| BackgroundThe vast majority of countries around the world are facing the rapidly growing problem of an aging population. The world will have a larger population of persons aged50years and over than under15years old by2025. The median age will be increased from28.1years old in2005to32.8years old in2025.The increasing percentage in population aged50and over will grow more fasting in developing countries than developed countries. The changing in age structure will bring a changing of health status, health problems of the adult and the elderly will become increasingly prominent in the global. Therefore, reliable, valid and comparable health data of older adult population is needed increasing, especially in the developing countries, where the vital statistics and disease surveillance is relatively weak.China is the fastest aging nations in the world, Shanghai is the earlist city which entered the aging society. As early as in1979, the people aged65years and over were7.2%of the total Population in Shanghai. By the end of2009, over3million people aged60years and over resided in Shanghai, which constitutes22.54%of the household Population, people aged65years and over was2.21million, accounting for15.78%, people aged80years and over was0.53million, accounting for17.8%of aged60years and over population,3.8%of the total population. The speed of aging is as same as Japan which is the pioneer in aging population. It is predicted that there will be an old man among three members of the public in Shanghai by2020.Aging situation is very grim.Aging before wealthy, and the pension and insurance systems are not yet mature, the pure old families were rapidly increased, and the first generation of the one-child parents are about to enter old age. Shanghai and the whole China will face many challenges, while older people’s health and health care issues will become particularly prominent. The purpose of this study was to explore the health status of the elder people and impacts of social and demographic factors on the basis of the regional population survey as the starting point of people aged50years and over in Nan hui area. The results will provide a baseline data for the researchers, public health officials and policy-makers to develop health care in Shanghai. This will help to establish scientific base for all the other countries in the world.ObjectsTo master the health status and influencing factors of people aged50years and over in Nanhui district community, which will provide a baseline data in formulating health care policy and planning information for the older people and provide a theoretical and practical foundation in looking for a way to adapt to the low cost of the Pudong New Area community, highly effective community health service model which will help to improve the quality of life and improve the capacity for independent living of older people.MethodsThe WHO survey on Global Aging questionnaire was used to collect information on the health status and influencing factors of older adults living in Nanhui district of Pudong New Area.1772people aged50years and over who live more than four months in Nanhui were interviewed. The cross-sectional study included the health status and their social and demographic impact factors among older people.Sampling methods:using multi-stage random cluster sampling to determine the sample town, village/neighborhood villages/residents groups, sample household. The sampling was conducted in four phases. The first sage:the original four towns in Nanhui district of Pudong New Area were randomly selected with probability proportionate to the scale of sampling (PPS) method; The second sage:using PPS in each town to take four village/neighborhood committees randomly; The third sage:using PPS in each village/neighborhood selected in second stage to take two villages/Juwei team randomly; The last sage:selecting35households containing people50years and over in the selected villages/Juwei team. There was total1120households where people50years and over were interviewed.Statistical analysis:using non-parametric test of Kruskal-Wallis H in single factor analysis of quantitative data, using χ2test in qualitative data. Non-conditional Logistic stepwise forward regression method in multivariate analysis was used to analyze the impact of different factors on the health of the older people, to explore the relevant factors that affect the ratio of poor ratio of health status to good ratio of the health status. Item Response Theory (IRT)was used to score the responses to the self-reported health questions using a partial credit model which served to generate a composite Health Status(HS) score and functional status(WHODAS) score.Results1. A total of1772people aged50years and over from1120households were successfully interviewed (n=1772). Among those interviewed, the ratio of male to female was1:1.09. The difference of the gender distribution in the different age groups was statistically significant (χ2=11.98, P=0.007).64.36%of respondents had no formal education, and there was a significant difference in gender, women’s educational level was lower than men (the ratio of primary and below was72.78%in women, and57.56%in men); With increasing age, divorced, widowed, and single was increased, but in