Background <p>Anxiety is a severe global health problem. The long-established urban-rural dichotomy in China has led to unequal development in rural and urban areas, which may result in significant differences in the anxiety of rural and urban China. However, a comprehensive nationwide study exploring such disparities among Chinese adults remains lacking.</p> Methods <p>The study extracted 27875 Chinese adults from the Psychology and Behaviour Investigation of Chinese Residents in 2022. The study utilized generalized linear regression analysis to explore the factors associated with Chinese adults’ anxiety in urban and rural areas. Further, we used the Blinder-Oaxaca decomposition to analyze the role of explanatory factors in urban-rural disparities in anxiety among Chinese adults.</p> Results <p>The median anxiety score among rural adults was 5.00 (P₂₅: 1.00, P₇₅: 7.00), surpassing that among urban adults, which was 4.00 (P₂₅: 0.00, P₇₅: 7.00) (<i>P</i> &lt; 0.001). The generalized linear model showed that the differences in anxiety between rural and urban Chinese adults were reflected in intermittent fasting and marital status, career status, family per capita monthly income, age, and gender. The Blinder-Oaxaca decomposition revealed that 83.49% of the urban-rural disparities in anxiety among Chinese adults could be explained, and interpersonal network level was the most significant explanatory factor.</p> Conclusion <p>The prevalence of anxiety was higher in rural than in urban Chinese adults. The government should identify urban-rural disparities’ explanatory factors to target precise intervention strategies, thereby narrowing the mental health differences between rural and urban.</p>