Research On The Association Of Relative Education Between Individual And Neighborhood With Healthy Aging

Background:In China,the aging of population process is accelerating.The phenomenon of longevity but unhealthy is relatively prominent among the elderly in China.In response,the World Health Organization(WHO)has set the goal of healthy aging and requires a community-wide effort to create more age-friendly environments based on the person-environment fit theory.Healthy aging concept emphasizes that multi-dimensions health of the elderly should be considered.The person-environment fit theory highlights the degree to which the elderly capacities match the characteristics of their environments,which can be most likely to establish and maintain their intrinsic capacity.A universal set of interconnected health indicators has been pooled to quantify the extent of healthy aging,but previous indicators failed to capture the interlinkages between these indicators.Studies have shown that individuals with low socioeconomic status had a health-promoting effect when they lived in neighborhoods with high socioeconomic status.However,some studies suggested that individuals with low socioeconomic status would have negative effects on their health when they lived in neighborhoods with high socioeconomic status.Therefore,there were no consistent conclusions on the association of individual and neighborhoods socioeconomic status with aging health.This divergence may be because previous empirical studies failed to consider health disparities resulting from relative socioeconomic status between individuals and neighborhoods and,thus,failed to capture some characteristics of the person-environment fit in healthy aging.Objective:On the basis of considering the health indicators interlinkages,the healthy aging index was constructed to evaluate the current status and trend of healthy aging in China.Then,the association of individual and neighborhood education level with healthy aging was analyzed,focusing on the relative education level with healthy aging to reveal the person-environment unfit in age-friendly environments.Based on the results,the study may have implications for proposing environmental interventions in healthy aging throughout the aging process.Methods:The study used data from the China Health and Retirement Longitudinal Study(CHARLS)from 2011 to 2018,including middle-aged and older adults(≥45 years).The final sample was 11633 participants residing in 443 neighborhoods with 43978 observations.16 indicators comprised the health indicator pool.Factor analysis and hierarchical cluster analysis were conducted to identify health indicators and different dimensions.Network analysis was applied to understand the relative importance of health indicators in healthy aging index through health indicators interlinkages.According to the contribution of indicators as weights,the comprehensive healthy aging index was calculated by Technique for Order Preference by Similarity to Ideal Solution(TOPSIS).Group-based trajectory modeling(GBTM)was applied to identify the development of the healthy aging index across the whole life process at the individual level.Based on the consideration of longitudinal weights and immigration weights,the weighted Generalized Linear Mixed Effect Model(GLMM)was used to evaluate the association of individual and neighborhoods education level with healthy aging,focusing on the association of their relative education level with healthy aging.Finally,the stability of the results was tested by robustness checks.Results:1.Results of the construction of healthy aging index:(1)According to the statistical description of 16 healthy indicators,mobility and cognitive function decreased obviously with age,while life satisfaction increased.Social participation was at a low level at any age,suggesting that the overall social participation of the elderly was low.(2)Factor analysis and hierarchical cluster analysis showed that indicators with factor loading greater than 0.3 were selected out and divided into one dimension,the four dimensions were adaptability,physical and functional health,sensory health and mental health.(3)According to the result of network analysis,mobility was the most important indicator in healthy aging index,with a weight of 0.398,followed by Activities of Daily Living(ADLs)(0.347),Instrumental Activities of Daily Living(IADLs)(0.333)in physical and functional health.For mental health,depressive symptoms and loneliness had higher weight,which were 0.362 and 0.265 respectively,while life satisfaction had a relatively low weight with 0.116.The weight of cognitive functions and social participation were respectively 0.226 and 0.093 in adaptability.For sensory health,each of the three indicators’weights was 0.285 for long distance vision functions,0.202 for near vision functions,and 0.266 for hearing functions.The healthy aging index decreased with age.Participants residing in a higher-education neighborhood tended to report better performance in healthy aging index.(4)Using GBTM,the healthy aging index for all respondents were classified into four groups:low starting point and fast decline,median starting point and slow decline,high starting point and slow decline,and high starting point with increase followed by decline.2.The separate and joint association of individual and neighborhood education with individual-level healthy aging(1)Descriptive characteristics:The mean(SD)age of the 11633 participants was 58.20(8.91)years at baseline with 6145 women(52.82%).The mean(SD)years of individual and neighborhood education were 4.89(4.15)and 4.81(1.88),respectively,at baseline.Among them,27.70%and 25.38%had individual education equal to or lower than the neighborhood level.The mean(SD)healthy aging index was 48.94(7.55)at baseline.About forty-two percent of participants experienced a high starting point and slow decline,nine percent of participants experienced a low starting point and fast decline.(2)The separate and joint association of individual and neighborhood education with individual-level healthy aging index:Individual and neighborhood education levels were both significantly and positively associated with individual-level healthy aging index.The higher the neighborhood average education level,the higher the healthy aging index(Coef.=0.75;95%CI:0.60-0.91),which was beneficial to their healthy aging index trajectory(OR=1.28;95%CI:1.21-1.35).For individuals with the same education level,the effects of neighborhood became higher(Coef.=0.74;95%CI:0.40-1.09)as neighborhood education increased to a level higher than individual education,which was more likely to belong to the high starting point(OR=1.22;95%CI:1.02-1.45).But,physical and functional health were not significantly associated with neighborhood education after controlling for individual education,which showed that the physical and functional health of individuals were greatly affected by their intrinsic capacity.However,within the same neighborhood,individuals with different levels of education received different health benefits from the neighborhood.The effects of improved neighborhood became weaker for healthy aging index(Coef.=-0.88;95%CI:-1.21--0.54)and trajectory group(OR=0.69;95%CI:0.58-0.82)as neighborhood education increased to a level higher than individual education.Individuals whose education level was higher than the average education level in the neighborhood had a higher healthy aging index(Coef.=1.90;95%CI:1.55-2.25),and better trajectory group(OR=1.78;95%CI:1.46-2.16),which meant that they could make better use of neighborhoods resources and obtained greater health benefits.Conclusion:1.For most participants,worsening healthy aging status was mainly attributed to physical and functional health.Meanwhile,mental health could be improved for some participants.the mean healthy aging index showed a downward trend with aging.2.Neighborhood education was found to be independently and positively associated with individual health.3.Poorly individual level were least healthy when they lived in neighborhoods with poorly education level.4.Within the same neighborhood,as individual education was lower than the neighborhood average,they may also have the additional stress of feeling "one-down" and develop a sense of poor person-environment fit.An improved neighborhood may entitle residents with lower education levels to more resources,but these people may encounter difficulty in mastering the resources within their environments.