.011), receiving financial support from others (-0.108 per year, 95% CI -0.208, -0.008) and perceived support (-0.068 per year, 95% CI -0.123, -0.013). When all markers were mutually adjusted for, the associations of living with spouse and receiving financial support from others with cognitive decline disappeared. Stratifying by rural-urban residence, medical insurance and meeting children 1-3 times per month were associated with a slower rate of cognitive decline in urban residents but not in rural residents. CONCLUSION: Overall, our findings confirm that the effects of distinct domains of social support on cognitive decline vary. More equally good social security systems should be established in urban and rural China.

The relationship between psychological conditions and recurrence of benign paroxysmal positional vertigo: a retrospective cohort study.

BACKGROUND: Psychological conditions have been found to be associated with an increased risk of incident benign paroxysmal positional vertigo (BPPV). However, much less is known on whether and how psychological conditions such as anxiety, insomnia and obsessive-compulsive disorder (OCD) affect the recurrence of BPPV. METHODS: A retrospective cohort study of 2,612 outpatients and inpatients diagnosed with BPPV between September 2012 and August 2020. BPPV recurrence was followed up until February 2021. The Cox proportional hazard regression was used to analyze the association between psychological conditions and the risk of the first recurrence. Poisson regression was applied to analyze the association between psychological conditions and the number of recurrences in patients with at least one relapse. RESULTS: During the follow-up, 391 patients had at least one BPPV recurrence. Female BPPV patients were more likely than male patients to experience relapses than male patients, but the characteristics of BPPV recurrence (number of recurrences and duration between recurrences) did not differ between men and women. After adjustment for sex, age and comorbidities, a heightened risk of first BPPV recurrence was found to be associated with anxiety (hazard ratio [HR]: 1.30, 95% confidence interval [CI]: 1.01, 1.68) and OCD (HR: 2.15, 95% CI: 1.31, 3.52). An increased risk of first BPPV recurrence associated with insomnia was only observed in male patients (HR: 2.22, 95% CI: 1.24, 3.98) but not in female patients (HR: 0.91, 95% CI: 0.63, 1.31). None of these psychological conditions were associated with the number of recurrences in patients who experienced recurrence. CONCLUSIONS: The presence of anxiety and OCD increased the risk of first BPPV recurrence, as well as insomnia for male patients. These psychological conditions were not associated with the number of BPPV recurrences. Diagnosis and treatment of these psychological conditions could be a useful strategy to prevent the recurrence of BPPV.

The relationship of income on stroke incidence in Finland and China.

BACKGROUND: Stroke incidence has continued to increase recently in most countries. The roles of individual-level income on the incidence of overall stroke and its subtypes are still unknown, especially in low- and middle-income countries and the cross-national evidence is also limited. We explored the association between individual-level income and stroke incidence in Finland and China. METHODS: Changde Social Health Insurance Database (N=571 843) and Finnish population register (N=4 046 205) data were used to calculate standard stroke incidence rates, which were employed to assess the absolute incidence difference between income quintiles. Cox regression was used to compare income differences in first-ever stroke incidence. RESULTS: The highest income quintile had lower overall and subtype stroke incidence when compared to lower-income quintiles. The relative difference was more evident in hemorrhagic stroke incidence. After adjusting for age and employment status, the disparity of stroke incidence between the lowest and highest income quintiles was high among both men and women and in Finland and China. The disparity was particularly notable among men: in Finland, the hazard ratio (HR) for hemorrhagic stroke was 0.633 [95% confidence interval (95% CI) 0.576-0.696] and HR 0.572 (95% CI 0.540-0.606) for ischemic stroke. The respective figures were HR 0.452 (95% CI 0.276-0.739) and HR 0.633 (95% CI 0.406-0.708) for China. CONCLUSIONS: Individual-level income is related to overall and subtype stroke incidence. Future studies should explore the causal relationship between individual-level income and stroke incidence.

Association Between Alcohol Use Disorders and Dementia in 262,703 Dementia-free Finnish Adults: Is Cardiovascular Disease a Mediator?

