CHARLS – Introduction and Health- SES Associations Among the Elderly Yaohui Zhao, Peking University Xiaoyan Lei, Peking University Albert Park, Oxford

CHARLS – Introduction and Health-SES Associations Among the Elderly

Yaohui Zhao, Peking UniversityXiaoyan Lei, Peking UniversityAlbert Park, Oxford UniversityYan Shen, Peking University

Jim Smith, RAND CorporationJohn Strauss, University of Southern California

July 2009

Alex Yang provided excellent research assistance

Significance of CHARLS

• China is one of the most rapidly aging countries in the world

• Economy is rapidly growing from a low level, so elderly in China face different challenges and opportunities than elderly in higher income countries

• China is in the process of transition from planned to market economy, so part of the transition is to replace the old public social safety nets

Health and Nutrition Transitions

• Nutrition: from under-nutrition and malnutrition to over-nutrition

• Health: from infectious to chronic diseases • Implications:

– Chronic diseases affect elderly more– Unawareness of chronic illness by individuals– The public health system is designed to handle

infectious diseases and not chronic diseases– Low health insurance coverage on chronic diseases

• New Rural Cooperative Medical Insurance• Urban Resident Health Insurance

– Low incomes: inadequate resources to handle the expensive treatment of chronic illnesses

Financial and Personal Care Needs

• Public pension coverage is low

• Personal saving undependable

• Number of children is decreasing

• Rural elderly work to support self

Aims of CHARLS

• Provide a high quality HRS-type data for behavioural and policy research

• Harmonize survey instruments with other HRS-type surveys to enable cross-country comparative studies

Research Design and Methods

• Biennial survey representative of the residents of China aged 45 and older– Age 45 is the early retirement age

• We interview one household member aged 45 and older and their spouse

• We will track the individuals in follow-up surveys to form a panel

• Institutional residents excluded but can show up in later waves

• Pilot in 2008, national baseline 2011

PILOT

• Pilot in 2 provinces-Zhejiang and Gansu– Dynamic coastal province and inland low income

province

Funding

• National Institute of Aging– R21-AG031372– R21-AG033675– R13-AG030312

• World Bank, China grant 7145915• National Natural Science Foundation of China,

grant 70773002

Sampling Design

• Multi-stage: counties, villages, household, persons

• Stratification: by province, regions and urban/rural

• Principal sampling units (PSUs) are village-level units– administrative villages in rural areas – communities (社区 ) or residence committees (居委

会 ) in urban areas

Sampling Procedures

1. Within each province, randomly select 16 county level units using PPS, stratified by regions and urban/rural

2. Within each county, randomly select 3 village-level units using PPS (village-level units include administrative villages in rural areas and neighborhoods (社区 ) or residence committees (居委会 ) in urban areas

3. Within each PSU, randomly select 25-36 from a complete list of dwelling units generated from a map

4. Within each chosen dwelling unit, determine the number of age-eligible households. If more than one, randomly select one age-eligible household.

5. In sampled age-eligible households, randomly select one age-eligible person and also interview spouse.

Table 2: Sample Size and Response rate (%)

Total Urban Rural Zhejiang Gansu

Total sampled 2592 1281 1311 1350 1242

Age-eligible rate 69.32 65.05 73.35 71.25 67.24

Response rate* 84.82 79.33 89.69 83.94 85.83

Total Households responded 1570 691 879 831 739

*Response rate is based on the age-eligible households.

Freq Frac % Freq Frac % Freq Frac %Total 2685 1302 1383

Under 50 536 19.99 192 14.77 344 24.9150-54 510 19.02 257 19.77 253 18.3255-59 467 17.42 235 18.08 232 16.8060-64 383 14.29 196 15.08 187 13.5465-69 283 10.56 152 11.69 131 9.4970-74 238 8.88 130 10.00 108 7.8275-79 154 5.74 82 6.31 72 5.2180 + 110 4.10 56 4.31 54 3.91

TotalAge group

Male Female

Table 3: Number and age/sex structure of individuals

AllProvinces

Questionnaire

• Cover screen• Demographics• Family structure/transfer• Health status and functioning• Biomarkers• Health care and insurance• Work, retirement and pension• Income and consumption• Assets (individual and household)• Community level information

Sections of Survey Instrument

• (0) Cover screen (determine household membership, age eligibility and respondents)– Basic Information (sex, age, relationship, marital

status) about household members• (a) Demographics (respondent and spouse):

– Birth place– Migration and registration history– Education– Marriage history – Simple questions about spouse if divorced or

widowed (birth year, education, year of divorce or death, cause of death)

(b) Family Structure/Transfer

• Additional information on household members other than respondent and spouse: education, registration, migration

• For parents and children, more details: – Biological or not; birth place– Year and cause of death if deceased– If living, current & past work, place of residence– Number of children of each child– Whether child lived away from parents during childhood

• Simple questions on siblings: number living, no. died after age 10

• Living arrangement of parents• Contact with each parent and child: how often do you/they

visit• Financial and time transfers with non-cohabitating parents

and each child

(c) Health Status and Functioning• General health now and before age 16

• Doctor diagnoses of chronic illnesses– Are you receiving treatment?

