107incompletos, inexactos o fuera de los plazos respectivos

COMMON CHRONIC DISEASES

As mentioned above, the most common chronic diseases of the elderly in Germany are hy- pertension, dyslipidemia, diabetes or high blood sugar, arthritis or rheumatism, and heart problems. On the other hand, the most common diseases among Chinese elderly are hy- pertension, arthritis or rheumatism, stomach or other digestive disease, heart problems

and chronic lung diseases.

The first apparent difference is that the incidence of stomach or digestive diseases among Chinese elderly is higher than that in Germany. According to WHO data, almost three quar- ters of the new stomach cancer cases occurred in Asia, and more than two fifths occurred in China. About forty-nine percent of all new oesophageal cancer cases occurred in China [73]. The incidence of chronic digestive disease in Germany is not that significant. One of the most important reasons that may lead to stomach cancer is certain dietary habits, which may result in exposure to N-nitroso compounds that are associated with an in- creased risk of gastric and oesophageal cancer [74]. Specifically, these eating habits include high intakes of salt-preserved or smoked foods and low intakes of fresh fruit or vegetables, fresh meat or fish and dairy products. As a developing country, it was a very common phe- nomenon that in winter pickled vegetables with salt served as main dishes, resulting in low intake of fresh vegetables, when the living standards are relatively low previously. An analysis of 60 relevant studies suggested a potential 50 percent higher risk of gastric cancer associated with intake of pickled vegetables, and perhaps the association is even stronger in China [75].

Besides, H. pylori infection is a major cause of peptic ulcer disease and chronic gastri- tis. Previous studies suggest that the prevalence of H.pylori infection is high in developing countries including China. An overall 60-70 percent prevalence rate of H. pylori infection was reported [76]. Within China, the infection rate in rural areas is higher than that in cities. A more recent systematic review reported that the mean prevalence of H pylori infection was 66 percent for rural Chinese populations and 47 percent for urban populations [77]. This is determined by the propagation route of H. Pylori. Previous studies have shown that several factors might be positively related to the spread of H.pylori, such as living condi- tions. Crowded living conditions, particularly a number of children in the household share a bed with others in childhood, assist the spread of H.pylori [78]. In addition, the preva- lence of H. pylori infection tends to be higher in the subjects who did not have indoor toilet or running water [79, 80]. The source of drinking water is another important influencing factor of H.pylori infection [81]. All these factors mentioned above are recognized as com- mon problems in rural area, which directly leads to a relatively higher infection rate of H. pylori.

Another significant difference is that the incidence of chronic respiratory diseases (CRDs) of Chinese elderly is higher than that of German elderly. Based on the statistics of WHO, more than one third of all newly diagnosed lung cancer cases occurred in China [73]. Many determinants have been identified for CRDs. The direct and indirect exposure to tobacco smoke is the principal risk factor. Other factors include heavy exposure to indoor and out- door air pollution , occupational agents, allergens, and multiple early lung infections [82]. The air pollution levels in Chinese cities are among the highest observed in the world. Be- cause of the rapid economic growth and urbanization in the past decades, the air pollution in many cities in China is extensive [83, 84] and way above health basic standards. Air pollution-associated health impacts have become a growing concern. There are many risk factors for air pollution. In China, coal has been the major energy source and the leading culprit of air pollution. According to the China Energy Statistical Yearbook, China con- sumed over 3.82 billion metric tons of coal in 2017, half of which was burned by the power sector. Coal burning leads to high emissions of fine particulates matter (PM2.5) to the at- mosphere, which serves as the main source of air pollution [85]. Previous studies have dis- covered that the range of exposure throughout PM is positive associated with lung cancer [86].

MAIN CAREGIVERS OF THE ELDERLY

In Germany, the largest group of the main caregivers are the daughters with a percentage of 29. Almost as often are the wives with 26 percent and the husbands represented with about 22 percent. One in ten caregivers is the son. And sons-in-law have taken 1 percent, which means they rarely provide care assistance to their parents-in-law. Even daughters-in-law, at around 5 percent, are rarely responsible for care. If the main caregivers are grouped together, caring for the relatives is mainly done in the context of spouses (48 percent) or their own children (39 percent). Other relatives or friends and acquaintances (3 percent) are seldom to be main caregivers for those in need of care [87].

