U.S. Department of Commerce

Economics and Statistics Administration 

U.S. CENSUS BUREAU 

U.S. Department of Health and 

Human Services

National Institutes of Health

NATIONAL INSTITUTE ON AGING

Issued September 2007

P95/07-2

By 

Wan He,

Manisha Sengupta

and

Kaiti Zhang,

Ping Guo

International Population Reports

China National Committee on Aging 

CHINA RESEARCH CENTER ON AGING

Health and Health Care of the Older 

Population in Urban and Rural China: 2000
This report was prepared by Wan He and Manisha Sengupta of

the U.S. Census Bureau, and Kaiti Zhang and Ping Guo of the

China Research Center on Aging (CRCA). General direction was provided by Peter O. Way, Chief, International Programs Center (IPC),

Population Division, U.S. Census Bureau, and Qingchun Yan, Vice

President, China National Committee on Aging. Within the Census

Bureau’s Population Division, additional direction was provided by

Enrique J. Lamas, Chief, John F. Long, former Chief, Victoria A.

Velkoff, Assistant Division Chief for Estimates and Projections, and

Kevin Kinsella, Chief, Aging Studies Branch (ASB), IPC.

Within the ASB, Mary Beth Kennedy was instrumental in verifying

the bulk of the report calculations. The authors also thank ASB

summer intern Michelle Cheuk, who assisted with various aspects

of the report. Within the CRCA, Fang Liu, Lujun Sun, Gang Chen,

Fengli Ma, and Wensheng Miao assisted with data analysis and

background research.

For their review of and substantive suggestions regarding this report,

the authors are grateful to Iris Chi, School of Social Work, University

of Southern California; James C. Gibbs, IPC, Population Division, U.S.

Census Bureau; Marjorie Hanson, Data Integration Division, U.S.

Census Bureau; Frank B. Hobbs and Judith W. Waldrop, Population

Division, U.S. Census Bureau; and David R. Phillips, Asia-Pacific

Institute of Population Studies, Lingnan University, Hong Kong. The

authors give special thanks to David Megill, IPC, Population Division,

U.S. Census Bureau, for his assistance in creating sample weights and

deriving sampling design estimators.

The sampling review was led by David W. Hall, Amy B. Herron,

Rebecca A. Olson, and Michael E. White, under the direction of

John Finamore, Demographic Statistical Methods Division 

(Ruth Ann Killion, Chief), U.S. Census Bureau. 

Janet Sweeney and Jamie Peters of the Administrative and

Customer Services Division, Walter C. Odom, Chief, provided publication and printing management, graphics design and composition,

and editorial review for print and electronic media. General direction

and production management were provided by Wanda Cevis, Chief,

Publications Services Branch.

The research and production of this report was supported by the

National Institute on Aging, part of the National Institutes of Health,

U.S. Department of Health and Human Services. Under an interagency

agreement, the National Institute on Aging supports a number of

Census Bureau activities in the area of aging-related statistics through

the institute’s Behavioral and Social Research Program, Richard M.

Suzman, Director.

Acknowledgments
U.S. Department of Commerce

Carlos M. Gutierrez,

Secretary

David A. Sampson,

Deputy Secretary

Economics and Statistics Administration

Cynthia A. Glassman, 

Under Secretary for Economic Affairs

U.S. CENSUS BUREAU

Charles Louis Kincannon,

Director

P95/07-2

Issued September 2007

Health and Health Care of the Older

Population in Urban and Rural China: 2000
Suggested Citation

He, Wan and Manisha Sengupta, 

Kaiti Zhang and Ping Guo

U.S. Census Bureau, 

International Population Reports,

P95/07-2 Health and Health Care 

of the Older Population in 

Urban and Rural China: 2000, 

U.S. Government Printing Office,

Washington, DC, 

2007.

ECONOMICS

AND STATISTICS

ADMINISTRATION

Economics and Statistics

Administration

Cynthia A. Glassman,

Under Secretary for Economic Affairs

U.S. CENSUS BUREAU

Charles Louis Kincannon,

Director

Preston Jay Waite, 

Deputy Director and Chief Operating Officer

Howard Hogan,

Associate Director for Demographic Programs

Enrique J. Lamas,

Chief, Population Division

For sale by the Superintendent of Documents, U.S. Government Printing Office

Internet: bookstore.gpo.gov Phone: toll free 866-512-1800; DC area 202-512-1800

Fax: 202-512-2250 Mail: Stop SSOP, Washington, DC 20402-0001
U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 iii

EXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Chapter 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . 3

China’s Aging Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Growth of China’s Older Population . . . . . . . . . . . . . . . . . . . . . . . 3

Decline of Fertility and Mortality Rates . . . . . . . . . . . . . . . . . . . . . 5