• Accidents, falls, prostate, vision, hearing, teeth

• Lifestyle and health behaviours: sleep, physical activities, social activities, smoking, drinking

• Subjective expectation of mortality

• ADLs, IADLs

(c) Health Status-2

• Cognition tests: calendar, season recognition, memory, numeracy, drawing

• Depression- short CES/D

• Health vignettes

Biomarkers

Anthropometric measurements: – height, weight, waist circumference, lower

right leg length and arm length (shoulder to wrist)

Lung capacity, grip strength, timed sit and stand,

hypertensionDried blood spots as part of a sister survey of

CHARLS-to be analyzed for:– C-reactive protein, hemoglobin, total

and HDL cholesterol

(d) Health Care and Insurance

• Health insurance coverage– Present insurance (type, location of issuance,

premium and reimbursement details)– Past insurance if currently not covered

• Health cost and utilization– Outpatient care

• Number in the past month• For the most recent visit, type of facility, distance,

location, cost of transportation, disease name, treatment, cost and insurance coverage

– Inpatient care in the past year

(e) Work, Retirement and Pension

• Work status• Work history; whether or not processed retirement• Earnings and labor supply for both employed and

self-employed • Job search and last job information for currently

not working• Detailed questions on retirement, pensions, social

security and job-related health insurance• Circumstances at the time retirement was

processed

(f) Income, Expenditure and Assets• Household income

– Incomes of household members other than R and spouse if he/she worked independently

– Household agricultural income– Household nonfarm business income– Household public transfer income

• Household expenditure: week, month, year• Household assets

– Housing (value, mortgage, windfall gain from housing reform, characteristics [telephone, internet, cooking and heating fuel])

– Land; productive equipments, value of household consumer durables

– Financial assets; debts• Individual income and assets belonging to R and spouse• Inheritance history

Community Survey Instruments • Basic information

– Land policy in village• Infrastructure and utilities

– Road access, distance to hospital, schools, bank, market, bus and train stations, communal elderly care facility, and other public facilities

– Source of water, fuel– Sewage, electricity, %households with telephone, TV, refrigerator

• Labor, education and out-migration • Health facilities: characteristics, distance • Health insurance: coverage, policy details• Community wage level• Community leaders: education, years of service• Facilities for the old people to exercise and socialize: availability and

source of funding• History of policy change, natural disasters or epidemics• Price levels: food, fuel, electricity, housing• Statistics: population, in-migration, finance

The Plan for Future CHARLS

• National baseline survey in 2011• About 10,000 households, 15,000 individuals to

be surveyed in some 212 counties• County sample sizes proportionate to population• Follow up every two years

Health Status-SES gradients

• Health Outcomes– General health– BMI– Hypertension and under-diagnosis – ADLs & IADLs– CES-D– Survival expectations

• SES– Education– PCE– Rural vs. urban and Province

Health status-SES gradients

• In this analysis is not causal

•Can show health status differentials by SES

Summary of results

• Results show that education tends to be more important than percapita expenditure

• Some outcomes: hypertension-invariant to SES

• Others: General health, IADLs, CES-D, survival expectations, strongly related in expected ways- better health positively correlated with higher schooling

• Others: Underdiagnosis of hypertension, BMI, related for women, but not men

Critical importance of region/community

• As provincial rural/urban and then community dummies are added SES sometimes loses significance and coefficients go towards zero- especially so for PCE

• Even when SES not significant, community dummies are-hypertension for example

• Demonstrates the critical importance of location- location coefficients are jointly statistically significant

Regional differences

• Regional differences found to be critical for almost all health outcomes examined, except for hypertension

• People who live in Gansu province have worse health outcomes, even AFTER controlling for schooling, income and age differences!– For men urban and rural Gansu roughly same– For women, rural Gansu worse

1020

3040

50%

rep

ortin

g ''p

oor''

40 50 60 70 80age

Men Women

for men and women, bw=.75Figure 1. Self-reported General Health against Age

Excel-lent

Verygood

Good Fair Poor NExcel-

lentVerygood

Good Fair Poor N

3.8 17.4 20.5 49.7 8.6 397 4.3 11.3 22.1 40.5 21.8 462(1.5) (2.5) (3.2) (4.6) (1.7) (1.8) (1.9) (2.7) (4.2) (4.4)4.9 10.7 24.7 40.0 19.7 373 0.9 9.0 19.9 41.9 28.3 365

(1.8) (2.0) (3.3) (3.4) (3.1) (0.6) (1.9) (4.0) (4.9) (6.2)3.1 8.3 19.7 49.3 19.6 251 0.7 8.0 12.4 48.5 30.4 203

(1.6) (2.5) (5.3) (11.0) (4.6) (0.8) (2.4) (2.7) (6.8) (5.3)1.3 13.9 22.1 32.8 30.0 93 3.2 8.9 18.6 28.3 41.0 94

(0.9) (4.0) (5.7) (6.8) (5.9) (2.0) (4.3) (4.9) (6.4) (8.7)3.8 12.7 21.6 45.4 16.5 1114 2.4 9.7 19.3 41.3 27.3 1124

(1.0) (1.5) (2.4) (4.4) (1.8) (0.7) (1.4) (1.9) (3.2) (4.1)

65-74

75+

Total (45+)

Table 1. Self-reported general health, by age and sexMen Women

45-54

55-64

1020

3040

% r

epor

ting

''poo

r''

Illiterate Can read or write Primary junior high and above

Men Women

educational level

by sex and educational levelFigure 2. Self-reported General Health,

Table 2. Regression for reported poor general health: Men(1) (2) (3) (4) (5)

