Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-26T18:52:21.224Z Has data issue: false hasContentIssue false

A latent class analysis of health lifestyles and health outcomes among Chinese older adults

Published online by Cambridge University Press:  06 August 2020

Li Zhang*
Affiliation:
School of Sociology, China University of Political Science and Law, Beijing, China

Abstract

Prior analyses have repeatedly documented the association between individual health behaviours and health outcomes. Nonetheless, few studies have taken a health lifestyle theory approach to examine how health lifestyle behaviours have shaped Chinese older adults’ health status. Using the most recent 2011–2012 data released by the Chinese Longitudinal Healthy Longevity Survey (CLHLS), latent class analysis was applied to identify predominant health lifestyles among Chinese older adults aged 65–105. Four distinct classes representing health lifestyles emerged. Furthermore, the research found the way in which the four classes representing older adults’ health lifestyles can be predicted by the respondent's demographic and socio-economic characteristics. In addition, health lifestyles were found to be strongly associated with Chinese older adults’ health outcomes which were measured by self-rated health, functional independence, cognitive function and chronic diseases, even after controlling for demographic features as well as individual and parental socio-economic disadvantage. Findings supported the cumulative disadvantage theory in health. The research highlighted the importance of promoting health lifestyles to improve older adults’ health outcomes.

Type
Article
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Asparouhov, T and Muthén, B (2014) Auxiliary variables in mixture modeling: three-step approaches using Mplus. Structural Equation Modeling: A Multidisciplinary Journal 21, 329341.CrossRefGoogle Scholar
Batis, C, Sotres-Alvarez, D, Gordon-Larsen, P, Mendez, MA, Adair, L and Popkin, B (2014) Longitudinal analysis of dietary patterns in Chinese adults from 1991 to 2009. British Journal of Nutrition 111, 14411451.CrossRefGoogle ScholarPubMed
Bengtsson, T and Mineau, GP (2009) Early-life effects on socio-economic performance and mortality in later life: a full life-course approach using contemporary and historical sources. Social Science & Medicine 68, 15611564.CrossRefGoogle ScholarPubMed
Biddle, SJH, Bennie, JA and Bauman, AE (2016) Too much sitting and all-cause mortality: is there a causal link? BMC Public Health 16, 635.CrossRefGoogle ScholarPubMed
Bielak, AA, Anstey, KJ, Christensen, H and Windsor, TD (2012) Activity engagement is related to level, but not change in cognitive ability across adulthood. Psychology and Aging 27, 219228.CrossRefGoogle Scholar
Bots, S, Tijhuis, M, Giampaoli, S, Kromhout, D and Nissinen, A (2008) Lifestyle- and diet-related factors in late-life depression – a 5-year follow-up of elderly European men: the FINE study. International Journal of Geriatric Psychiatry 23, 478484.CrossRefGoogle ScholarPubMed
Bourdieu, P (1984) Distinction: A Social Critique of the Judgment of Taste. Cambridge, MA: Harvard University Press.Google Scholar
Brashera, MS, George, LK, Shi, X, Yine, Z and Zeng, Y (2017) Incorporating biomarkers into the study of socio-economic status and health among older adults in China. SSM – Population Health 3, 577585.CrossRefGoogle Scholar
Burdette, A, Needham, B, Taylor, M and Hill, T (2017) Health lifestyles in adolescence and self-rated health into adulthood. Journal of Health and Social Behavior 58, 520536.CrossRefGoogle ScholarPubMed
Chan, CW and Leung, SF (2015) Lifestyle health behaviors of Hong Kong Chinese: results of a cluster analysis. Asia-Pacific Journal of Public Health 27, 293302.CrossRefGoogle ScholarPubMed
Chan, A, Raman, P, Ma, S and Malhotra, R (2015) Loneliness and all-cause mortality in community-dwelling elderly Singaporeans. Demographic Research 32, 13611382.CrossRefGoogle Scholar
Chao, SF (2016) Changes in leisure activities and dimensions of depressive symptoms in later life: a 12-year follow-up. The Gerontologist 56, 397407.CrossRefGoogle ScholarPubMed