Age Structure and Support Ratios . . . . . . . . . . . . . . . . . . . . . . . . . 8

Health Status and Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Health Status and Health Sector . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Disease Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Health Care Costs and Financing . . . . . . . . . . . . . . . . . . . . . . . . . 11

Survey Design and Estimation Procedures . . . . . . . . . . . . . . . . 13

Sample Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Estimation Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Basic Demographic and Socioeconomic Characteristics 

of China’s Older Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Age, Sex, and Urban/Rural Residence . . . . . . . . . . . . . . . . . . . . . 14

Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Education and Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Living Arrangements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Chapter 2. Physical Health . . . . . . . . . . . . . . . . . . . . . . . . 17

Disability and Activity Limitations . . . . . . . . . . . . . . . . . . . . . . . 17

Limitations in ADL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Limitations in Mobility-Related Activities . . . . . . . . . . . . . . . . . . . 19

Limitations in Household Activities . . . . . . . . . . . . . . . . . . . . . . . 21

Activity Limitations and Marital Status . . . . . . . . . . . . . . . . . . . . . 21

Activity Limitations, Education, and Income . . . . . . . . . . . . . . . . . 22

Chronic Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Self-Assessed Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Lifestyle Behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Alcohol Consumption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Physical Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Chapter 3. Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . 29

Life Satisfaction and Happiness . . . . . . . . . . . . . . . . . . . . . . . . . 30

Life Satisfaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Happiness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Socialization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Table of Contents
iv Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

Psychological Distress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Feeling Lonely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Feeling Like a Burden to Society or Family . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Old-Age Worries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Chapter 4. Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Medical Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Visits to Doctor’s Offices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Home Visits by Doctors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Hospitalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Informal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Health Service Utilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Easy Access to Medical Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Utilization of Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Financing Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Public Expenditure on Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Health Insurance Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Medical Expense Payment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Appendix A. Detailed Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Appendix B. Source and Accuracy of Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Figures

Figure 1-1. Population Aged 60 and Over: 1953 to 2050 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Figure 1-2. Speed of Population Aging, Selected Countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Figure 1-3. Percent Distribution of Population Aged 60 and Over: 1953 to 2050 . . . . . . . . . . . . . . . . . . . . . 5

Figure 1-4. Total Fertility Rates: 1953 to 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Figure 1-5. Crude Death Rates: 1953 to 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Figure 1-6. Life Expectancy at Age 60: 1964 to 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Figure 1-7. Population by Age and Sex: 1953 and 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Figure 1-8. Support Ratios: 1953 to 2050 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Figure 2-1. Percent of Population Aged 60 and Over With Limitations in Activities of Daily Living, 

Mobility, and Household Activities: 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Figure 2-2. Percent of Population Aged 60 and Over With One or More Limitations in Activities of 

Daily Living: 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Figure 2-3. Percent of Married and Unmarried People Aged 60 and Over With 

Activity Limitations: 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Figure 2-4. Percent of Population Aged 60 and Over With Activity Limitations: 2000 . . . . . . . . . . . . . . . . . . 22

Figure 2-5. Association Between Gender and Health Measures for Population Aged 60 and Over: 2000 . . . 23

Figure 2-6. Percent of Population Aged 60 and Over by Self-Assessed Health: 2000 . . . . . . . . . . . . . . . . . . 24

Figure 2-7. Percent of Population Aged 60 and Over With Selected Behaviors: 2000 . . . . . . . . . . . . . . . . . . 26

Figure 2-8. Percent of Population Aged 60 and Over Engaging in Physical Activity: 2000 . . . . . . . . . . . . . . 27

Figure 2-9. Percent of Population Aged 60 and Over Using Assistive Devices: 2000 . . . . . . . . . . . . . . . . . . 28
Figure 3-1. Percent of Population Aged 60 and Over Satisfied With Life: 2000 . . . . . . . . . . . . . . . . . . . . . . . 31

Figure 3-2. Association Between Gender or Urban/Rural Residence and Life Satisfaction for 

Population Aged 60 and Over: 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Figure 3-3. Percent of Population Aged 60 and Over Feeling Happy: 2000 . . . . . . . . . . . . . . . . . . . . . . . . . 33

Figure 3-4. Percent of Population Aged 60 and Over Enjoying Talking With People and Willing to 

Participate in Community Recreational Activities: 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Figure 3-5. Percent of Population Aged 60 and Over Feeling Lonely: 2000 . . . . . . . . . . . . . . . . . . . . . . . . . 35

Figure 3-6. Percent of Population Aged 60 and Over Feeling Like a Burden to Society: 2000 . . . . . . . . . . . . 36

Figure 3-7. Percent of Population Aged 60 and Over Feeling Like a Burden to Family: 2000 . . . . . . . . . . . . 36 

