Projecting Long-term Care Costs among Older Adults with ADL Disability and Cognitive Impairment in China.

BACKGROUND: Mounting evidence suggests that cognitive impairment is strongly associated with difficulties in performing activities of daily living (ADL disability). This study aims to estimate and project the trend in the number of older adults in China with ADL disability and cognitive impairment and the associated long-term care (LTC) costs in the next 20 years. METHODS: We used data from 37,942 adults aged ≥ 65 years from waves 2005-2018 of the Chinese Longitudinal Healthy Longevity Surveys (CLHLS). We used the Markov model to simulate the population of China and track the transition of Chinese older adults in the next 20 years between four disability-cognition states. We employed a two-part model to project direct and indirect LTC costs per capita. RESULTS: The proportion of disabled older adults without cognitive impairment (from 4.0% in 2022 to 4.3% in 2040) was projected to be slightly higher than that of those disabled and cognitively impaired (from 3.5% in 2022 to 4.1% in 2040). The indirect LTC cost was projected to increase from 316 billion yuan in 2022 to 4,399 billion yuan in 2040 for disabled older adults with cognitive impairment and from 197 billion yuan in 2022 to 1,697 billion yuan in 2040 for disabled older adults without cognitive impairment. CONCLUSIONS: Policymakers could include the assessment of cognition in the LTC needs assessment and allocate more compensation to LTC insurance participants with cognitive impairment.

Projecting Long-Term Care Costs for Home and Community-Based Services in China from 2005 to 2050.

OBJECTIVES: The aim of this study was to estimate and project the trend in long-term care (LTC) costs for home and community-based services as a percentage of gross domestic product in China between 2005 and 2050. DESIGN: Longitudinal. SETTING AND PARTICIPANTS: We used 61,249 observations from 37,702 adults age ≥65 years from waves 2005, 2008, 2011, 2014, and 2018 of the Chinese Longitudinal Healthy Longevity Surveys. METHODS: LTC costs for home and community-based services consisted of the monetary value of time spent on LTC and the direct LTC cost. We used the age-sex-residence-specific weights provided by the Chinese Longitudinal Healthy Longevity Surveys to estimate the LTC costs from 2005 to 2018. We used a component-based model to project LTC costs, in which the 2-part model was used to estimate the average LTC costs and the multi-state Markov model approach was used to project the future population by age, sex, and disability state. RESULTS: The percentage of older adults with disabilities was projected to increase from 6.1% in 2005 to 7.5% in 2020 and 9.6% in 2050. The total LTC cost for home and community-based services were projected to increase from 0.3% of gross domestic product in 2005 to 0.7% in 2020 and to 6.4% in 2050. CONCLUSIONS AND IMPLICATIONS: Policymakers in China should take urgent actions to delay the onset of disabilities among older adults, which would curb the increasing LTC costs and maintain the sustainability of the LTC policies.

Association between allostatic load and mortality among Chinese older adults: the Chinese Longitudinal Health and Longevity Study.

BACKGROUND: Allostatic load (AL) has shown that high burden of AL is associated with increased risk of adverse outcomes, but little attention has been paid to China with largest ageing population in the world. OBJECTIVE: This study is to examine the association between AL and all-cause mortality among Chinese adults aged at least 60 years. DESIGN: Population-based prospective cohort study. SETTING: In 2011-2012, an ancillary study, in which a blood test was added, including a total of 2439 participants, was conducted in eight longevity areas in the Chinese Longitudinal Healthy Longevity Survey. PARTICIPANTS: The final analytical sample consisted of 1519 participants (mean±SD age: men 80.5±11.3 years; women 90.2±11.8 years and 53% women). PRIMARY OUTCOME MEASURE: Cox models were used to examine the association between AL and mortality among men and women, separately. Analyses were also adjusted for potential confounders including age, ethnicity, education and marital status, smoking and exercise. RESULTS: Male with a medium AL burden (score: 2-4) and high AL burden (score: 5-9) had a 33% and 118% higher hazard of death, respectively, than those with a low AL burden (score: 0-1). We did not find significant difference between females with different levels of AL burden. CONCLUSION: Higher AL burden was associated with increased all-cause mortality among Chinese men aged at least 60 years. However, we did not find strong association among women. In conclusion, Intervention programmes targeting modifiable components of the AL burden may help prolong lifespan for older adults, especially men, in China.

