Xianghua Fang

Capital Medical University, Peping, Beijing, China

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Publications (18)38.77 Total impact

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    ABSTRACT: Objectives To evaluate transitions in health status and risk of death in older adults in relation to baseline health deficits and protective factors.DesignProspective cohort study with reassessments at 5, 8, and 15 years.SettingSecondary analysis of data from the Beijing Longitudinal Study on Aging.ParticipantsUrban and rural community-dwelling people aged 55 and older at baseline (n = 3,275), followed from 1992 to 2007, during which time 51% died.MeasurementsHealth status was quantified using the deficit accumulation–based frailty index (FI), constructed from 30 intrinsic health measures. A protection index was constructed using 14 extrinsic items (e.g., exercise, education). The probabilities of health changes, including death, were evaluated using a multistate transition model.ResultsWomen had more health deficits (mean baseline FI 0.13 ± 0.11) than did men (mean baseline FI 0.11 ± 0.10). Although health declined on average (mean FIs increased), improvement and stability were common. Baseline health significantly affected health transitions and survival over various follow-up durations (odds ratio (OR) = 1.27, 95% confidence interval (CI) = 1.17–1.37 for men; OR = 1.24, 95% CI = 1.16–1.33 for women for each increment of deficits). Each protective factor reduced the risk of health decline and the risk of death in men and women by 13% to 25%.Conclusion Deficit accumulation–based transition modeling demonstrates persisting effects of baseline health status on age-related health outcomes. Some mitigation by protective factors can be demonstrated, suggesting that improving physical and social conditions might be beneficial.
    Journal of the American Geriatrics Society 04/2014; · 4.22 Impact Factor
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    ABSTRACT: To observe the association between high-density lipoprotein cholesterol (HDL-C) level and rate of ischemic stroke recurrence.
    Zhonghua xin xue guan bing za zhi. 04/2014; 42(4):295-300.
  • Zachary Zimmer, Xianghua Fang, Zhe Tang
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    ABSTRACT: The aim of this study was to examine disability trends among men and women aged 70+ in Beijing, China; determine whether trends are impacted upon by changes in population composition; and investigate whether trends are experienced similarly across socio-demographic subgroups. Fifteen-year panel data were used to model probability of reporting activities of daily living (ADLs) disability adjusting for age, sex, marital status, residence, and education. Predicted probabilities and average annual percent change in probabilities are reported. The results showed increasing disability trends experienced by men, and stable or decreasing trends by women. Trends would be less favorable had education of older population not increased over time. Trends are much worse when bathing is excluded as an ADLs item. This is because trends in bathing were favorable whereas trends in other activities were not. On balance, results are not overly encouraging for reductions in population-level disability given population aging and increasing life expectancy in China. But, future increasing education could mitigate some increases in disability rates.
    Journal of Aging and Health 12/2013; · 1.56 Impact Factor
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    ABSTRACT: On average, as people age, they accumulate more health deficits and have an increased risk of death. The deficit accumulation-based frailty index (FI) can quantify health and its outcomes in aging. Previous studies have suggested that women show higher FI values than men and that the highest FI score (the "limit to frailty") occurs at a value of FI ~ 0.7. Even so, gender differences in the limit to frailty have not been reported. Data for this analysis were obtained from the Beijing Longitudinal Study of Aging that involved 3,257 community-dwelling Chinese people, aged 55+ years at baseline. The main outcome measure was 5-year mortality. An FI consisting of 35 health-related variables was constructed. The absolute and 99% FI limits were calculated for different age groups and analyzed by sex. The mean level of the FI increased with age and was lower in men than in women (F = 67.87, p < .001). The 99% FI limit leveled off slightly earlier with a relatively lower value in men (60 years; 0.44 ± 0.02) compared with that in women (65 years; 0.52 ± 0.04). The highest absolute FI value was 0.61 in men and 0.69 in women. In both groups, people with an FI greater than or equal to the 99% limit showed close to 100% mortality by 5 years. Compared with men, women appeared to better tolerate deficits in health, yielding both relatively lower mortality and higher limit values to the FI. Even so, the FI did not exceed 0.7 in any individual.