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      Ageing, the Urban-Rural Gap and Disability Trends: 19 Years of Experience in China - 1987 to 2006

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          Abstract

          Background

          As the age of a population increases, so too does the rate of disability. In addition, disability is likely to be more common in rural compared with urban areas. The present study aimed to examine the influence of rapid population changes in terms of age and rural/urban residence on the prevalence of disability.

          Methods

          Data from the 1987 and 2006 China Sampling Surveys on Disability were used to estimate the impacts of rapid ageing and the widening urban-rural gap on the prevalence of disability. Stratum specific rates of disability were estimated by 5-year age-group and type of residence. The decomposition of rates method was used to calculate the rate difference for each stratum between the two surveys.

          Results

          The crude disability rate increased from 4.89% in 1987 to 6.39% in 2006, a 1.5% increase over the 19 year period. However, after the compositional effects from the overall rates of changing age-structure in 1987 and 2006 were eliminated by standardization, the disability rate in 1987 was 6.13%, which is higher than that in 2006 (5.91%). While in 1987 the excess due to rural residence compared with urban was <1.0%, this difference increased to >1.5% by 2006, suggesting a widening disparity by type of residence. When rates were decomposed, the bulk of the disability could be attributed to ageing, and very little to rural residence. However, a wider gap in prevalence between rural and urban areas could be observed in some age groups by 2006.

          Conclusion

          The increasing number of elderly disabled persons in China and the widening discrepancy of disability prevalence between urban and rural areas may indicate that the most important priorities for disability prevention in China are to reinforce health promotion in older adults and improve health services in rural communities.

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          Most cited references8

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          The impact of socio-economic factors on functional status decline among community-dwelling older adults in China.

          The purpose of this paper is to examine the impact of baseline socio-economic factors on functional status decline over a period of 3 years among a sample of Chinese older men and women, using the China Health and Nutrition Surveys of 1997 and 2000. In addition, the study tries to determine whether risk differentials by these socio-economic factors can be explained by other demographic, health-related and nutritional risk factors. The eligible study population was defined as women and men aged 55 years and over who at baseline were free from any form of disablement in activities of daily living (ADLs) or instrumental activities of daily living (IADL) tasks. Among subjects with complete data at followed-up (N = 976), the overall incidence proportions of any functional status decline, IADL only and ADL declines were 25.8%, 18.9% and 6.9%, respectively. Our study found that education is strongly and inversely associated with incidence of combined functional status decline and IADL only but not with the onset of ADL disability. Similarly, household income per capita was inversely associated with functional status decline and IADL disability incidence, with a clear dose-response relationship, even after adjustment for age and gender. However, multivariate analysis demonstrated that the latter association was highly confounded by other demographic factors, especially urban-rural area of residence. Using a combined measure of socio-economic status that includes years of education and household income per capita, the age and gender-adjusted odds ratio for functional status decline and belonging to lower SES class as compared to middle, upper middle and upper classes was 3.82 (95% CI: 2.15, 6.77) and 2.77 (95% CI: 1.52, 5.03) after further adjustment for urban-rural area of residence and living arrangements. Hence, there are wide socio-economic disparities in the functional health of older adults in China, although such disparities are more seen for IADL decline and are almost exclusively attributed to differentials in educational attainment. Finally, nutritional and health-related risk factors do not seem to act as intermediate factors in this association and hence further research should try to uncover other mechanisms by which SES affects changes in functional health among older adults in China.
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            Ageing in China: health and social consequences and responses.

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              Prevalence and correlates of functional disability in Chinese older adults.

              This article examines the prevalence of functional disability as well as sociodemographic correlations among Chinese older adults based on the most recent China National Sample Survey on Disability in 2006. Functional disability was defined as lost motor function or limited movements and activities according to the International Classification of Function, Disability and Health, and physicians made the diagnosis of disability. Utilizing stratified, multiphase and cluster probability sampling design, a nationally representative sample of the non-institutionalized elderly Chinese population was studied. Factors associated with functional disability were determined using a logistic regression model. The prevalence of functional disability was 8.1%. Major causes were vascular disease, osteoarthritis and accidents. In the non-institutionalized elders, increased age, rural residence, less education, lower income, unemployment, being unmarried, living in simple housing, and living with others or non-homeowners emerged as factors associated with functional disability in men and women. To face the challenge of the rising prevalence of functional disability, prevention strategies should focus on reducing the incidences of chronic disease and improving socioeconomic status of older adults.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2010
                13 August 2010
                : 5
                : 8
                : e12129
                Affiliations
                [1 ]School of Public Health and Family Medicine, Capital Medical University, Beijing, China
                [2 ]Institute of Sociology, Chinese Academy of Social Sciences, Beijing, China
                [3 ]School of Exercise, Biomedical and Health Sciences, Edith Cowan University, Perth, Australia
                [4 ]Graduate School, Chinese Academy of Sciences, Beijing, China
                Yale University School of Medicine, United States of America
                Author notes

                Conceived and designed the experiments: XP S. Song WW. Analyzed the data: XP. Contributed reagents/materials/analysis tools: S. Song. Wrote the paper: XP. Participated in the preparation and revision of the manuscript: S. Sullivan WW. Contributed to administrative and technical support: JQ. Responsible for planning, acquisition of data, and obtaining funding for this study: WW.

                Article
                10-PONE-RA-17276R1
                10.1371/journal.pone.0012129
                2921329
                20730089
                640d8ed9-640f-4d9a-87c3-990b1070f4b2
                Peng et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                History
                : 22 March 2010
                : 17 July 2010
                Page count
                Pages: 6
                Categories
                Research Article
                Public Health and Epidemiology/Epidemiology
                Public Health and Epidemiology/Health Policy
                Public Health and Epidemiology/Social and Behavioral Determinants of Health

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