Page 11 - IJPS-3-1

Gu D, Feng Q, Sautter JM and Qiu L

1.2.2 China’s Urbanization Process
China has been experiencing a rapid process of urbanization in the last several decades,
with the urban proportion of the population increasing from 13% in the early 1950s
(United Nations, 2014) to 20% in 1982 (National Bureau of Statistics of China (NBSC),
1984) and to more than 55% in 2015 (NBSC, 2016). Of the more than 670 million
Chinese currently living in urban areas, 225 million were rural-to-urban migrants
(typically known as migrant workers or floating population in the Chinese literature)
(NBSC, 2012). According to China’s national plan (State of Council of People’s
Republic of China, 2014) and the projection made by the United Nations (United
Nations, 2014), another 250 million rural residents are expected to move to urban
areas or be locally urbanized in the next several decades. This massive rural to urban
population movement in China is unprecedented (Johnson, 2013), and will impose
great challenges on the public health system. The trajectory of China’s urbanization
process provides a good sample to study the relations between exposure to urban
environments and health in late-life.
1.2.3 Health of Rural-to-Urban Migrants
In China, rural-to-urban migrants are often found to be advantaged in self-rated
health, mental health, acute illnesses, and disabilities in comparison with native rural
residents (origin) and native urban residents (destination) (Chen, 2011; 2013; Hu,
Cook and Salazar, 2008; Lu and Qin, 2014; Tong and Piotrowski, 2012; Xu, Dupre,
Gu, et al., 2017; Xu, Luo and Wu, 2015). However, these migrants often experienced
stressful life events, such as loneliness because of separation from family (Lu, Hu
and Treiman, 2012) and exclusion from access to social welfare, health insurance,
and unemployment benefits in destination cities (Lee and Meng, 2010; Gu, Zhu and
Wen, 2015), which in turn affected their health negatively (Gu, Zhu and Wen, 2015;
Shankar, Hamer, McMunn, et al., 2013). Younger rural-to-urban migrants tend to be
economically driven, but late-life migration in China could be due to health purposes,
grandparenting, or family reunion (Dou and Liu, 2017). It is unclear whether the health
advantage of rural-to-urban migrants still exists at old age due to very limited studies.
In sum, coupled with the rapid urbanization, China has undergone a major
epidemiological transition, shifting from infectious to non-communicable diseases
in a much shorter timeframe than many other countries (Li, Song, Lin, et al., 2016;
Yang, Wang, Zeng, et al., 2013). Other population-level transitions include rapid
population aging and an ongoing reform of China’s national healthcare system (Ministry
of Human Resources and Social Security of China, 2015). All these macro changes
suggest a complicated scenario in the near future, in which urbanization intertwines
with population aging and changing healthcare needs. Thus, it is imperative to examine
the linkages between urban exposure and health among current older cohorts in China.

2 Methods

2.1 Study Population

We analyzed data from five waves of the Chinese Longitudinal Healthy Longevity
Survey (CLHLS) in 2002, 2005, 2008/2009, 2011/2012, and 2014/2015. The age range
of the respondents in each wave is from age 65 to age 100+. Following the common
practice of prior studies (e.g., Gu, Brown and Qiu, 2016; Xu, Dupre, Gu, et al., 2017;
Zhao, Sautter, Qiu, et al., 2017), we pooled these five waves together for more robust
results. The first two waves of the CLHLS (1998 and 2000) were not included because
they did not include older adults aged 65–79.
The CLHLS was originally conducted in a randomly selected half of the counties/
cities in 22 provinces. The de facto total population of these 23 provinces accounted
for 89% of the total population of China in the 2010 census (Zhang, Dupre, Qiu,
et al., 2017). From 2002 to 2011/2012, 33,512 respondents contributed 57,285
observations to the CLHLS datasets. Among the 33,512 respondents, 783 respondents

International Journal of Population Studies 2017, Volume 3, Issue 1 5