Aged 55-64 0.116*** 0.110*** 0.111*** 0.110*** 0.123***Aged 65-74 0.153*** 0.141*** 0.146*** 0.146*** 0.165***

Aged 75 and over 0.175*** 0.165*** 0.174*** 0.200*** 0.205***Can read and write -0.044 -0.034 -0.034 -0.007 0.009Finished primary -0.084** -0.068** -0.065* -0.059* -0.035

Junior high and above -0.070** -0.043 -0.034 -0.057 -0.026logPCE (< median) -0.026 -0.020 0.002 0.013

logPCE (> median, marginal) -0.039 -0.026 -0.024 -0.044Rural 0.079***

Rural Zhejiang 0.046Urban Gansu 0.125***Rural Gansu 0.194***

Community FE NO NO NO NO YESF-test for all age dummies 10.37*** 8.60*** 9.07*** 9.53*** 10.30***

(p-value) (0.000) (0.000) (0.000) (0.000) (0.000)F-test for all education dummies 2.35* 1.36 1.23 1.69 0.72

(p-value) (0.077) (0.261) (0.303) (0.174) (0.543)F-test for all logPCE splines 5.53*** 2.84* 0.46 0.81

(p-value) (0.005) (0.064) (0.634) (0.450)F-test for all location dummies 13.87*** 1.64***

(p-value) (0.000) (0.001)Observations 1108 1108 1108 1108 1108

Table 3. Regression for reported poor general health: Women(1) (2) (3) (4) (5)

Aged 55-64 0.075** 0.065** 0.065** 0.059* 0.067**Aged 65-74 0.033 0.023 0.028 0.033 0.035

Aged 75 and over 0.061 0.033 0.052 0.082 0.082Can read and write -0.132*** -0.118*** -0.099*** -0.054 -0.018Finished primary -0.100** -0.078* -0.050 -0.017 -0.003

Junior high and above -0.221*** -0.194*** -0.160*** -0.162*** -0.164***logPCE (< median) -0.054*** -0.049*** -0.032** -0.037**

logPCE (> median, marginal) 0.033 0.046 0.051 0.074**Rural 0.105***

Rural Zhejiang 0.033Urban Gansu 0.110**Rural Gansu 0.267***

Community FE NO NO NO NO YESF-test for all age dummies 2.00 1.42 1.58 1.69 1.87

(p-value) (0.120) (0.241) (0.200) (0.174) (0.142)F-test for all education dummies 12.42*** 8.63*** 5.92*** 5.58*** 4.70***

(p-value) (0.000) (0.000) (0.001) (0.001) (0.004)F-test for all logPCE splines 5.98*** 4.51** 2.14 3.37**



Country BMI differentials

• We know BMI distribution within countries shifts over time during health-nutrition transtion

• Figures from Strauss and Thomas, 2008 demonstrate from country cross-section

• What is less known is the education gradient of BMI also shifts – Becomes inverted u-shape from upwards

sloping, for women, but not for men– CHARLS data duplicates

0.2

.4.6

.81

CD

F

15 20 25 30 35BMI

Men Women

Note: vertical lines were drawn at BMI=18.5 and BMI=25.

Figure 3. CDF of BMI for Men and Women

2122

2324

BM

I

40 50 60 70 80age

Men Women

for men and women, bw=.75Figure 4. BMI against Age

05

1015

20%

40 50 60 70 80age

Men Women

for men and women, bw=.75Figure 5. Underweight [BMI<18.5] against Age

1020

3040

%

40 50 60 70 80age

Men Women

for men and women, bw=.75Figure 6. Overweight [BMI>=25] against Age

Table 4. BMI, by age and sex

BMIMean

% BMI<18.5

% BMI>=25.0

NBMI

Mean% BMI<18.5

% BMI>=25.0

N

23.2 4.9 29.2 334 23.5 4.7 31.4 371(0.3) (1.6) (4.7) (0.2) (1.4) (3.5)23.0 2.9 26.4 317 24.2 4.2 43.9 305(0.2) (1.0) (3.2) (0.3) (1.2) (5.0)21.6 7.8 12.7 203 23.1 9.6 24.3 169(0.3) (2.5) (3.7) (0.3) (2.6) (4.8)21.2 16.9 11.0 66 21.8 18.2 11.8 74(0.5) (5.2) (3.9) (0.4) (5.3) (4.5)22.6 5.8 22.9 920 23.5 6.7 32.6 919(0.2) (1.0) (2.8) (0.2) (1.0) (2.3)

Total(45+)

Men Women

45-54

55-64

65-74

75+

2223

2425

26B

MI


Men Women

educational level

Figure 7. BMI, by sex and education,

02

46

810

%


Men Women

educational level

by sex and educational levelFigure 8. Underweight [BMI<18.5],

1020

3040

5060

%


Men Women

educational level

by sex and educational levelFigure 9. Overweight [BMI>=25]

Table 5. Regression for BMI: Men(1) (2) (3) (4) (5)

Aged 55-64 0.083 0.150 0.162 0.137 0.089Aged 65-74 -0.940*** -0.771*** -0.795*** -0.894*** -1.063***

Aged 75 and over -1.122** -0.833* -0.863* -0.916* -1.192**Can read and write 0.356 0.293 0.279 0.235 0.296Finished primary 0.361 0.236 0.210 0.156 0.237