Association between primary caregiver type and mortality among Chinese older adults with disability: a prospective cohort study.

BACKGROUND: Socio-demographic transitions have dramatically changed the traditional family care settings in China, caused unmet care needs among older adults. However, whether different primary caregiver types have different influences on disabled older adults' health outcomes remain poorly understood. We aimed to examine the association between the type of primary caregiver (e.g., spouse and children) and death among community-dwelling Chinese older adults disabled in activities of daily living. METHODS: We used data from Chinese Longitudinal Healthy Longevity Survey. The analytic sample comprised 4278 eligible adults aged ≥ 80 years. We classified primary caregiver type into five categories: spouse, son/daughter-in-law, daughter/son-in-law, grandchildren, and domestic helper. We used Cox regression model to examine the association between primary caregiver type and all-cause mortality. Covariates included age, sex, residence, years of education, co-residence status, financial independence, whether living with children, number of ADL disability, number of chronic conditions, and self-reported health, cognitive impairment, and caregiving quality. RESULTS: Married older adults whose primary caregivers were son/daughter-in-law had a 38% higher hazard of death than those who had spouse as the primary caregiver. Married men who received care primarily from son/daughter-in-law or daughter/son-in-law had a 64 and 68% higher hazard of death, respectively, than those whose primary caregiver was spouse. The association between primary caregiver type and mortality among widowed older adults differed between urban and rural areas. Urban residents who had domestic helpers as the primary caregiver had an 16% lower hazard of death, while those living in rural areas had a 50% higher hazard of death, than those having son/daughter-in-law as the primary caregiver. CONCLUSIONS: The quality of care of the primary caregiver may be a risk factor for mortality of disabled older adults in China. Interventions are necessary for reducing unmet needs and managing care burden.

Prevalence and health correlates of reduced kidney function among community-dwelling Chinese older adults: the China Health and Retirement Longitudinal Study.

OBJECTIVES: We aimed to understand the prevalence of reduced kidney function in China by sociodemographics and geographical region, and to examine health correlates of reduced kidney function. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Participants were 6706 adults ≥60 years from the 2015-2016 wave of the China Health and Retirement Longitudinal Study. OUTCOME MEASURES: Reduced kidney function was defined as an estimated glomerular filtration rate of less than 60 mL/min per 1.73 m². The estimated glomerular filtration rate was calculated with the creatinine-cystatin C equation developed by the Chronic Kidney Disease Epidemiology Collaboration in 2012. The associations between reduced kidney function and potential risk factors were analysed using multivariable regression models. RESULTS: The prevalence of reduced kidney function was 10.3% (95% CI: 9.3% to 11.2%), corresponding to approximately 20 million older adults. Multivariable analysis showed that older adults with hypertension (ß=-3.61, 95% CI: -4.42 to 2.79), cardiac disease (ß=-1.90, 95% CI: -2.93 to 0.86), who had a stroke (ß=-3.75, 95% CI: -6.35 to 1.15), kidney disease (ß=-3.88, 95% CI: -5.62 to 2.13), slow gait speed (ß=-2.23, 95% CI: -3.27 to 1.20), and living in the South (ß=-4.38, 95% CI: -5.95 to 2.80) and South Central (ß=-1.85, 95% CI: -3.15 to 0.56) were more significantly likely to have reduced kidney function. CONCLUSIONS: Kidney function screening should be performed, especially in patients with hypertension, cardiac disease and who had a stroke. More efforts should be paid to improve the kidney function of older adults living in the South and South Central parts of China.

Prevalence and health correlates of anaemia among community-dwelling Chinese older adults: the China Health and Retirement Longitudinal Study.

