Urbanization and Cognitive Function Among Middle-Aged and Old Adults in China

Objectives Our study examined the effect of urbanization on cognitive function and its possible pathways among Chinese middle-aged and older adults independent of the influence of health-selective migration. Methods Using data from the China Health and Retirement Longitudinal Study, we compared cognitive function among three groups (urbanized-rural residents, rural nonmigrants, and urban nonmigrants). Logistic regression and structural equation models were applied to explore the impact of urbanization on cognitive function and the potential mechanisms. Results Compared with the urbanized-rural group, urban nonmigrants had better cognitive function, with a significant coefficient of 1.56 (95% CI: 1.22, 1.89) for global cognition scores and 0.37 (95% CI: 0.22, 0.53) for episodic memory scores. The rural nonmigrants had the worst cognitive function (beta = -0.79, 95% CI: -1.04, -0.55) and lower scores of mental intactness (beta = -0.65, 95% CI: -0.84, -0.57) and episodic memory (beta = -0.14, 95% CI: -0.26, -0.03). The association between urbanization and cognitive function was mainly mediated by income and living conditions among middle-aged and older adults. Discussion Rural people who experienced planned urbanization in China had higher cognitive scores than rural non-migrants. Urbanization could thus have a beneficial and cumulative effect on cognitive function. Improvements in living conditions and changes in income are the main drivers behind the relationship. However, urbanization could compensate for the negative impact on cognitive function from disadvantaged early-life conditions, but it cannot completely eliminate the gap between urbanized-rural people and urban nonmigrants.

Automated summary

Our study investigates the impact of urbanization on cognitive function among Chinese middle-aged and older adults, as well as the potential mechanisms. The findings suggest that urban nonmigrants have better cognitive function compared to urbanized-rural and rural nonmigrants. The improvement in living conditions and income are the main drivers behind the relationship, indicating the beneficial effect of urbanization on cognitive function.