AccScience Publishing / IJPS / Volume 3 / Issue 1 / DOI: 10.18063/ijps.2017.01.007.
Cite this article
Journal Browser
Volume | Year
News and Announcements
View All

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

Danan Gu1* Qiushi Feng2 Jessica M. Sautter3 Li Qiu4
Show Less
1 United Nations Population Division, New York, NY, USA
2 Department of Sociology, National University of Singapore, Singapore
3 Department of Behavioral and Social Sciences, University of the Sciences, Philadelphia, PA, USA
4 Independent Researcher, New York, NY, USA
© Invalid date by the Authors. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( )

We examined whether exposure to urban environments was linked with mortality in a longitudinal survey dataset of nearly 28,000 Chinese adults who were 65 years of age or older in the years 2002–2014. Urban life exposure was measured by residential status at birth, current residential status, and urban-related primary lifetime occupation, which generated eight different categories of urban life exposure: no exposure, mid-life-only exposure, late-life-only exposure, mid-late-life exposure, early-life-only exposure, early-mid-life exposure, early- & late-life exposure, and full life exposure. We also included a measure of migration, whether the respondent lived in the same county/city at birth and at first interview, to further classify these eight categories. Overall, we found that when demographics were controlled for, compared to those with no urban life exposure and no migration, mortality risk was lower for older adults with mid-late life exposure with or without migration and for older adults with full-life exposure with migration; mortality risk was higher for older adults with early-life-only exposure. Once socioeconomic status, family/social support, health behaviors, and baseline health were simultaneously controlled for, only the higher mortality risk for older adults with early-life-only exposure was still significant. Our findings provided valuable information about how urban life exposure at different life stages was associated with elderly mortality in China.

older adults
urban life exposure

Allender S, Foster C, Hutchinson L, et al. (2008) Quantification of urbanization in relation to chronic diseases in development countries: A systematic review. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 85(6): 938–951.


Anson J (2004). The migrant mortality advantage: A 70 month follow-up of the Brussels population. European Journal of Population, 20(3): 191–218.


Abraido-Lanza AF, Dohrenwend BP, Ng-Mak DS, et al. (1999) The Latino mortality paradox: A test of the “salmon bias” and healthy migrant hypotheses. American Journal Public Health, 89(10): 1543–1548.


Atella V and Deb P (2013). Gender difference in long term health outcomes of internal migrants in Italy. CEIS Working Paper No. 269, 11(5). Centre for Economic and International Studies.


Baum WM (2017). Understanding behaviorism: Behavior, culture, and evolution. 3rd ed. New York, NY, USA: John Wiley & Sons, Inc.


Ben-Shlomo Y and Kuh D (2002). A life course approach to chronic disease epidemiology: Conceptual models, empirical challenges and interdisciplinary perspectives. International Journal of Epidemiology, 31(2): 285–293.


Cable N (2014). Life course approach in social epidemiology: An overview, application and future implications. Journal of Epidemiology, 24(5): 347–352.


Cai F and Du Y (2015). The social protection system in ageing China. Asian Economic Policy Review, 10(2): 250–270.


Cai YY, Zhang XY, Ye E, et al. (2010). Analysis of differences in mortality of Chinese urban and rural residents and influencing factors. Modern Preventive Medicine, 37(21): 4070–4072. [in Chinese]


Chan KW and Zhang L (1999). The hukou system and rural-urban migration in China: Processes and changes. The China Quarterly, 160: 818–855.


Chatterjee S and Hadi AS (2012). Regression analysis by example. 5th ed. New York, NY, USA: John Wiley & Sons, Inc.


Chen J (2011). Internal migration and health: Re-examining the healthy migrant phenomenon in China. Social Science & Medicine, 72(8): 1294−1301.


––––– (2013). Perceived discrimination and subjective well-being among rural-to-urban migrants in China. Journal of Sociology & Social Welfare, 40(1): 131−156.


China Government Net (2014). [National New Urbanization Plan (2014–2020)]. Accessed on May 2, 2017. [in Chinese]


Dou X and Liu Y (2017). Elderly migration in China: Types, patterns and determinants. Journal of Applied Gerontology. 36(6): 751–771.


Eberhardt MS and Pamuk ER (2004). The importance of place of residence: Examining health in rural and nonrural areas. American Journal of Publish Health, 94(10): 1682–1686.


