Lihua Pang

Twenty-year trends in the prevalence of disability in China

OBJECTIVE To evaluate changes in the age-adjusted prevalence of disability in transitional China from 1987 to 2006. METHODS Data from nationally representative surveys conducted in 1987 and 2006 were used to calculate age-adjusted disability prevalence rates by applying appropriate sample weights and directly adjusting to the age distribution of the 1990 Chinese population. Trends were assessed in terms of average annual percentage change. FINDINGS The estimated number of disabled people in China in 1987 and 2006 was 52.7 and 84.6 million, respectively, corresponding to a weighted prevalence of 4.9% and 6.5%. The age-adjusted prevalence of disability decreased by an average of 0.5% per year (average annual percentage change, AAPC: -0.5%; 95% confidence interval, CI: -0.7 to -0.4) during 1987-2006. However, it increased by an average of 0.3% (AAPC: 0.3%; 95% CI: 0.1 to 0.5) per year in males and by an average of 1.0% (AAPC: 1.0%; 95% CI: 0.8 to 1.2) per year among rural residents, whereas among females it showed an average annual decrease of 1.5% (AAPC: -1.5%; 95% CI: -1.7 to -1.3) and among urban residents, an average annual decrease of 3.9% (AAPC: -3.9%; 95% CI: -4.3 to -3.5). Despite significant declining trends for hearing and speech, intellectual and visual disabilities, the annual age-adjusted prevalence of physical and mental disabilities increased by an average of 11.2% (AAPC: 11.2%; 95% CI: 10.5 to 11.9) and 13.3% (AAPC: 13.3%; 95% CI: 10.7 to 16.2), respectively. CONCLUSION In China, the age-adjusted prevalence of disability has declined since 1987, with inconsistencies dependent on the type of disability. These findings call for continuing and specific efforts to prevent disabilities in China.

Risk factors for depression in older adults in Beijing.

Objective: Depression is a common mental disorder in older adults. We examined the prevalence and risk factors for depression in older adults in the Beijing area. Method: We used data from a cross-sectional survey conducted in July 2006 in Beijing. As part of the national survey for older Chinese adults, 2002 older adults were interviewed. The 15-item Geriatric Depression Scale was used to assess depression. Demographics as well as other personal information were also collected. Results: Among Beijing older adults, 13.01% were categorized as depressed. Prevalence rates of depression in rural and urban older adults were 26.63% and 10.79%, respectively. Poor economic status, high activities of daily living (ADL) score, poor physical health, impious offspring, and feeling old were important predictors of depression in older adults in Beijing. For the urban sample, poor economic status, poor physical health, high ADL score, and impious offspring were risk factors for depression. For the rural sample, depression was significantly associated with poor economic status and poor physical health. Conclusions: Depression is a common mood disorder among older adults in the Beijing area. Filial piety is a unique predictor for depression in older Chinese adults, compared with findings in Western cultures.

Regional variations in and correlates of disability- free life expectancy among older adults in China

BackgroundConsiderable socioeconomic and health inequalities have been reported in China. However, because of a lack of appropriate data, limited research has been conducted on variations in disability-free life expectancy (DFLE) among older adults. This study aimed to use the most up-to-date disability survey data to explore geographical variations in DFLE at age 60 in China and to identify the socioeconomic and health care factors that partially account for these variations.MethodsThis study used 2006 mortality data extrapolated from the 1990 and 2000 Census and disability data from a national disability survey conducted in 2006. Disability was performance based and was diagnosed by trained physicians. DFLE was calculated by region using the Sullivan method. Multiple linear regression models by gender were conducted to explore correlates of DFLE.ResultsDFLE at age 60 varied widely by region, from 11.2 to 20.8 years in 2006. Per capita gross domestic product, proportion of urban residents, and access to health care were the primary factors associated with geographical variations in DFLE.ConclusionThe pattern of differences in DFLE by region mirrors the pattern of regional economic development in China. Countermeasures to decrease regional differences in DFLE include accelerating regional economic development and improving health care distribution.

Association between poverty and psychiatric disability among Chinese population aged 15-64 years.

