TY - RPRT T1 - Childhood Circumstances and Health Inequality in Old Age: Comparative Evidence from China and the United States Y1 - 2020 A1 - Chen, Xi A1 - Yan, Binjian A1 - Thomas M Gill KW - childhood circumstances KW - Frailty KW - inequality of opportunity KW - life course approach KW - Mental Health KW - Self-rated health AB - This paper estimates the extent to which childhood circumstances contribute to health inequality in old age and evaluates the importance of major domains of childhood circumstances to health inequalities in the USA and China. We link two waves of the China Health and Retirement Longitudinal Study (CHARLS) in 2013 and 2015 with the newly released 2014 Life History Survey (LHS), and two waves of the Health and Retirement Study (HRS) in 2014 and 2016 with the newly released 2015 Life History Mail Survey (LHMS) in the USA, to quantify health inequality due to childhood circumstances for which they have little control. Using the Shapley value decomposition approach, we show that childhood circumstances may explain 7-16 percent and 14-30 percent of health inequality in old age in China and the USA, respectively. Specifically, the contribution of childhood circumstances to health inequality is larger in the USA than in China for self-rated health, mental health, and physical health. Examining domains of childhood circumstance, regional and rural/ urban status contribute more to health inequality in China, while family socioeconomic status (SES) contributes more to health inequality in the USA. Our findings support the value of a life course approach in identifying the key determinants of health in old age. Distinguishing sources of health inequality and rectifying inequality due to early childhood circumstances should be the basis of policy promoting health equity. JF - IZA Discussion Paper Series PB - IZA Institute of Labor Economics CY - Bonn, Germany UR - http://ftp.iza.org/dp13460.pdf N1 - ISSN: 2365-9793 ER - TY - JOUR T1 - Childhood Circumstances and Health Inequality in Old Age: Comparative Evidence from China and the USA JF - Social Indicators Research Y1 - 2020 A1 - Chen, Xi A1 - Yan, Binjian A1 - Thomas M Gill KW - childhood circumstances KW - Frailty KW - inequality of opportunity KW - life course approach KW - Mental Health KW - Self-rated health AB - This paper estimates the extent to which childhood circumstances contribute to health inequality in old age and evaluates the importance of major domains of childhood circumstances to health inequalities in the USA and China. We link two waves of the China Health and Retirement Longitudinal Study in 2013 and 2015 with the newly released 2014 Life History Survey, and two waves of the Health and Retirement Study in 2014 and 2016 with the newly released 2015 Life History Mail Survey in the USA, to quantify health inequality due to childhood circumstances for which they have little control. Using the Shapley value decomposition approach, we show that childhood circumstances may explain 7–16 and 14–30% of health inequality in old age in China and the USA, respectively. Specifically, the contribution of childhood circumstances to health inequality is larger in the USA than in China for self-rated health, mental health, and physical health. Examining domains of childhood circumstance, regional and rural/urban status contribute more to health inequality in China, while family socioeconomic status contributes more to health inequality in the USA. Our findings support the value of a life course approach in identifying the key determinants of health in old age. Distinguishing sources of health inequality and rectifying inequality due to early childhood circumstances should be the basis of policy promoting health equity. SN - 1573-0921 ER - TY - JOUR T1 - Effect of arthritis in middle age on older-age functioning. JF - J Am Geriatr Soc Y1 - 2008 A1 - Kenneth E Covinsky A1 - Lindquist, Karla A1 - Dorothy D Dunlop A1 - Thomas M Gill A1 - Yelin, Edward KW - Activities of Daily Living KW - Arthritis KW - Chronic disease KW - Confidence Intervals KW - Female KW - Follow-Up Studies KW - Humans KW - Male KW - Middle Aged KW - Mobility Limitation KW - Prognosis KW - Prospective Studies KW - Risk Factors KW - Severity of Illness Index KW - Surveys and Questionnaires KW - Time Factors KW - Walking AB -

OBJECTIVES: To examine whether symptomatic arthritis in middle age predicts the earlier onset of functional difficulties (difficulty with activities of daily living (ADLs) and walking) that are associated with loss of independence in older persons.

DESIGN: Prospective longitudinal study.

SETTING: The Health and Retirement Study, a nationally representative sample of persons aged 50 to 62 at baseline who were followed for 10 years.

PARTICIPANTS: Seven thousand five hundred forty-three subjects with no difficulty in mobility or ADL function at baseline.

MEASUREMENTS: Arthritis was measured at baseline according to self-report. The primary outcome was time to persistent difficulty in one of five ADLs or mobility (walking several blocks or up a flight of stairs). Difficulty with ADLs or mobility was assessed according to subject interview every 2 years. Analyses were adjusted for other comorbid conditions, body mass index, exercise, and demographic characteristics.

RESULTS: Twenty-nine percent of subjects reported arthritis at baseline. Subjects with arthritis were more likely to develop persistent difficulty in mobility or ADL function over 10 years of follow-up (34% vs 18%, adjusted hazard ratio (HR)=1.63, 95% confidence interval (CI)=1.43-1.86). When each component of the primary outcome was assessed separately, arthritis was also associated with persistent difficulty in mobility (30% vs 16%, adjusted HR=1.55, 95% CI=1.41-1.71) and persistent difficulty in ADL function (13% vs 5%, adjusted HR=1.85, 95% CI=1.58-2.16).

CONCLUSION: Middle-aged persons who report a history of arthritis are more likely to develop mobility and ADL difficulties as they enter old age. This finding highlights the need to develop interventions and treatments that take a life-course approach to preventing the disabling effect of arthritis.

PB - 56 VL - 56 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18184204?dopt=Abstract U2 - PMC2875135 U4 - arthritis/Activities of Daily Living/Mobility ER -