Accounting for urban versus rural discrepancies in mortality and functional health among older adults in China

Broad differences exist in social and economic life between residents living in urban versus rural areas of China. To study the health implications of these differences, the current study employs data from a longitudinal study of older adults in the Beijing municipality, a region of China that has witnessed very rapid socio-economic growth coupled with widening rural/urban gaps in development and health service provision. Life expectancy and active life expectancy, the latter referring to expected years in a functionally healthy state, is estimated for rural and urban samples in a two-step process that involves first, the estimation of hazard rates considering transitions in functional health and mortality and next, the conversion of these rates into transition probabilities for the construction of multi-state life-tables. Estimates reveal a distinct urban advantage in both mortality and functional health. At age 55, urban elders live about 4½ years longer and 5½ more functionally active years than do their rural counterparts, and an advantage is maintained with increasing age. Covariates representing five domains are considered to determine factors that underlie the urban advantage. Socioeconomic status and access to health service indicators account for a good deal of the association, social support and health behaviors account for very little, while chronic disease acts as a suppressor. The results have obvious policy implications regarding the need for increasing education, better work opportunities, wider insurance coverage and easier access to health facilities for rural residents of China.