{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T21:11:08Z","timestamp":1793394668204,"version":"4.5.0"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,3,23]],"date-time":"2022-03-23T00:00:00Z","timestamp":1647993600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>This study aims to identify the dynamic changes in cognitive performance differentials between urban and rural older adults in China from 2008 to 2018 and decomposes determinants affecting such changes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Two waves (2008 and 2018) of data were extracted from the Chinese Longitudinal Healthy Longevity Survey. The cognitive function was tested using the Chinese Mini-Mental State Examination (MMSE). The effects of the explanatory variables (demographic, economic, neighborhood, environmental events and social and cultural domains) on the changes in the urban-rural inequality of cognitive performance were divided into two components using the Juhn\u2013Murphy\u2013Pierce (JMP) decomposition: quantity effect and price effect.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 14,628 (urban respondents: 5,675, rural respondents: 8,953) and 10,311 older adults (urban respondents: 5,879, rural respondents: 4,432) for 2008 and 2018, respectively, were included in our study. A narrowing of 0.071 in the urban-rural disparity in cognitive function score of the older adults from 2008 to 2018 was identified. Quantity and price effects of explanatory variables contributed 65.21 and 46.84%, respectively, to the observed components in explaining the narrowed disparity. Quantity effects of age (35.71%), exercise (56.72%), self-rated economic status (33.19%) and price effect of homeownership (54.97%) contributed significantly to the reduced urban-rural gap. Contrastingly, inequality in pension (\u221227.31%) and social security (\u221223.11%) between urban and rural widened cognitive performance differentials. Furthermore, effects of hunger in childhood (\u221210.53%) and less years of schooling (\u221277.20%) on the increase in urban-rural inequality seemed to be stronger over time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Economic development and reform of the rural health system are responsible for the decline in the urban-rural disparity in the cognitive performance of older adults. Equalizing the distribution of social security and welfare between urban and rural must be highlighted for eliminating cognitive ability disparity. Additionally, rural older adults who endured hunger and poor education in childhood also deserve further policy interventions.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2022.843608","type":"journal-article","created":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T22:07:37Z","timestamp":1648505257000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":15,"title":["Urban-Rural Disparity in Cognitive Performance Among Older Chinese Adults: Explaining the Changes From 2008 to 2018"],"prefix":"10.3389","volume":"10","author":[{"given":"Tao","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beiyin","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohe","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,3,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1212\/WNL.51.3.728","article-title":"The incidence of dementia: a meta-analysis","volume":"51","author":"Jorm","year":"1998","journal-title":"Neurology"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1985","DOI":"10.1001\/archneur.58.12.1985","article-title":"Current concepts in mild cognitive impairment","volume":"58","author":"Petersen","year":"2001","journal-title":"Arch Neurol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e661","DOI":"10.1016\/S2468-2667(20)30185-7","article-title":"Prevalence, risk factors, and management of dementia and mild cognitive impairment in adults aged 60 years or older in China: a cross-sectional study","volume":"5","author":"Jia","year":"2020","journal-title":"Lancet Public Health"},{"key":"B4","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1186\/s12877-017-0538-9","article-title":"Urban-rural differences in the association between access to healthcare and health outcomes among older adults in China","volume":"17","author":"Zhang","year":"2017","journal-title":"BMC Geriatrics"},{"key":"B5","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1016\/j.jad.2020.05.091","article-title":"Social participation and urban-rural disparity in mental health among older adults in China","volume":"274","author":"Jian","year":"2020","journal-title":"J Affect Disord"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1084","DOI":"10.1046\/j.1365-2443.1996.d01-231.x","article-title":"Effect of air pollution and rural-urban difference on mental health of the elderly in China","volume":"44","author":"Tian","year":"2015","journal-title":"Iran J Public Health"},{"key":"B7","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.archger.2018.11.011","article-title":"Gender differences in the association between migration and cognitive function among older adults in China and India","volume":"81","author":"Xu","year":"2019","journal-title":"Arch Gerontol Geriatr"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.1097\/MLR.0b013e3181adcc32","article-title":"Explaining urban-rural health disparities in China","volume":"47","author":"Fang","year":"2009","journal-title":"Med Care"},{"key":"B9","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1097\/MLR.0b013e3180618b9a","article-title":"Rural and urban disparity in health services utilization in China","volume":"45","author":"Liu","year":"2007","journal-title":"Medical Care"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1774","DOI":"10.1016\/S0140-6736(08)61363-X","article-title":"China's human resources for health: quantity, quality, and distribution","volume":"372","author":"Anand","year":"2008","journal-title":"Lancet"},{"key":"B11","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1186\/s12913-020-05194-6","article-title":"Rural and urban differences in health system performance among older Chinese adults : Cross-sectional analysis of a national sample","volume":"20","author":"Qin","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"B12","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1016\/S0140-6736(11)61880-1","article-title":"Early appraisal of China's huge and complex health-care reforms","volume":"379","author":"Yip","year":"2018","journal-title":"Lancet"},{"key":"B13","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1186\/1472-6963-14-142","article-title":"Integration of rural and urban healthcare insurance schemes in China: an empirical research","volume":"14","author":"Wang","year":"2014","journal-title":"BMC