Guangya Liu

Social Change and Socioeconomic Disparities in Health over the Life Course in China: A Cohort Analysis

This article examines social stratification in individual health trajectories for multiple cohorts in the context of China’s dramatically changing macro-social environment. Using data from the China Health and Nutrition Survey, we find significant socioeconomic status (SES) differences in the mean level of health and that these SES differentials generally diverge over the life course. We also find strong cohort variations in SES disparities in the mean levels of health and health trajectories. The effect of education on health slightly decreases across successive cohorts. By contrast, the income gap in health trajectories diverges for earlier cohorts but converges for most recent cohorts. Both effects are more pronounced in rural areas. Given that these cohort effects are opposite those reported in recent U.S. studies, we discuss China’s unique social, economic, and political settings. We highlight the association between SES and health behaviors, China’s stage of epidemiologic transition, and the changing power of the state government and its implications for health care.This article examines social stratification in individual health trajectories for multiple cohorts in the context of Chinas dramatically changing macro-social environment. Using data from the China Health and Nutrition Survey, we find significant socioeconomic status (SES) differences in the mean level of health and that these SES differentials generally diverge over the life course. We also find strong cohort variations in SES disparities in the mean levels of health and health trajectories. The effect of education on health slightly decreases across successive cohorts. By contrast, the income gap in health trajectories diverges for earlier cohorts but converges for most recent cohorts. Both effects are more pronounced in rural areas. Given that these cohort effects are opposite those reported in recent U.S. studies, we discuss Chinas unique social, economic, and political settings. We highlight the association between SES and health behaviors, Chinas stage of epidemiologic transition, and the changing power of the state government and its implications for health care.

Predictors of Longevity: Evidence From the Oldest Old in China

OBJECTIVES We investigated the characteristics of the oldest old in China and examined whether the factors associated with longevity varied with advanced age. METHODS Drawing from the largest nationally representative longitudinal sample of oldest-old adults, we stratified descriptive statistics separately by gender and urban-rural residence and then used ordered logit models to examine the multivariate factors associated with increasing age-group membership. RESULTS Differing combinations of demographic, social, physical, and behavioral factors were significantly related to surviving into later ages for men and women in urban and rural areas. With the exception of rural women, psychological disposition was not associated with increased longevity. Gender differences were generally smaller in urban areas than in rural areas, and urban-rural differences were more pronounced among women than among men. CONCLUSIONS Findings from the oldest-old population in China challenge many of the established relations in the health-inequality literature. Future research should examine why the oldest old are an exceptional group of physically, socially, and demographically heterogeneous individuals who exhibit healthy longevity beyond the average life span.

Association Between Divorce and Risks for Acute Myocardial Infarction

Background—Divorce is a major life stressor that can have economic, emotional, and physical health consequences. However, the cumulative association between divorce and risks for acute myocardial infarction (AMI) is unknown. This study investigated the association between lifetime exposure to divorce and the incidence of AMI in US adults. Methods and Results—We used nationally representative data from a prospective cohort of ever-married adults aged 45 to 80 years (n=15 827) who were followed biennially from 1992 to 2010. Approximately 14% of men and 19% of women were divorced at baseline and more than one third of the cohort had ≥1 divorce in their lifetime. In 200 524 person-years of follow-up, 8% (n=1211) of the cohort had an AMI and age-specific rates of AMI were consistently higher in those who were divorced compared with those who were continuously married (P<0.05). Results from competing-risk hazard models showed that AMI risks were significantly higher in women who had 1 divorce (hazard ratio, 1.24; 95% confidence interval, 1.01–1.55), ≥2 divorces (hazard ratio, 1.77; 95% confidence interval, 1.30–2.41), and among the remarried (hazard ratio, 1.35; 95% confidence interval, 1.07–1.70) compared with continuously married women after adjusting for multiple risk factors. Multivariable-adjusted risks were elevated only in men with a history of ≥2 divorces (hazard ratio, 1.30; 95% confidence interval, 1.02–1.66) compared with continuously married men. Men who remarried had no significant risk for AMI. Interaction terms for sex were not statistically significant. Conclusions—Divorce is a significant risk factor for AMI. The risks associated with multiple divorces are especially high in women and are not reduced with remarriage.

Psychological well-being of the institutionalized and community-residing oldest old in China: The role of children

Studies have shown that institutionalized older adults have worse psychological health than their community-residing counterparts. However, much less is known about this association in developing countries such as China with a rapidly aging population and a short history of institutional care. This article investigates the role of children in differences in psychological well-being between institutionalized and community-residing oldest-old adults in China. Using national data from the 1998, 2000, and 2002 waves of the Chinese Longitudinal Healthy Longevity Survey, results show that the institutionalized have significantly better psychological health-measured by positive affect, loneliness, and quality of life-than those living in the community. Furthermore, we find that the associations are moderated by child-related factors (number of children, proximity, and visits) and strengthened for the three measures of psychological well-being after adjustments for socioeconomic factors, social support, health behaviors, and health status. The results underscore the importance of family dynamics for the psychological health of the institutionalized population in a historically family-care oriented society.

Health Trajectories of Women in China: The Role of Parental Caregiving

OBJECTIVES Studies show that caregiving can have negative consequences on the psychological and physical health of its providers. However, few studies have examined the immediate and long-term impact of caregiving on health and none have considered these longitudinal associations among women in a predominately family-care society such as China. METHOD Six waves of data from the Ever-Married Women Survey component of the China Health and Nutrition Survey (n = 6,178) are used for analysis. Multivariate latent growth models are used to examine trajectories of self-rated health associated with providing care to parents (parental caregiving) among young-adult and middle-aged women in China. RESULTS Results show that women who are caregivers to their parents have consistently worse self-reported health than women who do not have caregiving responsibilities. We find that caregivers--especially those who provide high-intensity care--exhibit initially low levels of health, followed by a period of health improvement that is comparable to noncaregivers. However, this pattern of role adaptation in women is followed by a precipitous decline in self-rated health in later years. DISCUSSION The findings demonstrate the subjective health consequences of caregiving for women in China and provide new evidence to support the life course processes of wear-and-tear and role adaptation.