Figure 2.26: The statistics of caregivers of the elderly people in Germany.

Similar to the situation in Germany, although the need for nursing care from the elderly people in China is obvious, most of the people with such demand are taken care by their family members. Child and spouse play the most important role in home care. About 45 percent of the elderly people get help from their children with daily activities including dressing, bathing or showering, eating, getting into or out of bed and using the toilet. About 47 percent are helped by their spouse. Only 2 percent get assistance from the spouse of their children. Other caregivers such as nanny, volunteer or other relatives take only small portion in China.

Figure 2.27: The statistics of caregivers of the elderly people in China.

OTHER LIVING CONDITIONS

Besides the difference lying in chronic diseases and main caregivers of the elderly people, the comparison of living conditions between German and Chinese elderly is summarized and depicted in Table 2.1.

Table 2.1: A comparison of living and health situation of the elderly people age over 65 years old in Germany and China[72, 88–95]

Regarding the pension insurance of China that mentioned in the table above, it is neces- sary to introduce the Chinese household registration system, that is what so called "HuKou". Hukou is the household registration system based on household as a unit [96–98]. House- hold registration verifies the legitimacy of a natural person living in a certain place. Since the 1950s, the formulation and implementation of the population management policy in China has been based on this system. In the 1950s and 1980s, China implemented a planned economic policy, whereby the personal materials were delivered by the universal distribu- tion system, which relied on the household registration management system [99, 100]. At that time, individuals, attempting to move from rural to urban areas for non-agricultural work, must apply to the relevant authorities, and the approval limit for such kind of appli- cations is strictly controlled. There are six types of permits required to work outside the province [101]. People who leave their place of residence do not have food quotas, unit housing, or public medical care [102]. Science, education, health, medical care, employ- ment, marriage, etc. are also managed and controlled according to the household regis- tration. At the end of the 1990s, China’s household registration management system was loosened, but Hukou remained directly linked to welfare, schooling and employment op- portunities [103, 104].

Since the establishment of the pension policy, it has also been influenced by the house- hold registration system, which means it is impossible to implement a national unified pension insurance similar to Germany. At present, the development trend of China’s house- hold registration management is to completely eliminate the difference between urban and rural Hukou [105]. The reform of the pension system has also been adjusted accordingly. The new rural social pension and urban residents pension insurance have been fully im- plemented since 2012. The new pension systems are the results of adapting to this trend [106]. Pension programs of the government and institutions or basic pension of the firms are formulated for administrative agencies, institutions, employees, and urban flexible em- ployees. Urban residents pension is configured for the urban non-employed people above 16 years old (excluding students), who do not comply with the pension programs of the government And institutions or basic pension of the firms. These residents can be volun- tarily insured in the places where their households are registered. New rural social pension insurance is dedicated to the people above 16 years old (excluding students) in the rural

area, who are not participating the pension program of the government and institutions or basic pension of the firms. Again these people may voluntarily participate in the places where their households are registered. In 2014, the pension system was further developed by merging the new rural social pension insurance and urban residents pension system into Residents’ Pension, which covers all the rural and urban residents above 16 years old (excluding students), who are non-Staffing of government affiliated institutions and are not part of pension insurance of the firms [107–111]. According to the Ministry of Human Re- sources and Social Security of China, by the end of 2017, the total number of people partici- pating in basic pension insurance was 915 million. Among them, the number of employees participating in the pension insurance of the firms was 402 million, and the number of peo- ple who are secured by the basic pension insurance for urban and rural residents was 513 million.

To provide a schematic overview of all the statistical comparison analysis which have been elaborated in previous sections, all compared items are summarized again and listed in the following tables (see Table 2.2).

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