An examination of urban versus rural mortality in China using community and individual data.

OBJECTIVE Urban/rural residence is a critical health determinant and one researchers have historically found to distinguish health experiences. In this study, we investigated variations in older adult mortality across urban and rural areas of China and assessed mechanisms driving an urban advantage through a series of socioeconomic and health service covariates measured at individual and community levels. METHODS We employed 15 years of mortality data from the China Health and Nutrition Survey. We calculated average annual age-specific death rates and used combinations of covariates to examine Cox proportional hazards models. We employed the 2000 Chinese Census and the 2002 Demographic Yearbook descriptively to assess reliability and provide an alternative source for mortality variation. RESULT Hazard ratios and standardized death rates showed rural mortality to be about 30% higher than urban mortality. Cadre status, amenities within the community, and average wage within the community are important determinants of mortality, and adjusting for these covariates reduced the urban advantage. DISCUSSION There is great differentiation in economic and social life between urban and rural China, and this appears to be negatively influencing survival chances of older adults in rural areas. The policy implications are fairly clear: Investment in rural China is needed to reduce health inequalities.