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Exposure to urban life and mortality risk among older adults in China

Table 4. Relative hazard (mortality) and 95% CIs for urban life exposure based on residential status at birth and at the first
interview combined, CLHLS 2002–2014
Both sexes Women Men
Model I
Ages 65+
From rural to urban (ref: rural-rural) 0.97 (0.94–1.00) † 0.99 (0.94–1.03) 0.94 (0.89–0.99) *
From urban to rural (ref: rural-rural) 1.10 (0.99–1.22) † 1.13 (0.99–1.29) † 1.05 (0.89–1.25)
Remaining in urban (ref: rural-rural) 0.94 (0.90–0.99) * 0.96 (0.90–1.03) 0.91 (0.85–0.99) *
Ages 65–79
From rural to urban (ref: rural-rural) 0.87 (0.79–0.96) ** 0.86 (0.74–1.00) * 0.88 (0.77–1.00) *
From urban to rural (ref: rural-rural) 0.93 (0.70–1.24) 1.01 (0.68–1.49) 0.86 (0.57–1.30)
Remaining in urban (ref: rural-rural) 0.92 (0.80–1.06) 1.02 (0.82–1.26) 0.86 (0.71–1.03)
Ages 80+
From rural to urban (ref: rural-rural) 0.98 (0.94–1.01) 0.99 (0.95–1.04) 0.95 (0.90–1.00) †
From urban to rural (ref: rural-rural) 1.13 (1.01–1.26) * 1.14 (0.99–1.31) † 1.11 (0.91–1.34)
Remaining in urban (ref: rural-rural) 0.93 (0.88–0.98) * 0.94 (0.88–1.01) † 0.92 (0.85–1.00) †
Model II
Ages 65+
From rural to urban (ref: rural-rural) 0.98 (0.95–1.02) 0.98 (0.94-1.03) 0.99 (0.93-1.04)
From urban to rural (ref: rural-rural) 1.13 (1.02–1.26) * 1.18 (1.04–1.35) * 1.07 (0.89–1.28)
Remaining in urban (ref: rural-rural) 1.00 (0.94–1.05) 1.00 (0.93–1.07) 1.01 (0.92–1.10)
Ages 65–79
From rural to urban (ref: rural-rural) 0.94 (0.85–1.05) 0.94 (0.80–1.10) 0.94 (0.82–1.08)
From urban to rural (ref: rural-rural) 0.96 (0.72–1.29) 1.13 (0.77–1.68) 0.81 (0.53–1.25)
Remaining in urban (ref: rural-rural) 1.09 (0.93–1.28) 1.37 (1.07–1.76) * 0.96 (0.78–1.17)
Ages 80+
From rural to urban (ref: rural-rural) 0.98 (0.95–1.02) 0.98 (0.94–1.03) 0.98 (0.92–1.05)
From urban to rural (ref: rural-rural) 1.16 (1.04–1.31) * 1.19 (1.03–1.36) * 1.14 (0.93–1.39)
Remaining in urban (ref: rural-rural) 0.97 (0.91–1.03) 0.95 (0.88–1.03) 1.00 (0.91–1.09)
Note: (1) Relative mortality risk and the 95% CIs were estimated from 27,906 respondents interviewed in 2002–2011/2012 and their survival status in
the subsequent waves 2005–2014 with the length of risk exposure recorded in 2002–2014. Model I controlled for demographics only, while Model II
controlled for all covariates listed in the right column of Table 2. (2) † p < 0.1, * p < 0.05, ** p < 0.01, *** p < 0.001.
2007; Zhang, Gu and Hayward, 2008) by incorporating primary lifetime occupation
(PLO) and migration experience into the classification of urban exposure in the life
course. To our knowledge, this study is among the first to examine this expanded
concept of exposure to urban ecological context on mortality at later ages in Chinese
older adults. Our measurement scheme refines the routine measures to better capture
the heterogeneous experience of urban life among Chinese older adults, producing
meaningful typologies that represent varying degrees of urban life exposure and
diverse life courses. It echoes the call for more sophisticated classifications of
residential status in studying urban-rural experiences and disparities (Judd, Jackson,
Komiti, et al., 2002), and provides a useful analytical tool to understand diverse life
courses of the current Chinese elderly and their health care needs. This measurement
advance is important for a nation such as China that has gone through profound
transformations in institutions and economy over the past century, thus generating
cohorts of older adults with distinct experiences of urban and rural life.
We found that current urban residence, rather than birth in an urban area, matters
for mortality at old ages in China. Those who were born in an urban area have a
similar mortality risk compared to those rurally born, regardless of the presence of
different covariates. Mortality selection may have played a role here. Because rurally
born Chinese likely encountered more adversities in their life course and had higher
mortality (as shown in censuses) in earlier life stages, many rural residents in China

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