Junior high and above 0.641** 0.419 0.360 0.232 -0.029logPCE (< median) 0.495*** 0.449*** 0.413*** 0.257**

logPCE (> median, marginal) 0.179 0.036 0.108 0.087Rural -0.706**

Rural Zhejiang -0.140Urban Gansu 1.021***Rural Gansu -0.611

Community FE NO NO NO NO YESF-test for all age dummies 5.77*** 3.94** 4.50*** 5.33*** 6.96***

(p-value) (0.001) (0.011) (0.005) (0.002) (0.000)F-test for all education dummies 1.72 0.80 0.65 0.33 0.67

(p-value) (0.169) (0.496) (0.588) (0.807) (0.570)F-test for all logPCE splines 22.99*** 16.55*** 11.77*** 4.58**



Table 6. Regression for BMI: Women(1) (2) (3) (4) (5)

Aged 55-64 -0.127 -0.082 -0.071 -0.095 -0.272Aged 65-74 -0.415 -0.380 -0.389 -0.474 -0.615

Aged 75 and over -1.844*** -1.733*** -1.784*** -1.793*** -2.013***Can read and write 0.434 0.351 0.280 0.333 0.018Finished primary 1.374*** 1.264*** 1.182*** 1.172** 0.972**

Junior high and above 0.303 0.150 0.051 -0.123 -0.562logPCE (< median) 0.161 0.149 0.156 0.069

logPCE (> median, marginal) 0.152 0.101 0.159 0.259Rural -0.358

Rural Zhejiang 0.178Urban Gansu 1.129**Rural Gansu -0.107


(p-value) (0.003) (0.006) (0.003) (0.003) (0.007)F-test for all education dummies 3.37** 2.73** 2.36* 2.39* 2.73**

(p-value) (0.022) (0.049) (0.077) (0.074) (0.048)F-test for all logPCE splines 2.11 1.59 2.05 1.09

(p-value) (0.127) (0.209) (0.134) (0.340)F-test for all location dummies 2.85** 3.01***


Hypertension and Underdiagnosis

• No SES results for hypertension– Same as Indonesia

• However, not so for hypertension underdiagnoses, especially for women

2040

6080

%

40 50 60 70 80age

Men Women

for men and women, bw=.75Figure 10. Hypertension and Age

Table 7. Percentage of hypertension, by age and sex

% N % N

32.9 334 33.8 374(5.4) (4.0)38.8 318 45.2 306(3.0) (5.7)54.2 205 68.8 173(4.0) (4.9)65.1 73 80.6 77(7.1) (4.7)42.4 930 48.4 930(2.8) (2.0)

Total (45+)

Men Women

45-54

55-64

65-74

75+

Table 8. Regression for hypertension: Men(1) (2) (3) (4) (5)

Aged 55-64 0.088** 0.089** 0.089** 0.088** 0.094**Aged 65-74 0.259*** 0.260*** 0.259*** 0.257*** 0.255***

Aged 75 and over 0.357*** 0.354*** 0.354*** 0.355*** 0.351***Can read and write 0.022 0.021 0.021 0.022 -0.001Finished primary 0.007 0.004 0.004 0.003 -0.011

Junior high and above 0.048 0.042 0.041 0.035 0.019logPCE (< median) -0.018 -0.019 -0.018 -0.015


Rural Zhejiang -0.002Urban Gansu 0.042Rural Gansu -0.001




(p-value) (0.479) (0.563) (0.506) (0.657)F-test for all location dummies 0.16 1.53***


Table 9. Regression for hypertension: Women(1) (2) (3) (4) (5)

Aged 55-64 0.148*** 0.151*** 0.151*** 0.150*** 0.141***Aged 65-74 0.320*** 0.321*** 0.321*** 0.317*** 0.310***

Aged 75 and over 0.414*** 0.417*** 0.417*** 0.416*** 0.410***Can read and write 0.034 0.027 0.027 0.029 0.053Finished primary 0.017 0.009 0.009 0.007 0.023

Junior high and above -0.039 -0.053 -0.053 -0.062 -0.072logPCE (< median) -0.003 -0.003 -0.003 -0.003


Rural Zhejiang 0.029Urban Gansu 0.057Rural Gansu 0.010




(p-value) (0.431) (0.436) (0.394) (0.365)F-test for all location dummies 0.42 1.37**


3540

4550

55%

40 50 60 70 80age

Men Women

for men and women, bw=.75Figure 11. Underdiagnosis of Hypertension against Age

Table 10. Under-diagnosis of hypertension, by age and sex

% N % N

49.5 92 44.1 136(11.8) (8.0)47.6 124 33.1 163(7.6) (5.5)42.1 107 59.5 121(9.1) (8.4)43.6 45 42.6 59

(10.1) (9.9)46.0 368 44.3 479(3.9) (4.3)

Total (45+)

Men Women

45-54

55-64

65-74

75+

% N % N

26.8 92 39.7 136(9.9) (8.9)34.8 124 53.0 163(6.1) (5.0)43.2 107 31.7 121

(11.0) (7.2)37.5 45 50.2 59(9.3) (9.1)35.5 368 43.5 479(3.7) (4.3)

Standard error in Parenthesis

Total(45+)

Men Women

45-54

55-64

65-74

75+

Table 11. Percentage taking medication or treatment for hypertension, by age and sex

Table 12. Under-diagnosis of hypertension, by sex and education

% N % N

49.5 102 48.9 317(5.7) (3.7)49.0 91 36.4 79(7.6) (8.1)49.0 86 22.1 46(7.6) (6.5)39.6 88 56.2 37(7.7) (22.2)46.0 367 44.3 479(3.9) (4.3)