Engel L, Chudyk AM, Ashe MC et al. (2016). Older adults’ quality of life—Exploring the role of the built environment and social cohesion in community-dwelling seniors on low income. Social Science & Medicine, 164; 1–11.


Eriksson JG (2005). The fetal origins hypothesis—10 years on. The BMJ, 330(7500): 1096–1097.


Fang H, Chen J and Rizzo JA (2009). Explaining urban-rural health disparities in China. Medical Care, 47(12): 1209–1216.


Finch BK, Do DP, Frank R, et al. (2009). Could “acculturation” effects be explained by latent health disadvantages among Mexican immigrants? The International Migration Review, 43(3): 471–495.


Fu H and VanLandingham MJ (2012). Disentangling the effects of migration, selection and acculturation on weight and body fat distribution: Results from a natural experiment involving Vietnamese Americans, returnees, and never-leavers. Journal of Immigrant and Minority Health, 14(5): 786–796.


Gong P, Liang S, Carlton EJ, et al. (2012) Urbanization and health in China. The Lancet, 379(9818): 843–852.


Grossmann I, Karasawa M, Kan C, et al. (2014) A cultural perspective on emotional experiences across the life span. Emotion, 14(4): 679–692.


Gu D (2008). General data quality assessment of the Chinese Longitudinal Healthy Longevity Survey. In: Zeng Y, Poston Jr DL, Vlosky DA, et al. (eds.). Healthy longevity in China: Demographic, socioeconomic, and psychological dimensions. Dordrecht, The Netherlands: Springer Publisher. p. 39-59.


Gu D, Brown BL and Qiu L (2016). Self-perceived uselessness is associated with lower likelihood of successful aging among older adults in China. BMC Geriatrics. 16(172): 1–12.


Gu D and Dupre ME (2008). Assessment of reliability of mortality and morbidity in the 1998–2002 CLHLS waves. In: Zeng Y, Poston Jr DL, Vlosky DA, et al. (eds.). Healthy longevity in China: Demographic, socioeconomic, and psychological dimensions. Dordrecht, The Netherlands: Springer Publisher. p. 99-115.


Gu D, Zhu H and Wen M (2015). Neighborhood-health links: Differences between rural-to-urban migrants and natives in Shanghai. Demographic Research, 33(17): 499–524.


Hallqvist J, Lynch J, Bartley M, et al. (2004) Can we disentangle life course processes of accumulation, critical period and social mobility? An analysis of disadvantaged socio-economic positions and myocardial infarction in the Stockholm Heart Epidemiology Program. Social Science & Medicine, 58(8): 1555–1562.


Hu X, Cook S and Salazar MA (2008). Internal migration and health in China. The Lancet, 372(9651): 1717–1719.


Hu Y and Scott J (2016). Family and gender values in China: Generational, geographic and gender differences. Journal of Family Issues, 37(9): 1267–1293.


Johnson I (2013). China’s great uprooting: Moving 250 million into cities. Leaving The Land: Part I (Internet). The New York Times. Accessed on 16 October, 2016.


Jopp DS, Wozniak D, Damarin AK, et al. (2015). How could lay perspectives on successful aging complement scientific theory? Findings from a U.S. and a German life-span sample. Gerontologist, 55(1) : 91–106.


Judd FK, Jackson HJ, Komiti A, et al. (2002) High prevalence disorders in urban and rural communities. Australian and New Zealand Journal of Psychiatry, 36(1): 104–113.


Kawachi I and Berkman L (2000). Social cohesion, social capital, and health. In: Berkman LF and Kawachi I (editors). 1st ed. Social epidemiology. London, UK: Oxford University Press. p. 174–190.


Kristiansen M, Razum O, Tezcan-Güntekin H, et al. (2016) Aging and health among migrants in a European perspective. Public Health Reviews, 37(20): 1–14.


Lee L and Meng X (2010). Jobs, working hours, and remuneration packages for migrants and urban residents. In: Meng X, Manning C, Shi L, et al. (eds.) The great migration: Rural–urban migration in China and Indonesia. Cheltenham, UK: Edward Elgar Publishing. p. 47-73.


Leon DA (2008). Cities, urbanization and health. International Journal of Epidemiology, 37(1): 4–8.


Li L, Wang H-M, Ye X-J , et al. (2007). The mental health status of Chinese rural-urban migrant workers. Social Psychiatry and Psychiatric Epidemiology, 42(9): 716–722.


