Health Outcomes and Subsequent Working Status in Chinese Adults
Creators: name: Balakrishnan, Ellie
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2023

description: The relationship between economic status, employment status, and health is complex and often bidirectional. Introductory analysis investigates the association between working status and physical and mental health outcomes in Chinese adults, stratified by urbanization classification (rural vs. urban).  Investigating these relationships in low- and middle-income countries that have experienced rapid urbanization is crucial to understanding evaluation and impact of changes in health and economic outcomes in aging populations. We used data from 5,228 adults in the 2018 China Health and Nutrition Survey (CHNS) survey aged 58+ to assess how cognitive and physical function at the 2015 survey was associated with 2018 working status.  Measures of cognitive function included global cognitive score and verbal memory score, and measures of physical function included whether an individual had any limitations in terms of instrumental activities of daily living (IADLs) or any limitations with activities of daily living (ADLs). Descriptive statistics were estimated overall and for people living in rural areas/villages vs not living in rural areas/villages. We used minimally and fully adjusted logistic regression models to test for associations between working status and cognitive and physical function at the prior visit. Given hypothesized differences in the associations by whether an individual lived in rural areas/villages or not, we first tested for an interaction term between living in rural areas/villages and cognitive and physical function variables. If the interaction term wasn’t statistically significant (p ≥ 0.05) then we removed the interaction term and ran the model without the interaction to get an overall estimate of association. Minimally adjusted models control for age and gender, which are known covariates that affect working status in individuals.  Fully adjusted models involved more covariates to adjust for potential cohort effects, and other potential confounders including highest education obtained, region, marital status, and income. We found differences in the association between having IADL and ADL limitations and subsequent working status depending on whether individuals lived in rural areas/villages (p-value of <0.0001 for having no limitations in IADLs, and p-value of <0.0001 for having no limitation in ADLs).  In rural areas/villages, models suggested people with more physical limitations were more likely to be working, versus not working, than people with no physical limitations. People with no IADL limitations had an OR of 0.47 (95% confidence interval (CI) of 0.34-0.65)  for working vs. not compared to people with some IADL limitations and people with no ADL limitations had an OR of 0.34 (95% CI of 0.25-0.47) compared to people with some ADL limitations. However, in other areas, ORs showed people with better physical function were more likely to be working versus not with less physical function (OR of 2.44 [95% CI: (1.18,5.03) for people with no IADL limitations versus people with at least one limitation; OR of 1.91 [95% CI: (1.15,3.18)] for no ADL limitations versus people with at least one limitation). We found no statistical evidence of differential associations between cognitive function and subsequent working status by rural areas/villages and no statistically significant evidence of overall association either.