Social Determinants and Disparities in Active Aging Among Older Taiwanese
Abstract
:1. Introduction
1.1. Equity in Active Aging
The term inequity has a moral and ethical dimension. It refers to differences which are unnecessary and avoidable but, in addition, are also considered unfair and unjust. So, in order to describe a certain situation as inequitable, the cause has to be examined and judged to be unfair in the context of what is going on in the rest of society.
1.2. Background
2. Materials and Methods
2.1. Data and the Sample
2.2. Measures
2.2.1. Employment
2.2.2. Social Participation
2.2.3. Independent, Healthy, and Secure Living
- Physical activity was defined as performing exercise or physical activity at least five times per week.
- Access to health and dental care was defined as having no unmet medical or dental-care needs in the past 12 months.
- Independent living arrangements (for those aged 75+) were defined as the participant living alone or living only with a partner/spouse.
- Absence of poverty risk (for those aged 65+): In this study, we used the household income and number of household members to calculate the equivalized personal risk of poverty, and the risk of poverty was defined as an equivalized individual income below the lowest living standard in 2017.
- The absence of severe material deprivation was defined as having at least six of the 12 items commonly owned by Taiwanese households.
- Personal safety (from violence or crime) was defined as the absence of fear of violence or crime in the household or neighborhood.
- Personal safety from accidents or injury was defined as the absence of fear of being injured by traffic, falls, or other accidents in the household and in the neighborhood.
- Lifelong learning (for those aged 55–74) was defined as participation in any kind of education or training in the past month.
- Physical function independence was measured by no or only minor difficulty performing activities of daily life (ADLs).
- Primary prevention utilization (for those aged 65+) was defined as the use of flu vaccination and health checkups in the past year. These two primary prevention health services are free in Taiwan for those aged 65 and older.
2.2.4. Capacity of Active Aging and Supportive Environment
- Mental well-being was measured by the WHO-5 Well-Being Index [55], with a raw score of 0 to 25. Scores of 14 and above were defined as indicating positive mental well-being.
- Use of information and communications technology (ICT) was defined as the use of any kind of device with Internet access at least once per week.
- Social connectedness was defined as informal interactions with family or friends (not including business) at least once per week.
- Transportation accessibility was defined as the ability to access typical locations in one’s life circle by any kind of transportation.
- Transportation convenience was measured by rating multiple items, including pavement smoothness, crossroad convenience, traffic light/sign clarity, and convenience in taking the bus (frequency, timeliness, safety, good driver attitude). Ratings of good or excellent were defined as indicating convenient transportation.
- Barrier-free spaces were defined to indicate the absence of barriers in building and public spaces affecting social participation outdoors or at home in going up and down stairs in the past 12 months.
- Social integration and social respect were measured by community activities that consider accessibility for older adults, social activities and commodities that meet older adults’ needs, and a positive public view of older people. When all three items are positive, social integration and respect are present.
- Educational attainment (i.e., high school or higher education) was one of the TAAI indicators. In this study, educational level was also defined as a social determinant. Therefore, the total score of the seven indicators (each one scoring 0 or 1, indicating no or yes, respectively) was also used to define the score in this domain, which ranged from 0 to 7.