Li X, Song J, Lin T, et al. (2016) Urbanization and health in China, thinking at the national, local and individual levels. Environmental Health, 15(32): 1–11.


Liu P and McGuire W (2015). One regulatory state, two regulatory regimes: Understanding dual regimes in China’s regulatory state building through food safety. Journal of Contemporary China, 24(91): 119–136.


Löckenhoff CE, De Fruyt F, Terracciano A, et al. (2009) Perceptions of aging across 26 cultures and their culture-level associates. Psychology and Aging, 24(4): 941–954.


Lu Y, Hu P and Treiman DJ (2012). Migration and depressive symptoms in migrant-sending areas: Findings from the survey of internal migration and health in China. International Journal of Public Health, 57(4): 691–698.


Lu Y and Qin L (2014). Healthy migrant and salmon bias hypotheses: A study of health and internal migration in China. Social Science & Medicine, 102: 41–48.


Luo Y and Waite LJ (2005). The impact of childhood and adult SES on physical, mental, and cognitive well-being in later life. The Journals of Gerontology: Series B, 60(2): S93–S101.


Lynch J and Smith GD (2005). A life course approach to chronic disease epidemiology. Annual Review of Public Health, 26: 1–35.


Ministry of Human Resources and Social Security of China (2015). Annual report of the China social insurance. Beijing, China. [in Chinese]


National Bureau of Statistics of China (NBSC) (1984). The tabulation of the 1982 population census of the People’s Republic of China. Beijing, China: China Statistics Press. [in Chinese]


––––– (1992). The tabulation of the 1990 population census of the People’s Republic of China. Beijing, China: China Statistics Press. [in Chinese]


––––– (2002). The tabulation of the 2000 population census of the People’s Republic of China. Beijing, China: China Statistics Press. [in Chinese]


––––– (2012). The tabulation of the 2010 population census of the People’s Republic of China. Beijing, China: China Statistics Press. [in Chinese]


––––– (2016). China Demographic and Employment Yearbook. Beijing, China: China Statistics Press. [in Chinese]


National Health and Family Planning Commission (2016). China floating population report: 2016. Beijing, China: China Population Publishing House. [in Chinese]


Palloni A and Arias E (2004). Paradox lost: Explaining the Hispanic adult mortality advantage. Demography, 41(3): 385–415.


Popkin BM (1999). Urbanization, lifestyle changes and the nutrition transition. World Development, 1999; 27(11): 1905–1916.


Popkin BM and Du SF (2003). Dynamics of the nutrition transition toward the animal foods sector in China and its implications: A worried perspective. Journal of Nutrition, 133(11): 3898S–3906S.


Purser JL, Feng Q, Zeng Y, et al. (2012). A new classification of function and disability in China: Subtypes based on performance-based and self-reported measures. Journal of Aging and Health, 24(5): 779–798.


Seybolt PJ (1975). The rustication of urban youth in China: A social experiment. New York, NY, USA: Routledge: Taylor & Francis Group.


Shankar A, Hamer M, McMunn A, et al. (2013) Social isolation and loneliness: Relationships with cognitive function during 4 years of follow-up in the English Longitudinal Study of Ageing. Psychosomatic Medicine, 75(2): 161–170.


Sorensen AB (1996). The structural basis of social inequality. The American Journal of Sociology, 101(5): 1333–1365.


State of Council of People’s Republic of China (2014). National new-type of urbanization plan (2014-2020). Beijing, China: State of Council. [in Chinese]


Tong Y and Piotrowski M (2012). Migration and health selectivity in the context of internal migration in China, 1997–2009. Population Research and Policy Review, 31(4): 497–543.


United Nations (2014). The World Urbanization Prospects: The 2014 Revision. New York, NY, USA: United Nations.


Vlahov D and Galea S (2002). Urbanization, urbanicity, and health. Journal of Urban Health. 79(4): S1–S12.


Wakabayashi C (2010). Effects of immigration and age on health of older people in the United States. Journal of Applied Gerontology, 29(6): 697–719.


Wang YH and Li LM (2008). A comparison of life expectancy between the urban and rural residents in China, 1990–2005. Chinese Journal of Epidemiology, 29(3): 262–266. [in Chinese]


Wen M, Hawkley LC, and Cacioppo JT (2006). Objective and perceived neighborhood environment, individual SES and psychosocial factors, and self-rated health: An analysis of older adults in Cook County, Illinois. Social Science & Medicine, 63(10): 2575–2590.


