Leisure activity patterns and health vulnerability among older adults in China: a nationwide analysis of urban-rural differences based on CHARLS data.

BACKGROUND: To systematically examine the associations between different leisure activity patterns and health vulnerability among older adults in China, and to explore the moderating effects of socioeconomic factors, with the aim of informing targeted interventions for healthy aging. METHODS: Data were derived from the 2018 China Health and Retirement Longitudinal Study (CHARLS). Leisure activity patterns were identified using hierarchical cluster analysis. The associations between leisure patterns and health vulnerability were analyzed using an ordered probit model, with subgroup analyses conducted to assess heterogeneity by residence, education, and income. RESULTS: Three leisure patterns were identified: entertainment-oriented (50.23%), social-oriented (41.15%), and self-improvement-oriented (8.62%). Taking the social-oriented leisure pattern as the reference, both entertainment-oriented (β=-0.109, P < 0.01) and self-improvement-oriented (β=-0.185, P < 0.01) patterns significantly reduced health vulnerability. Robustness verification, including model replacement and variable adjustment, supported the reliability of the core conclusions. Heterogeneity analysis showed that entertainment-oriented (β=-0.320, P < 0.01) and self-improvement-oriented (β=-0.319, P < 0.01) patterns significantly reduced health vulnerability among older adults in urban and suburban areas, but showed a significant risk-increasing trend in rural areas (β = 0.317, 0.319; both P < 0.01). Among groups with middle school education or above, both patterns reduced health vulnerability (β=-0.074, -0.074; both P < 0.05), while in the illiterate group, participation in these two patterns significantly increased the risk of health vulnerability (β = 0.122, 0.121; both P < 0.01). Income level showed a gradient moderating effect: the protective effect was strongest in high-income groups (entertainment-oriented β=-0.228, self-improvement-oriented β=-0.230; both P < 0.01), weakened in middle-income groups (entertainment-oriented β=-0.131, self-improvement-oriented β=-0.135; both P < 0.05), and was not significant in low-income groups (entertainment-oriented β=-0.052, self-improvement-oriented β=-0.048; both P > 0.05). CONCLUSION: Participation in recreational and self-enhancing leisure activities is associated with reduced health vulnerability among Chinese older adults. However, these benefits are moderated by urban–rural context, education, and income. Differentiated intervention strategies should be formulated for older groups with different socioeconomic characteristics.