Adequate access to healthcare and added life expectancy among older adults in China

Abstract

Background: Adequate access to healthcare is associated with lower risks of mortality at older ages. However, it is largely unknown how many more years of life can be attributed to having adequate access to healthcare compared with having inadequate access to healthcare. Method: A nationwide longitudinal survey of 27,794 older adults aged 65+ in mainland China from 2002 to 2014 was used for analysis. Multivariate hazard models and life table techniques were used to estimate differences in life expectancy associated with self-reported access to healthcare (adequate vs. inadequate). The findings were assessed after adjusting for a wide range of demographic factors, socioeconomic status, family/social support, health practices, and health conditions. Results: At age 65, adequate access to healthcare increased life expectancy by approximately 2.0-2.5 years in men and women and across urban-rural areas compared with those who reported inadequate access to healthcare. At age 85, the corresponding increase in life expectancy was 1.0-1.2 years. After adjustment for multiple confounding factors, the increase in life expectancy was reduced to approximately 1.1-1.5 years at age 65 and 0.6-0.8 years at age 85. In women, the net increase in life expectancy attributable to adequate access to healthcare was 6 and 8% at ages 65 and 85, respectively. In men, the net increases in life expectancy were generally greater (10 and 14%) and consistent after covariate adjustments. In contrast, the increase in life expectancy was slightly lower in rural areas (2.0 years at age 65 and 1.0 years at age 85) than in urban areas (2.1 years at age 65 and 1.1 years age 85) when no confounding factors were taken into account. However, the increase in life expectancy was greater in rural areas (1.0 years at age 65 and 0.6 years at age 85) than in urban areas (0.4 years at age 65 and 0.2 years at age 85) after accounting for socioeconomic and other factors. Conclusions: Adequate access to healthcare was associated with longer life expectancy among older adults in China. These findings have important implications for efforts to improve access to healthcare among older populations in China.

Individual-level factors attributable to urban-rural disparity in mortality among older adults in China

“…Our findings are consistent with previous studies that have shown a mortality advantage among urban older adults relative to rural older adults in China [5,7,8,16]. With few exceptions, however, most of these studies did not distinguish urban-rural mortality differences by age or gender; and none of these studies explored the factors contributing to the differences in mortality by age or gender [5,7,16].…”

“…Historically, urban areas have had higher rates of infectious disease and mortality at the early stages of industrialization due to poor sanitation, hazardous working environments, and high population density-leading to a so-called urban mortality "penalty" [3]. However, today's urban areas usually have lower rates of mortality compared with rural areas due to improvements in infrastructure, better public health and medical systems, and overall advances in socioeconomic development [4][5][6][7]. These macro-level and institutional factors, along with a number of individual-level factors such as socioeconomic status [8], lifestyle and nutrition [9], and social networks [10], have been attributed to urban-rural disparity in mortality.…”

“…Studies have further shown that improvements in healthcare services, socioeconomic resources, and infrastructure (e.g., transportation and safe drinking-water) in urban areas may partly explain the urban-rural disparity in mortality in contemporary China [4,5,8,15,25]. Although China has witnessed a rapid urbanization since the 1990s [26], the urban-rural disparity is still persistent in the healthcare system, pension system, and ultimately in health outcomes and mortality [7,8,18,19].…”

Nonhuman primates at the intersection of aging biology, chronic disease, and health: An introduction to the American Journal of Primatology Special Issue on aging, cognitive decline, and neuropathology in nonhuman primates

“…Humans experience a relatively long, slow degradation of motor, sensory, and cognitive function and accumulate chronic diseases of aging such as sarcopenia, arthritis, hypertension, chronic kidney disease, diabetes, cardiovascular disease, and AD (Jaul & Barron, 2017). This is due in part to the aging of a population supported by good health care and nutrition (Chetty et al, 2016; Hao et al, 2020). However, with advancing age has come an increase in aging–related diseases.…”

Have the Chinese Older Adults Received Adequate Healthcare Services since the 2009 Health Reform? Examining the Socioeconomic Disparity in Receiving Adequate Healthcare

“…Providing adequate healthcare services to individuals with most medical needs could contribute to more positive health outcomes. Hao et al [8] found that receiving adequate healthcare services was associated with longer life expectancy among Chinese older adults. Receiving adequate healthcare services could make a difference in healthy longevity among Chinese older adults as well [9].…”