Health Serv Res"},{"key":"B14","volume-title":"Introduction to the Chinese Longitudinal Healthy Longevity Survey. (CLHLS)","author":"Zeng","year":"2008"},{"key":"B15","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1080\/00324720903216903","article-title":"Healthy longevity in China : demographic, socioeconomic, and psychological dimensions","volume":"63","author":"Zeng","year":"2008","journal-title":"Springer Ebooks"},{"key":"B16","doi-asserted-by":"publisher","first-page":"S25","DOI":"10.1093\/geronb\/63.1.S25","article-title":"Early life influences on cognitive impairment among oldest old Chinese","volume":"63","author":"Zhang","year":"2008","journal-title":"J Gerontol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1093\/ageing\/afx038","article-title":"The time trends of cognitive impairment incidence among older Chinese people in the community: based on the CLHLS cohorts from 1998 to 2014","volume":"46","author":"Gao","year":"2017","journal-title":"Age Ageing"},{"key":"B18","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1016\/S2215-0366(18)30060-9","article-title":"Social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews","volume":"5","author":"Lund","year":"2018","journal-title":"Lancet Psychiatry"},{"key":"B19","doi-asserted-by":"publisher","first-page":"693","DOI":"10.2307\/2525981","article-title":"Male-female wage differentials in urban labor markets","volume":"14","author":"Oaxaca","year":"1973","journal-title":"Int Econ Rev"},{"key":"B20","doi-asserted-by":"publisher","first-page":"436","DOI":"10.2307\/144855","article-title":"Wage Discrimination: reduced form and structural estimates","volume":"8","author":"Blinder","year":"1973","journal-title":"J Hum Resources"},{"key":"B21","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1086\/261881","article-title":"Wage inequality and the rise in returns to skill","volume":"101","author":"Juhn","year":"1993","journal-title":"J Politic Econ"},{"key":"B22","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1007\/s00181-007-0143-4","article-title":"Gender wage gap studies: consistency and decomposition","volume":"35","author":"Kunze","year":"2008","journal-title":"Empirical Econ"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1302","DOI":"10.1016\/j.socscimed.2011.02.017","article-title":"Building institutions for an effective health system: lessons from China's experience with rural health reform","volume":"72","author":"Bloom","year":"2011","journal-title":"Soc Sci Med"},{"key":"B24","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1111\/j.1540-6040.2012.01415.x","article-title":"Urban homeownership and mental health: mediating effect of perceived sense of control","volume":"11","author":"Manturuk","year":"2013","journal-title":"City Commun"},{"key":"B25","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1080\/10511482.2014.956776","article-title":"Why is homeownership associated with nonfinancial benefits? a path analysis of competing mechanisms","volume":"25","author":"Lindblad","year":"2015","journal-title":"Housing Policy Debate"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.1016\/S0140-6736(08)61360-4","article-title":"Internal migration and health in China","volume":"372","author":"Hu","year":"2008","journal-title":"Lancet"},{"key":"B27","doi-asserted-by":"publisher","first-page":"2189","DOI":"10.1377\/hlthaff.2009.0989","article-title":"China's rural-urban care gap shrank for chronic disease patients, but inequities persist","volume":"29","author":"Jian","year":"2010","journal-title":"Health Affairs"},{"key":"B28","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1007\/s10198-021-01267-3","article-title":"Does the universal medical insurance system reduce catastrophic health expenditure among middle-aged and elderly households in China? A longitudinal analysis","volume":"22","author":"Zhou","year":"2021","journal-title":"Eur J Health Econ"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1694","DOI":"10.1016\/j.apmr.2004.03.019","article-title":"The effects of exercise training on elderly persons with cognitive impairment and dementia: a meta-analysis","volume":"85","author":"Heyn","year":"2004","journal-title":"Arch Phys Med Rehabil"},{"key":"B30","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1016\/j.mayocp.2011.12.020","article-title":"Physical exercise, aging, and mild cognitive impairment: a population-based study","volume":"87","author":"Geda","year":"2012","journal-title":"Mayo Clin Proc Mayo Clinic"},{"key":"B31","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1108\/01443331011054217","article-title":"China's new rural pension scheme: can it be improved?","volume":"30","author":"Shen","year":"2013","journal-title":"Int J Sociol Soc Policy"},{"key":"B32","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1111\/issr.12030","article-title":"Extending social security coverage to the rural sector in China","volume":"67","author":"Chen","year":"2014","journal-title":"Int Soc Security Rev"},{"key":"B33","doi-asserted-by":"publisher","first-page":"e035993","DOI":"10.1136\/bmjopen-2019-035993","article-title":"Investigating the relationship between changes in social security benefits and mental health: a protocol for a systematic review","volume":"10","author":"Simpson","year":"2020","journal-title":"BMJ Open"},{"key":"B34","doi-asserted-by":"publisher","first-page":"113717","DOI":"10.1016\/j.socscimed.2021.113717","article-title":"Effects of social security policy reforms on mental health and inequalities: a systematic review of observational studies in high-income countries","volume":"272","author":"Simpson","year":"2021","journal-title":"Soc Sci Med"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1264","DOI":"10.1002\/hec.3397","article-title":"The long-term health effects of fetal malnutrition: evidence from the 1959\u20131961 china great leap forward famine","volume":"26","author":"Seonghoon","year":"2017","journal-title":"Health Econ"},{"key":"B36","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1212\/01.wnl.0000251303.50459.8a","article-title":"Education and Alzheimer disease without dementia - support for the cognitive reserve hypothesis","volume":"68","author":"Roe","year":"2007","journal-title":"Neurology"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.843608\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T22:07:47Z","timestamp":1648505267000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.843608\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,23]]},"references-count":36,"alternative-id":["10.3389\/fpubh.2022.843608"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2022.843608","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,23]]},"article-number":"843608"}}