BACKGROUND: The possible mediating role of cardiovascular disease (CVD) in the relationship between alcohol use disorders (AUD) and the risk of early-onset (

Pre-existing psychological disorders, diabetes, and pancreatic cancer: A population-based study of 38,952 Finns.

BACKGROUND: It remains unclear how pre-existing depression, anxiety, and diabetes of different durations are associated with the risk of pancreatic cancer, its clinical characteristics, treatment modalities, and subsequent survival. METHODS: From a register-based random sample of Finns residing in Finland at the end of the period 1987-2007, 6492 patients diagnosed with primary pancreatic cancer in 2000-2014, and 32 460 controls matched for birth cohort and sex, were identified. Pre-existing depression, anxiety, and diabetes were ascertained from the records of prescribed medication purchases. Information on pancreatic cancer outcomes was obtained from the Finnish cancer register. Data were analyzed using logistic and Cox regressions. RESULTS: The risk of developing pancreatic cancer was found to be associated with long-term anxiety (treatment started 36 + months before the cancer diagnosis) (odds ratio (OR): 1.13, 95% confidence interval (95%CI): 1.04-1.22) and long-term diabetes (OR 1.72, 95%CI 1.55-1.90), as well as with new-onset (treatment started 0-24 months before the cancer diagnosis) depression (OR 1.59, 95%CI 1.34-1.88), anxiety (OR 1.76, 95%CI 1.50-2.07), and diabetes (OR 3.92, 95%CI 3.44-4.48). However, the effects of these new-onset conditions were driven by cases that began treatment within 3 months before the cancer diagnosis (concomitant period). Patients with long-term depression, anxiety and diabetes and those with new-onset anxiety had a higher risk of not receiving standard treatments. Lower survival was found for pancreatic cancer patients with new-onset depression (hazards ratio (HR) 1.38, 95%CI 1.16-1.64). Survival was not associated with pre-existing anxiety or diabetes. CONCLUSIONS: The associations between pancreatic cancer risk and pre-existing depression and anxiety were mostly driven by concomitant effects. Individuals with diabetes, regardless of duration, should be closely monitored for pancreatic cancer. Pancreatic cancer patients with new-onset depression should be targeted to improve their survival.

Cognitive reserve over life course and 7-year trajectories of cognitive decline: results from China health and retirement longitudinal study.

BACKGROUND: Cognitive reserve (CR) could partly explain the individual heterogeneity in cognitive decline. No study measured CR from a life course perspective and investigated the association between CR and trajectories of cognitive decline in older Chinese adults. METHODS: Data of 6795 Chinese adults aged 60+ from China Health and Retirement Longitudinal Study were used. Global cognition score (0-32) was assessed in all four waves. A life-course CR score was constructed using markers of childhood circumstance, education, highest occupational class, and leisure activities in later life. Latent growth curve modelling (LGCM) was applied to assess the association between CR and trajectories of cognitive decline. RESULTS: For the life-course CR, factor loadings of markers in adulthood and later life were larger than that of markers in childhood. The life-course CR score (ranged between - 2.727 and 6.537, SD: 1.74) was higher in urban Chinese adults (0.75, SD: 1.90) than in rural Chinese adults (- 0.50, SD: 1.43). The unconditional LGCM results showed that urban older Chinese adults had better global cognition at baseline (intercept: 15.010, 95% CI: 14.783, 15.237) and a slower rate of cognitive decline per year (linear slope: -0.394, 95% CI: - 0.508, - 0.281) than their rural counterparts (intercept: 12.144, 95% CI: 11.960, 12.329; linear slope: -0.498, 95% CI: - 0.588, - 0.408). After controlling for all covariates, one-unit higher CR score was associated with 1.615 (95% CI: 1.521, 1.709) and 1.768 (95% CI: 1.659, 1.876) unit higher global cognition at baseline for urban and rural older Chinese adults, respectively. The slower rate of cognitive decline associated with higher CR was more evident in rural residents (slope: 0.083, 95% CI: 0.057, 0.108) than in their urban counterparts (0.054, 95% CI: 0.031, 0.077). CONCLUSIONS: CR was associated with better baseline cognition and slower cognitive decline in Chinese older adults. Although rural residents were disadvantaged in both CR and cognition, the protective effect of CR against cognitive decline was stronger for them than in those who live in urban area.

