Urban-rural Disparities in the Healthy Ageing Trajectory in China: a Population-based Study

Purpose: The aim of this study is to measure the trajectory of healthy ageing among Chinese middle-aged and older population, and explore the disparity of the trajectory, as well as contributing factors, between urban and rural areas in China.

Methods: A total of 9402 respondents aged 45 years and older interviewed in four waves (2011, 2013, 2015 and 2018) were selected from the China Health and Retirement Longitudinal Study. Healthy ageing score was calculated through item response theory. 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 further to explore associated factors in rural and urban areas separately.

Results: The healthy ageing score was lower in rural areas than urban areas in each survey wave. Five classes ("continuing-low", "continuing-middle", "continuing-middle-to-high", "significantly-declining", "continuing-high") were grouped through LGMM. The MLRM results showed that urban living was significantly associated with a higher likelihood of being healthy (for [continuing-low/continuing-high]: β = - 1.17, RRR = 0.31, P < 0.001, 95% CI = 0.18-0.53; and for [continuing-middle/continuing-high]: β = - 0.53, RRR = 0.59, P < 0.001, 95% CI = 0.49-0.71).

Conclusion: Healthy ageing is a prominent objective in the development of a country, and rural-urban disparities are an essential obstacle to overcome, with the rural population more likely to develop a low level of healthy ageing trajectory. Prevention and standardized management of chronic diseases should be enhanced, and social participation should be encouraged to promote healthy ageing. The policy inclination and resource investment should be enhanced to reduce disparity in healthy ageing between urban and rural areas in China.