Housing Poverty and Healthy Aging in China: Evidence from the China Health and Retirement Longitudinal Study

Background: Although prior research on the housing-health linkage suggested that those with poor housing conditions are more likely to report poor health, it is dominated by Western studies and offers little evidence on the housing-health relation in China. Scarce is empirical evidence on the potentially detrimental impact of either qualitative or quantitative housing poverty on health outcomes, especially for seniors in China. This paper aims to fill this void by using data from the 2011-2015 China Health and Retirement Longitudinal Study (CHARLS) to provide a comprehensive analysis of the demographic, socioeconomic, and behavioral factors that contribute to changes in healthy aging among Chinese adults aged 60 and over. Methods: Data collected from 8839 adults aged 60 and over in the 2011 and 2015 CHARLS (3732 in 2011 and 5107 in 2015) were used. We first used six blood-based biomarkers to construct a composite measure of the Chinese Healthy Aging Index (CHAI, ranging from 0 (healthiest) to 12 (unhealthiest)) and then assessed the psychometric properties of the CHAI score, including acceptability, internal consistency, convergent validity, discriminative validity and precision. In addition, we employed both mean-based Blinder-Oaxaca and unconditional quantile regression decomposition to decompose the change in healthy aging within the 2011-2015 period. Results: We overall identified a decrease in CHAI score from 5.69 in 2011 to 5.20 in 2015, which implies an improvement in healthy aging during this period. Our linear decomposition revealed that dependent on the type of measure used (whether quality, quantity, or combined quality-quantity), housing poverty explained 4-8% of the differences in CHAI score. Our distributional decompositions also highlighted an important role for housing poverty in the change in healthy aging, accounting for approximately 7-23% of the explained portion. Within this latter, the relative contribution of housing quantity and quality poverty was more pronounced at the median and upper end of the CHAI distribution. We also found household expenditure to be significantly associated with healthy aging among older Chinese adults and made the largest contribution to the improvement in healthy aging over time. Conclusions: The association between housing poverty and CHAI is independent of household expenditure. Regardless of type, housing poverty is positively associated with a decrease in healthy aging. Thus, improved housing conditions boost healthy aging, and housing amelioration initiatives may offer the most effective solution for augmenting healthy aging in China. Improvement of flush toilets and the access to potable water and a separate kitchen require particular attention. Since high-density congested housing has a negative impact on healthy aging, more attention can also be paid to improvements in the available space for older people. Especially at an institutional level, the government may extend the housing policy from a homeownership scheme to a housing upgrading scheme by improving housing conditions.