2.2.5. Demographics and Controlling Variables
2.3. Analysis
3. Results
4. Discussion
4.1. Gender Disparity
4.2. Educational Disparity
4.3. Disparity in Residential Areas
4.4. Age Differences
4.5. Limitations
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Social Determinants | Active Aging Indicators | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Sample % (n = 738) | Employment | Volunteering | Caring for Children | Caring for Elderly/Disabled | Politic Participation | Other Social Group Participation | Physical Activity | Medical Access | Independent Living | Absence of Poverty Risk | Absence of Material Deprivation | Owning Assets | |||
Total | 100.0 (738) | 34.8 | 15.9 | 19.5 | 5.3 | 3.1 | 11.5 | 70.6 | 98.0 | 30.9 | 83.1 | 98.8 | 82.9 | ||
*** | *** | * | |||||||||||||
Age 55–59 | 15.2 (112) | 69.6 | 13.4 | 23.2 | 6.3 | 0.0 | 8.0 | 59.8 | 96.4 | 21.4 | 83.8 | 100.0 | 86.6 | ||
Age 60–64 | 23.6 (174) | 48.3 | 17.8 | 28.2 | 6.9 | 5.2 | 15.5 | 69.0 | 95.4 | 28.7 | 91.0 | 99.4 | 83.9 | ||
Age 65–69 | 18.7 (138) | 29.0 | 15.9 | 23.9 | 4.3 | 0.7 | 13.8 | 73.9 | 98.6 | 35.5 | 80.0 | 100.0 | 84.8 | ||
Age 70–74 | 16.4 (121) | 25.6 | 13.2 | 15.7 | 1.7 | 3.3 | 10.7 | 75.2 | 100.0 | 36.4 | 75.0 | 97.5 | 81.8 | ||
Age 75+ | 26.1 (193) | 12.4 | 17.1 | 8.8 | 6.2 | 4.7 | 8.8 | 73.1 | 99.5 | 31.6 | 83.1 | 97.4 | 79.3 | ||
Gender | *** | * | *** | ||||||||||||
Male | 48.8 (360) | 42.2 | 13.8 | 18.3 | 5.6 | 3.6 | 10.6 | 74.4 | 98.1 | 33.3 | 82.0 | 98.3 | 90.3 | ||
Female | 51.2 (378) | 27.8 | 17.7 | 20.6 | 5.0 | 2.6 | 12.4 | 66.9 | 97.9 | 28.6 | 84.4 | 99.2 | 75.9 | ||
Education | *** | * | *** | *** | *** | * | *** | ||||||||
Illiterate/non-formal | 22.0 (162) | 20.4 | 9.3 | 8.6 | 3.7 | 1.9 | 3.7 | 72.2 | 97.5 | 29.0 | 82.0 | 96.9 | 66.0 | ||
Elementary school | 40.4 (298) | 32.9 | 14.4 | 21.1 | 5.0 | 3.0 | 9.1 | 70.1 | 97.3 | 24.8 | 78.2 | 99.7 | 87.6 | ||
Primary high school | 15.4 (114) | 52.6 | 19.3 | 32.5 | 3.5 | 2.6 | 18.4 | 69.3 | 98.2 | 28.9 | 86.3 | 100.0 | 83.3 | ||
Senior high school | 13.7 (101) | 39.6 | 24.8 | 17.8 | 6.9 | 5.0 | 19.8 | 71.3 | 100.0 | 37.6 | 87.5 | 98.0 | 91.1 | ||
College/University+ | 8.5 (63) | 41.3 | 19.0 | 19.0 | 11.1 | 4.8 | 17.5 | 69.8 | 98.4 | 57.1 | 95.5 | 98.4 | 90.5 | ||
Residence area | ** | * | * | *** | ** | ** | *** | ||||||||
Urban | 50.9 (376) | 29.0 | 18.6 | 22.9 | 6.1 | 2.1 | 16.5 | 64.9 | 99.7 | 32.4 | 81.9 | 98.9 | 88.8 | ||
Rural | 49.1 (362) | 40.9 | 13.0 | 16.0 | 4.4 | 4.1 | 6.4 | 76.5 | 96.1 | 29.3 | 84.5 | 98.6 | 76.8 | ||
Region | * | *** | *** | ** | ** | *** | |||||||||
Northern | 24.9 (184) | 36.4 | 12.5 | 20.1 | 3.8 | 1.6 | 8.7 | 69.6 | 98.9 | 26.6 | 88.1 | 100.0 | 76.1 | ||
