Porthole
Early Life Circumstances and Health Inequality among Older Adults in China and the U.S (307821)
*Xi Chen, Yale School of Public HealthKeywords: Early Life Circumstances, Health Inequality, Older Adults, China and the U.S
The United Statas and China are all facing unprecedented challenges from population aging. Aging starts early in life. We estimate the extent to which childhood circumstances contribute to health inequality in old age and evaluates the importance of major domains of childhood circumstances to health inequalities in the United States and China. We link waves of the China Health and Retirement Longitudinal Study (CHARLS) with the Life History Survey (LHS), and waves of the Health and Retirement Study (HRS) with the Life History Mail Survey (LHMS) in the U.S., to quantify health inequality due to childhood circumstances for which they have little control. Implementing the framework of an Shapley approach to a set of machine learning methods, such as conditional Inference Trees and Forests, we show that childhood circumstances may explain a sizable part of health inequality in old age in China and the U.S. Specifically, the contribution of childhood circumstances to health inequality is larger in the U.S. than in China for all health dimensions. Examining domains of childhood circumstance, regional and rural/urban status contribute more to health inequality in China, while family SES contributes more to health inequality in the U.S. Among all methods we use, conditional inference tree can be easily mapped the aging population types and thus lay bare the opportunity structure of a given society for a larger audience. On the other hand, conditional inference forests outperform all other methods in terms of out-of-sample performance, delivering the best estimates of the contributions of early life circumstances to health inequality in old age. Our findings support the value of a life course approach in identifying the key determinants of health in old age. Distinguishing sources of health inequality and rectifying inequality due to early childhood circumstances should be the basis of policy promoting health equity.