Healthy Longevity in China: Demographic, Socioeconomic, and Psychological Dimensions PDF
Preview Healthy Longevity in China: Demographic, Socioeconomic, and Psychological Dimensions
Healthy Longevity in China THE SPRINGER SERIES ON DEMOGRAPHIC METHODS AND POPULATION ANALYSIS Series Editor KENNETH C. LAND Duke University In recent decades, there has been a rapid development of demographic models and methods and an explosive growth in the range of applications of population analysis. This series seeks to provide a publication outlet both for high-quality textual and expository books on modern techniques of demographic analysis and for works that present exemplary applications of such techniques to various aspectsofpopulationanalysis. Topicsappropriatefortheseriesinclude: (cid:129) Generaldemographicmethods (cid:129) Techniquesofstandardization (cid:129) Lifetablemodelsandmethods (cid:129) Multistateandmultiregionallifetables,analysesandprojections (cid:129) Demographicaspectsofbiostatisticsandepidemiology (cid:129) Stablepopulationtheoryanditsextensions (cid:129) Methodsofindirectestimation (cid:129) Stochasticpopulationmodels (cid:129) Eventhistoryanalysis,durationanalysis,andhazardregressionmodels (cid:129) Demographicprojectionmethodsandpopulationforecasts (cid:129) Techniquesofapplieddemographicanalysis,regionalandlocal populationestimatesandprojections (cid:129) Methodsofestimationandprojectionforbusinessandhealthcare applications (cid:129) Methodsandestimatesforuniquepopulationssuchasschoolsandstudents Volumes in the series are of interest to researchers, professionals, and students in demography, sociology, economics, statistics, geography and regional science, public health and health care management, epidemiology, biostatistics, actuarial science, business,andrelatedfields. Thetitlespublishedinthisseriesarelistedattheendofthisvolume. Healthy Longevity in China Demographic, Socioeconomic, and Psychological Dimensions editedby Zeng Yi DukeUniversity,Durham,NC,USA;PekingUniversity,Beijing,China Dudley L. Poston, Jr. TexasA&MUniversity,CollegeStation,TX,USA Denese Ashbaugh Vlosky LouisianaStateUniversity,BatonRouge,LA,USA Danan Gu DukeUniversity,Durham,NC,USA Editors ZengYi DeneseAshbaughVlosky DukeUniversityDurham,NC,USA LouisianaStateUniversity, PekingUniversity,Beijing, BatonRouge,LA, China USA DudleyL.Poston,Jr. DananGu TexasA&MUniversity, DukeUniversity, CollegeStation, Durham,NC, TX,USA USA ISBN:978-1-4020-6751-8 e-ISBN:978-1-4020-6752-5 LibraryofCongressControlNumber:2007941177 (cid:2)c 2008SpringerScience+BusinessMediaB.V. Nopartofthisworkmaybereproduced,storedinaretrievalsystem,ortransmitted inanyformorbyanymeans,electronic,mechanical,photocopying,microfilming,recording orotherwise,withoutwrittenpermissionfromthePublisher,withtheexception ofanymaterialsuppliedspecificallyforthepurposeofbeingentered andexecutedonacomputersystem,forexclusiveusebythepurchaserofthework. Printedonacid-freepaper. 9 8 7 6 5 4 3 2 1 springer.com Preface The Chinese Longitudinal Healthy Longevity Study (CLHLS) was launched a decadeago.ProfessorZengYi,ProfessorXiaoZhenyuandI,withhelpfromvarious researchers at Peking University, the Chinese Academy of Social Science, Duke University,theMaxPlanckInstituteforDemographicResearch,andtheUniversity ofSouthernDenmark,coordinatedthedesignofthestudyandtherequiredfundrais- ing. The Max Planck Institute for Demographic Research provided some modest butcrucialseedmoney.AcontinuingresearchgrantfromtheNationalInstituteon Aging(NIA)oftheU.S.NationalInstitutesofHealthcoveredinternationalresearch expendituresaswellassomeexpensesinChina;Iwastheoriginaldirectorofthis grant, but Zeng Yi has now taken on that responsibility. The bulk of the effort in carrying out the survey—a mammoth undertaking—as well as much of the anal- ysis in China was provided by Peking University and the other involved Chinese institutions. Inour1997grantapplicationtotheNIA,wearguedthatitisimportanttostudy people 80 