Health of midlife and older adults in China: the role of regional economic development, inequality, and institutional setting

OBJECTIVES: To document the association between economic development, income inequality, and health-related public infrastructure, and health outcomes among Chinese adults in midlife and older age. METHODS: We use a series of multi-level regression models with individual-level baseline data from the China Health and Retirement Longitudinal Survey (CHARLS). Provincial-level data are obtained both from official statistics and from CHARLS itself. Multi-level models are estimated with different subjective and objective health outcomes. RESULTS: Economic growth is associated with better self-rated health, but also with obesity. Better health infrastructure tends to be negatively associated with health outcomes, indicating the likely presence of reverse causality. No supportive evidence is found for the hypothesis that income inequality leads to worse health outcomes. CONCLUSIONS: Our study shows that on top of individual characteristics, provincial variations in economic development, income inequality, and health infrastructure are associated with a range of health outcomes for Chinese midlife and older adults. Economic development in China might also bring adverse health outcomes for this age group; as such specific policy responses need to be developed. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00038-017-0970-9) contains supplementary material, which is available to authorized users.