Rural-Urban Inequalities in Poor Self-Rated Health, Self-Reported Functional Disabilities, and Depression among Chinese Older Adults: Evidence from the China Health and Retirement Longitudinal Study 2011 and 2015.

The household registration system (Hukou) in China classifies persons into rural or urban citizens and determines eligibility for state-provided services and welfare. Not taking actual residence into account may underestimate rural-urban differences. This study investigates rural-urban inequalities in self-reported health outcomes among older adults aged 60+, taking into account both Hukou and actual residence, adjusting for sociodemographic determinants, based on the China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 2015. Self-Rated Health (SRH) was assessed with a single question, functional abilities were assessed with the Basic Activities of Daily Living (BADLs) and Instrumental Activities of Daily Living (IADLs) scales, and depression was assessed with the 10-item version of the Center for Epidemiologic Studies Depression Scale. Rural respondents had poorer socioeconomic status and higher prevalence of poor SRH, functional disabilities, and depression than urban respondents in both years, which were closely related to rural-urban differences in educational level and income. Impairments appeared at a younger age among rural respondents. Analyses using only Hukou registration and not actual residence resulted in underestimation of rural-urban differences. This study may serve as a basis for interventions to address rural-urban differences in health and social services and reduce health inequalities among Chinese older adults.