Changes in perceived uselessness and risks for mortality: evidence from a National sample of older adults in China.

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BACKGROUND: Self-perception of uselessness is associated with increased mortality risk in older adults. However, it is unknown whether and to what extent changes in perceived uselessness are associated with mortality risk. METHODS: Using four waves of national longitudinal data of older adults from China (2005, 2008, 2011, and 2014), this study examines the association between changes in perceived uselessness and risk of subsequent mortality. Perceived uselessness is classified into three major categories: high levels (always/often), moderate levels (sometimes), and low levels (seldom/never). Five categories are used to measure change over three-year intervals: (1) persistently high levels, (2) increases to moderate/high levels, (3) persistent moderate levels, (4) decreases to moderate/low levels, and (5) persistently low levels. Cox proportional hazard models were used to estimate mortality risk associated with changes in levels of perceived uselessness. RESULTS: Compared to those with persistently low levels of perceived uselessness, those with persistently high levels of feeling useless had 80% increased hazard ratio (HR) in mortality [HR =1.80, 95% CIs: 1.57-2.08, p < 0.001]; and those with increasing levels, persistently moderate levels, and decreasing levels of perceived uselessness had 42% [HR = 1.42, 95% CIs: 1.27-159, p < 0.001], 50% [HR = 1.50, 95% CIs: 1.32-1.71, p < 0.001], and 23% [HR = 1.23, 95% CIs: 1.09-1.37, p < 0.001] increased hazard ratio in mortality, respectively, when background characteristics were taken into account. The associations were partially attenuated when socioeconomic, family/social support, behavioral, and health-related covariates were individually taken into account. Older adults with persistently high and moderate levels of perceived uselessness still exhibited significantly higher risks of mortality (16% [HR = 1.16, 95% CIs: 1.00-1.135, p < 0.05] and 22% [HR = 1.16, 95% CIs: 1.06-1.139, p < 0.015], respectively) after adjusting for all covariates, although no significant mortality risks were found for either increasing to moderate/high levels or decreasing to moderate/low levels of perceived uselessness. CONCLUSIONS: Persistently high and moderate levels of perceived uselessness are associated with significant increases in mortality risk. These findings have important implications for promoting successful aging in China.





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Zhao, Yuan, Matthew E Dupre, Li Qiu and Danan Gu (2017). Changes in perceived uselessness and risks for mortality: evidence from a National sample of older adults in China. BMC Public Health, 17(1). p. 561. 10.1186/s12889-017-4479-1 Retrieved from

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Matthew E. Dupre

Associate Professor in Population Health Sciences

Dr. Dupre is an Associate Professor in the Department of Population Health Sciences and the Department of Sociology. He is also a Senior Fellow at the Center for Aging and Human Development and member of the Cardiovascular Outcomes Group at the Duke Clinical Research Institute. Dr. Dupre is a medical sociologist who specializes in research on aging and the life course, health disparities, and cardiovascular disease (CVD) outcomes in older adults. As an interdisciplinary researcher, he has focused on several lines of work: (i) race and socioeconomic disparities in trajectories of chronic disease and mortality, (ii) the role of social stressors in the onset and progression of CVD, (iii) the development of adaptive risk-assessment models, and (iv) the social determinants of healthy aging in China. A unifying thread in his program of research is the application of life course theory to clinical outcomes research, the integration of population- and patient-level data, and the use of innovative statistical methods to better understand how exposure to social factors shape inequalities in health and aging. Dr. Dupre is the Editor-in-Chief of the Encyclopedia of Gerontology and Population Aging (2021), co-editor of the book Disability Trends at Older Ages (in press), and has published in the leading journals of medicine, epidemiology, sociology, and public health. He has served as an advisor to the National Academy of Sciences' Committee on Population Aging and currently serves on the editorial boards for multiple journals.

Areas of Expertise:
Medical Sociology; Population Health; Social Epidemiology; Cardiovascular Disease; Aging; and Quantitative Methods

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