Urban-rural disparities in the healthy aging trajectory in China: a population-based study

Abstract

Purpose: The aim of this study is to explore the differences and evaluate the equity in healthy aging trajectories between urban and rural areas in China. The hypothesis of this study is that there are differences in healthy aging trends between urban and rural areas, with inequity. Methods: A total of 9402 respondents aged 45 years and older interviewed in four waves were selected from the China Health and Retirement Longitudinal Study. A latent growth mixture model (LGMM) was applied to distinguish the trajectory of healthy aging. A multinomial logistics regression model (MLRM) was used to explore the relationship between urban-rural areas and healthy aging trajectories, and a concentration index was used to evaluate equity. Results: Urban-rural respondents differed in socioeconomic background, family characteristics, and personal lifestyle ( P < 0.05). Three classes (“low risk”, “middle risk”, and “high risk”) were grouped through LGMM. The MLRM results showed that urban living was significantly associated with a healthy aging trajectory (for [middle risk/low risk]: β=-0.41, RRR =0.66, P < 0.001, 95% CI =0.55–0.80, and for [high risk/low risk]: β=-1.10, RRR =0.33, P < 0.001, 95% CI =0.26–0.41). The concentration index was -0.022 and significantly indicated the inequity of healthy aging between rural and urban areas. Conclusion: Combined health status showed an irreversible downward trend with age, and this trajectory differed between urban and rural areas, with the rural population more likely to develop a high risk trajectory. Policy inclination and resource investment should be enhanced to reduce inequity in healthy aging between urban and rural areas in China.