Health Disparities between the Rural and Urban Elderly in China: A Cross-Sectional Study

Background: China is becoming an aging society, and the proportion of the population aged 60 years and above is increasing. There is a dualistic urban-rural economic structure between urban and rural areas in China, but there are few comparative health studies on the self-assessed health (SAH) status of the elderly between urban and rural areas. The aim of this study is to explore the SAH status of the elderly in China, and to identify the health disparity between the urban and rural elderly. Methods: The data from the fourth wave of the China Health and Retirement Longitudinal Study (CHARLS) in 2018 were adopted. A total of 9630 participants aged 60 and above were included in this study. SAH was used as the indicator, measuring the health status. Fairlie decomposition analysis was conducted to find the SAH disparity. Results: The proportion of good SAH of the rural elderly (24.01%) was significantly higher than the urban elderly (19.99%). The association of SAH was widely different between the rural and urban elderly. There was a stronger association between SAH and sleeping time in the urban elderly (Odds ratios (OR) = 3.347 of 4-8 h; OR = 3.337 of above 8 h) than the rural elderly (OR = 1.630 of 4-8 h; OR = 2.293 of above 8 h). Smoking and social activity were significant only in the urban elderly, while region and assets were significant only in the rural elderly. Drinking (11.45%), region (-33.92%), and assets (73.50%) were the main factors contributing to the urban-rural health disparities. Conclusions: This is the first comparative study examining SAH disparity, focusing on the elderly aged 60 and above in China. From the perspective of drinking, region, and assets, our study highlighted substantial urban-rural health disparities, and provided evidence for policy making on narrowing the health gap between urban and rural areas in China.

Automated summary

This study explores the self-assessed health status of the elderly in China, revealing that rural elderly have better health than urban elderly, and significant disparities in health outcomes between urban and rural elderly exist. Key factors contributing to urban-rural health disparities include drinking, region, and assets.