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Exploring the association between urbanisation and self-rated health of older adults in China: evidence from a national population sample survey

Exploring the association between urbanisation and self-rated health of older adults in China: evidence from a national population sample survey
Exploring the association between urbanisation and self-rated health of older adults in China: evidence from a national population sample survey
Objectives: this study investigated the association between urbanisation and self-rated health of older adults in China, particularly how different dimensions, rate and level of urbanisation are related to older people’s health. Additionally, it examined the moderating effect of education on the association between each of the four dimensions of urbanisation and older people’s health.

Design: the study uses a cross-sectional survey design.

Participants: this study analysed 236 030 individuals (aged 60–79 years) nested within 267 prefecture-level cities from 2005 China’s 1% population sample survey.

Outcome measures: self-rated health was the outcome variable. Four groups of predictors assessed prefectures’ level and rate of urbanisation: land-use conversion, economic growth, population concentration and health services. Multilevel logistic regression was used to examine the association between self-rated health and the level and rate of urbanisation, after adjusting for individual-level covariates. Multiplicative interactions explored variations by education.

Results: the odd of reporting fair or poor health was negatively associated with the level and rate of population concentration (OR 0.93,95%CI 0.87 to 0.99 and 0.74,95%CI 0.59 to 0.93, respectively) and positively associated with the level of health services (OR 1.12, 95% CI 1.06 to 1.19). Land-use conversion, economic growth and health service improvements (the forms of rate of urbanisation) were not significantly associated with self-rated health. Education had a moderating effect on the association between urbanisation and self-rated health.

Conclusions: older people living in more densely populated areas and areas undergoing rapid population concentration were less likely to report fair or poor health. This result supports healthy migration and ‘salmon bias’ hypotheses. No urban health penalty was observed for the older adults in China; therefore, the following pathways linking urbanisation to health are unclear: lifestyle changes, environmental pollution and cultivated land reduction.
2044-6055
Liu, Ye
b8f0aad7-cbbf-4b87-b69e-c271a582c172
Huang, Baishi
56b2f4fe-3201-4bcc-890c-36f2464735fd
Wang, Ruoyu
87337ca7-1c03-4c1c-a6b5-3dbf54d390ad
Feng, Zhixin
33c0073f-a67c-4d8a-9fea-5a502420e589
Liu, Yuqi
6ff85ab0-d7f9-416c-9961-d4754ed9c09d
Li, Zhigang
096004a8-6630-4fdb-8d0f-c51239ebc80a
Liu, Ye
b8f0aad7-cbbf-4b87-b69e-c271a582c172
Huang, Baishi
56b2f4fe-3201-4bcc-890c-36f2464735fd
Wang, Ruoyu
87337ca7-1c03-4c1c-a6b5-3dbf54d390ad
Feng, Zhixin
33c0073f-a67c-4d8a-9fea-5a502420e589
Liu, Yuqi
6ff85ab0-d7f9-416c-9961-d4754ed9c09d
Li, Zhigang
096004a8-6630-4fdb-8d0f-c51239ebc80a

Liu, Ye, Huang, Baishi, Wang, Ruoyu, Feng, Zhixin, Liu, Yuqi and Li, Zhigang (2019) Exploring the association between urbanisation and self-rated health of older adults in China: evidence from a national population sample survey. BMJ Open, 9 (6). (doi:10.1136/bmjopen-2019-029176).

Record type: Article

Abstract

Objectives: this study investigated the association between urbanisation and self-rated health of older adults in China, particularly how different dimensions, rate and level of urbanisation are related to older people’s health. Additionally, it examined the moderating effect of education on the association between each of the four dimensions of urbanisation and older people’s health.

Design: the study uses a cross-sectional survey design.

Participants: this study analysed 236 030 individuals (aged 60–79 years) nested within 267 prefecture-level cities from 2005 China’s 1% population sample survey.

Outcome measures: self-rated health was the outcome variable. Four groups of predictors assessed prefectures’ level and rate of urbanisation: land-use conversion, economic growth, population concentration and health services. Multilevel logistic regression was used to examine the association between self-rated health and the level and rate of urbanisation, after adjusting for individual-level covariates. Multiplicative interactions explored variations by education.

Results: the odd of reporting fair or poor health was negatively associated with the level and rate of population concentration (OR 0.93,95%CI 0.87 to 0.99 and 0.74,95%CI 0.59 to 0.93, respectively) and positively associated with the level of health services (OR 1.12, 95% CI 1.06 to 1.19). Land-use conversion, economic growth and health service improvements (the forms of rate of urbanisation) were not significantly associated with self-rated health. Education had a moderating effect on the association between urbanisation and self-rated health.

Conclusions: older people living in more densely populated areas and areas undergoing rapid population concentration were less likely to report fair or poor health. This result supports healthy migration and ‘salmon bias’ hypotheses. No urban health penalty was observed for the older adults in China; therefore, the following pathways linking urbanisation to health are unclear: lifestyle changes, environmental pollution and cultivated land reduction.

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Accepted/In Press date: 30 May 2019
Published date: 24 June 2019

Identifiers

Local EPrints ID: 432189
URI: http://eprints.soton.ac.uk/id/eprint/432189
ISSN: 2044-6055
PURE UUID: 7ebf9ca8-6969-4c4c-ae13-fd09d5f7bbe2

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Date deposited: 03 Jul 2019 16:30
Last modified: 16 Dec 2019 17:35

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