Wen M and Gu D (2011). The effects of childhood, adult, and community socioeconomic conditions on health and mortality among older adults in China. Demography. 48(1): 153–181.


Winship C and Radbill L (1994). Sampling weights and regression analysis. Sociological Methods and Research, 23(2): 230–257.


Woods R (2003). Urban-rural mortality differentials: An unresolved debate. Population and Development Review, 29(1): 29–46.


Wu W and Wang G (2014). Together but unequal: Citizenship rights for migrants and locals in urban China. Urban Affairs Review, 50(6): 781–805.


Xu H, Luo J and Wu B (2015). Self-reported diabetes treatment among Chinese middle-aged and older adults with diabetes: Comparison of urban residents, migrants in urban settings, and rural residents. International Journal of Nursing Science. 2(1): 9–14.


Xu H, Dupre ME, Gu D, et al. (2017) The impact of residential status on cognitive decline among older adults in China: Results from a longitudinal study. BMC Geriatrics, 17(107): 1–11.


Xu Y, Li J and Jiao S (2015). Impacts of Chinese urbanization on farmers’ social networks: Evidence from the urbanization led by farmland requisition in Shanghai. Journal of Urban Planning and Development, 142(2): 1–8.


Yang G, Wang Y, Zeng Y, et al. (2013) Rapid health transition in China, 1990–2010: Findings from the Global Burden of Disease Study 2010. The Lancet, 381(9882): 1987–2015.


Yang G and Zeng S (2016). The comparison of trust structure between urban and rural residents in China. American Journal of Industrial and Business Management, 6(5): 665–673.


Yip WC-M, Hsiao WC, Chen W, et al. (2012). Early appraisal of China’s huge and complex health-care reforms. The Lancet, 379(9818): 833–842.


Zeng Y, Gu D and Land KC (2007). Association of childhood socioeconomic with healthy longevity at oldest-older ages in China. Demography, 44(3): 497–518.


Zeng Y, Gu D, Purser J, et al. (2010) Associations of environmental factors with elderly health and mortality in China. American Journal of Public Health, 100(2): 298–305.


Zhang H (2007). Who will care for our parents? Changing boundaries of family and public roles in providing care for the aged in urban China. Care Management Journal, 8(1): 39–46.


Zhang X, Dupre ME, Qiu L, et al. (2017) Urban-rural differences in the association between access to healthcare and health outcomes among older adults in China. BMC Geriatrics, 17(151): 1–11.


Zhang Z, Gu D and Hayward M (2008). Early-life influences on cognitive impairment among oldest old Chinese. Journal of Gerontology: Series B, 63(1): S25–S33.


Zhao Y, Sautter JM, Qiu L, et al. (2017) Self-perceived uselessness and associated factors among older adults in China. BMR Geriatrics, 17(12): 1–19.


Zheng S and Kahn ME (2017). A new era of pollution progress in urban China? Journal of Economic Perspectives, 31(1): 71–92.


Zhu H and Xie Y (2007). Socioeconomic differentials in mortality among the oldest old in China. Research on Aging, 29(2): 125–143.


Zhu W, Chi A and Sun Y (2016). Physical activity among older Chinese adults living in urban and rural areas: A review. Journal of Sport and Health Science, 5(3): 281–286.


Zhu Y (2014). In situ urbanization in China: Process, contributing factors, and policy implications. World Migration Report 2015. Newark, NJ, USA: International Organization for Migration.


Zimmer Z, Kaneda T and Spess L (2007). An examination of urban versus rural mortality in China using community and individual data. Journal of Gerontology: Social Sciences, 62(5): S349–S357.


Zimmer Z, Kaneda T, Tang Z, et al. (2010) Explaining late life urban vs. rural health discrepancies in Beijing. Social Force, 88(4): 1885–1908.


Zimmer Z, Wen M and Kaneda T (2010). A multi-level analysis of urban/rural and socioeconomic differences in functional health status transition among older Chinese. Social Science & Medicine, 71(3): 559–567.

Back to top
International Journal of Population Studies, Electronic ISSN: 2424-8606 Print ISSN: 2424-8150, Published by AccScience Publishing