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 10/2013; · 4.31 Impact Factor
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    ABSTRACT: BACKGROUND: all cardiometabolic disorders become more common with age. Frailty and increased vulnerability to adverse outcomes are also common with aging. Even so, how commonly elderly people who are affected by cardiometabolic disorders are also frail remains unclear. OBJECTIVES: (i) to evaluate the prevalence of cardiometabolic disorders in relation to frailty. (ii) To estimate to which extent cardiometabolic diseases, when compared with frailty, affects mortality. METHODS: this is a secondary analysis of the Beijing Longitudinal Study of Ageing, a population-based representative cohort study (n = 3,257) assembled in 1992 and followed to 2007. The baseline frailty index (FI) considered 35 potential health deficits. People with an FI >0.22 were considered frail. The relationships between frailty and cardiometabolic disorders and mortality outcomes were evaluated using the Cox proportional hazard model, adjusted for baseline age, sex and education. RESULTS: the mean FI was 0.11 in men (SD = 0.10) and 0.14 (SD = 0.11) in women. On average, the FI increased with each cardiometabolic disorder (e.g. in men, mean ± SD = 0.16 ± 0.11 with hypertension, 0.23 ± 0.14 with stroke). As the number of disorders increased, so did the mean FI, and the proportion with the FI >0.22. For each condition, people with the FI >0.22 had a higher mortality, even after adjusting for sex, age and education. CONCLUSION: cardiometabolic disorders do not occur in isolation and commonly increase not just together, but in the presence of other health deficits. Healthcare providers who work with older adults with such problems need to develop methods to adapt their treatments to the needs of frail older adults.
    Age and Ageing 03/2013; · 3.82 Impact Factor
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    ABSTRACT: Mild to moderate ischemic stroke is a common presentation in the outpatient setting. Among the various subtypes of stroke, lacunar infarction (LI) is generally very common. Currently, little is known about the long-term prognosis and factors associated with the prognosis between LI and non-LI. This study aims to compare the risk of death and acute cardiovascular events between patients with LI and non-LI, and identify potential risk factors associated with these outcomes. A total of 710 first-ever ischemic stroke patients (LI: 474, non-LI: 263) from 18 clinics were recruited consecutively from 2003 to 2004. They were prospectively followed-up until the end of 2008. Hazard ratios and 95% confidence intervals were calculated using multivariable Cox proportional hazards regression. After a 5-year follow up, 54 deaths and 96 acute cardiovascular events occurred. Recurrent stroke was the most common cause of death (19 cases, 35.18%) and new acute cardiovascular events (75 cases, 78.13%). There were no significant differences between patients with LI and non-LI in their risks of death, new cardiovascular events, and recurrent stroke after adjusting for age, sex, hypertension, diabetes, cardiac diseases, body mass index, dyslipidemia, smoking, alcohol consumption, ADL dependence, and depressive symptoms. Among the modifiable risk factors, diabetes, hypertension, ADL dependency, and symptoms of depression were independent predictors of poor outcomes in patients with LI. In non-LI patients, however, no modifiable risk factors were detected for poor outcomes. Long-term outcomes did not differ significantly between LI and non-LI patients. Detecting and managing vascular risk factors and depression as well as functional rehabilitation may improve the prognoses of LI patients.
