Page 8 - IJPS-3-1

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

born in urban areas tend to have better cognitive function and self-rated health than
those born in rural areas (Wen and Gu, 2011; Zeng, Gu and Land, 2007; Zhang, Gu
and Hayward, 2010). More recent studies examined whether changes in urban-rural
residential status affect later health conditions. Xu et al. (2017), for example, showed
that those who were born in rural areas and urbanized later in the life course had better
cognitive function compared to lifetime rural dwellers.
However, much of the existing literature only focuses on residential status at
birth and/or at present, limiting the ability to capture more complete dynamics of
urban life exposure among older adults. This issue is particularly important for the
current cohorts of older adults in China who have been through a drastic historical
transformation associated with complicated experiences of urban life. In particular,
social welfare systems for older adults, important macro-level conditions that could
affect health in late life (Zeng, Gu, Purser, et al., 2010), have gone through significant
transformation in China (Cai and Du, 2015). After the establishment of communist
China in 1949, the social service system for older adults was gradually established to
complement the long tradition of family-based caregiving (Zhang, 2007). Although
there have been occasional interruptions, this trend toward government-based social
welfare has maintained and greatly speeded up in recent years. For example, in 2009
China launched a healthcare reform aiming for universal healthcare coverage by
2020 (Yip, Hsiao, Chen, et al., 2012). In the meantime, China unveiled the New-style
Urbanization Plan (2014–2020) in an effort to steer the country’s urbanization onto
a more human-centered and environmentally friendly path (China Government Net,
2014). All of these macro-level contexts and changes have shaped and will continue
to shape experiences of urban life for current cohorts of older adults (Xu, Dupre, Gu,
et al., 2017). These complex trajectories justify more refined models to describe and
interpret urban life exposure among older adults in China.
In this study, we propose to introduce lifetime occupation，an important but under-
studied aspect of urban exposure in mid-life, to better investigate the association of
urban life exposure with health outcomes among older adults in China. Urban-based
occupations, in contrast to agricultural or related activities in rural areas, normally
indicate higher socioeconomic statuses and advantaged life experiences, which may
have critical implications for health status and health care consumption (Sorensen,
1996; Wen and Gu, 2011). We also propose to emphasize the role of migration, which
is rarely investigated for the Chinese in this field (e.g., Xu, Dupre, Gu, et al., 2017).
Older adults are increasingly mobile in the context of China’s rapid urbanization
(National Health and Family Planning Commission, 2016), so incorporation of rural-
to-urban migration in urban life exposure analysis could have important implications.
While some older adults move to cities with their children, permanently or temporarily,
to provide care for grandchildren and households, others are still economically active
in the labor market, seeking jobs in the urban areas (National Health and Family
Planning Commission, 2016). All these issues suggest that adding occupation and
migration information would better reflect life course urban exposure and provide
some insights into its association with health or mortality at later ages.
Below we briefly review some selected theories that could be used to explain the
association between exposure to urban context and health or mortality. We also provide
a brief background on the institutional difference between urban and rural China,
urbanization process in China, and research on health of rural-to-urban migrants.
Section 2 presents data sources, measurements, and statistical modeling. Section 3
presents major results, followed by Section 4: Discussion and Conclusions.

1.1 Literature Review
Living in an urban area is a critical social determinant of health (Zimmer, Wen and
Kaneda, 2010) that is frequently used as an indicator of socioeconomic status in
addition to geographical location and surrounding environment (e.g., Zhu and Xie,
2007). This is particularly true for developing countries because urban areas in these
societies often have better infrastructure, sanitation, healthcare, income, and social

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