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Title: Socioeconomic impacts on healthy ageing in the US, England, China and Japan
Author: Lu, Wentian
ISNI:       0000 0004 7965 1761
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2019
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Background and Aims: Healthy ageing has become a popular topic worldwide. So far, a consensus definition of healthy ageing has not been reached. Socioeconomic position (SEP) is an important determinant of healthy ageing. Previous studies have indicated that people in advantaged SEPs are more likely to achieve healthy ageing than people in disadvantaged SEPs. However, only rare studies have compared the magnitude of socioeconomic inequalities in healthy ageing across countries. This thesis aims to conduct a cross-country comparison of socioeconomic inequalities in healthy ageing in the US, England, China and Japan. Data Sources: The data are from the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA), the China Health and Retirement Longitudinal Study (CHARLS) and the Japanese Study of Ageing and Retirement (JSTAR). The analysis includes 10305 HRS respondents (waves 7-12, 2004-2014), 6590 ELSA respondents (waves 1-7, 2002-2015), 5930 CHARLS respondents (waves 1, 2 and 4, 2011-2015) and 1935 JSTAR respondents (waves 1-3, 2007-2011) aged 60 years or more at baseline. Methods: A healthy ageing index (HAI) was created as the main outcome. Education, income, wealth and occupation were included as the main exposures. Data harmonisation was conducted. A two-fold fully conditional specification algorithm was employed to deal with missing data in socioeconomic indicators and covariates (Chapter 2). Pearson's r and Cronbach's α were calculated to check the HAI's test-retest reliability and internal consistency respectively. A Receiver Operating Characteristic curve analysis and a Cox proportional hazards model were applied to test the HAI's predictive performance on mortality risks (Chapter 3). Multilevel modelling was applied to assess the longitudinal relationships between SEPs and the HAI, allowing for random slopes and intercepts. Socioeconomic rank scores were derived and the slope indices of inequality were calculated to compare the magnitude of inequalities in healthy ageing by education, income and wealth across countries (Chapter 4). Path analysis was used to assess the mediating effects of occupation, income, wealth, smoking and drinking on the relationship between education and healthy ageing. The total, direct and indirect effects of education, occupation, income and wealth on healthy ageing were also calculated (Chapter 5). Results: Japanese and English participants achieved healthier ageing than American and Chinese participants. A positive socioeconomic gradient in healthy ageing existed in all countries. The socioeconomic inequality in healthy ageing was relatively small in Japan. In China, the inequality in healthy ageing, especially by education, is daunting. Education was a universally influential socioeconomic predictor of healthy ageing, and is likely to be an independent predictor of healthy ageing among the ageing population across all countries. There were complex pathways from education to healthy ageing in the four countries. The positive effects on healthy ageing of improving education should not be neglected. Wealth inequality in healthy ageing was greater in England than in any other country. Wealth was more influential than income in predicting inequalities in healthy ageing in the US, England and Japan, while income was more influential than wealth in China. Labour force non-participation (e.g. retirement, disability) had negative effects on healthy ageing in the US. Chinese people in paid and stable work were healthier than those in unpaid farming work in later life. Implications: This research provides sufficient theoretical and methodological guidelines for the development of well-suited assessments of healthy ageing in the area of public health. These guidelines will be useful for policymakers to capture key elements of healthy ageing when developing ageing policies for older people's health, social participation and security. This research also provided a unique opportunity to conduct a multinational comparison of socioeconomic impacts on healthy ageing between Western and Asian countries, which has never been done before. Identifying influential socioeconomic indicators of healthy ageing in each country is instructive for exploring universal and country-specific public health practices to support healthy ageing in both Western and Asian countries.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available