    PLoS ONE 01/2013; 8(11):e75019. · 3.53 Impact Factor
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    ABSTRACT: BACKGROUND: The prevalence rate of overweight and obese has been escalating over the past two decades in China. Even so, the association between obesity and stroke still remains unclear to some extent. AIMS: The aim of this study was to elucidate the association between body mass index and stroke in a large Chinese population cohort. METHODS: A cohort of 26 607 Chinese people, aged over 35 years, was investigated in 1987. Baseline information of body weight and height was used to calculate BMI (weight in kilograms divided by height in meters squared, kg/m(2) ). Cox proportional hazards model was fitted to estimate hazard ratios of stroke adjusted for age, educational level, smoking and alcohol consumption. RESULTS: The 11-year follow-up revealed (241 149 person-years) a total of 1108 stroke events (614 ischemic, 451 hemorrhagic, and 44 undefined stroke). Body mass index ≥ 30·0 was an independent risk factor for stroke both in men and women. Compared with normal weight, hazard ratios for total stroke were 0·74 in men underweight (95% confidence interval: 0·53∼1·03), 1·63 overweight (95% confidence interval: 1·35∼1·96), and 2·20 with obesity (95% confidence interval: 1·47∼3·30); and with ischemic stroke, hazard ratios were 0·52 in those underweight (95% confidence interval: 0·30∼0·89), 2·08 overweight (95% confidence interval: 1·65∼2·62), and 3·80 with obesity (95% confidence interval: 2·47∼5·86). In women, the corresponding hazard ratios for total stroke were 0·79 underweight (95% confidence interval: 0·58∼1·07), 1·42 overweight (95% confidence interval: 1·16∼1·73), and 1·57 with obesity (95% confidence interval: 1·06∼2·31); and for those with ischemic stroke, 0·92 underweight (95% confidence interval: 0·59∼1·43), 1·90 overweight (95% confidence interval: 1·44∼2·50), and 2·42 with obesity (95% confidence interval: 1·50∼3·93). There appeared an evident dose-response relationship between body mass index and the risk of developing stroke, which still appeared, however, adjusted low for hypertension, diabetes, and heart disease. Decreased risk for stroke in the leanest group was confined to men only. No association was found between body mass index and hemorrhagic stroke in both genders. CONCLUSIONS: Our data suggest that body mass index was an independent risk factor for total and ischemic stroke but not for hemorrhagic stroke in both genders. Association between body mass index and stroke was extremely mediated by hypertension, diabetes, and heart disease. Decreased risk for the leanest group was confined to men.
    International Journal of Stroke 10/2012; · 2.75 Impact Factor
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    ABSTRACT: BACKGROUND: Smoking is common in China, where the population is aging rapidly. This study evaluated the relationship between smoking and frailty and their joint association with health and survival in older Chinese men and women. METHODS: Data came from the Beijing Longitudinal Study of Aging, a representative cohort study with a 15-year follow-up. Community-dwelling people (n = 3257) aged more than 55 years at baseline were followed between 1992 and 2007, during which time 51% died. A frailty index (FI) was constructed from 28 self-reported health deficits. RESULTS: Almost half (1,485 people; 45.6%) of the participants reported smoking at baseline (66.8% men, 25.3% women). On average, male smokers were frailer (FI = 0.17±0.13) than male nonsmokers (FI = 0.13±0.10; p = .038). No such differences were seen in women. Men who smoked had the lowest survival probability; female nonsmokers had the highest. Compared with female nonsmokers, the risk of death for male smokers was 1.58 (95% CI = 1.41-1.95; p < .001), adjusted for age and education. Across all FI values, female smokers and male nonsmokers had comparable survival rates. CONCLUSION: Smoking was associated with an increased rate of both worsening health and mortality. At all levels of health status, as defined by deficit accumulation, women who smoked lost the survival advantage conferred by their sex.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 07/2012; · 4.31 Impact Factor
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    ABSTRACT: This study aimed to investigate the influence of apoE genetic polymorphism on serum lipid changes in a community-based elderly population in China in an 8-year period, in which 746 individual, aged 65.29±6.85 years (mean±standard deviation (SD)) were enrolled and serum lipid parameters were checked at baseline. After 8 years, serum lipids as well as apoE genotypes were measured. The frequencies of apoE allele were 9.4%, 81.7%, and 8.9% for ɛ2, ɛ3 and ɛ4, respectively. After the population was divided into 3 groups by different apoE allele carriers, the apoE allele carriers for ɛ2, ɛ3 and ɛ4 were 121 (16.2%), 513 (68.8%) and 112 (15.0%), respectively. Levels of total cholesterol (TC) and low density lipoprotein (LDL) in ɛ2 carriers were lower comparing with that of ɛ3 allele carriers at baseline. 8 years later, TC and high density lipoprotein (HDL) elevated and LDL decreased with aging in this population (p<0.01). The changes of TC levels were smaller in ɛ2 allele carriers as compared to that of ɛ3 allele carriers. The difference was still statistically significant after controlling for age, sex, smoking status, drinking habit, body mass index (BMI) and baseline TC level. The same trend of changes was noted for LDL between ɛ2 and ɛ3 allele carriers. However, no significant differences were noted between ɛ4 and ɛ3 allele carriers on lipid changes. This community-based study shows that ɛ2 allele is helpful on lipid changes. The effect of ɛ4 allele on lipid change is not strong in this elderly population. Genetic and environmental factors maybe co-operate on lipid metabolism in elderly persons.
