ArticleThe journals of gerontology. Series B, Psychological sciences and social sciences2026
Who is more fearful of being dependent? A Blinder-Oaxaca decomposition analysis of rural-urban difference among middle-aged and older Chinese adults.
Article in The journals of gerontology. Series B, Psychological sciences and social sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesThis study aimed to explore the rural-urban disparity in China regarding middle-aged and older adults' fear of dependence (FoD).
methodsWe adopted a sample of 1,499 adults (rural: 918; urban: 581) aged 50+ from the 2021 wave of the Chinese General Social Survey. FoD was measured based on a summative score of participants' worry about three scenarios: (a) financial dependence, (b) others making decisions on my behalf, and (c) needing assistance with activities of daily living. A twofold Blinder-Oaxaca decomposition analysis was employed to quantify and statistically account for the sources of the rural-urban disparity in FoD.
resultsRural older adults exhibited a significantly higher level of FoD than their urban peers (raw difference: 0.672, p < .001). The decomposition analysis demonstrated that 78.23% of the gap was associated with rural-urban differences in the observed explanatory factors (the endowment effect). Disparities in the affordability of quality medical services during critical illness accounted for the largest share of the explained rural-urban gap (56.87%), followed by lower subjective economic status (14.27%) and higher prevalence of chronic illness (11.12%) among older rural residents. DISCUSSION: The elevated FoD among rural older adults is primarily associated with vulnerability to catastrophic health expenditure, leading them to perceive dependence as a more immediate and disastrous threat to themselves and their families. Policy interventions aimed at increasing the financial resilience of rural families against severe illness are crucial to mitigate this concern and reduce long-lasting urban-rural health inequalities.
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