years old and older—the oldest-old—because this segment of the pop- ulation is rapidly growing, not only in developed countries but also in China and manyotherdevelopingcountries.UnitedNationsstatistics indicatethattheglobal populationoftheoldest-oldisgrowingat3.4percentannually.Becauseofthisrapid growth,theworld’soldest-oldmaynumberalmost200millionin2030andalmost 400millionin2050,comparedwithlessthan70millionin2000.Theoldest-oldare especiallysignificantbecauseoftheintensivehealthandsocialcaretheyrequire— and because, compared with other segments of the population, so little is known abouttheirneedsandaboutopportunitiestoimprovetheirhealthandwellbeing. More specifically we argued in our 1997 grant application that the elderly in China were worthyof carefulstudy.China is home to abouta fifth of the world’s population—andaboutafifthoftheworld’selderlypopulation.Asdescribedinthe introductorychapterofthisbook,thepaceofincreasein thenumbersandpropor- tionsoftheelderlyandtheoldest-oldinChinaisextraordinary.Thenumbersofthe elderlyinChinaarebeingswelledbythesurvivorsofthehugecohortsborninthe 1950sand1960s.TheriseinthepercentageofpeopleinChinawhoareelderlyis furtherfuelledbytherapiddeclineinfertilitysincethe1970s. Asdemographerswewereawareoftheproblemsofagemisreportingthatmake studies of the oldest-oldproblematicin many countries.For some of the minority v vi Preface populationsof China this is a major concern,but for the Han Chinese, who make up thegreatbulkof the Chinese population,reportsof ageare generallyaccurate. Thiswasdocumentedbyvariousscholarsandconfirmedbya pilotstudyreported inarticlebyWangZhenglian,ZengYi,BernardJeuneandmeinGenus. Thuswe were convincedin 1997that it was feasible and importantto conduct a longitudinalstudy focusing on the determinantsof healthylongevity amongthe oldest-old in the 22 provincesof China with overwhelminglyHan Chinese popu- lations. Under the leadership of Professor Zeng Yi and co-investigator Professor Xiao Zhenyu and with the help of hundredsof survey enumeratorsand other sci- entists,theCLHLSwassuccessfullylaunchedandcontinuedoverthepastdecade. Assummarizedin Chapter2ofthisbook,thefirstsurveywasundertakenin1998 with follow-up surveys in 2000, 2002 and 2005. These four surveys included in- terviews with about 9,000, 1,1000, 1,6000 and another 16,000 elderly people. In total,face-to-faceinterviewshavebeenconductedwithnearly11,000centenarians, more than 14,000 nonagenarians, some 16,500 octogenarians and almost 10,000 peopleaged 65–79.At each wave, CLHLSre-interviewedsurvivors,and replaced deceasedintervieweeswithadditionalparticipants.Forthe12,500peoplewhodied (at ages from 65 to more than 105) between waves, data on mortality and health status before death were collected in interviews with a close family member. No otherstudyanywhereintheworldhasconducteddetailedinterviewswithsomany centenarians, nonagenariansand octogenarians. Furthermore, the study of 10,000 peopleaged65–79isoneofthelargestsuchstudieseverundertakenandprovides valuableinformationontheyoungeroldincomparisonwiththeoldest-old. Adecadeagolittle wasknownaboutthedeterminantsofhealthylongevity.We documentedthis in our 1997 grant application. The scarceness of knowledge was remarkable—giventheinterestpeoplehaveshownin“secretsoflonglife”forthou- sands of years and given the rapidly growing numbers of the oldest-old. We now knowmuchmore,inimportantpartduetoresearchbasedonCLHLSdata.Ascited in various chapters of this book and in the Epilogue, research output includes 24 articlesininternationaljournals,91articlesinChinesejournals,80paperspresented atinternationalconferences,atleast8 doctoralthesesandat least13M.A. degree theses, 11 policyreportssubmittedto governmentalagenciesandfourbookspub- lishedinChina(twooftheminbothChineseandEnglish). The research in this book represents an important milestone in our emerging understanding of how individuals can endeavor to live a long, healthy life and how societies can help