Rural-urban inequalities in poor self-rated health, functional disabilities and depression among Chinese older adults: Evidence from the China Health and Retirement Longitudinal Study 2011 and 2015

Abstract

Background: The demand for healthcare and social services increases with the aging of the population and functional disabilities among older adults. Rural-urban inequalities in health have not been extensively studied previously from the national perspective, especially after classifying the effects of Hukou (household registration system in China) and residence. This study investigates rural-urban inequalities in prevalence of poor self-rated health, functional disabilities and self-reported depression among Chinese older adults and analyses determinants of rural-urban inequalities in self-reported health outcomes. Methods: The data originate from the China Health and Retirement Longitudinal Study (CHARLS), which started in 2011 and collects data every two years, a representative sample in 28 provinces in China. Older adults aged 60 years and above in CHARLS 2011 and CHARLS 2015 were studied. Sociodemographic factors were studied, including age, sex, marital status, living arrangement, living near children, educational level and income. 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. Results: Rural respondents had poor 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 were 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. Living arrangement and living near children did not have significant impacts on health outcomes. Conclusions: Rural-urban inequalities in poor SRH, functional disabilities and depression were mainly related to educational level and income.

The relationship between home and community-based healthcare service utilization and depressive symptoms in older adults in rural China: A moderated mediation model

“…low income and poor personal health status). [11][12][13]. Compared to basic activities of daily living (BADL), IADL, such as laundry, cooking, managing money, housekeeping, and transportation, is a more elaborate indicator of the competencies that rural older adults can utilize HCBHS and live in the community independently and socially [14][15][16], and higher IADL scores indicate higher risk of late-life depression [17,18].…”