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Urban/Rural Disparities in Health and Mortality in China
Principal Investigator: Zachary Zimmer (University of Utah)
Co-Investigators: Toshiko Kaneda (Population Reference Bureau)
Zhe Tang (Capital Medical University, Beijing, China)
Xianghua Fang (Capital Medical University, Beijing, China)
Kaiti Zhang (China Research Center on Aging, Beijing, China)
The Urban/Rural Disparities in Health and Mortality in China project was funded by a grant from the National Institutes of Health (R03 AG025729). The project began around April of 2007 and funding officially concluded around April of 2010. Unofficially, the project continues with several manuscripts still being completed.
The overall purpose was to examine levels of mortality and functional health in old-age across rural and urban environments in China and determine the extent to which differences could be explained by individual and community-level characteristics. The project utilized a number of different datasets, including the China Health and Nutrition Survey, The Sampling Survey of the Status of the Elderly in Urban and Rural China, and The Beijing Multidimensional Longitudinal Study of Aging, among others. Various types of analyses were conducted including cross-sectional, longitudinal, and multi-level. The mix of analytical techniques allowed for examination of the degree to which health experiences of urban and rural elders diverge and the relative importance of multi level factors in explaining the discrepancies.
As China continues its rapid economic development, distinctions between urban and rural life, in many ways are shaped by social, economic, and health environments, are increasing. Urban areas are witnessing expansions of modern infrastructure, private sector economic activities, and access to advanced health care. Less investment has been made in rural infrastructure and economy and particularly in health care. But, while health discrepancies between those in urban and rural areas have been documented in some parts of the world, there is often little consideration of the issue in China and other developing societies. As such, there is limited understanding of how location influences older adult health in these societies, why location matters, and how discrepancies can be reduced. The program of research pursued in this project filled the gap with respect to older adults in China. Results also have implications for other countries that, like China, are experiencing rapid population aging, increasing concentration of mortality and morbidity at old-ages, an over-representation of older adults living in rural areas, and urban/rural gaps in development
Some of the most critical findings from the project are summarized below:
- There is great differentiation in economic and social life between people living in rural and urban areas of China.
- This differentiation negatively influences the health of older adults in rural areas.
- Rural mortality is about 30% higher than urban mortality.
- Prevalence of functional limitation is higher in rural than in urban China across a number of measures of function, such as Activities of Daily Living.
- Socioeconomic differences are unmistakably part of the reason that urban elders are healthier than their rural counterparts. These differences occur on multiple levels.
- People in urban areas are advantaged by having higher levels of education and more income and wealth.
- While community-level predictors were proven to be somewhat less robust in this project, it is still the case that people get some advantage by living in urban communities that have better and more amenities.
- Other advantages that urbanites have over their rural counterparts that influence their health include: being more likely to have health insurance, having better access to medical care, and being more likely to be classified as a cadre.
- Policy implications are fairly clear: investment in people and communities in rural China is needed to reduce health inequalities.
The above findings, among others, come from the sources listed below. Links to these are provided where available:
Zachary Zimmer, Ming Wen and Toshiko Kaneda. 2010. A multi-level analysis of urban/rural and socioeconomic differences in functional health status transition among older Chinese. Social Science and Medicine. 71(3): 559-567. (PMCID: PMC2904335).
Zachary Zimmer, Toshiko Kaneda, Zhe Tang and Xianghua Fang. 2010. Explaining late life urban vs. rural health discrepancies in Beijing. Social Forces. 88(4): 1885:1908.
Toshiko Keneda, Zachary Zimmer, Zhe Tang and Xianghua Fang. 2009. Gender Differences in Functional Health and Mortality among the Chinese Elderly: Testing an Exposure versus Vulnerability Hypothesis. Research on Aging. 21(3):361-388.
Zachary Zimmer, Toshiko Kaneda and Laura Spess. 2007. An examination of urban versus rural mortality in China using community and individual level data. Journal of Gerontology: Social Sciences. 62(5): 349-357.
Conference Presentations: (available by request to author)
Toshiko Kaneda, Zachary Zimmer and Kaiti Zhang. Disabiltiy among urban and rural elderly in China: Explaining disparities using individual – and community – level characteristics. The Annual Meetings of the Population Association of America. Dallas, TX, USA, April 15, 2010.
Zachary Zimmer, Ming Wen and Toshiko Kaneda. A multi-level analysis of urban versus rural differences in functional status transition among older Chinese. Annual Meeting of REVES (The International Network on Health Expectancy and the Disability Process). Copenhagen, Denmark, May 29, 2009.
Toshiko Kaneda, Zachary Zimmer and Kaiti Zhang. Understanding the urban-rural health disparity among the Chinese elderly. The U.S. and China: Parallel Challenges in Health Care. Salt Lake City, UT, USA, December 4, 2008.
Toshiko Kaneda, Zachary Zimmer, Xinghua Fang and Zhe Tang. Gender differences in functional health and mortality among Chinese elderly. (Winner of best poster award.) The Annual Meetings of the Population Association of America. New Orleans, LA, USA, April 19, 2008.
Toshiko Kaneda and Zachary Zimmer. Explaining the Urban-Rural Divergence in Disability among Older Chinese Using a Large Scale National Dataset. Institute of Public and International Affairs Working Paper Series. Salt Lake City, Utah: IPIA, University of Utah. Link: www.ipia.utah.edu/workingpapers/2010_4_19.pdf
Zachary Zimmer. Late life urban versus rural health discrepancies in China's Beijing Municipality: An active life expectancy approach. College of Population Studies, University of North Carolina at Chappell Hill. April 17, 2009.
Zachary Zimmer. Urban versus rural mortality among older adults in China. College of Social and Behavioral Science Advisory Committee, University of Utah. April 13, 2007.