The Role of Childhood Circumstances in Healthy Aging Inequalities Among Older Adults - China, 2011-2020.

What is already known about this topic?: Addressing health disparities is a worldwide priority, with a well-established acknowledgment of the influence of childhood circumstances on these discrepancies. In China, particularly among the elderly, health inequalities are a notable concern. What is added by this report?: The inequality in healthy aging has increased from 2011 to 2020, both in general and concerning childhood factors. Nevertheless, the impact of early-life healthcare access and parental health behaviors on healthy aging gaps has reduced among older adults in better health within the top segment of healthy aging. What are the implications for public health practice?: Efforts towards reducing regional health disparities and improving healthcare access for children, along with promoting the health and well-being of parents, especially in economically disadvantaged households, are crucial policy considerations.

Income-related health inequality in urban China (1991-2015): The role of homeownership and housing conditions.

Unprecedented economic growth has been experienced over the several decades worldwide, but such rapid economic growth wasn't accompanied by equally-substantial improvement in health, especially health inequalities between the rich and poor. This study examines the role of housing in income-related health inequalities (income-health gradient) in urban China. We here analyze 1991-2015 China Health and Nutrition Survey data to ask how housing affects income-related health inequalities in urban China. We find pro-poor inequalities in self-reported bad health but pro-rich inequalities in objective bad health (general overweight/obesity, central obesity and high blood pressure). Housing conditions serve to reduce the health gradient, especially for objective health. On the contrary, homeownership exacerbates the health gradient. Improving housing conditions thus appears to be an effective way of reducing the income-health gradient in urban China.

Housing Poverty and Healthy Aging in China: Evidence from the China Health and Retirement Longitudinal Study.

BACKGROUND: Although prior research on the housing-health linkage suggested that those with poor housing conditions are more likely to report poor health, it is dominated by Western studies and offers little evidence on the housing-health relation in China. Scarce is empirical evidence on the potentially detrimental impact of either qualitative or quantitative housing poverty on health outcomes, especially for seniors in China. This paper aims to fill this void by using data from the 2011-2015 China Health and Retirement Longitudinal Study (CHARLS) to provide a comprehensive analysis of the demographic, socioeconomic, and behavioral factors that contribute to changes in healthy aging among Chinese adults aged 60 and over. METHODS: Data collected from 8839 adults aged 60 and over in the 2011 and 2015 CHARLS (3732 in 2011 and 5107 in 2015) were used. We first used six blood-based biomarkers to construct a composite measure of the Chinese Healthy Aging Index (CHAI, ranging from 0 (healthiest) to 12 (unhealthiest)) and then assessed the psychometric properties of the CHAI score, including acceptability, internal consistency, convergent validity, discriminative validity and precision. In addition, we employed both mean-based Blinder-Oaxaca and unconditional quantile regression decomposition to decompose the change in healthy aging within the 2011-2015 period. RESULTS: We overall identified a decrease in CHAI score from 5.69 in 2011 to 5.20 in 2015, which implies an improvement in healthy aging during this period. Our linear decomposition revealed that dependent on the type of measure used (whether quality, quantity, or combined quality-quantity), housing poverty explained 4-8% of the differences in CHAI score. Our distributional decompositions also highlighted an important role for housing poverty in the change in healthy aging, accounting for approximately 7-23% of the explained portion. Within this latter, the relative contribution of housing quantity and quality poverty was more pronounced at the median and upper end of the CHAI distribution. We also found household expenditure to be significantly associated with healthy aging among older Chinese adults and made the largest contribution to the improvement in healthy aging over time. CONCLUSIONS: The association between housing poverty and CHAI is independent of household expenditure. Regardless of type, housing poverty is positively associated with a decrease in healthy aging. Thus, improved housing conditions boost healthy aging, and housing amelioration initiatives may offer the most effective solution for augmenting healthy aging in China. Improvement of flush toilets and the access to potable water and a separate kitchen require particular attention. Since high-density congested housing has a negative impact on healthy aging, more attention can also be paid to improvements in the available space for older people. Especially at an institutional level, the government may extend the housing policy from a homeownership scheme to a housing upgrading scheme by improving housing conditions.

Inequality of weight status in urban Cuba: 2001-2010.

BACKGROUND: Although understanding changes in the body weight distribution and trends in obesity inequality plays a key role in assessing the causes and persistence of obesity, limited research on this topic is available for Cuba. This study thus analyzed changes in body mass index (BMI) and waist circumference (WC) distributions and obesity inequality over a 9-year period among urban Cuban adults. METHODS: Kolmogorov-Smirnov tests were first applied to the data from the 2001 and 2010 National Survey on Risk Factors and Chronic Diseases to identify a rightward shift in both the BMI and WC distributions over the 2001-2010 period. A Shapley technique decomposed the increase in obesity prevalence into a mean-growth effect and a (re)distributional component. A univariate assessment of obesity inequality was then derived by calculating both the Gini and generalized entropy (GE) measures. Lastly, a GE-based decomposition partitioned overall obesity inequality into within-group and between-group values. RESULTS: Despite some relatively pronounced left-skewing, both the BMI and WC distributions exhibited a clear rightward shift to which the increases in general and central obesity can be mostly attributed. According to the Gini coefficients, both general and central obesity inequality increased over the 2001-2010 period, from 0.105 [95% confidence interval (CI) = 0.103-0.106] to 0.110 [95% CI = 0.107-0.112] and from 0.083 [95% CI = 0.082-0.084] to 0.085 [95% CI = 0.084-0.087], respectively. The GE-based decomposition further revealed that both types of inequality were accounted for primarily by within-group inequality (93.3%/89.6% and 87.5%/84.8% in 2001/2010 for general/central obesity, respectively). CONCLUSIONS: Obesity inequality in urban Cuba worsened over the 2001-2010 time period, with within-group inequality in overall obesity dominant over between-group inequality. In general, the results also imply that the rise in obesity inequality is immune to health care system characteristics.

