Expectations Regarding Reciprocity of Flows of Intergenerational Support in China: Does Gender or Birth Order Matter?

This study investigates the flows of downward intergenerational transfer to adult children of different gender and birth order, and their influence on parental expectations towards old-age care and financial support, using data from the 2015-2016 China Health and Retirement Longitudinal Study (CHARLS). Based on the analytic sample of 1218 parents and 3237 adult children, we found that in multi-child families, sons are more likely to be expected by their parents as future caregivers if both they and their siblings received parental housing support, while it is the case for daughters when only they themselves received parental housing support. Parents' downward housing support shows a stronger effect on care expectations than on expectations of future financial support. This study contributes to our understanding of intergenerational transfer norms and expectations from parents' perspective and has important implications for old-age care policies in contemporary China.

Has COVID-19 Been the Great Leveler? The Changing Use of Intergenerational Digital Communications Amongst Older People in England During the Pandemic.

This research examines patterns of intergenerational digital contact before and during the COVID-19 pandemic in England, using data from the English Longitudinal Study of Ageing (ELSA) Wave nine and the first Wave of the ELSA COVID-19 Sub-study. Multivariate binary logistic regressions were applied to assess the determinants of frequent intergenerational digital communication. The findings indicate that when the pandemic began, many older persons shifted towards more frequent intergenerational digital contact, but a small minority shifted away. As a result, the pre-existing gender gap amongst older people in the use of digital communication technology narrowed, as did the disparity associated with family relationship closeness. However, pre-pandemic gaps in the intergenerational digital connection between internet users and non-users widened during the pandemic. Overall, the results suggest that the pandemic resulted in more frequent digitally-mediated social interactions within the family, which may strengthen ties between older and younger family members.

Typologies of Intergenerational Relations in Urban and Rural China: A Latent Class Analysis.

Understanding intergenerational relations in China has become increasingly important against a backdrop of rapid social and demographic transitions and an ongoing urban-rural divide. From the parental perspective, this research investigates patterns and determinants of intergenerational relations between middle-aged and older parents and their non-coresident children in urban and rural China using data from the China Health and Retirement Longitudinal Study (2018) (N = 14,616). Latent class analysis revealed three typologies of intergenerational relations found across both urban and rural China - Tight-knit, Support-at-distance and Material-oriented-detached, and one typology particularly for urban China - Staying-in-touch-but-independent. The observed patterns suggest intergenerational bonds remain solid alongside the emergence of new trends, reflecting the modernization process. Multivariate multinomial regression analysis identified determinants for membership of each relationship typology. The findings will inform policy-makers and care professionals, supporting the identification of the vulnerable groups and the design of targeted policies for older parents with different family resources.

Targeting Cash Transfers on the "Poorest of the Poor" in the Slums: How Well Did the Kenya's Older Persons Cash Transfer Programme Perform?

In resource poor environments, identifying those most in need of limited available resources is challenging. Kenya's older persons cash transfer programme (OPCT) targeted at the most poor used a 2-stage targeting process to identify beneficiaries, combining community-based selection with a proxy means-test. This paper investigates whether the process "correctly" identified targeted vulnerable older people in Nairobi's informal settlements and whether receipt of the OPCT resulted in an improvement in perceived financial wellbeing. Regression results show that individuals with greater need were covered under the OPCT. Using propensity score matching, the paper evidences that the OPCT improved subjective financial wellbeing among beneficiaries.

Sleep Problems and New Occurrence of Chronic Conditions during the COVID-19 Pandemic in the UK.

The COVID-19 pandemic has negatively impacted upon sleep health. Relatively little is known about how this may influence the population's health subsequently. This prospective longitudinal study aims to examine the consequences of sleep problems for physical and mental health during the COVID-19 pandemic in the UK, using data from the Understanding Society: COVID-19 Study, a large-scale population-based survey with 12,804 adults aged 16 and above. A measure of sleep problems was derived from Pittsburgh Sleep Quality Index (PSQI) questions, reflecting seven dimensions of sleep quality. Binary logistic regressions were applied to investigate the relationship between sleep problem and the incidence of cardiovascular disease (CVD), hypertension, diabetes, obesity, arthritis and an emotional, nervous or psychiatric problem over the 15 months follow-up period. The analysis confirms that sleep problems are prevalent and vary between sub-groups among adults. Notably, sleep problems are then significantly associated with a higher risk of cardiovascular disease, hypertension, diabetes, obesity, arthritis and emotional, nervous or psychiatric problems, independent of demographic, socioeconomic, familial and health confounders. Our findings suggest promoting good sleep hygiene should be prioritised during the pandemic, and more generally as part of wider programmes aimed at promoting good physical and mental health.

