A cross-sectional study of self-rated health among older adults: a comparison of China and the United States

OBJECTIVES: We used nationally representative samples of China and the US older population to investigate (1) whether factors influencing self-rated health among older Chinese were similar to those among older Americans; and (2) whether there was a significant cross-national difference in self-rated health between China and the USA after controlling those available influencing factors. DESIGN: A cross-sectional study. Data came from the 2014 Health and Retirement Study and China Health and Retirement Longitudinal Study conducted from 2014 to 2015. PARTICIPANTS: Our final sample size totaled 8905 older adults in the USA and 4442 older adults in China. OUTCOME: The response variable was self-rated health. Ordered logistic regression models were conducted to investigate factors influencing self-rated health among older adults. RESULTS: More than three-fourths (78%) of older adults in China reported fair or poor health status, while almost 74% of older adults in the USA reported excellent, very good or good health status. In the overall ordered logistic regression model, when controlling statistically for sociodemographics, family structure, functional limitations, cognition, chronic conditions, mental health and health-related behaviours, the Chinese survey respondents were much more likely to rate their health as being poorer than the US respondents. The odds of having better versus poorer health was almost five times greater in American older adults than those in China (OR=4.88, 95% CI 4.06 to 5.86). Older adults in China living alone rated their health better than those living with spouse/partner; however, no significant difference was found between these two living arrangements in older Americans. In contrast, older adults in the USA living with others rated their health worse compared with those living with spouse/partner. In addition, older adults who had more activities of daily living limitations, poorer self-reported memory, worse mental health and chronic health conditions had lower self-rated health in both countries. CONCLUSIONS: We found a striking difference in self-rated health between China and the USA even after controlling for measures of disease, functional status and other influencing factors. Relative to their American counterparts, Chinese elders were much more likely to report worse health.