Socio-Demographic Factors and Older Adult Health in China and India: What Can We Learn from Self-Reported Measures?

Type Working Paper
Title Socio-Demographic Factors and Older Adult Health in China and India: What Can We Learn from Self-Reported Measures?
Publication (Day/Month/Year) 2015
Background/Purpose: While the incidence of non-communicable diseases (NCDs) tends to increase with age, the association between age and NCD development is not clearly understood. Morbidity and mortality rates in developing countries are experiencing an epidemiological transition from infectious disease to NCDs, and China and India comprise two of the world’s largest aging populations. Chronic disease and disability, in combination with aging, are likely to become major challenges for China's and India’s health systems. Several studies point to significant heterogeneity in NCD prevalence as contributing to the lack of appropriate data to monitor prevalence of NCDs among older adults in developing countries. In order to explore factors related to aging and NCD development in China and India, this study examined the association between self-reported NCD diagnosis, health status, and key socio-demographic predictors. We conducted separate within country analyses, as well as combined country analyses that included additional measures to capture the effects of economic development and to account for unobserved country-specific effects. We discussed self-reported health status and NCD diagnosis as possible indicators of health literacy and access to health services that can be moderated by age and other socio-demographic factors, and implications for further research with longitudinal, panel data. This study contributes to the existing research on chronic disease and aging in China and India by providing a comparison of two subjective and contextual measures. Self-reported diagnoses and health ratings further elucidate socio-demographic disparities and provide insights into the considerable heterogeneity in NCD prevalence among older adults in these two countries.

Methods: Data and samples: We used the Study on Global AGEing and Adult Health (SAGE) China and India Wave 1 data, which was conducted from 2007 to 2010, to perform our cross-sectional analysis. Our study sample size was 7,150 individuals for India, and 13,367 individuals for China.

Measures: Eight chronic conditions were used to generate a composite variable indicating one or more NCDs. Global self-rated health status was measured with a five-point scale. PPP-adjusted state/province level GDP was used to account for the effects of economic development and a nationality measure was created to capture country fixed effects.

Results: In China and India, household and regional wealth are strongly associated with both higher self-rated health and higher likelihood of reporting an NCD diagnosis for older adults (p<.01). Urban living is associated with both higher self-rated health and greater NCD diagnosis in India (p<.05). For both countries, younger age and higher education levels are strongly associated with better self-rated health, and men report better overall health and are less likely to report NCDs than women (p<.01). Marital status was not clearly linked to either outcome.

Conclusions and Implications: Our findings indicate a discrepancy between self-reported health and NCD diagnoses. Efforts to study older adult health in China and India should examine socio-demographic factors that may lead to disparities in diagnosis and impact health literacy and access to health services.

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