Four-year trajectories of episodic memory decline in mid-late life by living arrangements: a cross-national comparison between China and England.

BACKGROUND: There is mixed evidence on the association between living arrangements and mid-late life cognition, which may be due to distinct familial arrangements and preferences between populations. To address such heterogeneity, we assessed these associations in China and England. METHODS: Four-year trajectories of episodic memory scores (0-20, word recall test) by living arrangements (living with partner only, living with partner and children/grandchildren, living with no partner but with children/grandchildren, and living alone) were estimated using latent growth curve modelling for men and women aged 50+ from China (n=12 801) and England (n=10 964). RESULTS: After adjusting for baseline socioeconomic, health behaviours and health covariates, worse baseline memory was found in Chinese adults living with no partner but with children/grandchildren and in Chinese women living with partner and children/grandchildren, compared with those living with partner only. Better baseline memory was associated with living alone in English women. A faster memory decline was found in Chinese men living with no partner but with children/grandchildren (-0.122 word/year, 95% CI -0.213 to -0.031), as well as in English women living with children/grandchildren with (-0.114, 95% CI -0.180 to -0.049) or without (-0.118, 95% CI -0.209 to -0.026) a partner, and those living alone (-0.075, 95% CI -0.127 to -0.024). No differences at baseline nor over follow-up were found between English men in different living arrangements. CONCLUSION: Overall, our findings did not confirm the protective effects of co-residence with children/grandchildren, nor the detrimental effects of living alone on mid-late life cognition in China and England.

Effective control of SARS-CoV-2 transmission in Wanzhou, China.

The effectiveness of control measures to contain coronavirus disease 2019 (COVID-19) in Wanzhou, China was assessed. Epidemiological data were analyzed for 183 confirmed COVID-19 cases and their close contacts from five generations of transmission of severe acute respiratory syndrome coronavirus 2 throughout the entire COVID-19 outbreak in Wanzhou. Approximately 67.2% and 32.8% of cases were symptomatic and asymptomatic, respectively. Asymptomatic and presymptomatic transmission accounted for 75.9% of the total recorded transmission. The reproductive number was 1.64 (95% confidence interval: 1.16-2.40) for G1-to-G2 transmission, decreasing to 0.31-0.39 in later generations, concomitant with implementation of rigorous control measures. Substantially higher infection risk was associated with contact within 5 d after the infectors had been infected, frequent contact and ≥8 h of contact duration. The spread of COVID-19 was effectively controlled in Wanzhou by breaking the transmission chain through social distancing, extensive contact tracing, mass testing and strict quarantine of close contacts.

Childhood adversity and trajectories of multimorbidity in mid-late life: China health and longitudinal retirement study.

BACKGROUND: The association between childhood adversity and an individual's health in later life has been extensively studied in Western societies; however, little is known about this association for the development of multimorbidity in China. METHODS: Three waves (2011-2012, 2013 and 2015) of the China Health and Retirement Longitudinal Study were used for adults aged 45-101 years. Multimorbidity was assessed by the summed scores of self-reported physician diagnoses of 14 chronic diseases. Childhood adversity was measured by the incidence of childhood abuse and neglect, negative caregiver's characteristics and low socioeconomic status. Latent growth curve modelling was used to investigate the trajectory of multimorbidity by childhood adversity. RESULTS: Parental physical abuse was associated with increased number of chronic diseases (intercept: 0.119; 95% CI: 0.033 to 0.205 for men and 0.268: 95% CI: 0.188 to 0.348 for women) and a higher rate of increase (slope: 0.013: 95% CI: 0.000 to 0.027 for men and 0.022: 95% CI: 0.008 to 0.036 for women) in multimorbidity. Adequacy of food was associated with a lower number chronic diseases at baseline (men: -0.171: 95% CI: -0.245 to -0.097; women: -0.223: 95% CI: -0.294 to -0.152) and a slower rate of change in multimorbidity (men: -0.015 per year: 95% CI: -0.027 to -0.003; women: -0.012 per year: 95% CI: -0.024 to -0.001). CONCLUSIONS: The results demonstrate that childhood adversity exerts long-lasting effects on multimorbidity among older adults in China. Prevention of childhood maltreatment may delay or even avert the emergence of multimorbidity in later life.

