Association of Urbanization with Psychological Well-Being in Chinese Adults Aged 50 Years and Older: A Population-Based Study

Abstract

Background China has undergone unprecedented urbanization in the past decades, with this rapid urbanization having profound and lasting impacts on human well-being. The aim of this study was to examine the association between urbanization and psychological well-being (PWB) in China. Methods Data was obtained from the 2015 China Health and Nutrition Survey and included 3,071 men and 3,385 women aged 50 years or older who lived in 288 communities across 12 provinces and municipalities. The urbanization index, summarizing 12 urbanization dimensions at community level, was categorized into tertiles representing low, medium and high levels of urbanization. PWB was assessed by scoring three self-reported questions. Gender-stratified multilevel analyses (level-1, individuals; level-2, communities; level-3: provinces/municipalities) were used to estimate the association between exposure to urbanization and PWB. Results The urbanization index was associated positively with PWB in middle-aged and elderly people after controlling for individual-level factors, with the association being stronger in women than in men. More specifically, an increase of one standard deviation in the score of community population density, economic activity, housing, education, sanitation, and diversity were associated significantly with PWB in both genders after adjustment for individual-level factors. In addition, the increase in the score of community communications, social services, transportation, and modern markets were also associated significantly with PWB in women, but not in men. Conclusions Urbanization has, on average, had an independent and positive effect on PWB in middle-aged and elderly Chinese populations, with many components of urbanization being separately and positively associated with PWB, especially in women. These findings provide novel insights for decision-makers on how to equitably allocate public resources to improve human well-being in the face of rapid urbanization.