IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v366y2025ics0277953625000486.html
   My bibliography  Save this article

Walking to the same winter: Urban-rural disparities in pain among middle-aged and older Chinese

Author

Listed:
  • Chen, Siyuan
  • Bracke, Piet
  • Delaruelle, Katrijn

Abstract

Chronic pain, as a barometer of population health, remains understudied from a socio-structural lens. This study adopts a life course perspective and integrates hukou as a potential institutional arrangement shaping pain, aiming to advance the understanding of health inequalities in China. Specifically, we examine urban-rural disparities in pain prevalence and investigate how these disparities evolve across the life course by using generalized estimating equations and the China Health and Retirement Longitudinal Study 2011–2020 (N = 16479). Our findings indicate that rural hukou holders experience more pain than their urban counterparts. Among rural hukou holders, urban dwelling is associated with a reduced pain risk. Furthermore, we observe that pain prevalence increases with age, yet such pain trajectories vary across urban and rural populations, showing a converging trend in pain over the life course. This study extends the literature on health inequalities by demonstrating how institutional and geographic characteristics jointly shape urban-rural gradients in pain prevalence. Moreover, it provides novel evidence for the age-as-leveler hypothesis in a non-Western context.

Suggested Citation

  • Chen, Siyuan & Bracke, Piet & Delaruelle, Katrijn, 2025. "Walking to the same winter: Urban-rural disparities in pain among middle-aged and older Chinese," Social Science & Medicine, Elsevier, vol. 366(C).
    • Handle: RePEc:eee:socmed:v:366:y:2025:i:c:s0277953625000486
    DOI: 10.1016/j.socscimed.2025.117719
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953625000486
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2025.117719?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Xiao, Chaowei & Silva, Elisabete A. & Zhang, Chuchu, 2020. "Nine-nine-six work system and people’s movement patterns: Using big data sets to analyse overtime working in Shanghai," Land Use Policy, Elsevier, vol. 90(C).
    2. Jiang, Shiqing & Lu, Ming & Sato, Hiroshi, 2012. "Identity, Inequality, and Happiness: Evidence from Urban China," World Development, Elsevier, vol. 40(6), pages 1190-1200.
    3. Mark Hayward & Bridget Gorman, 2004. "The long arm of childhood: The influence of early-life social conditions on men’s mortality," Demography, Springer;Population Association of America (PAA), vol. 41(1), pages 87-107, February.
    4. Gkiouleka, Anna & Huijts, Tim & Beckfield, Jason & Bambra, Clare, 2018. "Understanding the micro and macro politics of health: Inequalities, intersectionality & institutions - A research agenda," Social Science & Medicine, Elsevier, vol. 200(C), pages 92-98.
    5. Jason Hung, 2022. "Hukou System Influencing the Structural, Institutional Inequalities in China: The Multifaceted Disadvantages Rural Hukou Holders Face," Social Sciences, MDPI, vol. 11(5), pages 1-18, April.
    6. Zhang, Huafeng, 2010. "The Hukou system's constraints on migrant workers' job mobility in Chinese cities," China Economic Review, Elsevier, vol. 21(1), pages 51-64, March.
    7. Rubin, Sara & Zimmer, Zachary, 2015. "Pain and self-assessed health: Does the association vary by age?," Social Science & Medicine, Elsevier, vol. 130(C), pages 259-267.
    8. Topping, Michael & Fletcher, Jason, 2024. "Educational attainment, family background and the emergence of pain gradients in adulthood," Social Science & Medicine, Elsevier, vol. 346(C).
    9. McNamee, Paul & Mendolia, Silvia, 2014. "The effect of chronic pain on life satisfaction: Evidence from Australian data," Social Science & Medicine, Elsevier, vol. 121(C), pages 65-73.
    10. Luo, Ye & Pan, Xi & Zhang, Zhenmei, 2019. "Productive activities and cognitive decline among older adults in China: Evidence from the China Health and Retirement Longitudinal Study," Social Science & Medicine, Elsevier, vol. 229(C), pages 96-105.
    11. Afridi, Farzana & Li, Sherry Xin & Ren, Yufei, 2015. "Social identity and inequality: The impact of China's hukou system," Journal of Public Economics, Elsevier, vol. 123(C), pages 17-29.
    12. Ma, Xinxin, 2018. "Labor market segmentation by industry sectors and wage gaps between migrants and local urban residents in urban China," China Economic Review, Elsevier, vol. 47(C), pages 96-115.
    13. Audrey Dorélien & Hongwei Xu, 2020. "Estimating rural–urban disparities in self-rated health in China: Impact of choice of urban definition," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 43(49), pages 1429-1460.
    14. Song, Shige & Wang, Wei & Hu, Peifeng, 2009. "Famine, death, and madness: Schizophrenia in early adulthood after prenatal exposure to the Chinese Great Leap Forward Famine," Social Science & Medicine, Elsevier, vol. 68(7), pages 1315-1321, April.
    15. Xiaoyan Lei & Wanchuan Lin, 2009. "The New Cooperative Medical Scheme in rural China: does more coverage mean more service and better health?," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages 25-46, July.
    16. Lu, Yao & Qin, Lijian, 2014. "Healthy migrant and salmon bias hypotheses: A study of health and internal migration in China," Social Science & Medicine, Elsevier, vol. 102(C), pages 41-48.
