Urban‒rural disparities in unmet care needs among disabled older adults across regions in China: Evidence from national representative longitudinal survey

BACKGROUND The Chinese government has made a commitment to reducing urban‒rural disparities and promoting equitable access to essential elderly care services across regions. OBJECTIVE This research aims to quantitatively assess the disparities in unmet care needs between urban and rural areas and explore the contributing factors. METHODS Data were obtained from the 2018 wave of the China Health and Retirement Longitudinal Study (CHARLS) and were derived from the Harmonized CHARLS. A total of 3,031 participants aged 45 and above who were experiencing difficulty or inability with activities of daily living (ADL) from western (N=1,271), central (N=750), northeastern (N=212), and eastern (N=798) regions were considered disabled older adults and were included in the analysis. Those who did not receive any care support were defined as having unmet care needs, while conversely, receiving any assistance was defined as receiving care. Blinder-Oaxaca decomposition was employed to assess the disparities and identify the factors contributing to the rural‒urban disparity in unmet care needs. Demographic characteristics, socioeconomic status, social relationships, and pension factors were included in the model. RESULTS Compared to urban areas, older adults in rural areas exhibited higher levels of unmet care needs at the national level (62.63% vs. 64.24%), western (51.82% vs. 63.81%), central (69.86% vs. 70.62%), northeastern (33.68% vs. 51.28%), and eastern (62.63% vs. 64.24%) China. Significant urban‒rural disparities in receiving care were exclusively shown in the national (β=0.077, P<0.001) and western regions (β=0.120, P<0.001). Merged pension insurance-related variables accounted for the largest disparities, with 41% nationally and 48% in the western region, followed by demographic variables. In detail, the age group of 80+ accounted for the largest disparities within the western regions, with 27.21% (95% CI: 0.0006-0.0386), and at the national level, with 34.44% (95% CI: 0.0072-0.0293). In the western region, the reception of public pensions contributed 21.41% (95% CI: 0.0006-0.0302), and at the national level, the frequency of interaction with children accounted for 15.47% (95% CI: 0.0022-0.0142). CONCLUSIONS Older adults with disabilities in rural and central China face great unmet care needs. Urban‒rural disparities in care utilization need to be addressed, particularly at the national level and in western China. Care-related institutional designs, such as long-term care insurance and informal care support primarily provided by children, require enhancement in these disadvantaged areas, which also have a high distribution of the over80 age group. These efforts are paramount to actualize the national goal of equitable elderly care access.