Central | 23.8 (176) | 42.6 | 18.8 | 22.7 | 2.8 | 9.7 | 8.0 | 63.6 | 97.2 | 27.8 | 91.3 | 98.9 | 97.7 | ||
Southern | 24.8 (183) | 30.6 | 25.1 | 20.2 | 8.7 | 1.1 | 19.1 | 74.3 | 97.8 | 33.9 | 82.5 | 97.3 | 90.2 | ||
Eastern | 26.4 (195) | 30.3 | 7.7 | 15.4 | 5.6 | 0.5 | 10.3 | 74.4 | 97.9 | 34.9 | 74.2 | 99.0 | 69.2 | ||
Marital status | *** | * | ** | * | * | ||||||||||
Never married | 1.8 (13) | 38.5 | 15.4 | 7.7 | 0.0 | 7.7 | 7.7 | 69.2 | 84.6 | 46.2 | 100.0 | 92.3 | 53.8 | ||
Married | 72.4 (534) | 39.7 | 15.9 | 22.1 | 6.4 | 3.4 | 11.4 | 71.9 | 98.1 | 32.4 | 82.6 | 99.3 | 84.3 | ||
Divorce/Widow/Other | 25.8 (191) | 20.9 | 15.7 | 13.1 | 2.6 | 2.1 | 12.0 | 69.6 | 98.4 | 25.7 | 83.1 | 97.9 | 81.2 | ||
Social Determinants | Active Aging Indicators | ||||||||||||||
Safety (from Violence) | Safety (from Injury or Accidents) | Lifelong Learning | Absence of Severe Physical Disability | Absence of Severe Cognitive Impairment | Absence of Depressive Symptoms | Primary Prevention Utilization | Mental Well-being | ICT use | Social Connectedness | Educational Achievement | Transportation Accessibility | Transportation Convenience | Barrier-free Space | Social Integration and Respect | |
Total | 89.7 | 75.2 | 11.2 | 97.7 | 75.2 | 81.4 | 35.4 | 79.1 | 42.8 | 81.7 | 22.2 | 91.7 | 76.1 | 84.4 | 75.2 |
** | *** | *** | ** | ** | *** | *** | *** | *** | |||||||
Age 55–59 | 92.9 | 76.8 | 15.2 | 99.1 | 95.5 | 86.6 | 25.0 | 83.0 | 73.2 | 84.8 | 38.4 | 97.3 | 82.9 | 94.6 | 70.5 |
Age 60–64 | 89.1 | 79.3 | 13.2 | 100.0 | 84.5 | 86.2 | 29.9 | 87.4 | 63.2 | 84.5 | 29.9 | 98.9 | 83.1 | 90.8 | 77.6 |
Age 65–69 | 90.6 | 74.6 | 10.1 | 97.8 | 79.9 | 88.4 | 37.0 | 81.9 | 40.6 | 87.0 | 21.7 | 92.8 | 65.2 | 84.8 | 76.8 |
Age 70–74 | 90.9 | 77.7 | 11.6 | 98.3 | 74.4 | 79.3 | 33.1 | 70.2 | 30.6 | 76.9 | 15.7 | 94.2 | 80.0 | 86.8 | 71.9 |
Age 75+ | 87.0 | 69.4 | 7.8 | 94.3 | 52.8 | 70.5 | 46.6 | 73.1 | 16.1 | 76.7 | 10.4 | 79.8 | 70.8 | 71.0 | 76.7 |
Gender | * | *** | * | ||||||||||||
Male | 91.4 | 74.7 | 10.6 | 98.1 | 78.1 | 85.0 | 37.5 | 80.3 | 45.0 | 82.5 | 28.9 | 92.8 | 72.9 | 87.2 | 76.7 |
Female | 88.1 | 75.7 | 11.9 | 97.4 | 72.5 | 78.0 | 33.3 | 78.0 | 40.7 | 81.0 | 15.9 | 90.7 | 78.1 | 81.7 | 73.8 |
Education | * | *** | *** | *** | *** | * | *** | *** | |||||||
Illiterate/non-formal | 93.2 | 77.8 | 3.1 | 95.1 | 34.6 | 69.8 | 40.1 | 81.5 | 7.4 | 75.9 | --- | 79.6 | 72.7 | 64.8 | 80.2 |
Elementary school | 85.2 | 73.2 | 5.0 | 97.7 | 78.5 | 82.6 | 34.6 | 77.5 | 31.2 | 79.5 | --- | 92.6 | 76.5 | 85.9 | 77.2 |
