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

group of urban workers was more likely composed of those who participated in the
movement to establish socialist China before the 1950s, and who were admitted to
tertiary education in urban areas or joined the army in the 1950s and 1960s. These
individuals were more likely to come from rural economic or political elites with a
relatively higher socioeconomic status than their other rural peers (Chan and Zhang,
1999). In this sense, the lower risk of mortality associated with this type of urban
exposure may have resulted in part from the healthy migrant effect and in part from
favorable institutional factors.
Moreover, unlike many of today’s young rural-to-urban migrants in China who
are still bound by hukou status and often experience stressful life events related to
migration (Chen, 2013; Li, Wang, Ye, et al., 2007), the current cohorts of older adults
who migrated from rural to urban areas before late-life were likely not seeking jobs
in the urban regions, but were urbanized under institutional procedures such as cadre
assignment, graduate placement, and post-army arrangement; they were entitled to
the same social welfare benefits as urban-born residents and experienced relatively
less discrimination. China’s urban-rural dual-regime system led to the advantages of
urban areas, thus effectively compensating these individuals who had rural experience
in early years of human development (Wen and Gu, 2011). In this regard, our findings
could be aligned with the social mobility theory, which posits that upward social
mobility could offset adversity in earlier childhood and benefit health at later ages (Wen
and Gu, 2011; Luo and Waite, 2005).
Those who were exposed to urban settings in mid-late-life without migration to
another county/city also had lower mortality risks compared to those with no exposure
to urban life. We speculate that many of these respondents were possibly workers
at township/village enterprises who had a better income and more social benefits
compared to those older adults with no urban exposure. This group of people may
also include many who lived in the rural areas adjacent to cities and were later locally
urbanized through administrative delineations which directly changed the rural status
to urban. Literature has shown that residents living in suburban or rural places near
metropolitan areas have better health than residents living in either the city proper
or rural areas (Eberhardt and Pamuk, 2004). In the case of China, this group may
have long enjoyed more opportunities for urban jobs and advanced socioeconomic
conditions that are related to lower mortality risk.
Older adults who were exposed to urban ecological contexts throughout the life
course and migrated to another city made up another group that had a lower mortality
risk in reference to the lifetime rural dwellers (i.e., no exposure). Given that urban
areas are advantaged over rural areas in China, and the fact that those who moved to
another city were more likely to seek higher income, better job, and other opportunities
for career development (Zimmer, Wen and Kaneda, 2010), it is not surprising that this
group had a lower mortality risk compared to those with no exposure to urban settings
throughout the life course. Furthermore, the migration advantage in mortality risk was
still valid when compared to those with full urban exposure but without migration.
These findings somewhat support socio-ecological theory and the healthy migrant
hypothesis.
However, once socioeconomic status, family/social support, health behaviors, and
baseline health were controlled for, the beneficial association between urban exposure
and mortality risk became disadvantageous. This finding highlights the importance of
socioeconomic factors, health behaviors, and baseline health in affecting mortality at
older ages. This pattern is also generally in line with one recent study which found that
the urban advantage in older age mortality was either largely reduced or disappeared
once demographic factors and differences in socioeconomic characteristics were
controlled for (Zimmer, Kaneda, Tang, et al., 2010). This provides additional evidence
to the argument that it is the rural-urban dual system that has been driving the health
and mortality differentials between urban and rural areas in China (Zimmer, Wen and
Kaneda, 2010).

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