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Background Urban-rural disparity in mortality at older ages is well documented in China. However, surprisingly few studies have systemically investigated factors that contribute to such disparity. This study examined the extent to which individual-level socioeconomic conditions, family/social support, health behaviors, and baseline health status contributed to the urban-rural difference in mortality among older adults in China. Methods This research used the five waves of the Chinese Longitudinal Healthy Longevity Survey from 2002 to 2014, a nationally representative sample of older adults aged 65 years or older in China (n = 28,235). A series of hazard regression models by gender and age group examined the association between urban-rural residence and mortality and how this association was modified by a wide range of individual-level factors. Results Older adults in urban areas had 11% (relative hazard ratio (HR) = 0.89, p p p p > 0.10) after adjusting for individual socioeconomic factors. Similar results were found in women and men, and among the young-old and the oldest-old populations. Conclusions The urban-rural disparity in mortality among older adults in China was largely attributable to differences in individual socioeconomic resources (i.e., education, income, and access to healthcare) regardless of gender and age group.

Background Adequate access to healthcare is associated with lower risks of mortality at older ages. However, it is largely unknown how many more years of life can be attributed to having adequate access to healthcare compared with having inadequate access to healthcare. Method A nationwide longitudinal survey of 27,794 older adults aged 65+ in mainland China from 2002 to 2014 was used for analysis. Multivariate hazard models and life table techniques were used to estimate differences in life expectancy associated with self-reported access to healthcare (adequate vs. inadequate). The findings were assessed after adjusting for a wide range of demographic factors, socioeconomic status, family/social support, health practices, and health conditions. Results At age 65, adequate access to healthcare increased life expectancy by approximately 2.0–2.5 years in men and women and across urban-rural areas compared with those who reported inadequate access to healthcare. At age 85, the corresponding increase in life expectancy was 1.0–1.2 years. After adjustment for multiple confounding factors, the increase in life expectancy was reduced to approximately 1.1–1.5 years at age 65 and 0.6–0.8 years at age 85. In women, the net increase in life expectancy attributable to adequate access to healthcare was 6 and 8% at ages 65 and 85, respectively. In men, the net increases in life expectancy were generally greater (10 and 14%) and consistent after covariate adjustments. In contrast, the increase in life expectancy was slightly lower in rural areas (2.0 years at age 65 and 1.0 years at age 85) than in urban areas (2.1 years at age 65 and 1.1 years age 85) when no confounding factors were taken into account. However, the increase in life expectancy was greater in rural areas (1.0 years at age 65 and 0.6 years at age 85) than in urban areas (0.4 years at age 65 and 0.2 years at age 85) after accounting for socioeconomic and other factors. Conclusions Adequate access to healthcare was associated with longer life expectancy among older adults in China. These findings have important implications for efforts to improve access to healthcare among older populations in China.

Background Studies have shown that inadequate access to healthcare is associated with lower levels of health and well-being in older adults. Studies have also shown significant urban-rural differences in access to healthcare in developing countries such as China. However, there is limited evidence of whether the association between access to healthcare and health outcomes differs by urban-rural residence at older ages in China. Methods Four waves of data (2005, 2008/2009, 2011/2012, and 2014) from the largest national longitudinal survey of adults aged 65 and older in mainland China (n = 26,604) were used for analysis. The association between inadequate access to healthcare (y/n) and multiple health outcomes were examined—including instrumental activities of daily living (IADL) disability, ADL disability, cognitive impairment, and all-cause mortality. A series of multivariate models were used to obtain robust estimates and to account for various covariates associated with access to healthcare and/or health outcomes. All models were stratified by urban-rural residence. Results Inadequate access to healthcare was significantly higher among older adults in rural areas than in urban areas (9.1% vs. 5.4%; p

Background Self-perception of uselessness is associated with increased mortality risk in older adults. However, it is unknown whether and to what extent changes in perceived uselessness are associated with mortality risk. Methods Using four waves of national longitudinal data of older adults from China (2005, 2008, 2011, and 2014), this study examines the association between changes in perceived uselessness and risk of subsequent mortality. Perceived uselessness is classified into three major categories: high levels (always/often), moderate levels (sometimes), and low levels (seldom/never). Five categories are used to measure change over three-year intervals: (1) persistently high levels, (2) increases to moderate/high levels, (3) persistent moderate levels, (4) decreases to moderate/low levels, and (5) persistently low levels. Cox proportional hazard models were used to estimate mortality risk associated with changes in levels of perceived uselessness. Results Compared to those with persistently low levels of perceived uselessness, those with persistently high levels of feeling useless had 80% increased hazard ratio (HR) in mortality [HR =1.80, 95% CIs: 1.57–2.08, p