Dataset Information

The causal effect of retirement on stress in older adults in China: A regression discontinuity study.

ABSTRACT: Population aging in middle-income countries, including China, has resulted in strong economic incentives to increase the retirement age. These economic incentives should be weighed up against the effects of later retirement on physical and mental health and wellbeing. We aimed to determine the causal effect of retirement on perceived stress, an important measure of mental well-being. We used data from the China Health and Nutrition Survey in 2015 and adopted a non-parametric regression discontinuity design (RDD) to measure the causal effect of retirement on stress. Stress was assessed using the Perceived Stress Scale (PSS)-14. On average, the effect of retirement on stress was close to the null value and insignificant. In subgroup analyses, we found that retirement reduces stress in men but raises stress in women. Though these gender-specific effects were not statistically significant, their magnitudes were large. Thus, the average null result in the entire population appears to hide opposite gender-specific effects. More research is needed to confirm this finding in studies with larger sample sizes and understand the gender-specific pathways leading from retirement to stress.

SUBMITTER: Chen S

PROVIDER: S-EPMC7016446 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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The causal effect of retirement on stress in older adults in China: A regression discontinuity study.

Chen Simiao S Geldsetzer Pascal P Bärnighausen Till T

SSM - population health 20190730

Population aging in middle-income countries, including China, has resulted in strong economic incentives to increase the retirement age. These economic incentives should be weighed up against the effects of later retirement on physical and mental health and wellbeing. We aimed to determine the causal effect of retirement on perceived stress, an important measure of mental well-being. We used data from the China Health and Nutrition Survey in 2015 and adopted a non-parametric regression discontin ...[more]

PMID: 32083164

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Project description:BackgroundPrevious studies suggest that retirement, a major life event, affects overall healthcare utilization. We examine, the effects of retirement on inpatient healthcare utilization, including effect heterogeneity by gender, disease category, and type of health service.MethodsWe used routine health insurance claims data (N = 87,087) spanning the period 2021 - September 2013 from the Urban Employee Basic Medical Insurance (UEBMI), a mandatory social health insurance for working and retired employees in urban China. We applied a non-parametric fuzzy regression discontinuity design using the statutory retirement age in urban China as an exogenous instrument to measure the causal effect of retirement on six measures of inpatient healthcare utilization.ResultsRetirement reduced total hospital costs (-84.71 Chinese Yuan (CNY), 95% confidence interval (CI) -172.03 - 2.61), shortened length of hospital stays (-44.59, 95% CI -70.50 - -18.68), and increased hospital readmissions (0.06, 95% CI 0.00 - 0.12) and primary hospital visits (0.06, 95% CI 0.02 - 0.09) among women. Retirement did not significantly change inpatient healthcare utilization among men. The retirement effects among women varied by disease category. Specifically, retirement substantially increased hospitalizations for non-communicable diseases (NCDs), yet had only modest or no effect on hospitalizations for communicable diseases or injuries. Retirement effects among women also varied by the type of services. For relatively inexpensive services, such as nonoperative treatment, there were surges in the extensive margin (hospital readmission). For relatively expensive and invasive services, such as surgeries, retirement reduced the intensive margin (out-of-pocket expenditures and length of stay).ConclusionsRetirement decreases overall use of inpatient healthcare for women. The examination on the disease-related heterogeneous effects helps with the introduction and implementation of integrated healthcare delivery and appropriate incentive schemes to encourage better use of healthcare resources among older adults.

Project description:The regression discontinuity (RD) design is a quasi-experimental design that estimates the causal effects of a treatment by exploiting naturally occurring treatment rules. It can be applied in any context where a particular treatment or intervention is administered according to a pre-specified rule linked to a continuous variable. Such thresholds are common in primary care drug prescription where the RD design can be used to estimate the causal effect of medication in the general population. Such results can then be contrasted to those obtained from randomised controlled trials (RCTs) and inform prescription policy and guidelines based on a more realistic and less expensive context. In this paper, we focus on statins, a class of cholesterol-lowering drugs, however, the methodology can be applied to many other drugs provided these are prescribed in accordance to pre-determined guidelines. Current guidelines in the UK state that statins should be prescribed to patients with 10-year cardiovascular disease risk scores in excess of 20%. If we consider patients whose risk scores are close to the 20% risk score threshold, we find that there is an element of random variation in both the risk score itself and its measurement. We can therefore consider the threshold as a randomising device that assigns statin prescription to individuals just above the threshold and withholds it from those just below. Thus, we are effectively replicating the conditions of an RCT in the area around the threshold, removing or at least mitigating confounding. We frame the RD design in the language of conditional independence, which clarifies the assumptions necessary to apply an RD design to data, and which makes the links with instrumental variables clear. We also have context-specific knowledge about the expected sizes of the effects of statin prescription and are thus able to incorporate this into Bayesian models by formulating informative priors on our causal parameters.