the proportion of education level was gradually reduced and the proportion that did not participate in the work was increased.2.951of respondents (53.7%) had sufferred from chronic diseases among1772interviewed by self-reported, men were53.47%, and women were higher than men (χ2=19.93, P=0.005). The percentage of older people reporting more than one kind of chronic diseases increased with age increasing among both men and women. But aged80years and over were slightly lower than people between70-79years old. The top five self-reported prevalence of chronic diseases were hypertension (35.80%), joint inflammation (14.55%), cardiovascular diseases (10.35%), cataract (10.26%) and diabetes (7.92%).3. According to the diagnostic criteria of hypertension, a total of1150respondents were diagnosis of hypertension, the prevalence of hypertension was64.90%, which was far higher than the number of people with self-reported, and the major of hypertension was mild hypertension (34.56%). Hypertension distribution in different gender and different age groups were statistically significant. The prevalence of hypertension was increased with age, the difference was statistically significant (χ2=68.54, P<0.001) by linear trend chi-square test.4. The rate of simple obesity was38.16%, and the rate of central obesity was55.82%. The rate of central obesity was statistically significant between men and women, women was higher than men (women=60.79%, men=50.36%,χ2=19.08, P<0.0001), but the rate of simple obesity was not statistically significant. Both the rate of simple obesity and central obesity between the different age groups were statistically significant, increasing with age. The ratio of respondents who’s total cholesterol and triglycerides were higher than normal were respectively40.45%and42.95%, the difference of total cholesterol abnormal between men and women was statistically significant (women=44.19%, men=36.35%,χ2=11.20, P=0.0008).5. Overall, more than half of the respondents (65.55%) thought their overall health as good, and men (71.36%) was higher than women (60.24%). The median health status score of survey population was70.08(interquartile:28.83), men was higher than women (70.08(interquartile:26.12) for men,65.68(interquartile:31.25) for women,χ2=28.18, P<0.001). The men’s health status was better than women’s. The median health status scores in each age group were:75.90(interquartile:37.92),70.08(interquartile:27.10),59.01(interquartile:20.41) and49.66,(interquartile:21.78). Health status score was gradually reduced with increased age (χ2=269.42, P<0.001). Gender, age, marital status, level of education, work or not, suffering from chronic diseases, obesity, smoking status, drinking and Physical activity could influence health status score.6. The median score of WHODASi for the sample was100(interquartile:4.17). Generally, the WHODASi score was lower among women compared to men (100(interquartile:6.25) for men,97.92(interquartile:6.25) for women,χ2=21.51, P<0.001). WHODASi score among age groups were:100(interquartile:2.08),100(interquartile:4.17),95.83(interquartile:12.50) and85.42(interquartile:29.17), and the mean score decreasing with age increasing (χ2=317.85, P<0.001). Gender, age, marital status, education level, working or not, suffering from the kind of chronic diseases and physical activity level were statistically significant, but obesity, whether smoking or drinking were not statistically significant.7. It showed that odds ratios for health status associated significantly with gender, age, suffering from the kind of chronic diseases and physical activity. Women were more likely to report poor health as well as being scored for health status than men. In the final multivariate model, men had a67.3%lower risk than women(odds ratio(OR)=0.673,95%confidence interval(CI)0.536,0.847) of reporting a high health status. Older age(OR=1.429,95%CI:1.081,1.889), suffering from the kind of chronic diseases (OR=2.175,95%CI:1.694,2.793), particularly suffering from three kinds of chronic diseases (OR=7.475,95%CI:4.959,11.267)were also all related to a poorer health status. High-intensity physical activity had a lower risk than the low-intensity physical activity(OR=0.405,95%CI:0.252,0.650).8. Multivariate logistic regression analysis showed that odds ratios for function assessment score associated significantly with age and suffering from the kind of chronic diseases. Compared with the50to59age group,≥80years old was more likely to be in the bottom two quintiles of function assessment score (OR=13.151,95%CI:5.640,30.667). The OR of those with suffering from3and over kinds of chronic diseases was4.987(95%CI:2.259,11.008), so the functional status was negatively correlated with individual’s amount of diseases.Conclusions The overall health status of people aged50years and over was not optimistic. Suffering from chronic diseases, age, gender, physical activity and other factors affect the health status, health status declined with age increasing. Chronic diseases are important health problems of the elder and impact health significantly. We should strengthen care of the oldest old and complete community health services to improve the quality of life of older people. |
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