Chen, F, Yang, Y and Liu, G (2010) Social change and socioeconomic disparities in health over the life course in China: a cohort analysis. American Sociological Review 75, 126150.CrossRefGoogle ScholarPubMed
Christensen, VT and Carpiano, RM (2014) Social class differences in BMI among Danish women: applying Cockerham's health lifestyles approach and Bourdieu's theory of lifestyle. Social Science & Medicine 112, 1221.CrossRefGoogle ScholarPubMed
Claas, SA and Arnett, DK (2016) The role of healthy lifestyle in the primordial prevention of cardiovascular disease. Current Cardiology Reports 18, 56.CrossRefGoogle ScholarPubMed
Cockerham, WC (2005) Health lifestyle theory and the convergence of agency and structure. Journal of Health and Social Behavior 46, 5167.CrossRefGoogle ScholarPubMed
Conry, MC (2011) The clustering of health behaviours in Ireland and their relationship with mental health, self-rated health and quality of life. BMC Public Health 11, 692.CrossRefGoogle ScholarPubMed
Daw, J, Margolis, R and Wright, L (2017) Emerging adulthood, emerging health lifestyles: sociodemographic determinants of trajectories of smoking, binge drinking, obesity, and sedentary behavior. Journal of Health and Social Behavior 58, 181197.CrossRefGoogle ScholarPubMed
Ding, Z, Du, S and Wang, MX (2018) Research on falls and fall risk factors among urban elderly in China. Population and Development 24, 120129. (In Chinese)Google Scholar
Dodd, LJ, Al-Nakeeb, Y, Nevili, A and Forshaw, MJ (2010) Lifestyle risk factors of students: a cluster analytical approach. Preventive Medicine 51, 7377.CrossRefGoogle ScholarPubMed
Dupre, ME (2007) Educational differences in age-related patterns of disease: reconsidering the cumulative disadvantage and age-as-leveler hypotheses. Journal of Health and Social Behavior 48, 115.CrossRefGoogle ScholarPubMed
Ebrahim, S, Wannamethee, SG, Whincup, P, Walker, M and Shaper, AG (2000) Locomotor disability in a cohort of British men. International Journal of Epidemiology 29, 478486.CrossRefGoogle Scholar
Erkki, K, Tiina, L, Markku, P, Risto, S and Timo, P (2011) Self-reported sleep duration, all-cause mortality, cardiovascular mortality and morbidity in Finland. Sleep Medicine 12, 215221.Google Scholar
Feng, Z, Wang, WW, Jones, K and Li, Y (2012) An exploratory multilevel analysis of income, income inequality and self-rated health of the elderly in China. Social Science & Medicine 75, 24812492.CrossRefGoogle ScholarPubMed
Ferraro, K, Schafer, M and Wilkinson, L (2016) Childhood disadvantage and health problems in middle and later life: early imprints on physical health? American Sociological Review 81, 107133.CrossRefGoogle ScholarPubMed
Folstein, MF, Folstein, SE and McHugh, PR (1975) ‘Mini-mental state’: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189198.CrossRefGoogle Scholar
French, A (2012) Healthy behavior trajectories between adolescence and young adulthood. Advances in Life Course Research 17, 5968.CrossRefGoogle Scholar
Frohlich, KL, Corin, E and Potvin, L (2001) A theoretical proposal for the relationship between context and disease. Sociology of Health Illness 23, 776797.CrossRefGoogle Scholar
Glorioso, V and Pisati, M (2014) Socioeconomic inequality in health-related behaviors: a lifestyle approach. Quality and Quantity 48, 28592879.CrossRefGoogle Scholar
Gu, D and Zeng, Y (2004) Sociodemographic effects on the onset and recovery of ADL disability among Chinese oldest-old. Demographic Research 11, 142.CrossRefGoogle Scholar
Guallar-Castillón, P, Bayán-Bravo, A and León-Munoz, LM (2014) The association of major patterns of physical activity, sedentary behavior and sleep with health-related quality of life: a cohort study. Preventive Medicine 67, 248254.CrossRefGoogle ScholarPubMed
Han, SH, Tavares, JL, Evans, M, Saczynski, J and Burr, JA (2017) Social activities, incident cardiovascular disease, and mortality. Journal of Aging and Health 29, 268288.CrossRefGoogle ScholarPubMed
Herzog, AR and Wallace, RB (1997) Measures of cognitive functioning in the AHEAD study. Journals of Gerontology: Psychological Sciences and Social Sciences 52B, special issue, S37S48.CrossRefGoogle Scholar