    17. Zhan, Peng & Ma, Xinxin & Li, Shi, 2021. "Migration, population aging, and income inequality in China," Journal of Asian Economics, Elsevier, vol. 76(C).
    18. Kam Wing Chan, 2010. "The Household Registration System and Migrant Labor in China: Notes on a Debate," Population and Development Review, The Population Council, Inc., vol. 36(2), pages 357-364, June.
    19. Catherine Ross & John Mirowsky, 1999. "Refining the association between education and health: The effects of quantity, credential, and selectivity," Demography, Springer;Population Association of America (PAA), vol. 36(4), pages 445-460, November.
    20. Zhu, Yumei & Österle, August, 2017. "Rural-urban disparities in unmet long-term care needs in China: The role of the hukou status," Social Science & Medicine, Elsevier, vol. 191(C), pages 30-37.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Pan, Zehan & Yang, Feiyang & Yang, Nan & Nie, Riming, 2025. "Health disparity among older adults in urban China: Does labor migration matter," Social Science & Medicine, Elsevier, vol. 371(C).
    2. Chen, Binkai & Lu, Ming & Zhong, Ninghua, 2015. "How Urban Segregation Distorts Chinese Migrants’ Consumption?," World Development, Elsevier, vol. 70(C), pages 133-146.
    3. Song, Yang, 2014. "What should economists know about the current Chinese hukou system?," China Economic Review, Elsevier, vol. 29(C), pages 200-212.
    4. Uwe Dulleck & Jonas Fooken & Yumei He, 2020. "Hukou Status and Individual-Level Labor Market Discrimination: An Experiment in China," ILR Review, Cornell University, ILR School, vol. 73(3), pages 628-649, May.
    5. Haiting Jiang & Bo Burström & Jiaying Chen & Kristina Burström, 2021. "Rural–Urban Inequalities in Poor Self-Rated Health, Self-Reported Functional Disabilities, and Depression among Chinese Older Adults: Evidence from the China Health and Retirement Longitudinal Study 2," IJERPH, MDPI, vol. 18(12), pages 1-15, June.
    6. Shen, Ke & Zeng, Yi, 2014. "Direct and indirect effects of childhood conditions on survival and health among male and female elderly in China," Social Science & Medicine, Elsevier, vol. 119(C), pages 207-214.
    7. Kaizhi Yu & Yun Zhang & Hong Zou & Chenchen Wang, 2019. "Absolute Income, Income Inequality and the Subjective Well-Being of Migrant Workers in China: Toward an Understanding of the Relationship and Its Psychological Mechanisms," IJERPH, MDPI, vol. 16(14), pages 1-27, July.
    8. Marta Bengoa & Christopher Rick, 2018. "The effect of Hukou registration policy on rural-to-urban migrants’ health," WIDER Working Paper Series 028, World Institute for Development Economic Research (UNU-WIDER).
    9. Marta Bengoa & Christopher Rick, 2020. "Chinese Hukou Policy and Rural-to-Urban Migrants’ Health: Evidence from Matching Methods," Eastern Economic Journal, Palgrave Macmillan;Eastern Economic Association, vol. 46(2), pages 224-259, April.
    10. Dongmin Kong & Jiuyi Zhang & Mengxu Xiong, 2024. "The impact of low‐skilled migrants on firm productivity: Evidence from hukou reform in China," Review of Development Economics, Wiley Blackwell, vol. 28(3), pages 1192-1230, August.
    11. Siddique Abu Bakkar, 2020. "Identity-based Earning Discrimination among Chinese People," IZA Journal of Development and Migration, Sciendo & Forschungsinstitut zur Zukunft der Arbeit GmbH (IZA), vol. 11(1), pages 1-42, January.
    12. Pi, Jiancai & Zhang, Pengqing, 2016. "Hukou system reforms and skilled-unskilled wage inequality in China," China Economic Review, Elsevier, vol. 41(C), pages 90-103.
    13. Chen, Binkai & Liu, Dan & Lu, Ming, 2018. "City size, migration and urban inequality in China," China Economic Review, Elsevier, vol. 51(C), pages 42-58.
    14. Jo M. Hale & Daniel C. Schneider & Neil K. Mehta & Mikko Myrskylä, 2022. "Understanding cognitive impairment in the U.S. through the lenses of intersectionality and (un)conditional cumulative (dis)advantage," MPIDR Working Papers WP-2022-029, Max Planck Institute for Demographic Research, Rostock, Germany.
    15. Ming Lu & Yiran Xia, 2016. "Migration in the People’s Republic of China," ADBI Working Papers 593, Asian Development Bank Institute.
    16. Wang, Junhui & Ai, Shuang & Huang, Mian, 2021. "Migration history, hukou status, and urban household consumption," Economic Modelling, Elsevier, vol. 97(C), pages 437-448.
    17. Liu, Yiwei & Su, Yuting & Yin, Yuru, 2022. "Parental preference for boys in childhood and the health of the elderly: Evidence from China," Social Science & Medicine, Elsevier, vol. 302(C).
    18. Ko, Pei-Chun & Yeung, Wei-Jun Jean, 2019. "Childhood conditions and productive aging in China," Social Science & Medicine, Elsevier, vol. 229(C), pages 60-69.
    19. Kravdal, Øystein, 2008. "A broader perspective on education and mortality: Are we influenced by other people's education?," Social Science & Medicine, Elsevier, vol. 66(3), pages 620-636, February.
    20. Astri Syse & Bjorn H. Strand & Oyvind Naess & Ólöf Anna Steingrímsdóttir & Bernadette N. Kumar, 2016. "Differences in all-cause mortality," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 34(22), pages 615-656.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:366:y:2025:i:c:s0277953625000486. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.