Abstract
From the perspective of social epidemiology, health has always been closely related to socioeconomic factors. In the context of China's population ageing and rapid urbanisation, this thesis explores the socioeconomic determinants of health among middle-aged and older adults in China, using data from the China Health and Retirement Longitudinal Study. After providing an introduction, literature review, and methodology, three empirical chapters follow. The first of these, Chapter 4, investigates how childhood socioeconomic status shapes later health, including seven classic indicators of ageing from the domains of physical, mental and cognitive health. To date, this relationship has not been well studied in China. By employing Ordinary Least Squares and logistic regression, the results suggest that unfavourable health consequences later in life are generally associated with disadvantaged childhood socioeconomic status. However, being overweight is different. Later-life socioeconomic status largely explains the link between childhood conditions and being overweight. Individuals with higher household expenditure in later life are more likely to be overweight as well, which contrasts with the relationship between household expenditure and other health measures.The existing literature is also lacking on how life-course mobility shapes later-life health from a longitudinal view in China, especially on mental and cognitive well-being. As such, the second empirical chapter (Chapter 5) fills this gap by taking advantage of multilevel modelling for repeated measurements, which takes into account both geographical and temporal variations. One of the main findings is that rural-to-urban migration (relative to rural non-migrants) and upward educational mobility (relative to both father and the individual having an illiterate background) contribute positively to mental health and cognitive function, even after controlling for other potential explanatory factors such as socioeconomic status in childhood and later adulthood. In particular, rural-to-urban migrants with an urban hukou (the household registration system used in China) are likely to have more health advantages than those without it.
Population health research in China also faces the age-period-cohort identification problem, which is that those effects are conceptually different, while together they are exactly collinear. To the best of the author's knowledge, Chapter 6 is the first study to introduce a new extension of the Hierarchical Age-Period-Cohort multilevel structure in China, making the modelling of age-period-cohort effects more effective and accurate. The main results show that the depression score peaks in middle age. It then declines before increasing again in very old age. The cognitive score drops at an increasing rate throughout later life. The influence of particular historical contexts in which a cohort was born is also studied, alongside period effects. The thesis ends with a summary of key findings, overarching contributions, as well as limitations and suggestions.
This thesis contributes to both methodological and theoretical knowledge. It adds to, and expands, the existing literature about health outcomes in China and their potential causes, and offers insights for future research.
| Date of Award | 9 Dec 2025 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | David J Manley (Supervisor) & Richard J Harris (Supervisor) |
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