A pro-rich inequality in (IC) was observed among 7,695 older adults in China, with urban areas experiencing a higher degree of inequality.
The degree of inequality in IC among older adults has been widening over time, particularly in urban areas.
In rural areas, age was the largest contributor to IC inequality in 2013, while social activity became the main contributor by 2015.
Social activity contributed to IC inequality in both urban and rural areas by 2015, with contributions of 28.91% in urban and 22.69% in rural areas.
Factors associated with lower IC included increased age, higher scores in daily living activities, and the presence of chronic diseases.
Conversely, higher IC was associated with longer sleep duration, increased social activities, higher education levels, and improved green space.
In urban areas, having more children was positively associated with IC, while being married and exercising were only positively associated in rural areas.
Simplified
BACKGROUND: The growing population of older adults in China has drawn attention to the significant disparities in health resources and overall health status exist between urban and rural older adults. (IC), a key indicator of comprehensive health levels in older adults, plays a crucial role in achieving healthy aging. This study aimed to systematically evaluate the inequality in IC among Chinese older adults from an urban-rural divide perspective, identify the factors influencing these inequalities, and decompose the sources of inequality.
METHODS: On the basis of data from the China Health and Retirement Longitudinal Study (CHARLS), 7,695 adults aged 60 years and above were included. Concentration curves and concentration index (CI) were used to measure economic-related inequality in IC. Using the Dahlgren-Whitehead model of social determinants of health, generalized estimating equations (GEEs) were applied to analyze factors influencing IC among urban and rural older adults. Wagstaff's decomposition method was further employed to decompose the CI.
RESULTS: A pro-rich inequality in IC (CI > 0) was observed among both urban and rural older adults, with a higher degree of inequality in urban areas that continued to widen over time. In 2013, age was the largest contributor to inequality in rural areas (contribution to CI: 27.55%), while social activity was the main contributor in urban areas (contribution to CI: 26.02%). By 2015, social activity had become the primary contributor in both rural (contribution to CI: 22.69%) and urban (contribution to CI: 28.91%) areas. Multivariate analysis showed that increased age, higher Instrumental Activities of Daily Living (IADL)/Activities of Daily Living (ADL) scores, and the presence of chronic diseases were associated with lower IC, whereas longer sleep duration, more social activities, higher education levels, and improved green coverage in built-up areas were associated with higher IC. Having more children was positively associated with IC only among urban older adults, while being married and engaging in exercise were positively associated with IC only among rural older adults.
CONCLUSION: Chinese older adults showed inequality in IC, with more pronounced inequality in urban areas. Social activity and age are major contributing factors. Interventions such as promoting social participation, optimizing environmental resources, and implementing tailored urban-rural health policies are recommended to mitigate IC inequality and advance health equity.
Key numbers
0.0160
Concentration Index for Urban Adults
Concentration Index for urban older adults in 2015
27.55%
Age Contribution to Inequality in Rural Areas
Contribution to inequality in rural areas in 2013
28.91%
Social Activity Contribution to Inequality in Urban Areas
Contribution to inequality in urban areas in 2015
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Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: CHARLS was approved by the Biomedical Ethics Review Committee of Peking University, and the ethical approval number was IRB00001052-11015.procedures were in accordance with the ethical standards of the Helsinki Declaration. Participants provided informed consent before data collection. Consent for publication: Not applicable. Declaration of Generative AI and AI-assisted technologies in the writing process: We did not use AI at all during the writing process.
