Urban-Rural Disability Disparities Among Older Adults in Mexico, India, and China

Global aging and urbanization have emerged concurrently, especially in rapidly developing middle-income countries (MICs). Central to aging is disability which arises when health conditions interact with personal and environmental factors. Disability risk is often higher in rural, compared to urban, localities. Although it is unclear if known risk factors have differential influence on rural older adult disability disparities in MICs with varied urban-rural social stratification systems. Using 2017-2019 harmonized cross-sectional data from the Gateway to Global Aging Data platform, we investigated urban-rural disparities in activities of daily living (ADL) disability among respondents ages 60+ from Mexico (n=9,050), India (n=31,340), and China (n=10,746) using country-specific logistic regression models with odds ratios that progressively adjust for demographic (i.e., age; gender), sociocultural (i.e., historically disadvantaged), socioeconomic (i.e., education; household wealth), health (i.e., comorbidities), family ties (i.e., marital status; household size; child co-residence), and institutional support (i.e., public health insurance; pension) indicators. In Mexico, greater rural ADL disability odds were suppressed by indigenous language speakers, partially accounted for by socioeconomic factors, and suppressed by comorbidities. In India, greater rural ADL disability odds were partially accounted for by scheduled caste/tribe and socioeconomic factors but suppressed by comorbidities. In China, we consistently observed greater rural ADL disability odds.Decomposition analyses showed that education was the notable socioeconomic mediator between rurality and ADL disability. Our results highlight heterogeneity in the factors that contribute to rural disability disparities among older adults in three MICs. These findings are consequential to education and health care provisions in rural localities.