Figure 3-8. Percent of Population Aged 60 and Over Worrying About Financial Resources 

for Daily Living: 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Figure 3-9. Percent of Population Aged 60 and Over Worrying About Not Having Money for 

Medical Care: 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Figure 3-10. Percent of Population Aged 60 and Over Worrying About Not Getting Care 

When Needed: 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Figure 4-1. Percent of Population Aged 60 and Over Visiting a Doctor’s Office in the Last Year: 2000 . . . . . 41

Figure 4-2. Percent of Population Aged 60 and Over Visited by a Doctor at Home in 

the Last Year: 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Figure 4-3. Percent of Population Aged 60 and Over Hospitalized in the Last Year: 2000 . . . . . . . . . . . . . . 43

Figure 4-4. Percent of Population Aged 60 and Over With Activity Limitations and 

Receiving Assistance: 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Figure 4-5. Percent of Population Aged 60 and Over Having Easy Access to Medical Care: 2000 . . . . . . . . . 44

Figure 4-6. Percent of Population With Health Insurance Coverage: 1998/2000 . . . . . . . . . . . . . . . . . . . . . . 47

Figure 4-7. Sources of Medical Expense Payment for Population Aged 60 and Over: 2000 . . . . . . . . . . . . . . 49

Tables

Table 1-1. Population Aged 60 and Over by Residence and Selected Characteristics for China: 2000 . . . . . 14

Table 2-1. Percent of Population Aged 60 and Over With Limitations in Activities of Daily Living 

by Number of Limitations and Selected Characteristics for China: 2000 . . . . . . . . . . . . . . . . . . 19

Table 2-2. Percent of Population Aged 60 and Over With Limitations in Various Activities by 

Residence, Sex, and Type of Activity for China: 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Table 2-3. Odds Ratios Predicting the Association Between Health Measures and Gender for 

Population Aged 60 and Over for China: 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Table 3-1. Percent of Population Aged 60 and Over Satisfied With Life by Residence and 

Selected Characteristics for China: 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Table 3-2. Odds Ratios Predicting Likelihood to Be Satisfied With Life for Population 

Aged 60 and Over for China: 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Table 4-1. Average Number of Visits to Doctor’s Office Last Year for Population Aged 60 and Over 

by Residence and Selected Characteristics for China: 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Table 4-2. Regression Coefficients of Health Service Utilization for Population Aged 60 and Over 

for China: 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Table 4-3. Sources of Medical Expense Payment for Population Aged 60 and Over by 

Selected Characteristics for China: 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 v
Boxes

Box 1-1. Outline of the Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Box 1-2. The Sample Survey on Aged Population in Urban/Rural China . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Box 2-1. Physical Limitations and Accessibility Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Box 2-2. Gender Differences in Functioning Among Older Chinese . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Box 2-3. Assistive Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Box 3-1. Aging and Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Box 3-2. Chinese Culture and Psychological Distress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Box 4-1. Andersen’s Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Box 4-2. China’s Health Insurance Schemes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Appendix Tables

A-1. Population Aged 60 and Over by Sex, Residence, and Selected Characteristics 

for China: 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

A-2. Population Aged 60 and Over With Limitations in Activities of Daily Living by Sex, 

Type of Limitation, Residence, and Selected Characteristics for China: 2000 . . . . . . . . . . . . . . . 61

A-3. Population Aged 60 and Over Satisfied With Life by Sex, Age, Residence, and 

Selected Characteristics for China: 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

A-4. Average Number of Visits to Doctor’s Office in Last Year Among Population Aged 60 and 

Over by Sex, Age, Residence, and Selected Characteristics for China: 2000 . . . . . . . . . . . . . . . . 69

vi Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau
China has the largest older population in the world today, and it will

age much more rapidly than

Western countries in the near

future. Along with remarkable

socioeconomic transformation and

family and lifestyle changes, China

has begun the epidemiological

transition from the primacy of

acute infectious and deficiency diseases to a predominance of noncommunicable diseases and

chronic conditions commonly associated with an older population.

One of the biggest challenges facing the Chinese government will be

the expansion and retooling of its

health care system to address the

needs of its large aging population. 

This report presents a descriptive

analysis of the health status and

health care of China’s older population in 2000. Data come from the

Sample Survey on Aged Population

in Urban/Rural China (SSAPUR) conducted in December 2000. SSAPUR

was the first national survey of the

older population sponsored solely

by the Chinese government, with a

national random sample of approximately 20,000 respondents from

20 provinces. A second SSAPUR

was fielded in June–August 2006

with a similar sample size and an

improved sampling frame and

questionnaire design. The 2006

survey included a subsample of

9,380 respondents from the 2000

survey. When the 2006 data

become available, the two SSAPUR

surveys will provide a source for

studies on trends and changes in

older people’s health status and

health care utilization, and they

will permit longitudinal analyses

on the dynamics of health status

and transitions to and from different health conditions.