Hong, SI and Morrow-Howell, N (2010) Health outcomes of experience corps: a high-commitment volunteer program. Social Science & Medicine 71, 414420.CrossRefGoogle ScholarPubMed
Khan, N, Afaq, F and Mukhtar, H (2010) Lifestyle as risk factor for cancer: evidence from human studies. Cancer Letters 293, 133143.CrossRefGoogle ScholarPubMed
Kim, S, Symons, M and Popkin, B (2004) Contrasting socioeconomic profiles related to healthier lifestyles in China and the United States. American Journal of Epidemiology 159, 184191.CrossRefGoogle ScholarPubMed
Krueger, PM, Bhaloo, T and Rosenau, PV (2009) Health lifestyles in the United States and Canada: are we really so different? Social Science Quarterly 90, 13801402.CrossRefGoogle ScholarPubMed
Laaksonen, M, Prättälä, R and Lahelma, E (2002) Sociodemographic determinants of multiple unhealthy behaviors. Scandinavian Journal of Public Health 30, 17.Google Scholar
Lauderdale, DS (2001) Education and survival: birth cohort, period, and age effects. Demography 38, 551561.CrossRefGoogle ScholarPubMed
Lawrence, E, Mollborn, S and Hummer, R (2017) Health lifestyles across the transition to adulthood: implications for health. Social Science & Medicine 193, 2332.CrossRefGoogle ScholarPubMed
Lee, Y, Kim, J and Back, JH (2008) The influence of multiple lifestyle behaviors on cognitive function in older persons living in the community. Preventive Medicine 48, 8690.CrossRefGoogle ScholarPubMed
Lee, Y, Kim, J, Back, JH, Kim, S and Ryu, M (2013) Changes in combined lifestyle risks and disability transition in older adults: Korean Longitudinal Study of Aging, 2006–2008. Preventive Medicine 56, 124129.CrossRefGoogle Scholar
Li, Y (2020) Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: prospective cohort study. BMJ 368.Google ScholarPubMed
Li, Y, Xu, L, Chi, I and Guo, P (2013) Participation in productive activities and health outcomes among older adults in urban China. The Gerontologist 54, 784796.CrossRefGoogle ScholarPubMed
Llamas-Velasco, S, Contador, I, Villarejo-Galende, A, Lora-Pablos, D and Bermejo-Pareja, F (2015) Physical activity as protective factor against dementia: a prospective population-based study (NEDICES). Journal of the International Neuropsychological Society 21, 861867.CrossRefGoogle Scholar
Luo, Y and Waite, LJ (2005) The impact of childhood and adult SES on physical, mental, and cognitive well-being in later life. Journals of Gerontology: Psychological Sciences and Social Sciences 60B, S93S101.CrossRefGoogle Scholar
Lv, X, Li, W, Ma, Y, Chen, H, Zeng, Y, Yu, X, Hofman, A and Wang, H (2019) Cognitive decline and mortality among community-dwelling Chinese older people. BMC Medicine 17, 63.CrossRefGoogle ScholarPubMed
Lynch, SM (2003) Cohort and life-course patterns in the relationship between education and health: a hierarchical approach. Demography 40, 309331.CrossRefGoogle ScholarPubMed
Martinez-Gomez, D, Guallar-Castillon, P, Garcia-Esquinas, E, Bandinelli, S and Rodriguez-Artalejo, F (2017) Physical activity and the effect of multimorbidity on all-cause mortality in older adults. Mayo Clinic Proceedings 92, 376382.CrossRefGoogle ScholarPubMed
Martín-María, N, Caballero, FF, Moreno-Agostino, D, Olaya, B, Haro, JM, Ayuso-Mateos, JL and Miret, M (2020) Relationship between subjective well-being and healthy lifestyle behaviours in older adults: a longitudinal study. Aging & Mental Health 24, 611619.CrossRefGoogle ScholarPubMed
McDonnall, MC (2011) The effect of productive activities on depressive symptoms among older adults with dual sensory loss. Research on Aging 33, 234255.CrossRefGoogle ScholarPubMed
McGovern, CM, Militello, LK, Arcoleo, KJ and Melnyk, BM (2018) Factors associated with healthy lifestyle behaviors among adolescents. Journal of Pediatric Health Care 32, 473480.CrossRefGoogle ScholarPubMed
Meyer, OL, Castro-Schilo, L and Aguilar-Gaxiola, S (2014) Determinants of mental health and self-rated health: a model of socioeconomic status, neighborhood safety, and physical activity. American Journal of Public Health 104, 17341741.CrossRefGoogle Scholar