Psychiatric disability is an important public health problem in China, and poverty may be positively correlated with disability. Little study in the existing literatures has explored the contribution of poverty to the psychiatric disability among Chinese population. Using a nationally representative data, this paper aims to investigate the association between poverty and psychiatric disability in Chinese population aged 15-64 years. We used the second China National Sample Survey on Disability, comprising 1.8 million people aged 15-64 years. Identification and classification for psychiatric disability was based on consensus manuals. We used standard weighting procedures to construct sample weights considering the multistage stratified cluster sampling survey scheme. Population weighted numbers, weighted proportions, and the adjusted Odd Ratios (OR) were calculated. For people with psychiatric disability aged 15-64 years, more than 4 million were below the poverty level in China. After controlling for other demographic variables, poverty was found to be significantly associated with psychiatric disability (OR=2.25, 95% Confidence Interval (CI) 2.15-2.35). Given China is undergoing rapid social-economic transition and psychiatric diseases become a leading burden to the individuals, community, and health care systems, poverty reduction programs are warranted to prevent psychiatric disability and/or improve the lives for persons with psychiatric disability.

Schizophrenia-Related Disability in China: Prevalence, Gender, and Geographic Location

OBJECTIVE This study estimated the prevalence of schizophrenia-related disability in the Chinese population and explored factors that may contribute to differences in prevalence rates between women and men and across geographic regions. METHODS Data for 1,909,205 noninstitutionalized adults (age 18 and older) from a representative national sample were obtained from the Second China National Sample Survey on Disabilities in 2006 (participation rate of 99.8%). The sample was first screened for disability (activities of daily living and social participation adversely affected by the disorder) via in-person household interviews. Trained clinical psychiatrists then administered the ICD-10 Symptom Checklist for Mental Disorders and the World Health Organization Disability Assessment Schedule Version II to all individuals who screened positive for a psychiatric disability. RESULTS The prevalence of schizophrenia disability was .41% in China. It was higher in rural areas (.45%) than in urban areas (.32%). In rural areas, the prevalence was higher among women than among men (.51% versus .38%), but in urban areas, the rates were similar for women and men (.30% versus .35%). The results of logistic regression analysis showed that after adjustment for variables related to socioeconomic status, the likelihood of having schizophrenia disability was slightly lower among rural residents than among urban residents (odds ratio [OR]=.92, 95% confidence interval [CI]=.86-.98), although the disparity between rural women and rural men remained (OR=1.9, CI=1.78-2.02). CONCLUSIONS Socially disadvantaged rural women were disproportionately affected by schizophrenia-related disability. Limited access to health services may have contributed to the increased disease burden among rural women.

Prevalence of dementia-associated disability among Chinese older adults: results from a national sample survey

OBJECTIVE Due to rapid population aging and a tidal wave of dementia, dementia has become an urgent public health issue in China. Few large-scale surveys on dementia have been conducted in China and little was known about the magnitude of dysfunction and disability caused by dementia. In this study, using national sample survey data, we aimed to describe the prevalence rate of dementia-associated disability, its associated factors, and daily activities and social functions of people with dementia-associated disability in Chinese older adults. METHODS We used the second China National Sample Survey on Disability, comprising 2,526,145 persons from 771,797 households. Identification for dementia was based on consensus manuals. Standard weighting procedures were used to construct sample weights considering the multistage stratified cluster sampling survey scheme. Population weighted numbers, weighted prevalence, and the odd ratios (ORs) were calculated. RESULTS The prevalence rate of dementia-associated disability was 4.64% (95% CI: 4.26-5.01) and it accounted for 41.03% of mental disability among Chinese older adults. Urban residence (OR: 1.33 [1.12-1.57]), older age (80+ years) (OR: 4.12 [3.38-.03]), illiteracy (OR: 1.79 [1.27-2.53]), and currently not married (OR: 1.15 [1.00-1.32]) were associated with increased risk of dementia-associated disability. Compared with those with mental disability of other causes and those with other types of disabilities, older adults with dementia-asscoiated disability were more likely to have severe or extreme difficulty in daily activities and social functions. CONCLUSION Countermeasures are warranted to obtain a more precise overview of dementia in China, and strategies on enhancing early identification, treatment, and rehabilitation should be developed for people with dementia.

