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Background <p>The growing population of older adults in China has drawn attention to the significant disparities in health resources and overall health status exist between urban and rural older adults. Intrinsic capacity (IC), a key indicator of comprehensive health levels in older adults, plays a crucial role in achieving healthy aging. This study aimed to systematically evaluate the inequality in IC among Chinese older adults from an urban-rural divide perspective, identify the factors influencing these inequalities, and decompose the sources of inequality.</p> Methods <p>On the basis of data from the China Health and Retirement Longitudinal Study (CHARLS), 7,695 adults aged 60 years and above were included. Concentration curves and concentration index (CI) were used to measure economic-related inequality in IC. Using the Dahlgren–Whitehead model of social determinants of health, generalized estimating equations (GEEs) were applied to analyze factors influencing IC among urban and rural older adults. Wagstaff’s decomposition method was further employed to decompose the CI.</p> Results <p>A pro-rich inequality in IC (CI &gt; 0) was observed among both urban and rural older adults, with a higher degree of inequality in urban areas that continued to widen over time. In 2013, age was the largest contributor to inequality in rural areas (contribution to CI: 27.55%), while social activity was the main contributor in urban areas (contribution to CI: 26.02%). By 2015, social activity had become the primary contributor in both rural (contribution to CI: 22.69%) and urban (contribution to CI: 28.91%) areas. Multivariate analysis showed that increased age, higher Instrumental Activities of Daily Living (IADL)/Activities of Daily Living (ADL) scores, and the presence of chronic diseases were associated with lower IC, whereas longer sleep duration, more social activities, higher education levels, and improved green coverage in built-up areas were associated with higher IC. Having more children was positively associated with IC only among urban older adults, while being married and engaging in exercise were positively associated with IC only among rural older adults.</p> Conclusion <p>Chinese older adults showed inequality in IC, with more pronounced inequality in urban areas. Social activity and age are major contributing factors. Interventions such as promoting social participation, optimizing environmental resources, and implementing tailored urban-rural health policies are recommended to mitigate IC inequality and advance health equity.</p>

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Measuring and decomposing inequalities in intrinsic capacity among older adults in china: from an urban-rural divide perspective

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月29日

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  • Tian Zheng,
  • Li Chenyang,
  • Liu Shangjun,
  • Xiao Shuqin,
  • Dai Jiaqi,
  • Zhang Yanyan,
  • Jing Liwei

摘要

Background

The growing population of older adults in China has drawn attention to the significant disparities in health resources and overall health status exist between urban and rural older adults. Intrinsic capacity (IC), a key indicator of comprehensive health levels in older adults, plays a crucial role in achieving healthy aging. This study aimed to systematically evaluate the inequality in IC among Chinese older adults from an urban-rural divide perspective, identify the factors influencing these inequalities, and decompose the sources of inequality.

Methods

On the basis of data from the China Health and Retirement Longitudinal Study (CHARLS), 7,695 adults aged 60 years and above were included. Concentration curves and concentration index (CI) were used to measure economic-related inequality in IC. Using the Dahlgren–Whitehead model of social determinants of health, generalized estimating equations (GEEs) were applied to analyze factors influencing IC among urban and rural older adults. Wagstaff’s decomposition method was further employed to decompose the CI.

Results

A pro-rich inequality in IC (CI > 0) was observed among both urban and rural older adults, with a higher degree of inequality in urban areas that continued to widen over time. In 2013, age was the largest contributor to inequality in rural areas (contribution to CI: 27.55%), while social activity was the main contributor in urban areas (contribution to CI: 26.02%). By 2015, social activity had become the primary contributor in both rural (contribution to CI: 22.69%) and urban (contribution to CI: 28.91%) areas. Multivariate analysis showed that increased age, higher Instrumental Activities of Daily Living (IADL)/Activities of Daily Living (ADL) scores, and the presence of chronic diseases were associated with lower IC, whereas longer sleep duration, more social activities, higher education levels, and improved green coverage in built-up areas were associated with higher IC. Having more children was positively associated with IC only among urban older adults, while being married and engaging in exercise were positively associated with IC only among rural older adults.

Conclusion

Chinese older adults showed inequality in IC, with more pronounced inequality in urban areas. Social activity and age are major contributing factors. Interventions such as promoting social participation, optimizing environmental resources, and implementing tailored urban-rural health policies are recommended to mitigate IC inequality and advance health equity.