Income-related health inequality among Chinese adults during the COVID-19 pandemic: evidence based on an online survey.

BACKGROUND: Partial- or full-lockdowns, among other interventions during the COVID-19 pandemic, may disproportionally affect people (their behaviors and health outcomes) with lower socioeconomic status (SES). This study examines income-related health inequalities and their main contributors in China during the pandemic. METHODS: The 2020 China COVID-19 Survey is an anonymous 74-item survey administered via social media in China. A national sample of 10,545 adults in all 31 provinces, municipalities, and autonomous regions in mainland China provided comprehensive data on sociodemographic characteristics, awareness and attitudes towards COVID-19, lifestyle factors, and health outcomes during the lockdown. Of them, 8448 subjects provided data for this analysis. Concentration Index (CI) and Corrected CI (CCI) were used to measure income-related inequalities in mental health and self-reported health (SRH), respectively. Wagstaff-type decomposition analysis was used to identify contributors to health inequalities. RESULTS: Most participants reported their health status as "very good" (39.0%) or "excellent" (42.3%). CCI of SRH and mental health were - 0.09 (p < 0.01) and 0.04 (p < 0.01), respectively, indicating pro-poor inequality in ill SRH and pro-rich inequality in ill mental health. Income was the leading contributor to inequalities in SRH and mental health, accounting for 62.7% (p < 0.01) and 39.0% (p < 0.05) of income-related inequalities, respectively. The COVID-19 related variables, including self-reported family-member COVID-19 infection, job loss, experiences of food and medication shortage, engagement in physical activity, and five different-level pandemic regions of residence, explained substantial inequalities in ill SRH and ill mental health, accounting for 29.7% (p < 0.01) and 20.6% (p < 0.01), respectively. Self-reported family member COVID-19 infection, experiencing food and medication shortage, and engagement in physical activity explain 9.4% (p < 0.01), 2.6% (the summed contributions of experiencing food shortage (0.9%) and medication shortage (1.7%), p < 0.01), and 17.6% (p < 0.01) inequality in SRH, respectively (8.9% (p < 0.01), 24.1% (p < 0.01), and 15.1% (p < 0.01) for mental health). CONCLUSIONS: Per capita household income last year, experiences of food and medication shortage, self-reported family member COVID-19 infection, and physical activity are important contributors to health inequalities, especially mental health in China during the COVID-19 pandemic. Intervention programs should be implemented to support vulnerable groups.

Socioeconomic position and the health gradient in Cuba: dimensions and mechanisms.

BACKGROUND: To throw light on the under-researched association between socioeconomic position (SEP) and health in Cuba, this study examined SEP gradients in health and their underlying mechanisms among urban Cuban adults aged 18-65. METHODS: By applying linear regressions to data from the 2010 National Survey on Risk Factors and Chronic Diseases, the analysis explored the SEP-health gradient along three SEP dimensions - education, occupation, and skin colour - using ten health measures: self-reported health (SRH), general and abdominal obesity, hypertension, high glucose, high cholesterol, high triglycerides, low high-density lipoprotein cholesterol, metabolic syndrome, and cumulative risk factors. Regressions also included behaviours and health-related risk perceptions (tobacco and alcohol consumption, diet, physical activity, and risk-related behaviours). It thus investigated the SEP-health gradient and its underlying mechanisms via both behaviours and health-related risk perceptions. RESULTS: Once controlling for gender, age, marital status, region and provincial dummies, the analysis detected educational gradients in SRH (estimated coefficient [95% CI]: middle-level education = 3.535 [1.329, 5.741], p < 0.01; high-level education = 5.249 [3.050, 7.448], p < 0.01) that are partially explainable by both health-affecting behaviours (tobacco and alcohol consumption, diet, physical and sedentary activity) and risk perceptions. Using objective measures of health, however, it found no SEP-health gradients other than hypertension among people identified as having Black skin color (adjusted for demographic variables, 0.060 [0.018, 0.101], p < 0.01) and high cholesterol among those identified as having Mulatto or Mestizo skin color (adjusted for demographic variables, - 0.066 [- 0.098, - 0.033], p < 0.01). CONCLUSIONS: In terms of objective health measures, the study provides minimal evidence for an SEP-health gradient in Cuba, results primarily attributable to the country's universal healthcare system - which offers full coverage and access and affordable medications - and its highly developed education system.

Decomposing adult obesity trends in China (1991-2011).

Using data from the China Health and Nutrition Survey, this study analyses two decades (1991-2011) of change in adult obesity in China with a focus on whether rising obesity rates result from all population cohorts becoming more obese across time (intra-cohort change) or recent cohorts being more obese than their earlier counterparts (inter-cohort change or cohort replacement). To do so, we decompose changes in the body mass index (BMI), waist circumference (WC), general obesity and abdominal obesity of adults aged 20+ using both Firebaugh's linear decomposition and Das Gupta's non-linear technique. Our analysis not only reveals significant increases in both general and abdominal obesity (8.1 and 32 percentage points, respectively) in the two decades studied but shows that the rising means in all four measures are mostly attributable to intra-cohort change. In fact, contrary to findings for the U.S., inter-cohort change for the Chinese sample is actually negative, implying that cohort replacement attenuates intra-cohort change over time. Given that intra-cohort change is the central force for the increase in BMI, WC and obesity with individual increases in obesity widely distributed across all cohorts and age groups over time, policy interventions should focus more broadly on all age groups and birth cohorts.