Primary high school | 95.6 | 80.7 | 17.5 | 100.9 | 93.0 | 85.1 | 36.8 | 83.3 | 69.3 | 87.7 | --- | 96.5 | 75.7 | 89.5 | 71.1 |
Senior high school | 90.1 | 67.3 | 24.8 | 98.0 | 95.0 | 87.1 | 28.7 | 77.2 | 74.3 | 86.1 | --- | 98.0 | 82.9 | 98.0 | 68.3 |
College/University+ | 90.5 | 81.9 | 28.6 | 100.0 | 100.0 | 90.5 | 34.9 | 76.2 | 90.5 | 88.9 | --- | 100.0 | 72.7 | 96.8 | 71.4 |
Towns | *** | *** | *** | *** | *** | *** | ** | * | *** | *** | |||||
Urban | 93.6 | 77.5 | 17.3 | 98.1 | 90.7 | 84.0 | 33.5 | 68.1 | 62.5 | 83.0 | 36.7 | 94.7 | 82.6 | 91.8 | 61.4 |
Rural | 85.6 | 72.8 | 5.0 | 97.2 | 59.1 | 78.7 | 37.3 | 90.6 | 22.4 | 80.4 | 7.2 | 88.7 | 68.9 | 76.8 | 89.5 |
Region | *** | *** | ** | ** | * | *** | *** | *** | * | *** | *** | ** | |||
Northern | 94.0 | 84.2 | 9.2 | 96.7 | 70.1 | 84.8 | 38.6 | 87.0 | 48.4 | 82.1 | 17.4 | 90.2 | 85.0 | 80.4 | 81.5 |
Central | 67.6 | 44.9 | 17.6 | 98.3 | 85.8 | 75.6 | 34.7 | 86.9 | 56.3 | 65.9 | 27.8 | 90.9 | 79.1 | 90.3 | 78.4 |
Southern | 96.7 | 72.7 | 13.1 | 98.4 | 72.1 | 85.6 | 35.5 | 89.6 | 36.1 | 85.8 | 25.7 | 93.4 | 52.3 | 90.7 | 64.5 |
Eastern | 99.0 | 96.4 | 5.6 | 97.4 | 73.3 | 79.5 | 32.8 | 54.9 | 31.8 | 91.8 | 18.5 | 92.3 | 70.4 | 76.9 | 76.4 |
Marital status | * | *** | ** | ** | *** | ** | *** | ||||||||
Never married | 76.9 | 53.8 | 7.7 | 92.3 | 76.9 | 76.9 | 30.8 | 69.2 | 46.2 | 84.6 | 38.5 | 76.9 | 66.7 | 84.6 | 69.2 |
Married | 90.4 | 75.7 | 12.2 | 98.5 | 79.0 | 84.8 | 35.2 | 82.4 | 47.4 | 82.8 | 24.7 | 94.4 | 77.7 | 86.1 | 76.4 |
Divorce/Widow/Other | 88.5 | 75.4 | 8.9 | 95.8 | 64.4 | 72.3 | 36.1 | 70.7 | 29.8 | 78.5 | 14.1 | 85.3 | 72.5 | 79.6 | 72.3 |
Social Determinants | Work (Age 55–59) (n = 112) | Work (Age 60–64) (n = 174) | Work (Age 65–69) (n = 138) | Work (Age 70–74) (n = 121) | Work (Age 75+) (n = 193) |
---|---|---|---|---|---|
Sex (male) | 1.951 | 1.660 | 3.678 * | 2.241 | 2.559 |
Education | 1.360 | 1.313 * | 0.970 | 0.70 | 0.878 |
Marital status (having spouse) | 0.570 | 1.198 | 1.661 | 1.358 | 6.241 |
Residence (rural) | 0.687 | 2.703 * | 1.840 | 2.772 | 2.929 |
Region (central) | 0.902 | 2.592 * | 0.657 | 1.846 | 0.745 |
Region (southern) | 0.429 | 0.738 | 0.260 * | 1.064 | 0.587 |
Region (eastern) | 0.909 | 1.757 | 0.381 | 1.310 | 0.407 |
Model summary | –2LL = 186.778, χ2 = 16.318 (df = 7) * | –2LL = 269.303, χ2 = 24.789 (df = 7) *** | –2LL = 116.632, χ2 = 15.491 (df = 7) * | –2LL = 84.060, χ2 = 7.820 (df = 7) | –2LL = 60.078, χ2 = 12.064 (df = 7) |
Social Determinants | Volunteering | Caring for Children | Caring for Older or Disabled Family | Political Participation | Other Social Group Participation |
---|---|---|---|---|---|
Age 65–74 | 1.190 | 0.867 | 0.575 | 0.670 | 1.262 |