Total

Men Women

Illiterate

Can read and write

Finished primary

Middle school and above

Table 13. Regression for the under-diagnosis of hypertension: Men(1) (2) (3) (4) (5)

Aged 55-64 -0.119* -0.120* -0.129** -0.123** -0.168**Aged 65-74 -0.181** -0.186** -0.188** -0.172** -0.206**

Aged 75 and over -0.198* -0.208** -0.208** -0.183* -0.144Can read and write -0.110 -0.110 -0.113 -0.088 -0.068Finished primary -0.053 -0.049 -0.051 -0.038 0.009

Junior high and above -0.168** -0.159* -0.149* -0.154* -0.171**logPCE (< median) -0.049* -0.047 -0.026 -0.021

logPCE (> median, marginal) 0.033 0.072 0.069 0.080Rural 0.126**

Rural Zhejiang 0.068Urban Gansu 0.055Rural Gansu 0.219***

Community FE NO NO NO NO YESF-test for all age dummies 2.40* 2.73** 2.90** 2.50* 2.81**



(p-value) (0.158) (0.282) (0.643) (0.640)F-test for all location dummies 3.53** 1.40**


Table 14. Regression for the under-diagnosis of hypertension: Women(1) (2) (3) (4) (5)

Aged 55-64 -0.103* -0.108* -0.108* -0.102* -0.076Aged 65-74 -0.050 -0.053 -0.048 -0.039 -0.036

Aged 75 and over -0.121 -0.128 -0.112 -0.091 -0.060Can read and write -0.161*** -0.156*** -0.141** -0.115** -0.077Finished primary -0.266*** -0.258*** -0.248*** -0.222*** -0.154

Junior high and above -0.201** -0.194** -0.159* -0.157* -0.080logPCE (< median) -0.019 -0.013 -0.006 0.006


Rural Zhejiang 0.024Urban Gansu -0.004Rural Gansu 0.167***


(p-value) (0.291) (0.271) (0.303) (0.361) (0.651)F-test for all education dummies 6.16*** 5.68*** 5.51*** 4.19*** 1.23


(p-value) (0.712) (0.867) (0.885) (0.706)F-test for all location dummies 2.91** 1.51**


Table 15. Percentage of diagnosed disease, by age and sex

Men Women Men Women Men Women Men Women Men Women Men Women% 17.2 35.1 0.3 1.3 15.3 30.5 1.7 2.4 1.0 6.9 2.6 0.7

(2.4) (3.2) (0.2) (0.4) (2.4) (4.4) (0.5) (0.7) (0.5) (2.1) (2.0) (0.3)N 445 491 447 493 444 489 446 494 447 494 447 494% 31.4 64.5 2.6 3.6 25.5 45.0 3.2 5.6 5.6 13.1 1.3 1.9

(3.3) (6.1) (0.7) (1.2) (3.5) (3.5) (0.9) (1.4) (2.1) (3.1) (0.5) (0.7)N 420 402 424 405 424 404 424 405 424 405 424 405% 59.8 81.5 3.1 7.7 39.0 50.1 5.7 13.9 12.3 23.1 2.2 5.8

(3.7) (3.8) (1.0) (3.0) (3.6) (6.3) (1.6) (3.7) (4.2) (4.3) (0.8) (2.5)N 278 227 279 229 278 227 279 229 279 229 279 229% 80.4 94.2 16.4 12.8 53.7 62.4 19.3 23.3 31.7 41.6 7.9 10.1

(4.3) (2.5) (4.3) (3.7) (6.3) (8.0) (4.7) (5.7) (6.1) (7.7) (2.5) (2.9)N 119 113 119 113 118 113 119 113 119 113 119 113% 38.2 59.5 3.2 4.4 27.9 42.2 4.8 7.6 8.0 15.4 2.6 3.0

(2.0) (2.5) (0.6) (0.8) (2.2) (3.4) (0.8) (1.3) (1.4) (2.5) (0.8) (0.6)N 1262 1233 1269 1240 1264 1233 1268 1241 1269 1241 1269 1241

45-54

55-64

65-74

75+

Total(45+)

Heart diseaseHypertension High cholesterol Diabetes Cancer Lung disease

ADLs-IADLs

• ADLs have some SES gradient, but IADLs have strong SES gradient

0.2

.4.6

.8nu

mbe

rs

50 60 70 80age

Men Women

for men and women, bw=.75Figure 12. Numbers of Difficulties with ADL against Age

0.5

11.

52

num

bers

40 50 60 70 80age

Men Women

for men and women, bw=.75Figure 13. Numbers of Difficulties with IADL against Age

Table 16. Percent Individuals having difficulty with ADLs and IADLs: By Age and Sex

Men Women Men Women% 1.5 6.0 7.0 19.6

(0.6) (2.0) (2.1) (4.2)N 442 489 447 492

% 8.3 9.3 17.0 26.0(2.2) (2.4) (2.6) (3.5)

N 420 402 424 405

% 7.2 18.3 20.3 42.0(2.0) (4.9) (4.7) (6.1)

N 277 227 279 228

% 29.5 26.2 48.4 58.2(5.8) (7.2) (5.9) (8.3)

N 118 112 119 111

% 7.6 11.3 17.2 29.7(1.2) (2.2) (2.0) (3.1)

N 1257 1230 1269 1236

Total (45+)

