Rural-urban divergence in healthy aging: differential associations of social support versus individual attributes in China

Abstract

Against the backdrop of population aging, promoting healthy aging is a core strategy for aging governance in China. Driven by unbalanced rural–urban development, the associations between relevant factors and healthy aging among older adults may exhibit distinct rural–urban heterogeneity. Nevertheless, current empirical evidence requires further updating and enrichment. This study aims to examine the associations of individual attributes and social support with healthy aging among rural and urban older adults in Hubei Province, and explore the rural–urban heterogeneity in these relationships. A cross-sectional survey was administered via Wenjuanxing platform to 3,306 participants (urban = 1,711; rural = 1,595) by trained nursing undergraduates. Standardized assessments included individual attributes inventory, Healthy Aging Instrument (HAI), and Social Support Rating Scale (SSRS). Statistical methods comprised independent t-tests, ANOVA, Pearson correlations, and hierarchical regression modeling. Rural–urban older adults showed only a statistically significant difference rather than a substantive gap in healthy aging levels (Cohen’s d = 0.095), with social participation being a common vulnerable dimension. Among individual attributes, educational attainment (displaying a health–education gradient in urban older adults; peaking at the junior high school level among rural older adults), living arrangement (better outcomes for those living with others), and chronic disease burden (negatively associated) maintained independent associations in both groups, whereas economic resources showed independent associations only among rural older adults. After adjusting for individual attributes, social support yielded a much larger incremental explanatory power for healthy aging among rural older adults (β = 0.550, p < 0.001, ΔR²=24.7%) compared with urban counterparts (β = 0.296, p < 0.001, ΔR²=6.3%). No substantive difference existed in healthy aging levels between rural–urban older adults, while the associations of individual attributes and social support with healthy aging varied across rural–urban groups. Therefore, differentiated social support systems tailored to local conditions should be established for rural and urban areas to continuously advance equitable healthy aging.