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  • Ageing and Health: Navigating Disease, Care, and Prevention among Older People
    (2024) Chen, Shu
    Thesis
    My thesis consists of three interconnected projects on ageing and health that aim to improve health, access to long-term care, and reduce health inequities among older people, to foster a healthy ageing society. The first project advances the ageing metrics to reassess the implications of ageing for China. Specifically, it aims to measure the disease burden of ageing based on age-related diseases (ARDs), explore the sex and regional disparities, and the impact of health resources allocation on the burden in China. I used Global Burden of Diseases study estimates from 1990-2016 and China’s official statistics from 2010-2016 of 31 provinces of mainland China for analysis. I first identified the ARDs, calculated the burden of ARDs, and assessed the regional and sex disparity and historical change from 1990-2016. Fixed effects regression models were adopted to evaluate the impact of health expenditures and health workforce indicators on the ARD burden in 2010–2016. The study findings indicate that chronological age alone does not provide a sufficiently strong basis for appropriate resource planning or policymaking for population ageing. In China, concerted efforts should be made to reduce age-related diseases and the regional disparities of the burden in the east, central and west of China. More health resources should be allocated to western provinces, which are seemingly young but face large health challenges due to future ageing. The second project focuses on multimorbidity, an increasingly prevalent condition among older people. Specifically, it aims to assess the association between multimorbidity and informal long-term care (LTC) use in China, exploring socioeconomic and regional disparities. The study included 10,831 community-dwelling respondents aged 45 years and older from the China Health and Retirement Longitudinal Study in 2011, 2015, and 2018 for analysis. A two-part model with random effects to estimate the association between multimorbidity and informal LTC use. The heterogeneity of the association by socioeconomic position (education and income) and region was explored via a subgroup analysis. In addition, the change of informal LTC hours associated with multimorbidity was converted into monetary value, and the 95% uncertainty interval (UI) was calculated. We found a significantly positive association between multimorbidity and informal LTC use among older people, and those in higher socioeconomic status had better access to informal LTC. Our findings substantiate the threat of multimorbidity to LTC burden and call for strengthening the LTC services provision among older adults with multimorbidity. The third project focuses on dementia, another significant health threat among older people. Specifically, it studies the association between social environment, measured by the novel polysocial risk score, and dementia and explores whether a healthy lifestyle can mitigate the impact of an unfavourable social environment on developing dementia despite genetic risks. My study included 5,199 participants from the US Health and Retirement Study from 2006 to 2020 and selected 19 social determinants of health to develop the polysocial risk score. I used a survival analysis approach to assess the association between social environment and dementia risk in 2006-2020 and further explored the interaction between social environment and lifestyles and racial disparities. The study results suggest that an unfavourable social environment is linked to an increased risk of dementia, but healthy lifestyles can offset the increased risk. Further, the polysocial risk score is found to be a valuable new measure to complement the existing risk assessment tools to identify high-risk people. In summary, the three projects have generated original high-quality evidence on ageing and health, in accordance with the WHO public health framework to achieve healthy ageing, using longitudinal datasets from China and the US. They contribute to three out of four entry points of the WHO framework on 1) an improvement of healthy ageing metrics for a better understanding of the interactions between ageing and health (Project 1); 2) fostering an integrated health and LTC provision among older people with multimorbidity (Project 2); and 3) the development of an age-friendly social environment to prevent dementia (Project 3).