ADLs IADLs

45-54

55-64

65-74

75+

Men Women Men Women Men Women Men Women Men Women Men Women

% 14.7 16.8 8.8 4.4 3.2 2.2 0.0 1.5 5.8 7.8 4.7 8.6

(3.0) (2.9) (2.2) (1.3) (1.7) (0.9) (0.0) (0.7) (1.2) (2.1) (2.1) (2.1)

N 443 492 441 489 447 492 447 493 447 493 447 492

% 23.4 29.4 4.0 16.5 5.7 5.3 0.0 1.6 9.5 7.5 6.2 14.6

(3.3) (5.2) (1.0) (4.8) (1.6) (2.0) (0.0) (0.9) (1.7) (1.8) (1.4) (2.9)

N 422 406 421 404 424 405 423 405 424 406 424 406

% 32.4 29.0 12.1 13.4 13.1 6.3 0.2 1.0 15.4 9.2 12.0 14.2

(3.4) (6.3) (4.4) (6.4) (4.4) (2.4) (0.2) (0.8) (4.3) (2.1) (3.9) (4.4)

N 277 230 274 229 277 229 278 229 278 229 278 229

% 32.6 43.0 3.9 0.2 4.0 7.6 0.7 0.4 21.7 19.3 8.5 18.7

(5.7) (7.5) (1.9) (0.2) (1.8) (3.5) (0.7) (0.4) (4.9) (6.6) (3.2) (6.9)

N 119 113 119 111 118 113 119 113 119 113 119 113

% 23.5 26.1 7.7 9.9 6.5 4.6 0.1 1.4 10.8 9.1 7.3 12.7(1.9) (3.1) (1.5) (1.8) (1.5) (1.1) (0.1) (0.4) (1.3) (1.2) (1.6) (2.6)

N 1261 1241 1255 1233 1266 1239 1267 1240 1268 1241 1268 1240

Picking upcoins

Table 17. Percent individuals having difficulty with physical functioning:By age and sex

Jogging1km

Walking100m

Legsfunctions

Extendingarms

Lifting 5kg

45-54

55-64

65-74

75+

Total(45+)

0.1

.2.3

.4


Men Women

num

bers

educational level

by sex and educational levelFigure 14. Numbers of Difficulties with ADL,

0.5

11.

5


Men Women

num

bers

educational level

by sex and educational levelFigure 15. Numbers of Difficulties with IADL,

Table 18. Regression for the number of difficulties in ADLs: Men(1) (2) (3) (4) (5)

Aged 55-64 0.158*** 0.152*** 0.152*** 0.148*** 0.177***Aged 65-74 0.202*** 0.188*** 0.190*** 0.177*** 0.211***

Aged 75 and over 0.850*** 0.831*** 0.834*** 0.860*** 0.923***Can read and write -0.093 -0.084 -0.084 -0.045 -0.013Finished primary -0.078 -0.066 -0.065 -0.060 -0.039

Junior high and above -0.073 -0.056 -0.054 -0.098 -0.099logPCE (< median) -0.069 -0.068 -0.042 -0.052

logPCE (> median, marginal) 0.075 0.079 0.088 0.101Rural 0.025







Table 19. Regression for the number of difficulties in ADLs: Women(1) (2) (3) (4) (5)

Aged 55-64 0.078* 0.074* 0.076* 0.063 0.050Aged 65-74 0.265*** 0.264** 0.268*** 0.268*** 0.269***

Aged 75 and over 0.685*** 0.686*** 0.701*** 0.747*** 0.786***Can read and write -0.143** -0.138** -0.124* -0.044 -0.015Finished primary -0.116* -0.108* -0.087 -0.037 -0.027

Junior high and above -0.127** -0.108* -0.085 -0.099 -0.037logPCE (< median) 0.015 0.019 0.046 0.042

logPCE (> median, marginal) -0.072 -0.061 -0.045 -0.043Rural 0.074

Rural Zhejiang -0.055Urban Gansu 0.187**Rural Gansu 0.355***


(p-value) (0.000) (0.000) (0.000) (0.000) (0.000)F-test for all education dummies 2.24* 2.00 1.37 0.74 0.08




Table 20. Regression for the number of difficulties in IADLs: Men(1) (2) (3) (4) (5)

Aged 55-64 0.256*** 0.240*** 0.240*** 0.235*** 0.268***Aged 65-74 0.433*** 0.391*** 0.403*** 0.399*** 0.417***

Aged 75 and over 1.469*** 1.421*** 1.441*** 1.534*** 1.608***Can read and write -0.550*** -0.520*** -0.517*** -0.401*** -0.352***Finished primary -0.486*** -0.442*** -0.432*** -0.398*** -0.401***

Junior high and above -0.540*** -0.465*** -0.440*** -0.528*** -0.500***logPCE (< median) -0.160*** -0.146*** -0.065 -0.060





(p-value) (0.000) (0.000) (0.000) (0.000) (0.000)F-test for all logPCE splines 8.63*** 5.72*** 1.01 0.92



Table 21. Regression for the number of difficulties in IADLs: Women(1) (2) (3) (4) (5)

Aged 55-64 0.187** 0.142** 0.145** 0.101 0.107Aged 65-74 0.577*** 0.528*** 0.546*** 0.544*** 0.571***

