Rural-urban disparities in healthy ageing: Evidence from a national study in China

Background: The Chinese government has adopted the WHO healthy ageing framework to guide the development of services and initiatives to promote older people's health. Aim: To examine the rural-urban disparities within the WHO healthy ageing domains of functional ability. Methods: A secondary data analysis was conducted using a nationally representative survey from China Health and Retirement Longitudinal Study (CHARLS). Results: A total number of 10,746 older people were included, with the mean age of 69.10 years (SD = 7.15). More than 70% of older people lived in rural areas. Significant differences existed in all five domains of functional ability between rural and urban-dwelling older people, particularly in their ability to meet basic needs and in achieving psychosocial wellbeing. Urban respondents reported better self-perceived health status (2.95 ± 0.97) and had less functional difficulties. Rural respondents were more likely to have difficulties in making decisions for grocery shopping, taking medications and in managing finances (p < 0.001). Older people in urban areas were more supported with health insurance (97.4%) and retirement pension (57.3%) than rural residents, where only 554 (7.1%) received retirement pension (p < 0.001). In terms of contributing to society, urban respondents were more likely to participate in voluntary work, providing assistance to others, and were caregivers of individuals with disabilities than rural respondents (all p < 0.001). Conclusions: The rural-urban disparities in healthy ageing were prevalent in China. Further research and consideration toward health resource reallocation are needed to improve functional abilities of older people in rural areas. Summary of Relevance Problem: Little is known about the rural-urban differences on the healthy ageing domains of functional ability among older people in China. What is Already Known: Essential needs of older Chinese were largely unmet in rural areas when policies favoured the urban areas. What this Paper Adds: Older Chinese people living in rural areas were less likely to fulfil all five healthy ageing domains of functional ability. The self-perceived poor health status, difficulties in mobility and abilities to learn, grow and make decisions, the lack of retirement pension support, and limited chance of contributing to society should be recognised and be addressed in the provision of nursing and healthcare services.