Urban health advantage or urban health penalty? Urban-rural disparities in age trajectories of physiological health among Chinese middle-aged and older women and men

AimsUrbanization plays an important role in individuals' health. However, it is difficult to isolate healthy migrant effect between urbanization and health. This study examined the effects of urbanization on depressive symptoms and its possible pathways among Chinese middle-aged and older adults independent of the influence of health-selective migration.MethodsUsing the baseline survey of the China Health and Retirement Longitudinal Study, this study compared the depressive symptoms among three groups (urbanized rural residents, rural non-migrants and urban non-migrants). The 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) short form was used to measure depressive symptoms. Logistic regression models and Structural Equation Model (SEM) were applied to examine the association between urbanization and depressive symptoms and the corresponding potential mechanisms.ResultsOur final sample contained 11,156 respondents with an average age of 58.91 (SD = 9.48), with 5,142 males (46.09%) and 6,014 females (53.91%). Compared with urbanized rural residents, rural residents were more likely to have depressive symptoms (OR = 1.19, 95% CI = 1.07, 1.32), and urban residents were associated with a decreased risk of depressive symptoms (OR = 0.81, 95% CI: 0.70, 0.94). A large proportion of the association between urbanization and depressive symptoms were mainly mediated by social participation, income and living conditions.ConclusionsPlanned urbanization had an independent impact on decreased depressive symptoms. Improvements in social participation, income and living conditions are the main drivers behind this relationship. Additionally, urbanization compensates for the negative impact of depressive symptoms from disadvantaged early life conditions, but it cannot eliminate the gap between urbanized rural people and urban non-migrants.

Section: Discussionmentioning

confidence: 99%

“…The health effect of urbanization is controversial (12). On the one hand, it provides protective health opportunities, especially for people with depression, such as better living conditions, infrastructure development and access to health care (13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Urbanization and depressive symptoms among middle-aged and older adults in China

Hong

Xiong²,

et al. 2022

“…Second, the results of heterogeneity analysis showed that fertility more easily affected the physical and mental health of rural women compared with urban women. In China, there are evident development disparities being addressed between rural and urban areas, including gaps in income, social security, education, and infrastructure ( 66 – 68 ). Compared with urban women, rural women may experience poorer reproductive healthcare and medical treatment.…”

Section: Discussionmentioning

confidence: 99%

Motherhood Health Penalty: Impact of Fertility on Physical and Mental Health of Chinese Women of Childbearing Age

Yao

Yang

2022

BackgroundThe negative consequences of childbearing on mothers are called the motherhood penalty, and it manifests in the aspects of women's physical and mental health. In May 2021, China relaxed its birth policy that allowed a married couple to have three children. It gives women the opportunity to have more children, but also may increase more risks to mothers' physical and mental health.ObjectivesThe objectives of this study were to clarify the relationships between the fertility and the physical/mental health of women of childbearing age and empirically confirm the existence of the motherhood health penalty in China.Materials and MethodsUsing a nationally representative dataset from the China Labor-force Dynamics Survey 2018, we examined the effects of fertility on the physical and mental health of Chinese women of childbearing age. Physical health was self-rated, and mental health was assessed according to the Center for Epidemiological Studies Depression scale. The instrumental variable approach and the models of inverse probability of treatment weighting of propensity scores and regression adjustment were employed to overcome the endogeneity between fertility and health of women.ResultsThe empirical results showed that the total number of births had significant adverse impacts on the physical and mental health of women of childbearing age, which empirically demonstrated the existence of the motherhood health penalty in China. The results of heterogeneity analysis indicated that the physical and mental health of the rural women was more easily affected by childbearing compared with that of the urban samples. In a mechanism analysis, the pathways of income and the multiple roles played by mothers were found to mediate the impacts of the total number of births on the physical and mental health of women. The robustness checks showed that the results of this study were robust.ConclusionsThe findings of this study extend the motherhood penalty to the health domain, and they have important implications for improving healthcare policy for women of childbearing age in China and other countries and regions and promoting gender equality in the healthcare field.

“…Although this social relationship may be not conducive to adherence to tobacco avoidance behavior, more developed public healthcare services and voluntary or informal organizations may help patients make right choices and learn to adopt healthy behaviors, such as medication use (13,25,26,53). However, the "urban health penalty" may also expose residents to higher stress, worsening their tobacco use (54).…”

Section: Discussionmentioning

confidence: 99%

Social Engagement and Urban–Rural Disparity in Self-Management Behaviors: Study of Middle-Aged and Older Chinese Hypertension Patients

Lü

Liu

Wang

et al. 2022

BackgroundThis study examines the effect of social engagement on urban–rural disparities in self-management behaviors (medication use, self-monitoring, physical activity, and tobacco and alcohol avoidance) among middle-aged and older Chinese patients with hypertension.MethodsData from 2011 to 2018 were extracted from the four latest waves of the China Health and Retirement Longitudinal Study. Chi-square tests and t-tests were performed to examine urban–rural gaps in self-management behaviors. Random-effects panel logit regression models were adopted to confirm the effect of social engagement on urban–rural disparity in self-management behaviors and to explore whether this effect has narrowed or widened with “bilateral flow” between urban and rural residents. A Fairlie decomposition technique was also used to calculate the extent to which social engagement reflects urban–rural disparities.ResultsThere was significant urban–rural disparity in medication use and tobacco avoidance behaviors among the sampled patients. Medication use behavior (p < 0.001) among urban middle-aged and older patients was significantly better, whereas tobacco avoidance behavior (p < 0.05) was significantly lower compared with the rural population. Social engagement significantly enlarged the urban–rural gap in tobacco avoidance behavior (p < 0.01), but significantly narrowed the urban–rural gap in medication use behavior (p < 0.001). The Fairlie decomposition revealed that ~75.000% and 29.412% of the explained urban–rural gap in tobacco avoidance and medication use, respectively, could be attributed to social engagement. The negative effect of social engagement on urban–rural disparity in medication use increased when urban residents moved to rural areas (p < 0.05).ConclusionsThe urban–rural disparities in self-management behaviors of middle-aged and older Chinese hypertensive patients were mainly manifested in medication use and tobacco avoidance behaviors. The gaps in these two behaviors partly changed with social engagement, while the migration of urban population to rural areas weakens the positive role of social engagement in narrowing the urban–rural gap in medication use behavior. The insights of this paper on social engagement and urban–rural disparity in self-management behaviors, and the effect of urban–rural migration thereof, deserve the attention of health policymakers and researchers.