Rural-urban inequalities in health among older adults in China have not been extensively studied from the national perspective. In particular, studies have not taken into account combinations of Hukou (household registration system in China) and actual residence, which may be important so as not to underestimate rural-urban differences. This study investigates rural-urban inequalities in prevalence of poor self-rated health, self-reported functional disabilities and depression among Chinese older adults in 2011 and 2015, and analyses sociodemographic determinants of rural-urban inequalities in self-reported health outcomes.
Data from the nationwide China Health and Retirement Longitudinal Study (CHARLS), on older adults aged 60 years and above in CHARLS 2011 and CHARLS 2015 were used. Only rural residents with rural Hukou and urban residents with urban Hukou were included. Sociodemographic factors, including age, sex, marital status, living arrangement, living near children, educational level and income were studied. Self-Rated Health (SRH) was assessed with a single question. Basic Activities of Daily Living (BADLs) and Instrumental Activities of Daily Living (IADLs) were used to measure self-reported functional abilities. The 10-item version of the Center for Epidemiologic Studies Depression Scale was used to measure self-reported depression.
Rural respondents had poorer socioeconomic status and higher prevalence of poor SRH, functional disabilities and depression than urban respondents. The levels of functional disabilities, both BADLs and IADLs, were similar in 2011 and 2015, while the prevalence of poor SRH and self-reported depression was lower in 2015, both among rural and urban respondents. Impairments increased with age and appeared at younger age among rural respondents compared to urban respondents. Being female, unmarried, with low educational level and low income increased the odds ratios of reporting poor SRH, functional disabilities and depression. Sensitivity analyses using only Hukou registration resulted in underestimation of rural-urban differences.
There were large rural-urban inequalities in poor SRH, self-reported functional disabilities and depression that were closely related to rural-urban differences in educational level and income. Key words : China; depression; functional ability; health inequalities; household registration system; older adults; rural-urban; self-rated health; social determinants of health