Concordance and discordance between objectively and subjectively measured successful aging and their linkages with mortality
Successful aging has extended from the biomedical-oriented model to the biomedi-cal-and-psychosocial mixed model. However, few studies have investigated the subtypes of the joint classification between subjective (psychosocial-oriented) (SSA) and objective (biomedi-cal-oriented) (OSA) measures to identify and distinguish different risk groups. This study aims to examine how concordance and discordance between SSA and OSA are associated with sub-sequent mortality based on five waves of a nationwide longitudinal survey in China from 2000 to 2011 with 30,948 sampled persons aged 65 and older. SSA was measured by absence of poor life satisfaction, poor self-rated health, and psychological distress, while OSA was measured by absence of disability, cognitive impairment, and chronic diseases. We then defined a variable with four subtypes of concordance and discordance from these two dichotomous variables: Type I (not-OSA & not-SSA), Type II (not-OSA & SSA), Type III (OSA & not-SSA) and Type IV (OSA & SSA). Types I and IV are concordance types, while Types II and III are discordance types. The results showed that a negative association between Type IV (SSA & OSA) and risk of mortality was universal over age groups and sexes. Compared to Type I (not-SSA & not-OSA), Type IV (SSA & OSA) has a 25–71% lower risk of mortality, depending on age group and sex, after controlling for a rich set of confounders. Concordance and discordance between OSA and SSA provide added power in predicting subsequent mortality. Public health programs should target those more vulnerable subtypes to promote successful aging.
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