Did the Socio-Economic Gradient in Depression in Later-Life Deteriorate or Weaken during the COVID-19 Pandemic? New Evidence from England Using Path Analysis.

It is well established that there is a socioeconomic gradient in adult mental health. However, little is known about whether and how this gradient has been exacerbated or mitigated by the COVID-19 pandemic. This study aims to identify the modifiable pathways involved in the association between socioeconomic position (SEP) and mental health during the COVID-19 pandemic. The analysis included 5107 adults aged 50+ living in England and participating in the English Longitudinal Study of Ageing Wave nine (2018-2019) and the COVID-19 study (June 2020). Mental health was measured using a shortened version of the Centre for Epidemiologic Studies Depression scale. Path analysis with multiple mediator models was used to estimate the direct effect of SEP (measured by educational qualification and household wealth) on mental health (measured by depression), along with the indirect effects of SEP via three mediators: COVID-19 infection symptoms, service accessibility and social contact. The results show that the prevalence of depression for the same cohort increased from 12.6% pre-pandemic to 19.7% during the first wave of the pandemic. The risk of depression increased amongst older people who experienced COVID-19 infection, difficulties accessing services and less frequent social contact. The total effects of education and wealth on depression were negatively significant. Through mediators, wealth and education were indirectly associated with depression. Wealth also directly affected the outcome. The findings suggest that the socioeconomic gradient in depression among older people may have deteriorated during the initial phase of the pandemic and that this could in part be explained by increased financial hardship, difficulties in accessing services and reduced social contact.

The Impact of Changing Social Support on Older Persons' Onset of Loneliness During the COVID-19 Pandemic in the United Kingdom.

BACKGROUND AND OBJECTIVES: Social distancing measures aimed at controlling the spread of coronavirus disease 2019 (COVID-19) are likely to have increased social isolation among those older than 70 instructed to shield at home. This study examines the incidence of loneliness by gender over the first 10 months of the COVID-19 pandemic among persons aged 70 and older in the United Kingdom, and the impact of changing social networks and perceived social support on the new occurrence of loneliness. RESEARCH DESIGN AND METHODS: Participants (N = 1,235) aged 70 and older with no reports of loneliness before the pandemic who participated in 7 rounds of the Understanding Society: COVID-19 Study (April 2020-January 2021) and the main Understanding Society Study conducted during 2019. Cox regression analyzed the time to a new occurrence of loneliness. RESULTS: Among older people who hardly ever/never felt lonely before the pandemic, 33.7% reported some degree of loneliness between April 2020 and January 2021. Living in a single-person household, having received more social support before the pandemic, changes in support receipt during the pandemic, and a deteriorating relationship with one's partner during the pandemic increased the risk of experiencing loneliness. Older women were more likely than older men to report loneliness, even when living with a partner. DISCUSSION AND IMPLICATIONS: During the 3 COVID-19-related lockdowns in the United Kingdom, changes in older people's social networks and support resulted in a significant onset of loneliness. Findings highlight the risks of shielding older persons from COVID-19 in terms of their mental well-being and the importance of strengthening intergenerational support.

Prospective longitudinal study of 'Sleepless in Lockdown': unpacking differences in sleep loss during the coronavirus pandemic in the UK.

