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International Journal of Population Studies

RESEARCH ARTICLE

Concordance and discordance between

objectively and subjectively measured

successful aging and their linkages with

mortality

*
Danan Gu
United Nations Population Division, Two UN Plaza, DC2-1910, New York, NY 10017, USA

Abstract: 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.
Keywords: successful aging, subjective successful aging, objective successful aging, concor-
dance, discordance, mortality, China

*Correspondence to: Danan Gu, United Nations Population Division, Two UN Plaza, DC2-1910, New York,
NY 10017, USA; Email: gudanan@yahoo.com

Received: May 12, 2015; Accepted: June 28, 2015; Published Online: July 6, 2015
Citation: Gu D. (2015). Concordance and discordance between objectively and subjectively measured
Copyright: © 2015 Danan Gu. This is successful aging and their linkages with mortality. International Journal of Population Studies, vol.1(1):
an Open Access article distributed un- 29–41. http://dx.doi.org/10.18063/IJPS.2015.01.003.
der the terms of the Creative Commons
Attribution-NonCommercial 4.0 Interna- 1. Introduction
tional License (http://creativecommons.
org/licenses/by-nc/4.0/), permitting all A growing body of literature in the last few decades has expanded the scope of successful
non-commercial use, distribution, and
reproduction in any medium, provided aging and extended our understanding of successful aging (Cosco, Prino, Perales et al.,
the original work is properly cited. 2014; Rowe and Kahn, 1997; 2015). About two decades ago, the definition of successful

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