Correlation between air pollution and cognitive impairment among older individuals: empirical evidence from China.

BACKGROUND: Little information is available regarding the impact of air pollution on cognitive impairment in older individuals in developing countries. This study empirically tested the impacts of the air quality index (AQI), air pollution intensity (quantified by the number of days of extreme air pollution in a year), and different pollutants on the cognitive abilities of older Chinese individuals. METHODS: A panel of 28,395 participants spanning 122 cities in 2015 and 2018 was used, based on 3-year follow-up survey data from the China Health and Retirement Longitudinal Study (CHARLS) database. Data from the two phases of the CHARLS microsurvey were combined with relevant statistical data on air pollution in each region in the current year. These two surveys were used to investigate changes in basic health and macro-environmental indicators in older individuals in China, and a mean difference test was conducted. We then reduced the sample selection error by controlling for environmental migration and used two-way fixed and instrumental variable methods for endogenous treatment to avoid the estimation error caused by missing variables. RESULTS: Air pollution had a significantly negative effect on the cognitive abilities of older individuals (odds ratio [OR]: 1.4633; 95% confidence interval [95% CI]: 1.20899-1.77116). Different pollution intensities(only AQI value is greater than 200 or more) had apparent effects on cognitive impairment, with an OR of approximately 1.0. Sulfur dioxide had significantly negative effects on cognitive ability, with OR of 1.3802 (95% CI: 1.25779-1.51451). Furthermore, air pollution impact analysis showed heterogeneous results in terms of age, sex, education, and regional economic development level. In addition, social adaptability (calculated using social participation, learning, adaptability, and social support) not only had a significant positive effect on the cognitive abilities of older individuals, but also regulated the cognitive decline caused by air pollution. CONCLUSIONS: Air pollution affects cognitive impairment in older individuals, especially in those with lower education levels, and living in economically underdeveloped areas. This effect is synchronous and has a peak at an AQI of > 200.

Impact of socioeconomic status and health risk on fall inequality among older adults.

Socio-economic status (SES) is one of the important indicators reflecting individual social participation and resource allocation, and it plays an important role in individual health shock. Health shock indicates the body being in a non-healthy state, such as illness, injury and death. This study used data from the China Health and Retirement Longitudinal Study conducted in 2013, 2015 and 2018 and utilised the panel logit model, causal step-by-step analysis and path analysis to empirically test the impact of SES on fall inequality among the elderly and the mediating effect of health shock. The results demonstrated obvious group inequality in the fall risk among older adults, the core of which was the impact of SES on health, causing health inequality and affecting fall inequality. The activities of daily living and pain rate of the high-income group were 61.16% and 28.69%, respectively, that of the low-income group. The evaluation of good sight and hearing were 3.6833 and 3.8572 times, respectively, that of the low-income group. The non-depressive status was 38.4638 times of the low-income group. The path effect confirmed the mediating role of health shock. Therefore, this study concluded that SES had an important impact on the risk of falls among the elderly, and this impact was mainly from health shock. This study proposed that to reduce the incidence of falls among the elderly, differences in health shock risks among the elderly with different SES must be actively monitored and accurate and effective policy interventions should be implemented from the level of group heterogeneity.

Evaluating the long-term care insurance policy from medical expenses and health security equity perspective: evidence from China.

BACKGROUND: Since the national long-term care (LTCI) policy pilot in 2016 of China, the LTCI policy has had significant impact on the residents in the pilot area. METHODS: From the perspective of medical expenses and health security equity, this study selects tracking survey data from the CHARLS database in 2013, 2015, and 2018 and empirically investigates the effect of LTCI policy pilot by using differences-in-differences method (DID). Moreover, this study measures the economic distribution and health equity of the treated and untreated groups using the concentration and Theil indices. RESULTS: The results showed that group heterogeneity of medical expenses and health level of elderly in the treatment group were narrowing. Moreover, the policy results showed that the LTCI policy pilot significantly affects the outpatient, hospital expenses, and length of stay of elders. Residence registration, income level, and basic medical insurance play a significant regulatory role. Additionally, LTCI policy pilot significantly improved the overall health of the elderly. CONCLUSIONS: The measurement results of inequality show that the policy increases the income of low-income people, lowers the inequality level of outpatient and inpatient reimbursement, and reduces the concentration index of ADL disability and serious diseases. However, the inequality of serious diseases is becoming higher. Based on this, this paper provides several suggestions on optimizing the pilot policy of LTCI.

Impact of Air Pollution on Residents' Medical Expenses: A Study Based on the Survey Data of 122 Cities in China.

Background: With the development of the social economy, air pollution has resulted in increased social costs. Medical costs and health issues due to air pollution are important aspects of environmental governance in various countries. Methods: This study uses daily air pollution monitoring data from 122 cities in China to empirically investigate the impact of air pollution on residents' medical expenses using the Heckman two-stage and instrumental variable methods, matching data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) survey. Results: The study found that poor air quality, measured by the air quality index (AQI), significantly increased the probability of chronic lung disease, heart disease, and self-rated poor health. Additionally, the AQI (with an effect of 4.51%) significantly impacted health-seeking behavior and medical expenses. The medical expenditure effects of mild, moderate, severe, and serious pollution days were 3.27, 7.21, 8.62, and 42.66%, respectively. Conclusion: In the long run, residents' health in areas with a higher air pollution index, indicating poor air quality, is negatively impacted. The more extreme the pollution, the higher the probability of residents' medical treatment and the subsequent increase in medical expenses. Group and regional heterogeneity also play a role in the impact of air pollution on medical expenses. Compared with the existing literature, this study is based on individuals aged 15 years and above and produces reliable research conclusions.