OBJECTIVES: To identify the prevalence of anaemia among older adults in China by sociodemographic and geographical regions, and cross-sectionally examine the associations between anaemia and several geriatric outcomes. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Participants were 6656 older adults aged at least 60 years with haemoglobin data from the 2015 to 2016 wave of the China Health and Retirement Longitudinal Study. METHODS: We examined the prevalence of anaemia by sociodemographics (age, sex, residence, education, marital status) and geographical regions, adjusting for age. We investigated the associations between anaemia and geriatric conditions. RESULTS: The prevalence of anaemia was 20.6% among adults ≥60 years and was higher at advanced ages, among those who were females, living in rural areas, and those who were unmarried. The southern region of China had a higher burden of anaemia than the north. Anaemic adults had a higher age-adjusted prevalence of falls, activities of daily living (ADL) disability, instrumental ADL disability, lower extremely functional limitation, upper extremely functional limitation, low gait speed, low grip strength and low self-reported memory. CONCLUSIONS: Anaemia affected approximately one in five older adults in China, particularly in those with disadvantaged sociodemographics, and anaemia was associated with a higher burden of geriatric conditions. Huge geographical disparities of anaemia prevalence between northern and southern regions reflected the dietary variations in different regions. Efforts on preventing anaemia and reducing regional disparities of anaemia were needed to improve older adults' health in China.

The Association between Frailty and Healthcare Expenditure among Chinese Older Adults.

OBJECTIVES: The purpose of this study was to examine whether frailty could explain variability in healthcare expenditure beyond multimorbidity and disability among Chinese older adults. DESIGN: Cross-sectional. SETTING AND PARTICIPANTS: Participants were 5300 community-dwelling adults age at least 60 years from the China Health and Retirement Longitudinal Study. METHODS: Frailty was identified by the physical frailty phenotype approach that has been created and validated among Chinese older adults. Five criteria were used: slowness, weakness, exhaustion, inactivity, and shrinking. Persons were classified as "nonfrail" (0 criteria), "prefrail" (1‒2 criteria), or "frail" (3‒5 criteria). Healthcare expenditure was measured based on participants' self-report and was classified into 3 types: outpatient expenditure, inpatient expenditure, and self-treatment expenditure. The association of frailty and healthcare expenditure was analyzed using a 2-part regression model to account for excessive zero expenditures. RESULTS: Frailty was associated with higher odds of incurring outpatient, inpatient, and self-treatment expenditure. Among persons with non-zero expenditure, prefrail and frail persons, on average, had US $30.62 [95% confidence interval (CI) 8.41, 52.82] and US $60.60 (95% CI 5.84, 115.36) higher outpatient expenditure than the nonfrail, adjusting for sociodemographics, multimorbidity, and disability. After adjustment for all covariates, prefrail persons, on average, had US $3.34 (95% CI 0.54, 6.13) higher self-treatment expenditure than the nonfrail. CONCLUSIONS AND IMPLICATIONS: Frailty is an independent predictor of higher healthcare expenditure among older adults. These findings suggest that timely screening and recognition of frailty are important to reduce healthcare expenditure among older adults.

AU-binding factor 1 expression was correlated with metadherin expression and progression of hepatocellular carcinoma.

RNA-binding factor 1 (AUF1) was found to be up-regulated in numerous tumors compared with untransformed tissues. Furthermore, it has been identified to regulate mRNAs en masse in hepatocellular carcinoma (HCC). Metadherin (MTDH) as a novel oncogene also promotes tumor progression and metastasis in HCC. Our study aimed to investigate the correlation between AUF1 and MTDH expressions by immunochemistry in 146 HCC patients from Heilongjiang region. AUF1 expression in HCC tumors was higher than that in the matched normal liver tissues. Particularly, AUF1 overexpression was closely associated with tumor size (P < 0.022), TNM stage (P < 0.003), hepatitis B surface antigen status, and AFP serum levels (P < 0.05). Furthermore, AUF1 overexpression led to poor outcome during 5-year follow-up (P < 0.001). Additionally, AUF1 and MTDH expressions were correlated with each other. Our findings suggest that the AUF1 gene may play an important role in HCC progression and be a novel biomarker in the future.