TY - JOUR
T1 - Cognitive functioning transitions, health expectancies, and inequalities among elderly people in China
T2 - A nationwide longitudinal study
AU - Hou, Chengbei
AU - Lin, Yinan
AU - Ren, Ming
AU - Liu, Mengyang
AU - Ma, Yuan
AU - Li, Haibin
AU - Tao, Lixin
AU - Wang, Wei
AU - Li, Xia
AU - Fang, Xianghua
AU - Guo, Xiuhua
N1 - Publisher Copyright:
© 2018 John Wiley & Sons, Ltd.
PY - 2018/12
Y1 - 2018/12
N2 - Objective: In China, cognitive impairment has become a huge challenge owing to the rapid aging process. We investigate cognitive health expectancy and potential factors leading to inequalities of cognitive health for Chinese older people. Methods: The study included 19 943 participants aged 65 to 95 at the first observation in Chinese Longitudinal Healthy Longevity Survey collected during 2002-2014. Cognitive impairment was categorized into none, mild, and severe by the score of cMMSE. Multistate models based on continuous-time Markov process were applied to calculate cognitive health expectancies and estimate hazard ratio from no impairment to impairment for potential factors. Results: Urban women and men aged 65 were expected to spend 31.18% and 19.82% of their remaining 17.46 and 15.45 years with cognitive impairment; meanwhile, rural women and men aged 65 were expected to spend 35.31% and 21.39% of their remaining 16.73 and 14.87 years with cognitive impairment. Women achieving lower educational attainment (HR1-6 years = 0.78, 95% CI, 0.71-0.87; HR7+ years = 0.59, 95% CI, 0.49-0.70) than men and rural residents having less access to medical service (HR = 0.79, 95% CI, 0.68-0.92) and doing less regular exercise (HR = 0.87, 95% CI, 0.80-0.96) than urban people caused the differences of cognitive health for genders and regions. Conclusions: Women and rural people experience less cognitive health expectancies compared with their counterparts, respectively. Chinese government should pay more attention to rural women and make efforts to reduce the inequalities of cognitive health by increasing opportunities of education for women and improving access to medical service and healthy lifestyle for rural people.
AB - Objective: In China, cognitive impairment has become a huge challenge owing to the rapid aging process. We investigate cognitive health expectancy and potential factors leading to inequalities of cognitive health for Chinese older people. Methods: The study included 19 943 participants aged 65 to 95 at the first observation in Chinese Longitudinal Healthy Longevity Survey collected during 2002-2014. Cognitive impairment was categorized into none, mild, and severe by the score of cMMSE. Multistate models based on continuous-time Markov process were applied to calculate cognitive health expectancies and estimate hazard ratio from no impairment to impairment for potential factors. Results: Urban women and men aged 65 were expected to spend 31.18% and 19.82% of their remaining 17.46 and 15.45 years with cognitive impairment; meanwhile, rural women and men aged 65 were expected to spend 35.31% and 21.39% of their remaining 16.73 and 14.87 years with cognitive impairment. Women achieving lower educational attainment (HR1-6 years = 0.78, 95% CI, 0.71-0.87; HR7+ years = 0.59, 95% CI, 0.49-0.70) than men and rural residents having less access to medical service (HR = 0.79, 95% CI, 0.68-0.92) and doing less regular exercise (HR = 0.87, 95% CI, 0.80-0.96) than urban people caused the differences of cognitive health for genders and regions. Conclusions: Women and rural people experience less cognitive health expectancies compared with their counterparts, respectively. Chinese government should pay more attention to rural women and make efforts to reduce the inequalities of cognitive health by increasing opportunities of education for women and improving access to medical service and healthy lifestyle for rural people.
KW - cognitive functioning transitions
KW - cognitive health expectancy
KW - cognitive impairment
KW - multistate model
KW - potential factors
UR - http://www.scopus.com/inward/record.url?scp=85053373050&partnerID=8YFLogxK
U2 - 10.1002/gps.4966
DO - 10.1002/gps.4966
M3 - Article
C2 - 30206988
AN - SCOPUS:85053373050
SN - 0885-6230
VL - 33
SP - 1635
EP - 1644
JO - International Journal of Geriatric Psychiatry
JF - International Journal of Geriatric Psychiatry
IS - 12
ER -