Abstract
Objectives
To assess urban–rural differentials in age-related biological risk among middle-aged and older Chinese and links to individual and community characteristics.
Methods
Data come from the national baseline survey of the China Health and Retirement Longitudinal Study. Biological risk is assessed using a set of measured biomarkers that reflect cardiovascular, metabolic, and inflammatory processes.
Results
Urban residents who are officially registered in urban areas have greater biological risk than rural residents. Having junior school or higher education provides an independent and persistent protective effect against biological risk and eliminates the effect of community-level measures. The reduced physical activity of urban dwellers with urban origins explains a substantial part of the difference in risk.
Conclusions
Urban dwellers with urban household registration have elevated risk compared with their rural peers, indicating that lifetime exposure to urban areas is an important risk factor for increased biological risk in China. The urban–rural differential in risk is accounted for by adjusting for health behaviors, particularly physical activity. The reduced physical activity among urban dwellers with urban household registration appears to be highly related to their elevated risk. No significant associations between community-level characteristics and biological risk are found beyond individual characteristics.
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References
Allen L, Williams J, Townsend N, Mikkelsen B, Roberts N, Foster C, Wickramasinghe K (2017) Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: a systematic review. Lancet Glob Health 5:e277–e289. https://doi.org/10.1016/S2214-109X(17)30058-X
Beltrán-Sánchez H, Crimmins EM (2013) Biological risk in the Mexican population at the turn of the 21st century. J Cross Cult Gerontol 28:299–316. https://doi.org/10.1007/s10823-013-9199-0
Brown DC, Hayward MD, Montez JK, Hummer RA, Chiu CT, Hidajat MM (2012) The significance of education for mortality compression in the United States. Demography 49:819–840. https://doi.org/10.1007/s13524-012-0104-1
Chen F, Yang Y, Liu G (2010) Social change and socioeconomic disparities in health over the life course in China: a cohort analysis. Am Sociol Rev 75:126–150. https://doi.org/10.1177/0003122409359165
Crimmins EM (2015) Physiological differences across populations reflecting early life and later life nutritional status and later life risk for chronic disease. J Popul Ageing 8(1–2):51–69. https://doi.org/10.1007/s12062-014-9109-4
Crimmins EM, Kim JK, Seeman TE (2009) Poverty and biological risk: the earlier “aging” of the poor. J Gerontol A Biol Sci Med Sci 64:286–292. https://doi.org/10.1093/gerona/gln010
Cutler DM, Lleras-Muney A (2006) Education and health: evaluating theories and evidence. National Bureau of Economic Research, Cambridge. https://doi.org/10.3386/w12352
Geronimus AT, Hicken M, Keene D, Bound J (2006) “Weathering” and age patterns of allostatic load scores among blacks and whites in the United States. Am J Public Health 96:826–833. https://doi.org/10.2105/AJPH.2004.060749
Gong P, Liang S, Carlton EJ, Jiang Q, Wu J, Wang L, Remais JV (2012) Urbanization and health in China. Lancet 379:843–852. https://doi.org/10.1016/S0140-6736(11)61878-3
Hayward MD, Miles TP, Crimmins EM, Yang Y (2000) The significance of socioeconomic status in explaining the racial gap in chronic health conditions. Am Sociol Rev 65:910–930. https://doi.org/10.2307/2657519
Hou X (2008) Urban–rural disparity of overweight, hypertension, undiagnosed hypertension, and untreated hypertension in China. Asia Pac J Public Health 20:159–169. https://doi.org/10.1177/1010539507312306
Hu X, Cook S, Salazar MA (2008) Internal migration and health in China. Lancet 372:1717–1719. https://doi.org/10.1016/S0140-6736(08)61360-4
Jia J, Wang F, Wei C, Zhou A, Jia X, Li F et al (2014) The prevalence of dementia in urban and rural areas of China. J Alzheimer’s Dis 10:1–9. https://doi.org/10.1016/j.jalz.2013.01.012