Age 75+ | 1.839 * | 0.530 * | 1.371 | 7.958 ** | 0.829 |
Sex (male) | 0.565 ** | 0.987 | 0.550 | 0.663 | 0.644 * |
Education | 1.283 ** | 0.898 | 1.350 * | 2.194 ** | 1.282 ** |
Marital status (having spouse) | 1.233 | 1.829 * | 2.168 | 3.020 | 1.083 |
Residence (rural) | 0.901 | 0.669 | 0.961 | 5.327 * | 0.481 |
Region (central) | 1.055 | 1.109 | 0.687 | 1.674 | 0.743 |
Region (southern) | 1.065 | 0.893 | 2.445 * | 0.912 | 1.220 |
Region (eastern) | 0.578 | 0.496 * | 2.219 | 0.368 | 1.278 |
Model summary | –2LL = 668.5990, χ2 = 22.326 (df = 9) ** | –2LL = 760.371, χ2 = 29.338 (df = 9) ** | –2LL = 314.476, χ2 = 22.530 (df = 9) ** | –2LL = 138.130, χ2 27.679 (df = 9) ** | –2LL = 605.006, χ2 = 24.557 (df = 9) ** |
Social Determinants | Physical Activity | Medical Care Accessibility | Independent Living | Absence of Poverty Risk | No Severe Material Deprivation | Owning Assets | Physical Safety (from Violence) | Physical Safety (from Injury or Accidents) | Lifelong Learning | Absence of Severe Physical Disability | Absence of Severe Cognitive Impairment | Absence of Depressive Symptoms | Using Preventive Care |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Age 65–74 | 1.761 ** | 11.405 | 2.170 *** | 0.546 * | 2.064 | 1.037 | 0.977 | 0.847 | 1.077 | 0.092 | 0.545 | 0.883 | 1.226 |
Age 75+ | 2.210 ** | 22.645 | 1.994 ** | 1.339 | 0.081 ** | 0.626 | 0.725 | 0.396 ** | 1.074 | 0.031 * | 0.227 *** | 0.503 * | 2.082 ** |
Sex (male) | 1.516 * | 1.968 | 0.830 | 0.769 | 0.343 | 1.348 | 3.462 *** | 1.034 | 0.546 ** | 0.843 | 0.696 | 1.094 | 1.175 |
Education | 1.103 | 1.231 | 1.556 *** | 1.683 *** | 0.613 | 1.113 | 0.717 ** | 0.977 | 1.695 *** | 1.460 | 2.115 *** | 1.229 * | 1.086 |
Marital status (having spouse) | 1.183 | 1.110 | 1.512 *** | 0.599 | 1.769 | 2.168 ** | 0.998 | 0.755 | 1.557 | 1.964 | 2.223 * | 1.854 ** | 1.003 |
Residence (rural) | 2.050 ** | 0.074 ** | 1.397 | 1.604 | 0.848 | 0.408 ** | 0.253 ** | 0.805 | 0.455 | 1.217 | 0.214 *** | 0.903 | 1.127 |
Region (central) | 0.853 | 0.372 | 1.507 | 0.800 | 0.000 | 6.673 *** | 0.420 * | 0.462 ** | 1.497 | 7.884 | 2.171 | 0.662 | 1.682 * |
Region (southern) | 1.195 | 0.234 | 1.730 | 0.440 | 0.000 | 1.248 | 1.304 | 0.490 ** | 1.055 | 2.146 | 0.545 | 0.888 | 0.848 |
Region (eastern) | 1.094 | 0.493 | 2.590 *** | 0.134 *** | 0.000 | 1.816 | 39.604 * | 12.887 *** | 0.640 | 1.852 | 1.921 | 1.140 | 0.658 |
