Area-socioeconomic disadvantage and cognitive function among Chinese older adults: the mediating role of healthcare resources and the moderating role of individual socioeconomic status

OBJECTIVES: This study examines how city-level socioeconomic status (SES) is associated with cognitive function among older adults in China, and explores the mediating role of healthcare resources and the moderating role of individual SES in this context. METHODS: We relied on data from the 2018 wave of the China Health and Retirement Longitudinal Study, which provided individual cognitive function and demographic characteristics. Area-level SES and healthcare resource indicators were obtained from national statistical sources. A total of 9520 individuals aged 60 years or older from 123 cities were included in the analysis. A multilevel moderated mediation model was applied, and subgroup analyses by gender were conducted. RESULTS: Both individual- and area-level SES were positively associated with cognitive function. Multilevel mediation models of healthcare resources showed that only physician density (i.e., not hospital or bed supply) partially mediated the association between area-level SES and cognitive function. After individual SES was introduced as a moderator, the cognitive benefits of healthcare human resources were greater for low-SES individuals than for high-SES individuals. However, evidence for this moderating effect was not consistently supported across variations in sample composition and cognitive measurement. Gender-stratified analyses further showed no clear evidence supporting an individual-SES-based moderating effect in either men or women. CONCLUSION: Our findings emphasize the fact that area-level SES and healthcare human resources shape late-life cognition, suggesting equity-focused policies that address structural disadvantage to reduce disparities in cognitive aging.