Self-rated Health and Mortality Risk in the Oldest Old in China Chinese Longitudinal Healthy Longevity Study Liu Yuzhi, Li Qiang Institute of Population Research, Center for Healthy Aging and Family Studies, Peking University, Beijing, China

Self-rated HealthMortality risk Risk factors e.g. Socio-demographic characteristics Engagement with life Functional ability Disease burden Introduction

Many studies have suggested that self-rated health (SRH) is significantly associated with mortality risk in young people, adults and the young old (e.g. Benyamini & Idler, 1999; Idler & Benyamini, 1997). Moreover, early research have proposed that self-rated health reflect the effects of disease burden and functional ability on the mortality. Several research have pointed out that that older persons reported weaker associations between self-rated health and mortality compared with younger (Ilder & Angel, 1990; Strawbridge & Wallhagen, 1999). Meanwhile, previous studies have proposed that the oldest old (Fourth Age) is very different from the young old (Third Age: e.g. Baltes & Smith, 2003; Maier and Smith, 1999; Suzman, et al., 1992; Zeng et al., 2002). However, few studies investigated the relationship between self-rated health and mortality in the oldest old (Cai, 2004). Introduction

Is there significant association between self-rated health and mortality risk in the Chinese oldest old? Is there the gender differences of the predictability of self- rated health for mortality risk? Is missing values (as the additional level) in self-rated health related to higher mortality risk? Research Questions

Three waves of Chinese Longitudinal Healthy Longevity Study. N=7623; 60.03% women; 3 Age cohort: 80~89 (n=2962); 90~99(n=2651);100~105 (n=2010) Sample 3,264 Died 8,805 Participants Age 80~ Lost 1,563 Died 565 Lost 2,563 Participants 4,690 Participants Final sample:7623 (3026 for censor; 4597 for death)

Hazard model with piecewise linear baseline intensity the logarithm of the force of mortality at attained age x; the log-hazard baseline with nodes at 85, 90, 95, and 100 years of age; Self-rated health, the only time-varying variable in the model; the coefficients of self-rated health; covariates in the model; coefficients of covariates. Models

Measures Self-rated health: “How do you rate your health at present?” Socio-demographic characteristics: Sex Type of residence; Years of schooling; Occupation before 60 years old; Marital Status; Caregivers while serious illness. Engagement with life: Number of activities including housework, reading, watch TV, religious activities et al. Functional ability: Self-reported Number of illness Central Variable: Covariates Self-reported ADL; MMSE; Vision; Hearing; Bedridden.

Results Piecewise-Linear Baseline Log-Harzard of Mortality in the Oldest Old Log-Hazard Age

Self-rated health Relative risk adjusted for AgeAll covariates Very good11 Good1.13**1.06 Fair 1.50*** 1.32*** Bad 1.97*** 1.55*** Missing values 2.25*** 1.67*** Mortality risk associated with Self-rated health in the oldest old Note: *p<. 1; **p<.05; ***p<.01. Results

Self-rated HealthMortality risk Risk factors e.g. Socio-demographic characteristics Engagement with life Functional ability Number of illness Results

Self-rated health Relative risk adjusted for all covariates MaleFemale Very good 11 Good Fair 1.37*** 1.28*** Bad 1.75*** 1.44*** Missing values 1.71*** 1.65*** Note: *p<.05; **p<.01; ***p<.001. Results Mortality risk associated with self-rated health by gender Gender Pattern is similar as the total pattern. No significant gender difference was found in our sample.

Self-rated health is a significant predictor of mortality risk in the oldest old in China with controls for socio-demographic characteristics, engagement with life, functional ability, and number of illness! Engagement with life and functional ability partly explain the relationship between self-rated health and mortality risk in the oldest old. The impact of number of illness can be negligible. No gender difference on the relationship between self-rated health and mortality risk is founded in our sample. Missing values in self-rated health is highly associated with mortality risk. And more, participants with incomplete data in the self-rated health have the highest mortality risks. Discussion

Covariates: time-varying variables. Follow-up Analyses