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. 2025 Jul 15;83(1):187.
doi: 10.1186/s13690-025-01669-2.

The independent and joint role of socioeconomic status and family relationships on mortality risk in China: cultural differences and health inequalities in the context of intergenerational cohabitation

Zhixi Zhu  1 , Yiying Wang  2 , Xin Wang  2 , Fuyan Zhang  2 , Lisha Yu  3 , Tao Liu  4
Affiliations

The independent and joint role of socioeconomic status and family relationships on mortality risk in China: cultural differences and health inequalities in the context of intergenerational cohabitation

Zhixi Zhu et al. Arch Public Health. .

Abstract

Background: Socioeconomic status (SES) and family relationships are critical social determinants of health disparities. The mechanisms underlying their interactions remain insufficiently understood in Asian cultures with prevalent intergenerational cohabitation. This study investigates the independent and combined effects of SES and family relationships on all-cause mortality in China.

Methods: A baseline survey was conducted in 2010 involving 9280 adult permanent residents from 12 counties (districts) in Guizhou Province, using stratified cluster random sampling. Two follow-ups (2016-2020, 2023) were conducted. SES was assessed using a composite score comprising household income, education, and occupation, while family relationships were classified as either "good" or "mediocre." The Cox proportional hazards model was employed to evaluate the independent and combined effects of SES and family relationships on all-cause mortality.

Results: Among 5949 participants were included, and the cumulative mortality rate was 6.4% over a median follow-up of 12 years. With a decrease in mortality risk as SES increased (P < 0.001). Compared with SES ≤ 6, mortality risk with SES scores of 7, 8, and ≥ 9 decreased by 36.9% (HR = 0.631, 95% CI = 0.473-0.842), 36.6% (HR = 0.644, 95% CI = 0.469-0.886), and 73% (HR = 0.270, 95% CI = 0.183-0.397), respectively. The independent effect of family relationship on the risk of death was not statistically significant (HR = 0.847, 95% CI = 0.0.670- 1.070). The joint analysis showed the compensatory effect was significant when SES exceeded a threshold (SES ≥ 9), alleviating the mortality risk associated with family relationships (HR = 0.2197, 95% CI = 0.073-0.652).

Conclusion: Findings demonstrate SES independently reduces mortality in Chinese populations, while the effect of family relationships is modulated by cultural background. The resource substitution hypothesis is valid at specific SES thresholds. Intervention efforts should prioritize the vulnerable group characterized by "low SES and weak family support".

Keywords: All-cause mortality; Family ties; Intergenerational cohabitation; Resource substitution hypothesis; Socioeconomic position.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Institutional Review Board of Guizhou Province Center for Disease Control and Prevention (No. S2017-02), and written informed consent was signed by all subjects. Our research adhered to the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the analysis included in this study
Fig. 2
Fig. 2
Dose–response relationship between SES composite score and the risk of all-cause mortality in the population
Fig. 3
Fig. 3
The dose–response relationship between SES composite scores of different family relationships and the risk of all-cause mortality in the population. Note: (a) Family relations are better (b) Family relationships are mediocre
Fig. 4
Fig. 4
Sensitivity analysis. Notes: (a) Deaths with less than 2 years of follow-up were excluded; (b) Add the adjustment variable "life satisfaction"; (c) Add the adjustment variable "PHQ-9 score"; (d) Participants with a baseline age of more than 80 years were excluded
Fig. 5
Fig. 5
Subgroup analysis of the relationship between SES and the risk of all-cause mortality in different family relationships. Notes: (a) Good family relations; (b) Mediocre family relations
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References

    1. Chetty R, Stepner M, Abraham S, Lin S, Scuderi B, Turner N, Cutler D, et al. The association between income and life expectancy in the United States, 2001–2014. JAMA. 2016;315(16):1750–66. - PMC - PubMed
    1. Zhou M, Wang H, Zeng X, Yin P, Zhu J, Chen W, Liang X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet Public Health. 2021;6(5):e330–9.
    1. Zhong S, Lee C, Foster MJ, et al. Intergenerational communities: A systematic literature review of intergenerational interactions and older adults’ health-related outcomes[J]. Soc Sci Med. 2020;264. 10.1016/j.socscimed.2020.113374. - PubMed
    1. Liu Z Z , Huang L , Tian H D ,et al. The chain mediating role of family health and physical activity in the relationship between life satisfaction and health-promoting lifestyles among young adults in China[J]. Front Public Health, 2024.10.3389/fpubh.2024.1408988. - PMC - PubMed
    1. Das M, Anand A, Barman P, et al. Exploring the relationship between socioeconomic status and teenage pregnancy in India: a review on National Family Health Survey[J]. SN Social Sciences. 2024;4(4). 10.1007/s43545-024-00889-7.

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