OBJECTIVES: COVID-19 is having a disproportionate impact on Black, Asian and minority ethnic (BAME) groups and women. Concern over direct and indirect effects may also impact on sleep. We explore the levels and social determinants of self-reported sleep loss among the UK population during the pandemic, focusing on ethnic and gender disparities. SETTING: This prospective longitudinal study analysed data from seven waves of the Understanding Society: COVID-19 Study collected from April 2020 to January 2021 linked to prepandemic data from the 2019 mainstage interviews, providing baseline information about the respondents prior to the pandemic. PARTICIPANTS: The analytical sample included 8163 respondents aged 16 and above who took part in all seven waves with full information on sleep loss, defined as experiencing 'rather more' or 'much more' than usual sleep loss due to worry, providing 57 141 observations. PRIMARY OUTCOME MEASURES: Self-reported sleep loss. Mixed-effects regression models were fitted to consider within-individual and between-individual differences. RESULTS: Women were more likely to report sleep loss than men (OR 2.1, 95% CI 1.9 to 2.4) over the 10-month period. Being female, having young children, perceived financial difficulties and COVID-19 symptoms were all predictive of sleep loss. Once these covariates were controlled for, the bivariate relationship between ethnicity and sleep loss (1.4, 95% CI 1.6 to 2.4) was reversed (0.7, 95% CI 0.5 to 0.8). Moreover, the strength of the association between gender and ethnicity and the risk of sleep loss varied over time, being weaker among women in July (0.6, 95% CI 0.5 to 0.7), September (0.7, 95% CI 0.6 to 0.8), November (0.8, 95% CI 0.7 to 1.0) and January 2021 (0.8, 95% CI 0.7 to 0.9) compared with April 2020, but positively stronger among BAME individuals in May (1.4, 95% CI 1.0 to 2.1), weaker only in September (0.7, 95% CI 0.5 to 1.0). CONCLUSIONS: The pandemic has widened sleep deprivation disparities, with women with young children, COVID-19 infection and BAME individuals experiencing sleep loss, which may adversely affect their mental and physical health.

Changing living arrangements and stress during Covid-19 lockdown: Evidence from four birth cohorts in the UK.

BACKGROUND: The outbreak of Covid-19 in the UK has seen many families unexpectedly brought back together. The circumstances and stories of individual families have been picked up in the press focussing on the difficulties of people adjusting to their changed living arrangements. Yet, there have been few empirical analyses on how such changes might influence people's health and wellbeing. Therefore, this study explored the changing patterns of perceived stress by living arrangements change during the first wave of the Covid-19 pandemic in 2020. METHODS: The data used relates to 12,532 cohort members in the special Covid-19 surveys conducted with the participants of the 1958, 1970, 2000-01 British birth cohorts and Next Steps (born in 1989-90) in May 2020. Probit regression models were used to assess the chance of reporting increased stress amongst those who had experienced changes in living arrangements during the pandemic compared to those who had not. RESULTS: The results provide strong evidence that those individuals whose living arrangements changed during the Covid-19 pandemic have a higher likelihood of reported increased stress than those whose living arrangements remained unchanged. This was most clearly seen for older cohorts. Increased interpersonal conflict plays a role in mediating the association, especially for the younger cohort. CONCLUSIONS: The findings confirm that during the first lockdown, changing living arrangements were negatively associated with individuals' mental wellbeing. As prolonged periods of stress can lead to serious health problems and policymakers need to be mindful that services may need to take these new, albeit for many temporary, forms of living arrangements into account.

Work histories of older adults in China: Social heterogeneity and the pace of de-standardisation.

Inequalities in the labour market are recognised as presenting a major impediment to extending the working lives of older adults in China as part of any proposed reforms of the public pension system against the background of population ageing. While a growing body of literature has paid attention to understanding this issue within the wider international context, there remains a dearth of research on work histories in China. This research which is crucial for the understanding of inequalities in later life. This paper provides a unique evidence on the work experiences over the life course of 7281 Chinese individuals aged 60 and over (born between 1930-1954), using retrospective life history data from the China Health and Retirement Longitudinal Study. With the application of sequence analysis and cluster analysis, results reveal a picture of significant social heterogeneity within work trajectories between urban and rural areas and between men and women. Such differences are largely shaped by the wider economic and institutional context, as well as by key personal characteristics such as educational attainment. More importantly, cohort comparisons highlight how different groups of current Chinese older alduts have been affected by changes in the labour market and the public pension system over the past sixty years. Whilst it is to be expected that younger cohorts amongst today's older population will have experienced some de-standardisation of work trajectories following the opening up of the economy since the 1980s, the heterogeneity in work trajectories across different social groups within and between cohorts is notable. These findings emphasise the importance of ensuring policy design that delivers equitable pension entitlements and supports flexible working patterns in order to reduce inequalities in the labour market between rural and urban residents and between men and women.

Chinese women's health and wellbeing in middle life: Unpacking the influence of menopause, lifestyle activities and social participation.