Aged 75 and over 1.392*** 1.266*** 1.334*** 1.486*** 1.478***Can read and write -0.564*** -0.503*** -0.435*** -0.165 -0.146Finished primary -0.625*** -0.523*** -0.420*** -0.252*** -0.254**

Junior high and above -0.740*** -0.589*** -0.473*** -0.533*** -0.444***logPCE (< median) -0.194*** -0.177*** -0.085 -0.088

logPCE (> median, marginal) 0.001 0.052 0.111 0.114Rural 0.371***







67

89

10C

ES

-D 1

0

40 50 60 70 80age

Men Women

for men and women, bw=.75Figure 16. CES-D 10 against Age

Strong CES-D differentials with SES

• Especially for women

• Same as Indonesia

Table 22. Regression for CES-D 10: Men(1) (2) (3) (4) (5)

Aged 55-64 0.385 0.231 0.245 0.224 0.278Aged 65-74 1.006* 0.650 0.744 0.811 1.149**

Aged 75 and over 1.155 0.721 0.924 1.576 1.831*Can read and write -0.868 -0.668 -0.680 -0.115 -0.125Finished primary -0.984* -0.636 -0.635 -0.468 -0.489

Junior high and above -1.304* -0.746 -0.644 -1.118* -0.987logPCE (< median) -1.119*** -1.025** -0.562* -0.585**





(p-value) (0.274) (0.663) (0.681) (0.157) (0.383)F-test for all logPCE splines 11.86*** 7.99*** 2.03 2.37*



Table 23. Regression for CES-D 10: Women(1) (2) (3) (4) (5)

Aged 55-64 0.674 0.493 0.497 0.409 0.754Aged 65-74 0.370 0.203 0.276 0.503 0.746

Aged 75 and over -0.054 -0.510 -0.264 1.034 1.160Can read and write -2.643*** -2.423*** -2.218*** -1.114** -0.692Finished primary -1.915*** -1.510*** -1.234** -0.368 -0.159

Junior high and above -3.584*** -3.127*** -2.761*** -3.129*** -2.420***logPCE (< median) -1.178*** -1.076*** -0.612* -0.613

logPCE (> median, marginal) 0.953 1.049 1.086* 0.972Rural 1.280*




(p-value) (0.000) (0.000) (0.000) (0.000) (0.003)F-test for all logPCE splines 5.23*** 4.28** 1.89 1.21



Survival expectations

• Survival expectations asked similar to HRS

• Have problem that depending on age, are asked about survival to different ages

• We use 2 approaches: – First, we standardize each answer by mean

answer given by all who are asked about same survival age as respondent

– Second, we use only respondents under 65, all of whom are asked about survival to 75

.96

.98

11.

021.

041.

06no

rmal

ized

sco

re

40 50 60 70 80age

Men Women

for men and women, bw=.75Figure 17. Normalized Life Expectation against Age

1015

2025

30%

sai

d''n

ot v

ery

likel

y'' o

r ''a

lmos

t im

poss

ible

''

40 45 50 55 60 65 70age

Men Women

for men and women under 65, bw=.75Figure 18. Life Expectation to 75 aginst Age:

Almostimpossible

Not verylikely

Maybe Very likelyAlmostcertain

N

5.4 12.7 33.0 21.5 27.4 713

(1.3) (1.8) (3.1) (2.6) (2.8)

6.0 14.1 30.5 24.6 24.7 759

(2.2) (2.2) (2.9) (3.0) (2.9)

Table 24. Life expectation to 75, for men and women under 65

Men

Women

.8.9

11.

11.

2no

rmal

ized

sco

re


Men Women

educational level

by sex and educational levelFigure 19. Normalized Life Expectation,

510

1520

2530

% s

aid'

'not

ver

y lik

ely'

' or

''alm

ost i

mpo

ssib

le''


Men Women

educational level

for those bellow 65, by sex and educationFigure 20. Life Expectation to 75,

Table 25. Regression for normalized life expectation: Men(1) (2) (3) (4) (5)

Aged 55-64 -0.034 -0.026 -0.028 -0.027 -0.040Aged 65-74 0.020 0.042 0.037 0.039 0.023

Aged 75 and over 0.026 0.045 0.037 -0.000 -0.023Can read and write 0.083*** 0.066** 0.066** 0.024 -0.003Finished primary 0.119*** 0.094*** 0.092*** 0.084** 0.044

Junior high and above 0.123*** 0.074** 0.067** 0.102*** 0.064*logPCE (< median) 0.057** 0.051* 0.015 0.002

logPCE (> median, marginal) 0.045 0.034 0.037 0.043Rural -0.071*

Rural Zhejiang -0.018Urban Gansu -0.195***Rural Gansu -0.255***


(p-value) (0.420) (0.251) (0.287) (0.243) (0.184)F-test for all education dummies 6.59*** 3.51** 3.37** 4.13*** 1.56

(p-value) (0.000) (0.018) (0.022) (0.008) (0.205)F-test for all logPCE splines 14.84*** 9.09*** 3.18** 1.64



Table 26. Regression for normalized life expectation: Women(1) (2) (3) (4) (5)

Aged 55-64 -0.048* -0.037 -0.037 -0.028 -0.031Aged 65-74 -0.005 0.007 0.004 0.003 -0.000

Aged 75 and over 0.031 0.065 0.052 0.020 0.032Can read and write 0.130*** 0.111*** 0.100*** 0.048 0.054Finished primary 0.058 0.034 0.016 -0.023 -0.036