Model summary | –2LL = 915.185, χ2 = 34.484 (df = 9) *** | –2LL = 55.028, χ2 = 20.007 (df = 10) * | –2LL = 840.524, χ2 = 77.950 (df = 9) *** | –2LL = 383.842, χ2 = 68.295 (df = 9) *** | –2LL = 59.500, χ2 = 25.115 (df = 9) ** | –2LL = 488.667, χ2 = 36.318 (df = 9) *** | –2LL = 323.057, χ2 = 65.171 (df = 9) *** | –2LL = 683.539, χ2 = 109.090 (df = 9) *** | –2LL = 582.791, χ2 = 67.830 (df = 9) *** | –2LL = 99.089, χ2 = 28.190 (df = 9) ** | –2LL = 353.962, χ2 = 184.491 (df = 9) *** | –2LL = 605.936, χ2 = 41.153 (df = 9) *** | –2LL = 910.451, χ2 = 29.818 (df = 9) *** |
Social Determinants | Mental Well-Being | Use of ICT | Social Connectedness | Educational Attainment | Transportation Accessibility | Transportation Convenience | Barrier-Free Space | Social Integration and Respect |
---|---|---|---|---|---|---|---|---|
Age 65–74 | 0.553 * | 0.340 *** | 0.967 | 0.556 * | 0.508 | 0.656 | 0.601 | 0.975 |
Age 75+ | 0.373 ** | 0.205 *** | 0.523 * | 0.354 *** | 0.125 *** | 1.037 | 0.293 ** | 0.781 |
Sex (male) | 0.873 | 1.000 | 0.913 | 2.354 *** | 0.487 | 0.661 | 0.858 | 0.917 |
Education | 1.116 | 2.030 *** | 1.261 ** | --- | 1.604 ** | 0.742 * | 1.614 *** | 1.148 |
Marital status (having spouse) | 1.539 | 1.221 | 0.980 | 1.579 * | 2.684 * | 1.222 | 1.261 | 1.070 |
Residence (rural) | 10.234 *** | 0.277 *** | 1.143 | 0.145 *** | 0.904 | 0.270 * | 0.506 * | 7.397 *** |
Region (central) | 1.284 | 1.293 | 0.678 | 2.092 ** | 1.200 | 1.330 | 0.807 | 1.152 |
Region (southern) | 1.033 | 0.370 *** | 1.447 | 2.087 ** | 1.761 | 0.334 ** | 0.808 | 0.213 *** |
Region (eastern) | 0.065 *** | 0.279 *** | 3.301 *** | 1.383 | 2.827 * | 0.993 | 1.784 | 0.925 |
Model summary | –2LL = 610.400, χ2 = 261.792 (df = 9) *** | –2LL = 690.391, χ2 = 299.824 (df = 9) *** | –2LL = 626.565, χ2 = 44.495 (df = 9) *** | –2LL = 838.848, χ2 = 112.806 (df = 8) *** | –2LL = 239.954, χ2 = 68.743 (df = 9)*** | –2LL = 226.636, χ2 = 22.561 (df = 9) ** | –2LL = 383.578, χ2 = 72.145 (df = 9) *** | –2LL = 843.348, χ2 = 109.013 (df = 9) *** |
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Hsu, H.-C.; Liang, J.; Luh, D.-L.; Chen, C.-F.; Wang, Y.-W. Social Determinants and Disparities in Active Aging Among Older Taiwanese. Int. J. Environ. Res. Public Health 2019, 16, 3005. https://doi.org/10.3390/ijerph16163005
Hsu H-C, Liang J, Luh D-L, Chen C-F, Wang Y-W. Social Determinants and Disparities in Active Aging Among Older Taiwanese. International Journal of Environmental Research and Public Health. 2019; 16(16):3005. https://doi.org/10.3390/ijerph16163005
Chicago/Turabian StyleHsu, Hui-Chuan, Jersey Liang, Dih-Ling Luh, Chen-Fen Chen, and Ying-Wei Wang. 2019. "Social Determinants and Disparities in Active Aging Among Older Taiwanese" International Journal of Environmental Research and Public Health 16, no. 16: 3005. https://doi.org/10.3390/ijerph16163005