OBJECTIVES: To examine Chinese middle-aged women's health and wellbeing and the associated biosocial correlates. STUDY DESIGN: This study used a cross-sectional design, including selected retrospectively collected information on the final menstrual period, drawn from the 2013 wave of the China Health and Retirement Longitudinal Study (CHARLS). Women aged 45 to 59 were selected. MAIN OUTCOME MEASURES: Factor analysis of 16 menopausal symptom ratings yielded four different and independent measures of pre-/peri-menopausal and early postmenopausal women's health. These were: negative mood (feel frustrated, sad, lonely, worried, bored, angry, tired and stressed), positive emotions (feel enthusiastic, content and happy), musculoskeletal pain (shoulder/neck pain, knee and other joint pain, and back pain), and sleep and memory problems (trouble sleeping and poor memory). RESULTS: Menopausal status was positively associated with sleep and memory problems, whilst the number of years since the final menstrual period was positively associated with musculoskeletal pain. In contrast, lifestyle activities and social participation were linked to positive emotions. The association between selected biosocial factors and negative mood was not significant after controlling for other demographic and social background factors. CONCLUSIONS: Musculoskeletal health as well as sleep and memory problems are positively associated with menopausal biological factors amongst Chinese mid-life women. Maintaining active social engagement contributes to positive wellbeing among middle-aged women.

Menopausal transition and change in employment: Evidence from the National Child Development Study.

OBJECTIVES: This study aims to investigate the impact of the menopausal transition and severe symptoms on changes in employment. STUDY DESIGN: This longitudinal prospective study analysed data from a population-based cohort study, the UK National Child Development Study Wave 8 and Wave 9, when the cohort was aged 50 and 55 respectively. The analytical sample comprised 3109 employed women at age 50. MEASURES: The outcome variable was the employment change from age 50 to age 55, with three categories: i) continued employed without reduced working time; ii) continued employed with reduced working hours; and iii) exit employment. The employment dynamics of women were compared using multinomial logistic regression modelling. Key independent variables included menopausal transition status and severe menopausal symptoms experienced. RESULTS: 53.5 % of employed women at age 50 reported at least one severe menopausal symptom. Women experiencing severe menopausal symptoms had a higher chance of employment exit or reducing their working hours. The odds ratios contrasting severely symptomatic women with those with no severe symptoms were 1.43 (95 % CI = 1.11-1.84) between exiting employment vs continued employment without reducing working hours, and 1.23 (95 % CI = 1.02-1.48) between reducing working hours vs continued employment without reducing working hours. The strength of the association between women's severe menopausal symptoms and the risk of employment exit or reducing working hours varied according to their HRT usage and their partner's economic activity. CONCLUSIONS: Menopausal symptoms can pose obstacles to some middle-aged women in terms of remaining in employment or maintaining their number of working hours.

Social Participation and Health Outcomes Among Caregivers and Noncaregivers in Great Britain.

This study investigates the relationship between social participation and health outcomes between caregivers and noncaregivers in Great Britain. Previous studies indicate that the impact of informal caregiving on the carer's health is complex, and the intensity of care provision has an adverse impact on the caregivers' health, while social participation could have a protective role in this respect. Using qualitative and quantitative data from Wave 8 of the 1958 National Child Development Study, the analysis shows that social participation has a positive effect on the carers' mental health and subjective well-being. Individuals who did not engage in social participation reported lower levels of mental health and control, autonomy, self-realization and pleasure (CASP) scores than those engaged in social participation. The qualitative results showed the barriers to social participation of caregivers to be time, energy, and finance. We discuss ways in which the government could address such barriers to improve the level of social participation among caregivers.

Unravelling the wider benefits of social pensions: Secondary beneficiaries of the older persons cash transfer program in the slums of Nairobi.

A growing number of low and middle income countries have introduced social pension programs for older people. Research has highlighted that the impact of such programs can extend beyond the primary recipient when funds are shared. It less clear the extent to which such redistribution persists in the lowest resource settings. Using data from a survey conducted in 2016, this paper examines how recipients of the Kenyan Older Persons Cash Transfer Program (OPCTP) living in two slum communities in Nairobi reallocate their social pension by examining the characteristics of older people who are more likely to share their cash and identifying secondary beneficiaries. Findings suggest that 40% of beneficiaries re-allocate some or all of the cash received. The majority of secondary beneficiaries are either grandchildren or children of the primary beneficiary. Overall, a higher proportion of the total cash is shared with secondary beneficiaries living in rural Kenya, as compared to those living in the same household. This highlights the role played by older people, even the most vulnerable, in providing support to wider kin networks; reinforcing the argument that investing in social pensions has much broader potential societal impact than the intended aims of reducing recipient household poverty. By enhancing economic opportunities and investments in human capital more broadly, societies that invest in social pension programs may improve the overall living conditions and experiences of ageing in their countries at a critical moment of global population ageing.

