The Bayesian multi-state model with informative priors is constructed to characterize the health transition patterns of urban and rural older populations after adjusting for mortality, based on data from China Health and Retirement Longitudinal Study (CHARLS) 2011-2020 and the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2008-2018. It further measures DLE and life expectancy with varying degrees of disability. A theoretical explanation for the urban-rural disparities in DLE is provided based on the social-economic factors and the health promotion factors. The study reveals the following findings: (1) In 2020, urban older individuals exhibited significantly higher DLE compared to their rural counterparts. In absolute terms, the urban-rural disparities existed in the mild, moderate and severe DLE. In relative terms, the proportion of DLE in life expectancy of urban older female was significantly higher than that of rural older female.(2) In 2020, the healthy life expectancy of urban older individuals at 60 was higher than that of rural counterparts. (3) The proportion of severe DLE in life expectancy of urban older individuals was significantly higher than that of rural counterparts, which tended to expand with age. Efforts should be made to strengthen the primary healthcare systems and elderly rehabilitation service systems in urban and rural areas to reduce DLE. Additionally, an equitable financing system for long-term care insurance should be established to address urban-rural disparities.

BACKGROUND

Urban-rural disparities in disability life expectancy (DLE) are critical for evaluating long-term care needs and advancing national strategies to address population aging. While existing studies have examined DLE differences across socioeconomic groups, either directly or indirectly, few have accounted for mortality-related biases in health state transition models. Moreover, most prior research lacks the description of the uncertainty of health state transition parameters. Therefore, the issue of urban-rural disparities in life expectancy with different degree of disability still needs further empirical evidence.

OBJECTIVE

This study aims to quantify urban-rural disparities in disability life expectancy (DLE) across different disability severity levels in China, based on multiple nationally representative longitudinal surveys of the older population. By providing those new empirical evidence, this research seeks to provide new insights for theoretical discussions on social stratification on DLE, and the potential reform of long-term care policies in China.

METHODS

A Bayesian multi-state model incorporating informative priors was developed to analyze the health transition patterns among urban and rural older population in China, using data from the China Health and Retirement Longitudinal Study (CHARLS) 2011–2020 and the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2008–2018. The three-parameter model life table method and a dichotomy search algorithm were employed to estimate the life expectancy for older population in urban and rural areas. By integrating adjusted mortality rates, we refined the health transition probability matrices derived from the Bayesian model, enabling more accurate quantification of life expectancy across different disability severity levels. 

RESULTS

In 2020, notable urban-rural disparities in disability life expectancy (DLE) among older population were observed in China across multiple dimensions: (1) The DLE for urban males aged 60 was significantly longer at 3.37 years compared to 2.54 years for rural males, while urban females aged 60 also exhibited an advantage (5.28 years vs. 3.84 years for rural females). (2) The urban-rural disparities persisted across mild, moderate and severe DLE. Notably, the severe DLE among urban adults aged 60 was 1.72 times higher than that of their rural counterparts. (3) The healthy life expectancy of urban older population was also longer than that of rural counterparts. (4) For proportion of DLE in life expectancy, urban females aged 60 had a significantly higher proportion of DLE (21.04%) than rural females (17.61%), whereas no significant difference was observed between urban and rural males. (5) The proportion of severe DLE in total life expectancy was significantly higher among urban older adults than rural counterparts, with this gap widening with age.

CONCLUSIONS

This study provides empirical evidence that, in China, urban older population exhibits a significantly higher disability life expectancy (DLE) than their rural counterparts in absolute terms. Furthermore, the proportion of severe DLE in total life expectancy is also markedly greater among the urban older population when assessed in relative terms. To mitigate these disparities, policymakers in China should prioritize strengthening both the primary healthcare systems and the elderly rehabilitation service systems to reduce DLE and the proportion of DLE in life expectancy. Additionally, an equitable financing system for long-term care insurance should be established to address the urban-rural disparities in DLE. 

CONTRIBUTION

This paper presents novel evidence on urban-rural disparity in disability life expectancy (DLE) among China’s older population, with methodological and theoretical marginal contributions. First, it introduces a Bayesian multi-state model with an informative priors, integrated with the three-parameter life table method, to correct mortality underreporting in health transition probability matrices. This approach captures urban-rural DLE disparities by explicitly accounting for parameter uncertainty, addressing a gap in existing research methodologies. Second, based on the baseline findings of the urban-rural disparities in DLE and healthy life expectancy, the study empirically tests theoretical hypotheses regarding the “protective” and “selective” effects of socioeconomic factors on DLE, as well as the health promotion hypothesis.