Challenge of Population Aging on Health

Population aging is a triumph of civilization (Chamie 2010). With socio-economic development, especially the development of public health, the human being is in a brand new stage with lower mortality and lower fertility . When more and more people enjoy longer lives, governments have to make economic and social adjustments to face the challenge of population aging, especially the impact of aging on health service and cost.

Wealth Inequality and Mental Disability Among the Chinese Population: A Population Based Study

In the study described herein, we investigated and explored the association between wealth inequality and the risk of mental disability in the Chinese population. We used nationally represented, population-based data from the second China National Sample Survey on Disability, conducted in 2006. A total of 1,724,398 study subjects between the ages of 15 and 64, including 10,095 subjects with mental disability only, were used for the analysis. Wealth status was estimated by a wealth index that was derived from a principal component analysis of 10 household assets and four other variables related to wealth. Logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for mental disability for each category, with the lowest quintile category as the referent. Confounding variables under consideration were age, gender, residence area, marital status, ethnicity, education, current employment status, household size, house type, homeownership and living arrangement. The distribution of various types and severities of mental disability differed significantly by wealth index category in the present population. Wealth index category had a positive association with mild mental disability (p for trend <0.01), but had a negative association with extremely severe mental disability (p for trend <0.01). Moreover, wealth index category had a significant, inverse association with mental disability when all severities of mental disability were taken into consideration. This study’s results suggest that wealth is a significant factor in the distribution of mental disability and it might have different influences on various types and severities of mental disability.

Incidence of road traffic disabilities trending upwards in transitional China: a retrospective analysis from 1980 to 2005

Objective To evaluate the change in incidence rates of road traffic disabilities from 1980 to 2005 in China. Methods We employed the 2006 China National Sample Survey on Disability to derive weighted number of persons with disabilities resulting from road crashes and weighted age-gender-specific population at risk by disability occurrence year. The annual incidence rate of road traffic disabilities and corresponding 95% CI were estimated. We used the World Population Prospects (WPP) and the death rate of people with disabilities (PWD) to estimate potential earlier loss of lives before 2006. Both WPP-adjusted and PWD-adjusted incidence rates of road traffic disabilities were further adjusted using the life table analysis. Results The WPP-adjusted incidence rate for road traffic disabilities increased over time from 1.50 (95% CI 1.47 to 1.52) in 1980 to 11.19 (95% CI 11.13 to 11.25) per 100 000 persons in 2005. The PWD-adjusted incidence rate also increased from 1.71 (95% CI 1.68 to 1.73) to 11.51 (95% CI 11.45 to 11.57) per 100 000 persons. Conclusions Road crashes disable thousands of Chinese and remain a significant population health and development problem. The increasing burden of road traffic disabilities calls for more efforts and specific strategies to improve road safety in China.

County-level social factors and schizophrenia: a multilevel study of 1.9 million Chinese adults

There is little evidence on the association between area-level social factors and schizophrenia in China. This study aimed to investigate the relationship between county-level social factors and schizophrenia in Chinese adults aged 18 years old and above. We obtained data from the Second China National Sample Survey on Disability, and selected 1,909,205 adults for analysis. Schizophrenia was ascertained according to the International Statistical Classification of Diseases, Tenth Revision. Multilevel logistic regressions showed that areas with higher urbanization rate was associated with increased risk of schizophrenia (areas with moderate urbanization rate: OR = 1.28, 95% CI: 1.15, 1.44; areas with high urbanization rate: OR = 1.48, 95% CI: 1.26, 1.75). Stratified analyses found that, in female adults, urbanization rates, divorce rates and socioeconomic conditions were positively associated with increased risks for schizophrenia. However, in male adults, low socioeconomic conditions was related to decreased risk of schizophrenia, and there was no significant association between rates of divorce and risks for schizophrenia. In conclusion, county-level social factors, in the form of urbanization rate, divorce rate, and socioeconomic conditions, were associated with the risk of schizophrenia in Chinese adults. Gender differences were found in these associations.