General Health Questionnaire-12 reliability, factor structure, and external validity among older adults in India.

AIMS: The purpose of this study is to analyze the internal consistency, factor structure, and external validity of the 12-item General Health Questionnaire (GHQ-12) among older adults in India. SETTINGS AND DESIGN: This study analyzes data collected as part of the UNFPA "Building Knowledge Base on Ageing in India (BKPAI)" project. The BKPAI Survey was conducted in 2011 in seven major demographically advanced states of India - Himachal Pradesh, Punjab, West Bengal, Odisha, Maharashtra, Kerala, and Tamil Nadu. MATERIALS AND METHODS: A community-based representative sample of 9692 respondents aged 60 and above from seven Indian states was employed. The GHQ-12 questionnaire was administered. STATISTICAL ANALYSIS: The Cronbach's alpha was calculated to analyze internal consistency. Factor analysis was applied to explore the factor structure of GHQ-12, and then correlation coefficients were calculated to examine the external validity of the measurement. RESULTS: The Cronbach's alpha of the GHQ-12 is 0.9. Factor analysis reveals two significant components which accounted for 59% of the variance. The correlation between the overall score of GHQ-12 and the subjective well-being inventory (SUBI) is 0.58. CONCLUSIONS: The GHQ-12 shows adequate reliability among the older population in India.

Elder abuse as a risk factor for psychological distress among older adults in India: a cross-sectional study.

OBJECTIVES: This study examines the association between elder abuse and psychological distress among older adults in India and explores whether this association varies by the level of psychosocial and material resources. DESIGN: The study uses a cross-sectional survey design. SETTING: The data are drawn from a representative sample of 9589 adults aged 60 and above in seven Indian states-Himachal Pradesh, Punjab, West Bengal, Odisha, Maharashtra, Kerala and Tamil Nadu-in 2011. STATISTICAL ANALYSES: Secondary analysis, using bivariate and multivariate logistic regression models, is conducted using the United Nations Population Fund project Building Knowledge Base on Ageing in India survey. Elder abuse (physical and/or emotional) emanating from family members in the previous month before the survey is examined. Multivariate models are run on the total analytical sample and for men and women separately. RESULTS: The overall prevalence of psychological distress among persons aged 60 and over living in the seven Indian States is 40.6%. Among those older persons who experienced some form of physical or emotional abuse or violence in the last month, the prevalence of psychological distress is much higher than that in the general older population, at 61.6% (p<0.001). The results show that the experience of abuse is negatively associated with the mental health of older adults, and this relationship persists even after controlling for demographic and socioeconomic factors (OR=1.60, 95% CI 1.22 to 2.09). The findings also suggest that household wealth has an inverse relationship with mental health, with the association between experiencing elder abuse and reporting poor mental health being strongest among older people in wealthy households. CONCLUSIONS: Elder abuse in India is currently a neglected phenomenon, and greater recognition of the link between abuse and mental health is critical to improve the well-being of vulnerable older adults, some of whom may be 'hidden' within well-off households.

Sleep disturbance and the older worker: findings from the Health and Employment after Fifty study.

Objectives The aim of this study was to characterize the descriptive epidemiology of insomnia in midlife and explore the relative importance of different occupational risk factors for insomnia among older workers. Methods A questionnaire was mailed to all adults aged 50-64 years registered with 24 English general practices. Insomnia was defined as having at least one of four problems with sleep severely in the past three months. Subjects were also asked about employment conditions, feelings concerning work, and their health. Associations were assessed by logistic regression and population attributable fractions (PAF) calculated. Results Analysis was based on 8067 respondents (5470 in paid work), 18.8% of whom reported insomnia. It was more common among women, smokers, obese individuals, those living alone, and those in financial hardship, and less prevalent among the educated, those in South-East England, and those with friendships and leisure-time pursuits. Occupational risk factors included unemployment, shift working, lack of control and support at work, job insecurity, job dissatisfaction and several of its determinants (lacking a sense of achievement, feeling unappreciated, having difficult work colleagues, feeling unfairly criticized). Population burden of insomnia was associated more strongly with difficulties in coping with work demands, job insecurity, difficult colleagues, and lack of friendships at work [population attributable fraction (PAF) 15-33%] than shift work and lack of autonomy or support (PAF 5-7%). It was strongly associated with seven measures of poorer self-assessed health. Conclusions Employment policies aimed at tackling insomnia among older workers may benefit from focusing particularly on job-person fit, job security and relationships in the workplace.