Morrow-Howell, N (2010) Volunteering in later life: research frontiers. Journals of Gerontology: Psychological Sciences and Social Sciences 65B, S461S469.CrossRefGoogle Scholar
Murtaugh, C, Spillman, B and Wang, X (2010) Lifetime risk and duration of chronic disease and disability. Journal of Aging and Health 23, 554577.CrossRefGoogle ScholarPubMed
Oftedal, S, Kolt, GS, Holliday, EG, Stamatakis, E, Vandelanotte, C, Brown, WJ and Duncan, MJ (2019) Associations of health-behavior patterns, mental health and self-rated health. Preventive Medicine 118, 295303.CrossRefGoogle ScholarPubMed
Pampel, FC, Krueger, PM and Denney, JT (2010) Socioeconomic disparities in health behaviors. Annual Review of Sociology 36, 349370.CrossRefGoogle ScholarPubMed
Peeters, GM, Verweij, LM, van Schoor, NM, Pijnappels, M, Pluijm, SM, Visser, M and Lips, P (2010) Which types of activities are associated with risk of recurrent falling in older persons? Journals of Gerontology: Biological Sciences and Medical Sciences 65A, 743750.CrossRefGoogle Scholar
Peres, K, Helmer, C, Amieva, H, Orgogozo, JM, Rouch, I, Dartigues, JF and Barberger-Gateau, P (2008) Natural history of decline in instrumental activities of daily living performance over the 10 years preceding the clinical diagnosis of dementia: a prospective population-based study. Journal of the American Geriatrics Society 56, 3744.Google ScholarPubMed
Preston, SH and Taubman, P (1994) Socioeconomic differences in adult mortality and health status. In Martin, LG and Preston, SH (eds), Demography of Aging. Washington, DC: National Academy Press, pp. 279317.Google Scholar
Prochaska, JJ, Spring, B and Nigg, CR (2008) Multiple health behavior change research: an introduction and overview. Preventive Medicine 46, 181188.CrossRefGoogle ScholarPubMed
Rizzuto, D, Orsini, N, Qiu, C, Wang, HX and Fratiglioni, L (2019) Lifestyle, social factors, and survival after age 75: population based study. Journal of Aging and Health 31, 12971314.Google Scholar
Rogers, R, Hummer, RA, Krueger, PM and Pampel, FC (2005) Mortality attributable to cigarette smoking in the United States. Population and Development Review 31, 259292.CrossRefGoogle Scholar
Ruan, R, Feng, L, Li, J, Ng, TP and Zeng, Y (2013) Tea consumption and mortality among oldest-old Chinese. Journal of the American Geriatrics Society 61, 113.CrossRefGoogle ScholarPubMed
Saint Onge, JM and Krueger, PM (2017) Health lifestyle behaviors among U.S. adults. SSM – Population Health 3, 8998.CrossRefGoogle ScholarPubMed
Shen, K, Yan, P and Zeng, Y (2016) Coresidence with elderly parents and female labor supply in China. Demographic Research 35, 645670.CrossRefGoogle Scholar
Sinha, DP (1992) Project lifestyle: developing positive health lifestyles for schoolchildren in Antigua. Journal of School Health 62, 449453.CrossRefGoogle ScholarPubMed
Smith, K and Victor, C (2019) Typologies of loneliness, living alone and social isolation, and their associations with physical and mental health. Ageing & Society 39, 17091730.CrossRefGoogle Scholar
Spring, B, Moller, AC and Coons, MJ (2012) Multiple health behaviors: overview and implications. Journal of Public Health 34, supplement, i3i10.CrossRefGoogle ScholarPubMed
Stefansdottir, IK and Vilhjalmsson, R (2007) Dimensions of health-related lifestyle in young adulthood: results from a national population survey. Scandinavian Journal of Caring Sciences 21, 321328.CrossRefGoogle ScholarPubMed
Streeter, JL (2017) Socioeconomic factors affecting food consumption and nutrition in China: empirical evidence during the 1989–2009 period. The Chinese Economy 50, 168192.CrossRefGoogle Scholar
Suzuki, E, Yorifuji, T, Takao, S, Komatsu, H, Sugiyama, M, Ohta, T, Ishikawa-Takata, K and Doi, H (2009) Green tea consumption and mortality among Japanese elderly people: the prospective Shizuoka elderly cohort. Annals of Epidemiology 19, 732739.CrossRefGoogle ScholarPubMed
Ueshima, K, Ishikawa-Takata, K, Yorifuji, T, Suzuki, E, Kashima, S, Takao, S and Doi, H (2010) Physical activity and mortality risk in the Japanese elderly: a cohort study. American Journal of Preventive Medicine 38, 410418.CrossRefGoogle ScholarPubMed