Relationship Between COVID-19 Infection and Risk Perception, Knowledge, Attitude, and Four Nonpharmaceutical Interventions During the Late Period of the COVID-19 Epidemic in China: Online Cross-Sectional Survey of 8158 Adults.

BACKGROUND: So far, there have been no published population studies on the relationship between a COVID-19 infection and public risk perception, information source, knowledge, attitude, and behaviors during the COVID-19 outbreak in China. OBJECTIVE: This study aims to understand the relationships between COVID-19 infection; four personal nonpharmaceutical interventions (NPIs; handwashing, proper coughing habits, social distancing, and mask wearing); and public risk perception, knowledge, attitude, and other social demographic variables. METHODS: An online survey of 8158 Chinese adults between February 22 and March 5, 2020, was conducted. Bivariate associations between categorical variables were examined using Fisher exact test. We also explored the determinants of four NPIs as well as their association with COVID-19 infection using logistic regression. RESULTS: Of 8158 adults included, 57 (0.73%) were infected with COVID-19. The overwhelming majority of respondents showed a positive attitude (n=8094, 99.2%), positive risk perception (n=8146, 99.9%), and high knowledge levels that were among the strongest predictors of the four adopted NPIs (handwashing: n=7895, 96.8%; proper coughing: 5997/6444, 93.1%; social distancing: n=7104/8158, 87.1%; and mask wearing: 5011/5120, 97.9%). There was an increased risk of COVID-19 infection for those who did not wash their hands (2.28% vs 0.65%; risk ratio [RR] 3.53, 95% CI 1.53-8.15; P=.009), did not practice proper coughing (1.79% vs 0.73%; RR 2.44, 95% CI 1.15-5.15; P=.03), did not practice social distancing (1.52% vs 0.58%; RR 2.63, 95% CI 1.48-4.67; P=.002), and did not wear a mask (7.41% vs 0.6%; RR 12.38, 95% CI 5.81-26.36; P<.001). For those who did practice all other three NPIs, wearing a mask was associated with a significantly reduced risk of infection compared to those who did not wear a mask (0.6% vs 16.7%; P=.04). Similarly, for those who did not practice all or part of the other three NPIs, wearing a mask was also associated with a significantly reduced risk of infection. In a penalized logistic regression model including all four NPIs, wearing a mask was the only significant predictor of COVID-19 infection among the four NPIs (odds ratio 7.20, 95% CI 2.24-23.11; P<.001). CONCLUSIONS: We found high levels of risk perception, positive attitude, desirable knowledge, as well as a high level of adopting the four NPIs. The relevant knowledge, risk perception, and attitude were strong predictors of adapting the four NPIs. Mask wearing, among the four personal NPIs, was the most effective protective measure against COVID-19 infection, with added preventive effect among those who practiced all or part of the other three NPIs.

Do multigenerational living arrangements influence depressive symptoms in mid-late life? Cross-national findings from China and England.

BACKGROUND: While living alone predicts depression in diverse ageing populations, the impact of multigenerational living is unclear. This study compared mid-late life depressive symptoms by living arrangements between societies with distinct kinship ties. METHODS: Repeated data on depressive symptoms and living arrangements over 4 years from 16,229 Chinese (age≥45) and 10,403 English adults (age≥50) were analyzed using multilevel mixed-effects logistic regression. Elevated depressive symptoms were identified using the Center for Epidemiological Depression Scale criteria in each study. RESULTS: Higher odds ratios (ORs) of elevated depressive symptoms were found in both Chinese and English adults aged<60 living with no partner but with children/grandchildren, compared to those living with a partner only. These ORs were greater for men (Chinese men: 3.09, 95% confidence interval: 2.00-4.78; English men: 3.44, 1.36-8.72) than for women (Chinese women: 1.77, 1.23-2.56; English women: 2.88, 1.41-3.67), after controlling for socioeconomic position, health behaviors, and health status. This male disadvantage was also observed for English, but not for Chinese, adults aged<60 living alone. For adults aged 60+, the increased odds among those living with no partner but with children/grandchildren and those living alone were smaller in both countries. LIMITATIONS: Bias may exist because depressed participants are more likely to experience divorce or separation prior to baseline. CONCLUSIONS: The relationship between living arrangements and depressive symptoms appears robust and consistent across social contexts, although the mechanisms differ. The protective role of partners in both China and England supports targeting those who do not live with partners to reduce depression.

