The impact of rural-urban community settings on cognitive decline: Results from a nationally-representative sample of seniors in China

Yuanxi Xiang, Hossein Zare, Cuiling Guan, Darrell Gaskin

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: Aging and rural-urban disparities are two major social problems in today's ever-developing China. Much of the existing literature has supported a negative association between adverse community setting with the cognitive functioning of seniors, but very few studies have empirically investigated the impact of rural-urban community settings on cognitive decline in the late life course of the population in developing countries. Methods: Data of seniors aged 65 or above (n = 1709) within CHARLS (The China Health and Retirement Longitudinal Study, a sister study of HRS), a nationally representative longitudinal cohort (2011-2015) in China, were analyzed using a multilevel modeling (MLM) of time within individuals, and individual within communities. Cognitive impairment was assessed with an adapted Chinese version of Mini-Mental State Examination. Results: Urban community setting showed a significant protective effect (β = - 1.978, p <.000) on cognitive impairment in simple linear regression, and the MLM results showed it also had a significant lower cognitive impairment baseline (β = - 2.278, p <.000). However, the curvature rate of cognitive decline was faster in urban community setting indicated by a positive interaction between the quadratic time term and urban community setting on cognitive impairment (β = 0.320, p <.05). A full model adjusting other individual SES factors was built after model fitness comparison, and the education factor accounted for most of the within and between community setting variance. Conclusions: The findings suggest that urban community setting in one's late-life course has a better initial cognitive status but a potentially faster decline rate in China, and this particular pattern of senior cognitive decline emphasize the importance of more specific preventive measures. Meanwhile, a more holistic perspective should be adopted while construct a risk factor model of community environment on cognitive function, and the influence at society level needs to be further explored in future research.

Original languageEnglish (US)
Article number323
JournalBMC geriatrics
Issue number1
StatePublished - Dec 29 2018


  • China
  • Cognitive decline
  • Community settings
  • MMSE
  • Multilevel modelling
  • Rural-urban

ASJC Scopus subject areas

  • Geriatrics and Gerontology


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