    Archives of gerontology and geriatrics 12/2011; 55(3):713-7. · 1.36 Impact Factor
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    ABSTRACT: We assessed the effects of smoking and smoking cessation on life expectancy and active life expectancy among persons aged 55 years or older in Beijing. This study included 1593 men and 1664 women who participated in the Beijing Longitudinal Study of Aging, which commenced in 1992 and had 4 survey waves up to year 2000. An abridged life table was used to estimate life expectancy, in which age-specific mortality and age-specific disability rates were adjusted by using a discrete-time hazard model to control confounders. The mean ages (SD) for men and women were 70.1 (9.25) and 70.2 (8.72) years, respectively; mortality and disability rates during follow-up were 34.7% and 8.0%, respectively. In both sexes, never smokers had the highest life expectancy and active life expectancy across ages, as compared with current and former smokers. Current heavy smokers had a shorter life expectancy and a shorter active life expectancy than light smokers. Among former smokers, male long-term quitters had a longer life expectancy and longer active life expectancy than short-term quitters, but this was not the case in women. Older adults remain at higher risk of mortality and morbidity from smoking and can expect to live a longer and healthier life after smoking cessation.
    Journal of Epidemiology 07/2011; 21(5):376-84. · 2.11 Impact Factor
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    ABSTRACT: Differences in frailty between rural and urban older adults have been demonstrated in developed countries. It is not understood how the apparently greater differences in living conditions between different types of regions in China may affect health and outcomes of older Chinese adults. Here, a frailty index (FI) based on the accumulation of health deficits was used to investigate health and survival differences in older Chinese men and women. We studied rural (n=1121) and urban (n=2136) older adults (55-97 years old) in the Beijing Longitudinal Study of Aging (BLSA), of whom 48.9% (rural) and 35.4% (urban) died over 8 years of follow-up. The FI was generated from 35 self-reported health deficits. The mean FI increased exponentially with age (r(2)=0.87) and was higher in women than in men. The death rate increased significantly with increases in the FI, but women showed a lower death rate than did men. The mean FI in urban older adults (0.12±0.10) was lower than that in their rural counterparts (0.14±0.12, p<0.001). Urban dwellers showed better survival compared with their counterparts in the rural areas. Adjusted by age, sex, and education level, the hazard ratio for death for each increment of the FI was 1.28 for urban people and 1.27 for rural people. Chinese urban dwellers showed better health and survival than rural dwelling older adults. The FI readily summarized health and mortality differences among different geographic regions, reflecting the impact of the environment, socioeconomics, and medical services on deficit accumulation and on survival.
    Archives of gerontology and geriatrics 05/2011; 54(1):3-8. · 1.36 Impact Factor
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    ABSTRACT: Frailty in individuals can be operationalized as the accumulation of health deficits, for which several trends have been observed in Western countries. Less is known about deficit accumulation in China, the country with the world's largest number of older adults. This study analyzed data from the Beijing Longitudinal Study of Aging, to evaluate the relationship between age and deficit accumulation in men and women and to evaluate the impact of frailty on mortality. Community dwelling people aged 55+ years at baseline (n = 3275) were followed every two to three years between 1992 and 2000, during which time 36% died. A Frailty Index was constructed using 35 deficits, drawn from a range of health problems, including symptoms, disabilities, disease, and psychological difficulties. Most deficits increased the eight-year risk of death and were more lethal in men than in women, although women had a higher mean level of frailty (Frailty Index = 0.11 ± 0.10 for men, 0.14 ± 0.12 for women). The Frailty Index increased exponentially with age, with a similar rate in men and women (0.038 vs. 0.039; r > 0.949, P < 0.01). A dose-response relationship was observed as frailty increased. A Frailty Index employed in a Chinese sample, showed properties comparable with Western data, but deficit accumulation appeared to be more lethal than in the West.