Project description:China has a lower rate of vaccination among older adults and those who have chronic conditions and functional disabilities. As China has recently ended the zero-COVID policy, understanding the factors behind low vaccination rates among these vulnerable populations can inform immediate policy priorities to save lives for China and offer lessons for the world at large. We used the fifth wave (2021-22) of the China Health and Retirement Longitudinal Study (CHARLS), which represented mainland Chinese 45 and older. Vaccination status was updated in the summer of 2022, reflecting the current situation because very few additional vaccinations were administered afterward. For those who were unvaccinated, self-reported reasons were recorded. Using regression analysis, we investigated the determinants of non-vaccination, including demographics, functional status, and chronic conditions. In addition, two-thirds of the respondents had their vaccination status recorded twice in 2021 and 2022, allowing us to examine changes in vaccination rates in the recent year, zeroing in on the effects of the government's most recent vaccination campaign. Finally, we corroborated the regression results using self-reported reasons for non-vaccination in both years. A total of 12900 participants were included in the analysis. By the summer of 2022, the weighted COVID-19 vaccination rate among older Chinese people (≥60 years old) was 92.3%, with 88.8% having completed the primary series and 72.7% having received boosters. Only 72.0% of the oldest-old (≥80 years old) had completed the primary series, and 47.1% had had boosters. Regression analysis showed that participants who were older, female, unmarried, registered with urban Hukou residence, functionally dependent, and comorbid with chronic conditions were less likely to receive COVID-19 vaccines. A significant increase in vaccination rates among ethnic minorities, older adults, rural residents, and those with chronic conditions and functional dependency was observed in the year after the winter of 2021 when the government started to push for universal vaccination. The self-reported reasons for non-vaccination in 2022 were contraindications (48%), advanced ages/frailty/health conditions (21%), problems in accessing vaccines (18%), concerns about side effects or efficacy (9%), and having never heard of COVID-19 vaccine (6%). Nevertheless, as China has ended the zero-COVID policy, many older people, especially the oldest and those with chronic conditions and disabilities, have not yet been fully vaccinated with the primary series or booster doses, exposing them to the danger of infection. Therefore, health authorities should immediately abandon the previous practice of refusing to vaccinate those with chronic conditions, change people's mistaken perceptions of contraindications and side effects, and improve access to vaccines. Most importantly, China should strengthen public trust in vaccines by making information transparent regarding the vaccine's protection rates and side effects.

Project description:Background: Little is known about whether sarcopenia predicts incident depressive symptoms in older adults. Using the nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS), we conducted cross-sectional and longitudinal analyses to estimate the association between sarcopenia and depressive symptoms among older adults. Methods: The sample comprised 7,706 participants aged at least 60 years (50.6% women; mean age 68.0 ± 6.5) from the CHARLS 2015. Based on the Asian Working Group for Sarcopenia 2019 (AWGS 2019) criteria, sarcopenia status was classified into three types: no-sarcopenia, possible sarcopenia, and sarcopenia. Depressive symptoms were assessed using the validated 10-items of the Center for Epidemiologic Studies Depression Scale. A cross-sectional analysis was used to examine the relationship between sarcopenia status and depressive symptoms. A total of 4,652 participants without depressive symptoms were recruited from the same cohort in 2015 and were followed up in 2018. Cox proportional hazards regression models were conducted to examine the effect of sarcopenia status on subsequent depressive symptoms with the report of hazard ratio (HR). Results: The prevalence of depressive symptoms in total populations, no-sarcopenia, possible sarcopenia, and sarcopenia individuals were 27.1% (2085/7706), 21.5% (927/4310), 33.6% (882/2627), and 35.9% (276/769), respectively. Both possible sarcopenia (OR: 1.75, 95% CI: 1.46-2.10) and sarcopenia (OR: 1.64, 95% CI: 1.23-2.19) were positively associated with higher odds of depressive symptoms (all p < 0.01). During the 3.7 years of follow-up, 956 cases (20.6%) with incident depressive symptoms were identified. In the longitudinal analysis, individuals with the diagnosed possible sarcopenia (HR: 1.27, 95% CI: 1.01-1.58) and sarcopenia participants (HR: 1.49, 95% CI: 1.06-2.09) were more likely to have new onset depressive symptoms than no-sarcopenia peers. Conclusions: Both possible sarcopenia and sarcopenia, assessed using the AWGS 2019 criteria, were independent predictors for the occurrence of depressive symptoms among Chinese older adults. Our findings provided new evidence supporting the longitudinal connection between sarcopenia and mental health problems, it also provides further justification for timely identification and management of both possible sarcopenia and sarcopenia as part of comprehensive strategies to fight against depressive symptoms.

Dataset Information

The causal effect of retirement on stress in older adults in China: A regression discontinuity study.

Publications

The causal effect of retirement on stress in older adults in China: A regression discontinuity study.

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