Childhood adversity and depressive symptoms among middle-aged and older Chinese: results from China health and retirement longitudinal study.

Objectives: A number of studies have established the link between childhood adversity (CA) and depression across the life span. This association can be culturally specific, and it remains unclear whether and how different aspects of CA affect depressive symptoms in later life in non-Western societies.Method: Data were from the China Health and Retirement Longitudinal Study in 2011, 2013, 2014 (Life Event History survey) and 2015 (N = 13,710). Depressive symptoms were measured repeatedly in 2011, 2013, and 2015 using the ten-item Centre for Epidemiologic Studies Depression Scale (CES-D-10). CA was assessed in 2014 by parental physical abuse, maternal emotional neglect, early parental death, parental mental health problems, poor quality of parental relationship, and childhood socioeconomic disadvantage. Multilevel linear models were used to analyse the data.Results: Parental physical abuse was associated with 0.51 (95% confidence interval [CI]: 0.28, 0.74) and 0.59 (95% CI: 0.31, 0.88) higher CES-D-10 scores compared to those without such abuse experience for men and women, respectively. Emotional neglect predicted 0.30 (95% CI: 0.07, 0.51) and 0.33 (95% CI: 0.08, 0.58) higher CES-D-10 scores for men and women. Elevated CES-D-10 scores were also found among men and women whose parents had poor mental health and poor relationship, and those who experienced food inadequacy (men: 0.78, 95% CI: 0.54, 1.01; women: 1.15, 95% CI: 0.90, 1.41). Early parental death nevertheless was not associated with CES-D-10 scores.Conclusion: CA exerts long-term detrimental effects on mental health in mid- and late-life among Chinese adults. The findings are consistent with those from Western societies, except for early parental death.

The relationship between living arrangements and higher use of hospital care at middle and older ages: to what extent do observed and unobserved individual characteristics explain this association?

BACKGROUND: Previous research has shown that certain living arrangements, such as living alone, are associated with worse health at older ages. We assessed the association between living arrangements and hospital care use among middle-aged and older adults, and investigated to what extent observed and unobserved individual characteristics explain this association. METHODS: Longitudinal Finnish registry data for men and women aged 50-89 years were used for the period 1987-2007. The relationship between living arrangements (based on whether an individual lived with a partner, other adults or alone, and whether they lived with minor/adult children) and heavy hospital care use (i.e., having been in hospital for 8 or more days in a year) was studied. First, we applied logistic regression models and linear probability models controlling for observed time-invariant factors (socioeconomic status measured by education, labour force status, and household income; and marital status), and then individual linear probability models with fixed-effects to further account for unobserved time-invariant individual characteristics in the measurement period. Analyses were done separately for 10 year age-groups. RESULTS: In the logistic regression models, men and women who lived alone had higher crude odds of heavy hospital care use than those living only with their partner. These odds ratios were highest for men and women in the youngest age category (50-59 years, 1.72 and 1.36 respectively) and decreased with age. Adjusting for observed time-invariant socioeconomic status attenuated these odds by 14-40%, but adjusting for marital status did not affect the results. Lower odds were observed among adults aged 50-59 years who lived with their partner and (minor or adult) children. But odds were higher for individuals aged 60-79 years who co-resided with their adult children, regardless of whether they lived with a partner. Adjusting for observed time-invariant factors generally did not change these results. After further adjusting for unobserved time-invariant individual characteristics in the individual fixed-effects models, most of these associations largely attenuated or disappeared, particularly for ages 80-89 years. CONCLUSIONS: The association between living arrangements and higher use of hospital care at middle and older ages is largely explained by socioeconomic disadvantage and unobserved time-invariant individual characteristics.