them do so. The book captures highlights of a decade of effort—bythetensofthousandsofChinesewhowereinterviewed,bythehundreds of survey enumerators who organized and carried out the interviews, and by the scores of scientists who have sifted through the data. We still have only a partial understanding of the determinants of healthy longevity, but we have a consider- ablybetterunderstandingthanwehada decadeago—andwecan lookforwardto prospectsfordeeperunderstandingbasedinsignificantmeasureonfurtheranalysis ofdatafromtheongoingCLHLSendeavor. Director,MaxPlanckInstituteforDemographicResearch JamesW.Vaupel ResearchProfesser,DukeUniversity Acknowledgments Early versions of almost all the chapters in this book were first presented at one of the four seminars, symposia, and conferencesfocusing on the analyses of data fromthe“ChineseLongitudinalHealthyLongevitySurvey(CLHLS).”Therewere: (1) the “International Seminar on Determinants of Healthy Longevity in China,” held at the Max Planck Institute for Demographic Research (MPIDR), Rostock, onAugust2–4,2004;(2)the“ConferenceonChineseHealthyAgingandSocioe- conomics:InternationalPerspectives,” held at Duke University, on August 20–21, 2004;(3)the“SymposiumontheChineseLongitudinalHealthyLongevitySurvey: Unique Data Resource and Research Opportunities,” at the 57th annual scientific meetingofGSA,WashingtonDC,November19–23,2004and(4)the“International ConferenceonHealthyLongevity,”heldinPengshan,SichuanProvince,China,on September21–23,2005. Wethanktheseveralinstitutionsandtheirpersonnelforsupportingtheacademic activitieswhichhaveledtotheresearchreportedthisbook.TheNationalInstitute onAginghasprovidedfundinginsupportoftheCLHLS(P01AG08761,10/1998– 8/2004,PI:ZengYiandP01ProgramDirector:JamesW.Vaupel;R01AG023627– 01, 9/2004–8/2009,PI: Zeng Yi). The United Nations Fund for Population Activ- ities(UNFPA) andtheChinaNationalFoundationforSocialSciencesjoinedNIA to co-sponsor an expanded survey in 2002. Since 2005, the National Natural Sci- ence Foundation of China (grants 70440009 and 70533010) and the Hong Kong Research Grant Council joined the NIA to co-sponsor the expanded survey. The AcademiaSinicainTaiwanhasprovidedfundingtosupportthesub-sampleofthe adultchildrenoftheelderlyinterviewees.PekingUniversity,DukeUniversity,and theChinaAcademyofSocialScienceshaveallprovidedinstitutionalsupport.Since 1997,theMaxPlanckInstituteforDemographicResearch(MPIDR)hasprovided supportforinternationaltrainingaswell as fundingsupportforthe 2004seminar. DukeUniversity’sViceProvostforInternationalAffairsandDevelopmentandthe Vice Provost for Interdisciplinary Research, along with the Asian/Pacific Studies Institute,providedfundingtosupportthe2004conferenceatDukeUniversity.The GerontologySocietyofAmericaofferedtheopportunityofoursymposiumheldin Washington DC. The governments of the Mei Shan Municipality and Peng Shan CountyofSichuanProvince,China,providedfundingtosupportthe2005interna- tionalconferenceatPengShan.WealsowishtothanktheCentreforHealthAging vii viii Acknowledgments andFamilyStudies/ChinaCenterforEconomicResearchatPekingUniversity,and theCenterforStudyofAgingandHumanDevelopment,GeriatricsDivision,Popu- lationResearchInstituteandtheCenterforChinesePopulationandSocioeconomic StudiesatDukeUniversityfortheirinstitutionalsupportsandcontributionsaslocal hostsoftheseminarsandconferences. We sincerely thank Peking University and the China Mainland Information GroupfortheirvaluablesupportandcontributionsintheCLHLSdatacollections. We are very grateful to all interviewees and interviewers who participated in the CLHLS surveys. Without their efforts and collaboration, this nationwide project could neverhave been conducted.We would like to sincerely thankthe following individualswhoparticipatedinorprovidedadviceoradministrativesupportforthe CLHLSpilotstudies,questionnairedesign,training,surveyfieldwork,dataproces- sion and archiving (alphabetically listed): Wenmei Cai, Huashuai Chen, Junhong