Adult women worse-off than men in China, reveals living conditions survey of elderly

Researchers from Peking University, USC, Hong Kong University of Science and Technology, and a team of international institutions today released the first major report from a massive survey of Chinese adults over the age of 45, providing critical insights into the most rapidly aging population in the world.

Across 17,708 individuals from both urban and rural areas, from a nationally representative sample of China except Tibet, the researchers found stark gender differences in how men and women age in the developing world.

The report combines extensive socioeconomic data, such as on employment, education and consumption, with self-reported and actual measures of physical and psychological health, including blood pressure and cognitive decline - providing policymakers and researchers with a broad range of data on the real circumstances of people in China as they age.

In the first major report from the baseline CHARLS data, released today at a press conference in Beijing, older women are much more likely to be in poor health than men, the researchers found. Individuals in the China Health and Retirement Longitudinal Study (CHARLS) will be followed-up with every two years, allowing researchers to track whether these gender differences remain the same or change in the next decade as China continues develop.

Adult women fared worse than men both in self-reported measures and actual health. Most strikingly, women were much more likely to have higher levels of depressive symptoms, with more than 47 per cent of elderly women 60 and over and 32 per cent of elderly men reporting higher levels of depressive symptoms, such as restless sleep or feelings of fear.

Overall, 40 per cent of the Chinese population aged 60 and over - or 74 million people - reported higher levels of depressive symptoms.

Elderly women, defined in this report as those age 60 and over, also fared much worse than men in other health measures, including :

• More than 27 per cent of elderly women reported needing help with basic daily activities, compared to 20 per cent of older men.
• Older women were much more likely to report pain: 39 per cent of elderly women reported body pain, compared to 28 per cent of men.
• About 24 per cent of men age 60 and over are overweight, compared to 32 per cent of elderly women.
• Hypertension affected 59 per cent of elderly women and 49 per cent of elderly men. Overall, comparing self-reported data on doctor diagnoses to real blood  pressure measurements taken by the survey team reveals that hypertension is underdiagnosed by at least 40 per cent in China, according to the CHARLS  report  - meaning nearly 40 million adults in China have hypertension and don't know it.
• A gender gap exists in cognitive decline among older people, which has important implications for social relations, victimization, psychological distress  and  longevity of working life. In a test of word memory, men aged 60 and over were able to remember 3.09 words out of ten, on average, compared to  only 2.73 words  for women.
• Across the lifespan, women were also much less likely than men to be in the workforce, with a significant gender gap in the dropoff as we age. In the 50-54  age  range, 75 per cent of men work, compared to less than 45 percent of women.
• Older women were much more likely than men to live in poverty by Chinese standards. Twenty-four per cent of women aged 60 and over had per capita  consumption levels that put them below the government's new poverty line, compared to 21.8 per cent of men.
• Overall, 22.9 per cent of Chinese people over the age of 60 - 42.4 million elderly people - live below the poverty line.
• Health findings correlate strongly to education, and the survey also found that older women are much more likely to have no schooling than men of the  same  cohort. Among adult women aged 45 and over, a full 39 per cent have no schooling, compared to just 11.8 per cent of men.

''Women for a variety of reasons generally report worse health than men, even though adult mortality is lower among women. In addition, the biomarkers are generally worse for women than men. That's borne out here and not specific to China,'' said John Strauss, professor of economics in the USC Dornsife College of Letters, Arts and Sciences and principal investigator of CHARLS.

"The fact that women are consistently worse off than men across multiple dimensions of well-being is a striking finding of the CHARLS survey that definitely merits further investigation. While it is true that elderly women in many countries are in poorer health than men, some of the gender gaps we find in China are quite large, such as those for depressive symptoms and cognitive function," said Albert Park of the Hong Kong University of Science and Technology, a principal author of the report.

Park continued, "Some of these differences may be associated with the much higher rate of illiteracy among elderly women in China, which is known to lead to poorer health and lower socioeconomic status. But the high incidence of depressive symptoms and suicides among women in China suggest that other social factors may be important as well."

In recent years, responding to a rapidly aging population, the Chinese government has made significant strides in strengthening its social safety net programs for older adults, including expanding public pension and health insurance.

But the survey found that in this rapidly developing country, family support still plays a significant role in the well-being of the elderly, and out-of-pocket costs for medical treatment remains very high. Under the most common health insurance program, the rural-based New Cooperative Medical Insurance program, Chinese adults aged 45 and older who went for inpatient care spent 39.7 per cent of their total yearly expenditure on such care, at the median. More than one-in-three adults who had inpatient care spent more than 50 percent of their per capita expenditure on this medical care.

While only 37.8 per cent of the elderly 60 and older live with adult children, the vast majority of elderly have at least one child living in the same city or county, if not in the same immediate neighborhood. Just less than half of elderly (46.9 per cent) received financial assistance from adult children with whom they do not live, mirroring the direction of giving in most developing countries where due to rapid growth younger people earn more than their parents. Only 19 per cent of elderly gave financial assistance to children with whom they do not live, the more common pattern in Western countries such as the United States.

The second wave of data collection for CHARLS goes into the field this summer, with a team of more than 400 people trained at Peking University by CHARLS researchers.

Yaohui Zhao of the National School of Development of Peking University, Strauss and Gonghuan Yang of the Chinese Academy of Medical Sciences and Peking Union Medical College, are the principal investigators of CHARLS.