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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (3): 549-554. doi: 10.19723/j.issn.1671-167X.2021.03.018

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Association between education and the onset of disability in activities of daily living in middle-aged and older Chinese adults: The mediator role of social participation

PENG Shun-zhuang,FU Xi-xi,FENG Xing-linΔ()   

  1. Department of Health Policy and Management, Peking University School of Public Health, Beijing 100191, China
  • Received:2021-02-25 Online:2021-06-18 Published:2021-06-16
  • Contact: Xing-lin FENG E-mail:fxl@bjmu.edu.cn
  • Supported by:
    National Natural Sciences Foundation of China(71761130083)

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Abstract:

Objective: To investigate the association between educational attainment and the onset of disability in activities of daily living (ADL), and to explore the mediating effect of social participation on such association. Methods: A longitudinal dataset was drawn from the China Health and Retirement Longitudinal Study (CHARLS, 2015 to 2018). The measurements of educational attainment, social participation and other covariates were identified from 2015, while the outcome measurement of ADL disability was constructed with data from survey 2018. Descriptive analyses were conducted, and basic characteristics and social engagement of the respondents were compared between illiterates and non-illite-rates using Chi-square test. Logistic regression was used to investigate the associations of educational attainment and social participation on the onset of ADL disability. Mediation analysis was employed to examine the mediator role of the social participation on the linkage from being illiterate to the ADL disability onset. Results: A total of 11 359 adults aged 45 years and above were included in the sample, of whom 3 222 were illiterates. The incidence of the onset of ADL disability of illiterates and non-illiterates were 10.4% and 6.2%, respectively. Among these respondents, only half of them were involved in social activities. Of all the 8 social activities, the percentage of interacting with friends (34.1%) was the highest, and the lowest percentage was observed in participating in an educational or training course (0.6%). Moreover, the percentages of participation in all these 8 social activities among illiterates were significantly lower than that of their educated counterparts (all P<0.001). The illiterate middle-aged and older adults were less likely to develop ADL disability in the follow-up period [adjusted odds ratio (aOR)=1.22, 95%CI: 1.02-1.45], and social participation was significantly associated with ADL disability onset (aOR=0.73, 95%CI: 0.63-0.85). Findings from mediation analysis illustrated that social participation accounted for 12.22% of the adverse effect of being illiterate on ADL disability onset. Conclusion: Social participation could buffer the negative effect of being illiterate on ADL disability onset in middle-aged and older adults, suggesting that engagement in social activities might have impact on prevention of impairments in physical function, especially for middle-aged and older illiterates.

Key words: Educational status, Social participation, Activities of daily living, Aged, Health status

CLC Number: 

  • R195

Figure 1

Framework of the potential mediating effect of social participation in the association between education and ADL disability ADL, activities of daily living."

Figure 2

Flowchart of sampling ADL, activities of daily living."

Table 1

Basic characteristics of respondents by education (Year 2015)"

Characteristics Overall, n (%)
(n=11 359)		 Illiterate, n (%)
(n=3 222)		 Non-illiterate, n (%)
(n=8 137)		 χ2 P value
Female 6 597 (58.1) 2 567 (79.7) 4 030 (49.5) 861.39 <0.001
Han 10 460 (92.1) 2 905 (90.2) 7 555 (92.8) 22.85 <0.001
Rural 7 174 (63.2) 2 444 (75.9) 4 730 (58.1) 311.60 <0.001
Age group/years 698.95 <0.001
45- 3 466 (30.5) 510 (15.8) 2 956 (36.3)
55- 3 881 (34.2) 1 185 (36.8) 2 696 (33.1)
65- 2 855 (25.1) 910 (28.2) 1 945 (23.9)
75- 1 157 (10.2) 617 (19.1) 540 (6.6)
Marital status 310.13 <0.001
Married/partnered 9 812 (86.4) 2 493 (77.4) 7 319 (89.9)
Others 1 547 (13.6) 729 (22.6) 818 (10.1)
Insurance 345.98 <0.001
UEBMI 1 283 (11.3) 97 (3.0) 1 186 (14.6)
URBMI/NRCMS 9 670 (85.1) 3 041 (94.4) 6 629 (81.5)
Other insurances 262 (2.3) 37 (1.1) 225 (2.8)
Without insurance 144 (1.3) 47 (1.5) 97 (1.2)
Economic status 390.26 <0.001
Poorest 2 422 (21.3) 1 032 (32.0) 1 390 (17.1)
Poor 2 493 (21.9) 757 (23.5) 1 736 (21.3)
Average 2 301 (20.3) 592 (18.4) 1 709 (21.0)
Rich 2 217 (19.5) 475 (14.7) 1 742 (21.4)
Richest 1 926 (17.0) 366 (11.4) 1 560 (19.2)
Smoke 696 (6.1) 84 (2.6) 612 (7.5) 96.90 <0.001
Drink 4 587 (40.4) 932 (28.9) 3 655 (44.9) 245.19 <0.001
Numbers of conditions 30.62 <0.001
0 4 887 (43.0) 1 277 (39.6) 3 610 (44.4)
1 3 166 (27.9) 1 007 (31.3) 2 159 (26.5)
2 1 949 (17.2) 558 (17.3) 1 391 (17.1)
3 and above 1 357 (11.9) 380 (11.8) 977 (12.0)
ADL disability onset* 837 (7.4) 334 (10.4) 503 (6.2) 59.21 <0.001

Table 2

Social participation of respondents by education (Year 2015)"

Items Overall, n (%)
(n=11 359)		 Illiterate, n (%)
(n=3 222)		 Non-illiterate, n (%)
(n=8 137)		 χ2 P value
Social participation 5 678 (50.0) 1 304 (40.5) 4 374 (53.8) 162.89 <0.001
Interacted with friends 3 877 (34.1) 957 (29.7) 2 920 (35.9) 39.25 <0.001
Played mahjong, chess and cards, or went to community club 2 061 (18.1) 287 (8.9) 1 774 (21.8) 258.37 <0.001
Provided help to family, friends, or neighbors who did not live with you or pay you for help 1 677 (14.8) 356 (11.0) 1 321 (16.2) 49.32 <0.001
A sport, social, or other kind of club 837 (7.4) 120 (3.7) 717 (8.8) 87.51 <0.001
A community-related organization 245 (2.2) 23 (0.7) 222 (2.7) 44.38 <0.001
Done voluntary or charity work 153 (1.3) 12 (0.4) 141 (1.7) 32.14 <0.001
Cared for a sick or disabled adult who did not live with you or pay you for help 349 (3.1) 63 (2.0) 286 (3.5) 18.85 <0.001
An educational or training course 69 (0.6) 2 (0.1) 67 (0.8) 22.16 <0.001

Table 3

Associations between education, social participation and ADL disability onset (Logistic regression)"

Variables Unadjusted model Adjusted model
OR 95%CI P value aOR 95%CI P value
Illiterate
Yes 1.75 1.52-2.03 <0.001 1.22 1.02-1.45 0.026
No Reference Reference
Social participation
Yes 0.66 0.57-0.76 <0.001 0.73 0.63-0.85 <0.001
No Reference Reference

Table 4

The mediation role of social participation on the association between education and ADL disability onset (KHB method)"

Effect Unadjusted model Adjusted model
β 95%CI P value Mediated β 95%CI P value Mediated
Total effect 0.565 0.420-0.710 <0.001 0.232 0.066-0.398 0.006
Direct effect 0.517 0.371-0.663 <0.001 8.36% 0.203 0.037-0.370 0.017 12.22%
Indirect effect 0.047 0.027-0.068 <0.001 0.028 0.013-0.044 <0.001
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