Junior high and above 0.158*** 0.124*** 0.101*** 0.110*** 0.083**logPCE (< median) 0.054*** 0.050*** 0.030*** 0.030***

logPCE (> median, marginal) -0.016 -0.025 -0.032 -0.044Rural -0.074**

Rural Zhejiang -0.026Urban Gansu -0.175***Rural Gansu -0.260***


(p-value) (0.160) (0.122) (0.182) (0.531) (0.425)F-test for all education dummies 10.65*** 7.33*** 5.20*** 5.11*** 3.56**

(p-value) (0.000) (0.000) (0.002) (0.003) (0.017)F-test for all logPCE splines 13.13*** 9.98*** 4.51** 4.53**



(1) (2) (3) (4) (5)Aged 55-64 0.014 -0.000 0.002 0.004 0.014

Can read and write -0.121** -0.098* -0.099* -0.055 -0.052Finished primary -0.174*** -0.142*** -0.141*** -0.140*** -0.123**

Junior high and above -0.097 -0.043 -0.038 -0.085 -0.065logPCE (< median) -0.166*** -0.151*** -0.068 -0.063

logPCE (> median, marginal) 0.115* 0.117* 0.067 0.062Rural 0.077*

Rural Zhejiang -0.021Urban Gansu 0.172***Rural Gansu 0.290***

Community FE NO NO NO NO YESF-test for all education dummies 3.84** 3.34** 3.54** 2.94** 2.15




Table 27. Regression for "not very likely" or "almost impossible"to reach 75: Men under 65

(1) (2) (3) (4) (5)Aged 55-64 0.073** 0.054 0.053* 0.049 0.052*

Can read and write -0.137*** -0.111** -0.090* -0.027 -0.036Finished primary -0.156*** -0.113** -0.092* -0.039 -0.078

Junior high and above -0.187*** -0.132*** -0.099** -0.098** -0.153***logPCE (< median) -0.101*** -0.093*** -0.042** -0.044**


Rural Zhejiang 0.011Urban Gansu 0.153**Rural Gansu 0.351***

Community FE NO NO NO NO YESF-test for all education dummies 6.60*** 3.56** 2.20* 1.76 3.05**

(p-value) (0.000) (0.017) (0.093) (0.161) (0.035)F-test for all logPCE splines 21.31*** 15.33*** 2.59* 3.82**



Table 28. Regression for "not very likely" or "almost impossible"to reach 75: Women under 65

Ever and Current Smoking

• As in the rest of Asia, smoking is a male vice, women don’t smoke per se

• Are cohort effects in who ever smoked

• Is some quitting as men age

• Current smoking status unrelated to SES– A bit different from Indonesia

4050

6070

80%

40 50 60 70 80age

Ever smoker Current smoker

For Men Only, bw=.75Figure 21. Ever and Current Smoking by Age:

Table 29. Percentage of current smoker, by age and sex

% N % N

63.3 398 0.9 462(4.8) (0.4)53.0 375 7.1 366(3.6) (4.5)34.1 251 2.7 204(7.8) (1.3)36.9 93 0.7 95(6.5) (0.6)50.4 1117 3.3 1127(4.2) (1.6)

Total (45+)

Men Women

45-54

55-64

65-74

75+

Table 30. Regression for smoking: Men

(1) (2) (3) (4) (5)Aged 55-64 -0.050 -0.094** -0.089** -0.088** -0.088** -0.078**Aged 65-74 -0.129*** -0.218*** -0.206*** -0.203*** -0.204*** -0.207***

Aged 75 and over -0.146** -0.309*** -0.296*** -0.292*** -0.298*** -0.271***Can read and write 0.077* 0.004 -0.005 -0.005 -0.011 -0.004Finished primary 0.075* 0.021 0.007 0.008 0.007 0.018

Junior high and above 0.068 0.030 0.009 0.013 0.017 0.016logPCE (< median) 0.043** 0.046** 0.041** 0.044**

logPCE (> median, marginal) -0.014 -0.008 -0.008 0.008Rural 0.038

Rural Zhejiang 0.047Urban Gansu -0.022Rural Gansu 0.014

Community FE NO NO NO NO NO YESF-test for all age dummies 3.45** 12.69*** 11.14*** 11.05*** 11.58*** 10.57***

(p-value) (0.020) (0.000) (0.000) (0.000) (0.000) (0.000)F-test for all education dummies 1.40 0.16 0.04 0.05 0.11 0.09

(p-value) (0.248) (0.921) (0.990) (0.983) (0.952) (0.963)F-test for all logPCE splines 3.42** 4.24** 3.45** 4.70**

(p-value) (0.037) (0.017) (0.036) (0.011)F-test for all location dummies 0.49 1.77***

(p-value) (0.693) (0.000)Observations 1111 1111 1111 1111 1111 1111

Eversmoking

Current smoking

Community-Redux

• The apparent importance of regional and community factors is a major result of this analysis---WHY?

• In our theory we talk about different prices, different health care availability and quality– These are likely to explain some, but almost

surely there are other, unmeasured factors

• Different health environment: air, water

• Different food preferences: diet

Community-Redux 2

• Understanding the factors behind these community effects must be the subject of future research

• CHARLS is well-placed for that in part because of the detailed community information we collect- far more detailed than other HRS-type surveys

Documents

CHARLS – Introduction and Health- SES Associations Among the Elderly Yaohui Zhao, Peking University Xiaoyan Lei, Peking University Albert Park, Oxford