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Subjective poverty, mental health, and mortality among Chinese older people: a prospective cohort study from 2008 to 2018

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Abstract

Purpose

The associations of duration of subjective poverty and poverty status with mortality among older people remains inconclusive, and the underlying mechanisms of mental health on them are rarely discussed in population-based epidemiological studies.

Methods

We used the data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) (2008–2018). The Cox regression model was used to estimate hazard ratio (HR) and 95% confidence intervals (CIs) for mortality. Mediation analysis was applied to assess the effect of mental health.

Results

When compared with participants without subjective poverty, those who reported subjective poverty at one time point (2008 or 2011) or two time points (2008 and 2011) had a higher risk of death, with multivariable-adjusted HR (95% CIs) of 1.08 (1.00–1.16) and 1.22 (1.06–1.39), respectively. For poverty status, the multivariable-adjusted HR (95% CIs) of mortality were 0.81 (0.66–0.98) for “just objective poverty” and 0.78 (0.62–0.98) for “neither subjective nor objective poverty” compared with participants who reported “just subjective poverty”, while there was no statistically significant association between “poverty subjectively and objectively” and mortality (HR = 0.88, 95% CI 0.72–1.07). Besides, we found that the proportion mediated by mental health was 26.6%, and age was a significant effect modifier.

Conclusions

Subjective poverty may be associated with a higher risk of death among Chinese older people. This study showed that promoting mental health alone may not substantially reduce socioeconomic inequality in health. Further explorations of measures to tackle the social determinants of health are still needed.

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Data availability

The datasets that support this article are publicly available from the project of the CLHLS. The questionnaires and datasets are free download at website: https://opendata.pku.edu.cn/dataset.xhtml?persistentId=doi:10.18170/DVN/WBO7LK.

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Acknowledgements

The authors appreciate the support and comments from all reviewers. The authors would like to thank the Center for Healthy Aging and Development Studies, Peking University for supporting the database.

Funding

This study was supported by the National Social Science Foundation of China (Grant No. 18ZDA085). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Author information

Author notes

  1. Yong Gan and Zuxun Lu have contributed equally.

Authors and Affiliations

  1. Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China

    Minzhi Xu, Pan Ke, Ying Zhou, Yong Gan & Zuxun Lu

  2. School of Public Health, Zhengzhou University, Zhengzhou, Henan, China

    Qingfeng Tian

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  1. Minzhi Xu
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Contributions

MX: Conceptualization, methodology, data curation and analysis, original draft preparation. PK, YZ, YG, ZL: Validation, visualization, critical revision of the manuscript. MX, YZ: Investigation, data interpretation, technical support. QT, YG: Methodology, reviewing and editing. ZL: Administrative support, supervision.

Corresponding authors

Correspondence to Yong Gan or Zuxun Lu.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

The CLHLS study was approved by the Research Ethics Committee of Peking University (IRB00001052-13074), and all participants or their proxy respondents signed an informed consent form.

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Not applicable.

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Not applicable.

Supplementary Information

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Supplementary file1 (DOCX 43 KB)

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Xu, M., Ke, P., Zhou, Y. et al. Subjective poverty, mental health, and mortality among Chinese older people: a prospective cohort study from 2008 to 2018. Soc Psychiatry Psychiatr Epidemiol 58, 795–803 (2023). https://doi.org/10.1007/s00127-022-02380-1

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  • DOI: https://doi.org/10.1007/s00127-022-02380-1

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