van Gool, CH, Kempen, GI, Penninx, BJW, Deeg, DJ, Beekman, AT and van Eijk, JT (2003) Relationship between changes in depressive symptoms and unhealthy lifestyles in late middle aged and older persons: results from the Longitudinal Aging Study Amsterdam. Age & Ageing 32, 8187.CrossRefGoogle ScholarPubMed
Vermeulen-Smit, E, Ten Have, M, Van Laar, M and De Graaf, R (2015) Clustering of health risk behaviours and the relationship with mental disorders. Journal of Affective Disorders 171, 111119.CrossRefGoogle ScholarPubMed
Vermunt, JK (2010) Latent class modeling with covariates: two improved three-step approaches. Political Analysis 18, 450469.CrossRefGoogle Scholar
Visser, M, Wijnhoven, HAH, Comijs, HCC, Thomése, FGCF, Twisk, JWR and Deeg, DJHD (2019) A healthy lifestyle in old age and prospective change in four domains of functioning. Journal of Aging and Health 31, 12971314.CrossRefGoogle ScholarPubMed
Wagner, DC and Short, JL (2014) Longitudinal predictors of self-rated health and mortality in older adults. Preventing Chronic Disease 11, E93.CrossRefGoogle ScholarPubMed
Wang, F (2019) Status constraint and lifestyle transition: a latent class analysis of health-related lifestyles among different social strata in China. Journal of Chinese Sociology 6, 23.CrossRefGoogle Scholar
Wang, HX, Karp, A, Winblad, B and Fratiglioni, L (2002) Latelife engagement in social and leisure activities is associated with a decreased risk of dementia: a longitudinal study from the Kungsholmen project. American Journal of Epidemiology 155, 10811087.CrossRefGoogle Scholar
Wen, M and Gu, D (2011) The effects of childhood, adult, and community socioeconomic conditions on health and mortality among older adults in China. Demography 48, 153181.CrossRefGoogle ScholarPubMed
Wilson, K, Senay, I, Durantini, M, Sanchez, F, Hennessy, M, Spring, B and Albarracín, D (2015) When it comes to lifestyle recommendations, more is sometimes less: a metaanalysis of theoretical assumptions underlying the effectiveness of interventions promoting multiple behavior domain change. Psychological Bulletin 141, 474509.CrossRefGoogle Scholar
Wu, L and Zhang, H (2016) Health-related quality of life of low-socioeconomic-status populations in urban China. Health & Social Work 41, 219227.CrossRefGoogle ScholarPubMed
Xiao, YX, Romanelli, M. and Lindsey, MA (2019) A latent class analysis of health lifestyles and suicidal behaviors among U.S. adolescents. Journal of Affective Disorder 255, 116126.CrossRefGoogle Scholar
Xu, H and Xie, Y (2017) Socioeconomic inequalities in health in China: a reassessment with data from the 2010–2012 China Family Panel Studies. Social Indicators Research 132, 219239.CrossRefGoogle ScholarPubMed
Zeng, Y, Vaupel, JW, Xiao, Z, Zhang, C and Liu, Y (2002) Sociodemographic and health profiles of the oldest old in China. Population and Development Review 28, 251273.Google Scholar
Zeng, Y, Gu, D and Land, KC (2007) The association of childhood socioeconomic conditions with healthy longevity at the oldest-old ages in China. Demography 44, 497518.CrossRefGoogle Scholar
Zeng, Y, Gu, D and Purser, J (2010) Associations of environmental factors with elderly health and mortality in China. American Journal of Public Health 100, 298305.CrossRefGoogle ScholarPubMed
Zhang, L, Qiu, L, Ding, Z and Hwang, K (2018) How does socioeconomic status affect Chinese adolescents’ weight status? A study of possible pathways. Chinese Sociological Review 50, 423442.CrossRefGoogle Scholar
Zhao, Y, Dupre, ME, Qiu, L and Gu, D (2017) Changes in perceived uselessness and risks for mortality: evidence from a national sample of older adults in China. BMC Public Health 17, 561.CrossRefGoogle ScholarPubMed
Zhen, S, Ma, Y, Zhao, Z, Yang, X and Wen, D (2018) Dietary pattern is associated with obesity in Chinese children and adolescents: data from China Health and Nutrition Survey (CHNS). Nutrition Journal 17, 68.CrossRefGoogle Scholar
Zimmer, Z and Kwong, J (2004) Socioeconomic status and health among older adults in rural and urban China. Journal of Aging and Health 16, 4470.CrossRefGoogle ScholarPubMed