    BMC Geriatrics 01/2011; 11:17. · 2.34 Impact Factor
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    ABSTRACT: Social characteristics that differ by place of residence are consequential for health. To study implications of this among older adults in rural vs. urban China, this study employs data from the Beijing municipality, a region that has witnessed growth and gaps in development. Life and active life expectancy is assessed using a multistate life table technique that estimates hazard rates and subsequent expected years in various health states. Hazards are estimated for a model that adjusts regional differences for age and sex and for a series of other models including additional covariates. Results indicate urban residents have an advantage. Specific factors show socio-economic status and access to health service account for a large part, social support and health behaviors for little, while disease is a suppressor.
    Social Forces 06/2010; 88(4):1885-1908. · 1.29 Impact Factor
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    ABSTRACT: To investigate the impact of depressive symptoms on health-related quality of life (HR-QOL) in a group of patients with early Parkinson's disease (PD). A 20-item scale, the Center for Epidemiologic Studies Depression Scale (CESD) and a 36-item questionnaire, the medical outcomes study short form (SF-36) were administered as part of baseline assessment of a clinical trial in PD, enrolling 391 early-stage, L-dopa exposed PD patients in China. We used multiple regression models to examine the relationship of depressive symptoms, measured by the CESD with HR-QOL, as measured by the SF-36. The SF-36 score of the depressed patients was compared with those non-depressed, as well. A total of 146 (37.3%) patients screened positive for depression. Compared with those non-depressed, depressed patients had lower scores in all dimensions of SF-36 profile (p<0.001). Multiple regression analysis revealed that depressive symptoms, measured by CESD, increased our ability to explain the variance of SF-36 total score by 34.5%. Additionally, depressive symptom is the only variable which has the predictive value not only for total SF-36 total score, but also for each subdimension score of SF-36 profile. Depressive symptoms are common early in the disease, having a substantial impact on patients' HR-QOL, affecting many areas other than the obvious mental health dimension of the HR-QOL profile. Our results highlight the broad importance of treating depression in this population.
    Clinical neurology and neurosurgery 09/2009; 111(9):733-7. · 1.30 Impact Factor
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    ABSTRACT: To identify the motor and non-motor factors that are associated with health related quality of life (HR-QOL) in a subgroup of Parkinson's disease (PD) patients with Levodopa therapy in early clinical stages. 391 Levodopa exposed patients were evaluated during the baseline assessment of a clinical trial in China. HR-QOL was measured by the Short Form 36 (SF-36). Motor and non-motor variables were determined during a structured interview and by clinical examination by movement disorder specialists. Multiple regression analyses were used to determine which variables were associated with low levels of HR-QOL. Even if excluding non-motor variables from the regression model, motor factors, particularly motor deficits (measured by motor score of UPDRS), rigidity (measured by item 22 of UPDRS), and disease severity (measured by Hoehn&Yahr scale), explained only 18.9% of the variance of total SF-36 score. Whereas, when non-motor variables were included in the model, especially depression (measured by CES-D), sleep disturbances (measured by PSQ-I), and fatigue (measured by FSS), 61.7% of the variance of SF-36 score could be explained. Two motor variables, UPDRS motor score and Hoehn&Yahr score, were also contributed to the model, however, the 95% confidence intervals (CIs) of these two motor factors were wide and included the null value (CIs -0.282, 0.019 for UPDRS motor score, and CIs -4.043, 0.856 for Hoehn&Yahr score). Neither, did higher daily levodopa dose contribute significantly to both models predicting SF-36 score. In our sample patients with levodopa therapy, motor disability and severity of parkinsonism contributed to a lesser extent to patients' self-report distress, within the first 5 years of disease onset. The clinical factors that showed the highest predictive value for worsen HR-QOL were non-motor symptoms, such as depression, sleep disorders, and fatigue. Great effort should be made to recognize and treat those conditions, thus improving all aspects of PD and giving these patients as a good HR-QOL as possible.
