| A systematic analysis of global health life expectancy in Global Disease Burden Studies from 1990 to 2017 showed that unhealthy time for aged people was prolonged while the average life expectancy increased.The aged population is huge and increasing rapidly in China while average life expectancy is increasing.However,the traditional measurements could not fully reflect the health status of the elderly,thus the more comprehensive evaluation system for the elderly's health is important and necesarry.This study based on life course theory,gathering data from 2015-2014 from the most representative national survey,namely the Chinese Logitudinal Healthy Longevity Survey(CLHLS),using frailty index and frailty trajectory to study the association of socioeconomic status and elderly's health.First,this study chose 40 health related variables,inclufing ADL,IADL,chornic diseases,self-rated health and so on,to create solid frailty index;Second,use frailty index in different years and group-based trajectory models to simulate edlerly's frailty trajectory;Third,based on exisiting literatures,childhood socioeconomic status were measured by 6variables,including whether receiving adequate medical services,whether feeling hungry during childhood,born place and so on,while aged socioeconomic status were measured by 5 variables including main job before age 60,whether having pensions and so on.Change of socioeconomic status was also formed in this step.Finally,HLM models were taken to study the effects of socioeconomic status on frailty index,while multi-nominal logistic model was taken to study the effects on frailty trajectory.The specific research findings are as follows:(1)The socio-economic status has a significant association with the elderly's frailty index and the type of frailty trajectory from life course perspectivesFor the childhood socioeconomic status,father's occupation and the survival of the parents at the age of 10 have a significant association with the frailty index,the higher level of father's occupational,the lower possibility of frailty index Perspectives remains high.The frailty index of old adults whose parents were both survival at age 10 is lower than those parents were dead before their 10 years old.Medical conditions nutrution status during childhood has a significant association with frailty trajectory of old adults.Frailty trajectory of old adults with better medical and nutrution conditions during childhood are more likely to belong to Type 1(compared to Type 3).For the socioeconomic status during the middle-aged and old age,whether going to school,and whether having enough living fee have a significant association with the elderly's frailty index and the type of frailty trajectory.Educated older people are less likely to have a higher frailty index than uneducated ones,and older people who with enough living fee are less likely to have a higher frailty index.Older people living in rural areas are less likely to have a higher frailty index than older people living in urban areas.Old adults with enough living fee during middle-aged and old age are more likely to have a frailty trajectory of Type 1(compared to Type 3).From the life course perspectives,socioeconomic status in different periods has a significant association with the frailty index and the types of frailty trajectories.When the socioeconomic status related variables in childhood and middle-aged ages are simultaneously included in one model,the elderly who live in rural areas and have enough living feee,parents were survival at the age of 10 are less likely to have a higher frailty index.The frailty trajectory of the elderly who had better medical condition and nutrition in childhood is more likely to be type 1(compared to type 3),and the elderly with adequate living fee are relatively more likely to belong to Type 1(compared to Type 3).(2)Changes of socioeconomic stasus have significant associations with the frailty index and the type of frailty trajectoryThe moving down of socioeconomic status have a significant association with frailty index,highlighting the protective effect of high socioeconomic status during childhood on health.Old adults with moving down socioeconomic status is less likely to have a higher frailty index than those who keep in low socioeconomic status.Changes of socioeconomic stasus have significant associations with the type of frailty trajectory.Old adults with moving up socioeconomic status are more likely to belong to frailty trajectory Type 1(compared to Type 3)than those who keep in low socioeconomic status.The going up of socioeconomic status has a protective effect on the health of the elderly.For Control variables,demographic variables(gender,age,marriage)are significant,while healthy behaviors such as smoking,drinking,eating fruits,eating vegetables,and exercising are significantly.These health behavior variables have protective effects,elderly with thses healthy behaviors are less likely to have higher frailty index.Association with the frailty index and the type of frailty trajectory is different from the frailty index.gender and age are significant,healthy behaviors only eating fruits has a significant impact on the frailty trajectories type.In addition,from the perspective of socioeconomic environment variables,air quality,unemployment rate and illiteracy rate have significant effects on the old people's frailty index and frailty trajectory.Under the condition of good air quality,lower unemployment rate and low illiteracy rate,the elderly are less frailty.The probability of a high index is lower,and old adult's frailty trajectory are more likely to belong frailty trajectory of Type 1(compared to Type 3).Finally,based on the previous results,this study reveals that socioeconomics status during different periods,as well as changes of socioeconomic status,have different associations with the elderly's health.this study propeses that the construction of failty index and health protection mechanisms could be carried out in three aspects: First of all,the conceptual framework which could build under a comprehensive,multi-faceted,and full life course theory.Secondly,establish a complete proposal to establish a sound system of weak prevention and healthy life expectancy promotion.Thirdly,special populations should be strengthen as well as the construction of targeted risk protection mechanisms. |
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