Kaneda T, Zimmer Z, Zhang K (2010) Explaining the urban–rural divergence in disability among older Chinese using a large scale national dataset. Institute of Public and International Affairs (IPIA) Working Paper Series. IPIA, University of Utah, Salt Lake City, Utah
Li Y, Dorsten L (2010) Regional and urban/rural differences of public health in China. Glob J Health Sci 2(1):20–30. https://doi.org/10.5539/gjhs.v2n1p20
Li LW, Liu J, Xu H, Zhang Z (2016) Understanding rural–urban differences in depressive symptoms among older adults in China. J Aging Health 28(2):341–362. https://doi.org/10.1177/0898264315591003
Mirowsky J, Ross CE (2003) Education, social status, and health. Transaction Publishers, New York
National Bureau of Statistics of China (2016) China statistical yearbook 2016. China Statistics Press, Beijing
Ross CE, Wu C (1995) The links between education and health. Am Sociol Rev 60:719–745. https://doi.org/10.2307/2096319
Seeman TE, Singer BH, Rowe JW, Horwitz RI, McEwen BS (1997) Price of adaptation—allostatic load and its health consequences: MacArthur studies of successful aging. Arch Intern Med 157:2259–2268. https://doi.org/10.1001/archinte.1997.00440400111013
Seeman TE, McEwen BS, Rowe JW, Singer BH (2001) Allostatic load as a marker of cumulative biological risk: MacArthur studies of successful aging. Proc Natl Acad Sci 98:4770–4775. https://doi.org/10.1073/pnas.081072698
Smith JP (2004) Unraveling the SES: health connection. Popul Dev Rev 30:108–132
Smith JP, Tian M, Zhao Y (2013) Community effects on elderly health: evidence from CHARLS national baseline. J Econ Ageing 1:50–59. https://doi.org/10.1016/j.jeoa.2013.07.001
Sorlie PD, Backlund E, Keller JB (1995) US mortality by economic, demographic, and social characteristics: the national longitudinal mortality study. Am J Public Health 85(7):949–956
Stringhini S, Bovet P (2017) Socioeconomic status and risk factors for non-communicable diseases in low-income and lower-middle-income countries. Lancet Glob Health 5:e230–e231. https://doi.org/10.1016/S2214-109X(17)30054-2
U.S. Department of Health and Human Services, U.S. Department of Agriculture (2015) Dietary guidelines for Americans 2015–2020. https://health.gov/dietaryguidelines/2015/guidelines/. Accessed 29 Oct 2017
Wang H, Zhai F (2013) Programme and policy options for preventing obesity in China. Obes Rev 14:134–140. https://doi.org/10.1111/obr.12106
Wang Y, Mi J, Shan XY, Wang QJ, Ge KY (2007) Is China facing an obesity epidemic and the consequences? The trends in obesity and chronic disease in China. Int J Obes 31:177–188. https://doi.org/10.1038/sj.ijo.0803354
Yang G, Kong L, Zhao W, Wan X, Zhai Y, Chen LC, Koplan JP (2008) Emergence of chronic non-communicable diseases in China. Lancet 372:1697–1705. https://doi.org/10.1016/S0140-6736(08)61366-5
Yen IH, Michael YL, Perdue L (2009) Neighborhood environment in studies of health of older adults: a systematic review. Am J Prev Med 37:455–463. https://doi.org/10.1016/j.amepre.2009.06.022
Zhao Y, Strauss J, Yang G, Giles J, Hu P, Hu Y, Lei X, Liu M, Park A, Smith PJ, Wang Y (2013) China Health and Retirement Longitudinal Study 2011–2012 national baseline users’ guide. National School of Development, Peking University, Beijing
Zhao Y, Crimmins E, Hu P, Hu Y, Ge T, Kim J-K, Strauss J, Yang G, Yin X, Wang Y (2014a) China Health and Retirement Longitudinal Study—2011–2012 national baseline blood data user’s guide. School of National Development, Peking University, Beijing
Zhao Y, Hu Y, Smith JP, Strauss J, Yang G (2014b) Cohort profile: the China Health and Retirement Longitudinal Study (CHARLS). Int J Epidemiol 43:61–68. https://doi.org/10.1093/ije/dys203
Zhao Y, Crimmins EM, Hu P, Shen Y, Smith JP, Strauss J, Wang Y, Zhang Y (2016) Prevalence, diagnosis, and management of diabetes mellitus among older Chinese: results from the China Health and Retirement Longitudinal Study. Int J Public Health 61:347–356. https://doi.org/10.1007/s00038-015-0780-x
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Zhang, Y.S., Crimmins, E.M. Urban–rural differentials in age-related biological risk among middle-aged and older Chinese. Int J Public Health 64, 831–839 (2019). https://doi.org/10.1007/s00038-018-1189-0
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DOI: https://doi.org/10.1007/s00038-018-1189-0