Urban Versus Rural Mortality Among Older Adults in China

Urban versus rural place of residence has proven to be a critical health determinant over time and across countries. Several studies have demonstrated an urban advantage in mortality in China. This variation by place of residence could be a function of differences in characteristics of individuals, differences in urban and rural communities, or a combination of individual and community factors. Population aging, coupled with a growing distinction between urban and rural life, is creating some urgency in the effort to determine the magnitude of the urban advantage among older adults and to ascertain the mechanisms responsible for the association. Using data from the China Health and Nutrition Survey, with additional information from the 2000 Chinese Census, the current study examines urban/rural variation in mortality of adults aged 50 and older. The analysis describes differences in mortality and examines the extent to which variations are accounted for by socioeconomic and health-access and health-availability characteristics that are measured at individual and community levels. Age-specific mortality rates across regions and Cox proportional hazard model ratios are provided using mortality data from 1989 to 2000. Results show unadjusted rural mortality to be 30 percent higher than urban mortality. Adjusting for cadre status and number of amenities within the community reduces the difference to about 18 percent, so that these two covariates account for about 40 percent of the baseline urban advantage. 3 This paper investigates variations in the mortality of older adults across urban and rural areas of China. Urban versus rural place of residence is a critical health determinant; it has been found to distinguish the health experiences of individuals throughout history. Urban/rural residence may be a particularly important determinant in China in light of rapid population aging and widening social and economic disparities between urban and rural areas. These forces have implications for policy because they can alter the balance of formal and informal health-care needs across geographical areas and across age groups. Population aging, which is occurring at an unprecedented rate in China and in other countries in East Asia, results in a greater majority of health problems and mortality occurring at older ages. This aging lends urgency to the effort to ascertain the determinants of health among older adults, the magnitude the urban advantage, and the mechanisms responsible for the association, all important elements in the provision and planning of health care. This analysis describes an urban advantage in older-adult …