Health, work, and income among middle-aged and older adults: A panel analysis for China

This paper analyzes for the first time changes in health experienced by middle-aged and older adults in China and the extent to which they are associated with changes in individual work and income outcomes. The paper uses a fixed effect specification, six measures of health (self-reported health status, activities of daily living (ADLs), instrumental ADLs, depression, word recall, and hypertension) and data from three waves of the China Health and Retirement Longitudinal Survey (CHARLS). We find gender and rural-urban gaps in levels and rates of decline in the health of middle-aged and older Chinese, with worse health outcomes overall and worse declines for women among those with rural household registration status (or Hukou)-rural residence. Results from the fixed effects models indicate that among men age 45 to 59 with rural Hukou and residing in rural areas, health decrements are significantly associated with a lower likelihood of working and reduced work hours, earnings, and income. The work status and work hours of older women (age 60-69) with a rural Hukou (regardless of rural or urban residence) are associated with health changes, while earnings or income are not. These results suggest that in China, gender, Hukou, and residence are particularly important factors to consider for the relationship between health and individual work and income outcomes for middle-aged and older adults. Overall, they point towards a need in China for policies that support health, work, and income among middleaged and older adults in rural areas, especially among middle-aged men with rural Hukou-rural residence.