Frailty, prefrailty and employment outcomes in Health and Employment After Fifty (HEAF) Study.

OBJECTIVES: Demographic changes are requiring people to work longer. No previous studies, however, have focused on whether the 'frailty' phenotype (which predicts adverse events in the elderly) is associated with employment difficulties. To provide information, we assessed associations in the Health and Employment After Fifty Study, a population-based cohort of 50-65-year olds. METHODS: Subjects, who were recruited from 24 English general practices, completed a baseline questionnaire on 'prefrailty' and 'frailty' (adapted Fried criteria) and several work outcomes, including health-related job loss (HRJL), prolonged sickness absence (>20 days vs less, past 12 months), having to cut down substantially at work and difficulty coping with work's demands. Associations were assessed using logistic regression and population attributable fractions (PAFs) were calculated. RESULTS: In all, 3.9% of 8095 respondents were classed as 'frail' and 31.6% as 'prefrail'. Three-quarters of the former were not in work, while 60% had left their last job on health grounds (OR for HRJL vs non-frail subjects, 30.0 (95% CI 23.0 to 39.2)). Among those in work, ORs for prolonged sickness absence, cutting down substantially at work and struggling with work's physical demands ranged from 10.7 to 17.2. The PAF for HRJL when any frailty marker was present was 51.8% and that for prolonged sickness absence was 32.5%. Associations were strongest with slow reported walking speed. Several associations were stronger in manual workers than in managers. CONCLUSIONS: Fried frailty symptoms are not uncommon in mid-life and are strongly linked with economically important adverse employment outcomes. Frailty could represent an important target for prevention.

Children's migration and lifestyle-related chronic disease among older parents 'left behind' in india.

Lifestyle-related chronic diseases such as cardiovascular diseases and diabetes are now the leading causes of death and disability in India. Interestingly, those Indian states with the highest prevalence of lifestyle-related chronic disease among older adults are also found to have the highest rates of international or internal out-migration. This paper investigates the association between having migrant (adult) children and older parents' lifestyle-related chronic disease in India. Bi-variate and multivariate analysis are conducted using data from a representative sample of 9507 adults aged 60 and older in seven Indian states from the UNFPA project 'Building Knowledge Base on Ageing in India'. The results show that for any of the diagnosed conditions of hypertension, diabetes and heart disease, the prevalence among older people with a migrant son is higher than among those without. More specifically, the odds ratio of reporting a lifestyle-related chronic disease is higher among older adults with at least one adult son living in another district, State or outside India than those with their children living closer. This study contributes empirical evidence to the academic and policy debate about the consequences of globalization and urbanization for older people's health status generally, and particularly their risk for reporting chronic diseases that relate to changes in their lifestyle.

Children's migration and chronic illness among older parents 'left behind' in China.

The relationship between adult children's migration and the health of their older parents 'left behind' is an emerging research area and existing studies reflect mixed findings. This study aims to investigate the association between having migrant (adult) children and older parents' chronic illness in China, using chronic stomach or other digestive diseases as a proxy. Secondary analysis of the national baseline survey of the 2011 China Health and Retirement Longitudinal Study (CHARLS) was conducted. Analyses were conducted in a total of sample of 6495 individuals aged 60 years and above from 28 out of 31 provinces in China, who had at least one child at the baseline survey. Binary logistic regression was used. The prevalence of any of the diagnosed conditions of chronic stomach or other digestive diseases was higher among older people with a migrant son than among those without (27 percent vs 21 percent, p < 0.001). More specifically, the odds ratio of reporting a disease was higher among older adults with at least one adult son living in another county or province than among those with all their sons living closer (OR = 1.29, 95% CI = 1.10-1.51). The results from this large sample of older adults support the hypothesis that migration of sons significantly increases the risk of chronic stomach and other digestive diseases among 'left behind' elderly parents in contemporary China.