Background
The aging population, including octogenarians (aged 80–89) and nonagenarians (aged 90–99), is rapidly increasing. Understanding their self-rated health in urban and rural settings is vital for public health policy development. This study examined factors associated with self-rated health among octogenarians and nonagenarians across urban and rural areas of South Korea.
Methods
We analyzed data from 21,896 older adults (aged 80–99) from the 2023 Korea Community Health Survey. Self-rated health was assessed on a 5-point scale and categorized as “good” or “poor.” Variables included age, residence area (urban/rural), sociodemographic characteristics, health behaviors, healthcare utilization, morbidity, and social interactions. Descriptive statistics were used to examine variable distributions, and logistic regression models identified factors associated with self-rated health in each age group and residential area.
Results
Among octogenarians, 18.7% in urban areas reported good self-rated health, compared to 15.0% in rural areas. Conversely, a smaller proportion of nonagenarians in urban areas (13.6%) reported good self-rated health than those in rural areas (14.7%). Among octogenarians, having a high school education or higher was associated with better self-rated health compared to those with no formal education (urban OR = 1.67, 95% CI = 1.39–2.00; rural OR = 1.67, 95% CI = 1.30–2.14). Furthermore, a monthly household income of 3 million Korean Won (KRW) or more, compared to an income of less than 1 million KRW, was associated with better self-rated health among octogenarians (urban OR = 1.35, 95% CI = 1.09–1.66; rural OR = 1.54, 95% CI = 1.19–2.00). The associations between educational level and self-rated health were less pronounced among nonagenarians. Consistently across both age groups and settings, regular walking (OR range: 1.39 [95% CI = 1.21–1.60] for rural octogenarians to 2.17 [95% CI = 1.78–2.64] for urban nonagenarians), good self-rated oral health (OR range: 2.51 [95% CI = 1.96–3.22] for urban nonagenarians to 3.51 [95% CI = 3.01–4.09] for rural octogenarians), and participation in social activities (OR range: 1.23 [95% CI = 1.09–1.41] for urban octogenarians to 1.58 [95% CI = 1.20–2.07] for rural octogenarians) were positively associated with good self-rated health.
Conclusions
Characteristics associated with self-rated health differed significantly between octogenarians and nonagenarians in rural and urban areas. Public health strategies must support health-promoting behaviors such as regular walking, enhance oral health services, improve healthcare accessibility, reduce environmental stressors, and strengthen social support networks to promote health among octogenarians and nonagenarians.