Chu, HarveyCohen, Qiushi Feng, BaochangGu, Danan Gu, Ling Guan, Zhigang Guo, Cheng Jiang, Leiwen Jiang, Jianxin Li, Ling Li, Qiang Li, George Linda, Guiping Liu, Yuzhi Liu, Jiehua Lu, Cindy Owens, Kenneth Land, Diane Parham, GeorgeanneE.Patmios,DudleyL.Poston,Jr.,KeShen,JacquiSmith,RichardSuz- man,LiqunTao,BeckyTesh, JamesW. Vaupel,NancyVaupel,DeneseAshbaugh Vlosky, Zhenglian Wang, Changping Wu, Deqin Wu, Zhenyu Xiao, Qin Xu, Ye Yuan,XianxinZeng,ZengYi,JieZhan,ChunyuanZhang,FengyuZhang,Wenjuan Zhang,ZhenZhang,BaohuaZhao,ZhenzhenZheng,YunZhou. WewouldliketoexpressourspecialgratitudeandrespecttoProfessorWenmei Caiwhopassedawayatage80in2004.ProfessorCaiwasoneoftheinitialmembers oftheCLHLSresearchteam,andshe activelyparticipatedin thepilotstudiesand the field surveys in the first three waves of CLHLS in 1998, 2000, and 2002. We aredeeplysaddenedbyherdeath;herpassingwillbealossfortheCLHLSproject. Her life was exemplarily active, productive, and fruitful. Our CLHLS study has benefitedsignificantlyfromheranthropologicalfieldobservationsandcontributions insociologicalanddemographictheories.Wededicatethisvolumetoher. Contents 1 Introduction:AgingandAgedDependencyinChina ............... 1 DudleyL.PostonJr.andZengYi PartI CLHLSanditsDataQualityAssessment 2 IntroductiontotheChineseLongitudinalHealthyLongevitySurvey (CLHLS) ...................................................... 23 ZengYi 3 GeneralDataQualityAssessmentoftheCLHLS................... 39 DananGu 4 ReliabilityofAgeReportingAmongtheChineseOldest-Oldinthe CLHLSDatasets ............................................... 61 ZengYiandDananGu 5 AgeReportingintheCLHLS:ARe-assessment.................... 79 HeatherBoothandZhongweiZhao 6 Assessment of Reliability of Mortality and Morbidity in the 1998–2002CLHLSWaves ....................................... 99 DananGuandMatthewE.Dupre PartII TheEffectsofDemographicandSocioeconomicFactors 7 TheEffectsofSociodemographicFactorsontheHazardofDying AmongChineseOldestOld ......................................121 DudleyL.PostonJr.andHosikMin 8 WhenI’m104:TheDeterminantsofHealthyLongevityAmongthe Oldest-OldinChina ............................................133 D.A.Ahlburg,E.JensenandR.Liao ix x Contents 9 AssociationofEducationwiththeLongevityoftheChineseElderly ..149 JianminLi 10 AnalysisofHealthandLongevityintheOldest-OldPopulation—A HealthCapitalApproach........................................157 ZhongZhao 11 TheMoreEngagement,theBetter?A StudyofMortalityofthe OldestOldinChina ............................................177 RongjunSunandYuzhiLiu PartIII LivingArrangementsandElderlyCare 12 LivingArrangementsandPsychologicalDispositionoftheOldest OldPopulationinChina ........................................197 ZhengWuandChristophM.Schimmele 13 Health and Living Arrangement Transitions among China’s Oldest-old .....................................................215 ZacharyZimmer 14 IntergenerationalSupportandSelf-ratedHealthoftheElderlyin RuralChina:AnInvestigationinChaohu,AnhuiProvince ..........235 LuSong,ShuzhuoLi,WenjuanZhangandMarcusW.Feldman 15 TheEffectsofAdultChildren’sCaregivingontheHealthStatusof TheirElderlyParents:ProtectionorSelection? ....................251 ZhenZhang 16 TheChallengetoHealthyLongevity:InequalityinHealthCareand MortalityinChina..............................................269 ZhongweiZhao PartIV SubjectiveWellbeingandDisability 17 SuccessfulAgeingoftheOldest-OldinChina......................293 PengDu 18 Impairments and Disability in the Chinese and American Oldest-OldPopulation ..........................................305 WilliamP.Moran,SihanLvandG.JohnChen 19 ToothLossAmongtheElderlyinChina...........................315 YunZhouandZhenzhenZheng 20 PsychologicalResourcesforWell-BeingAmongOctogenarians, Nonagenarians, and Centenarians: Differential Effects ofAgeandSelectiveMortality ...................................329 JacquiSmith,DenisGerstorfandQiangLi
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