    Parkinsonism & Related Disorders 06/2009; 15(10):767-71. · 3.27 Impact Factor
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    ABSTRACT: In this study, the authors focused on older adults in Beijing with three objectives: to examine gender differences in functional health and mortality at the end of a five-year study period, controlling for initial functional health; to determine the extent to which these differences were a function of exposure versus vulnerability to risk factors; and to analyze the relative importance of social, economic, and psychological risk factors in explaining gender differences. The results show that women were more likely to survive and to be functionally dependent at follow-up compared with men among those functionally independent at baseline. No significant differences among those who were initially dependent were apparent. Differential vulnerability to risk factors, more so than exposure, explained the variation in health outcomes across gender. Smoking, a lack of formal education, a lack of health insurance, a low sense of control, stressful events, and rural living played large roles in explaining the differences.
    Research on Aging 05/2009; 31(3):361-388. · 1.23 Impact Factor
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    ABSTRACT: To study the relationship between body mass index (BMI), hypertension and all-cause mortality in the elderly population in Beijing. In 1992, a cohort of 3 257 people above 55 years old was selected from 3 different areas of Beijing, i.e. urban and suburbs (both plain and mountain areas). Information on physical condition, history of chronic diseases, self-perceived health, as well as smoking and drinking status was collected. Blood pressure, body height and weight were measured among 2 086 of 3 257 subjects. BMI was decreasing with age, while the prevalence of hypertension increased with age. Meanwhile the prevalence of hypertension increased with age as well as with BMI. There was a reverse relationship between BMI and all-cause mortality, i.e. the risk of death was 39.0% lower for those with BMI = 20.0 - 24.9 kg/m(2) (Hazard ratio: 0.61, 95% Confidence interval: 0.49 - 0.75) and 62% lower for those with BMI >/= 25.0 kg/m(2) (Hazard ratio: 0.38%, 95% Confidence interval: 0.29 - 0.49) than those with BMI < 20.0 kg/m(2). After controlling for age, gender, residential place, hypertension as well as self-perceive health status and cognition function, low BMI remained a significant and independent predictor to death. The distribution of BMI was different in elderly from the youth. The findings suggested that it was important to control the body weight among the elderly hypertensives.
    Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi 02/2002; 23(1):28-31.
  • Zachary Zimmer, Xianghua Fang
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    ABSTRACT: Broad differences exist in social and economic life between residents living in urban versus rural areas of China. To study the health implications of these differences, the current study employs data from a longitudinal study of older adults in the Beijing municipality, a region of China that has witnessed very rapid socio-economic growth coupled with widening rural/urban gaps in development and health service provision. Life expectancy and active life expectancy, the latter referring to expected years in a functionally healthy state, is estimated for rural and urban samples in a two-step process that involves first, the estimation of hazard rates considering transitions in functional health and mortality and next, the conversion of these rates into transition probabilities for the construction of multi-state life-tables. Estimates reveal a distinct urban advantage in both mortality and functional health. At age 55, urban elders live about 4½ years longer and 5½ more functionally active years than do their rural counterparts, and an advantage is maintained with increasing age. Covariates representing five domains are considered to determine factors that underlie the urban advantage. Socioeconomic status and access to health service indicators account for a good deal of the association, social support and health behaviors account for very little, while chronic disease acts as a suppressor. The results have obvious policy implications regarding the need for increasing education, better work opportunities, wider insurance coverage and easier access to health facilities for rural residents of China.

Publication Stats

81 Citations
38.77 Total Impact Points

Institutions

  • 2009–2014
    • Capital Medical University
      • Department of Neurobiology
      Peping, Beijing, China
  • 2012–2013
    • Dalhousie University
      Halifax, Nova Scotia, Canada
  • 2002–2013
    • Xuanwu hospital
      Peping, Beijing, China
  • 2010
    • University of Utah
      Salt Lake City, Utah, United States