This report first examines older

people’s activity limitations, selfassessed health, chronic disease

status, and lifestyle behaviors. In

addition to providing information

on physical health, SSAPUR results

permit study of the mental health

of older Chinese, an area that has

been unexplored due to a lack of

data. This report also examines the

utilization of health care services

by China’s older people, another

area that has not been widely

researched.

Major findings include the

following:

Nearly half of the older

population in China reported

some activity limitation.

About 45 percent of older people

reported at least one limitation in

activities of daily living (ADL),

mobility, or household activities.

Among the three measures of functional disability used in this report,

mobility difficulty was the most

common (40 percent), followed by

instrumental-ADL-like household

activity limitations (26 percent) and

ADL limitations (19 percent). 

Women, the unmarried, the less

educated, and the poor more

commonly reported activity

limitations.

The SSAPUR confirms findings from

other countries that activity limitations are more common among

women, the unmarried, the less

educated, and the poor. Education is

strongly associated with functional

ability. ADL and mobility limitations

were highest among the illiterate

(people aged 15 and older who are

unable to read) and decreased progressively with each level of education. The largest difference was

observed between the illiterate and

the primary schooled, indicating

that even a few years of education

may be associated with better physical functioning at older ages.

More than half of 

older Chinese reported a

chronic condition.

About 55 percent of older Chinese

reported a chronic health condition. It is clear that good health is

linked to diet, exercise, and

lifestyle. While over half of the 60-

and-older population in China have

never smoked or consumed alcohol, dramatic economic transformations and environmental changes

related to urbanization are leading

to changes in diet and lifestyle

among relatively younger Chinese. 

U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 1

Health and Health Care of 

the Older Population in 

Urban and Rural China: 2000

EXECUTIVE SUMMARY
Older Chinese women were

more likely than older Chinese

men to be satisfied with life. 

Most older people in China (63 percent) said they were satisfied with

their life. On the surface, older men

and women appeared similar in

terms of reported life satisfaction.

However, regression analyses controlling for various socioeconomic

and demographic variables showed

that women were more likely than

men to report life satisfaction.

These results imply that if older

women had the same marital status,

education, and money income as

older men, they would have

reported greater life satisfaction.

About half of older Chinese

worried about financial

resources for daily living and

health care.

Financial strains are one of the

main causes of stress for older

people, who typically do not work

for pay. Four of ten SSAPUR respondents stated that they were worried about not having enough

financial resources for daily living,

and about half worried that they

may not be able to afford medical

care when needed. The SSAPUR

data also indicate that 63 percent

of older Chinese felt themselves to

be a burden to their families.

Urban/rural residence was

associated with older people’s

health care utilization.

While many demographic and

socioeconomic variables (e.g., age,

sex, marital status, living arrangement, education, income) were

associated with health care utilization, urban/rural residence

emerged as the factor that most

affected older people’s health care.

Compared with their urban counterparts, rural older people were

less likely to use structured forms

of health care, such as visits to

doctor’s offices and clinics or hospitalization, but more than twice as

likely to receive relatively unstructured medical care such as doctor

home-visits. About 40 percent of

rural residents (compared with 16

percent of urban residents) had

doctors visit them in their own

home in 2000. This finding reflects

the lower prevalence of doctor’s

offices and clinics in rural areas

than in urban areas, as well as

increased physical inconveniences

in rural areas, such as longer distances to doctor’s offices and difficulty with or lack of transportation.

Older people themselves paid

about half of their medical

expenses, with children or

other family members covering

another third. 

Survey data on medical expense

payments by source show that older

individuals paid up to half of their

medical expenses out of pocket,

with another one-third covered by

their children or other family members. Just about 10 percent was

covered by insurance. Older women

had a lower proportion of their

medical expense covered by insurance than older men (8 percent

compared with about 14 percent)

but received more help from children or family than their male counterparts (47 percent and 28 percent,

respectively).

2 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau
China’s Aging Process

Growth of China’s Older

Population 

China has the largest older population in the world today.1 In 2005,

142.4 million Chinese people were

aged 60 and over, representing

21.3 percent of the world’s total

older population. Over the past 50

years, China’s older population has

increased substantially. The number of people 60 and older has

more than tripled, from 41.5 million in 1953, at China’s first census, to 130.0 million in 2000, at

China’s fifth census (Figure 1-1).2

The older population is expected

to more than triple again between

2000 and 2050, based on population projections by the U.S. Census

Bureau.3 By 2030, the older population is projected to reach about

350 million, and it may increase to

459 million in 2050.

Perhaps more important than the

sheer size of the older population

is the speed of aging of China’s

population in the near future.

During the past 50 years, the

growth of the older population outpaced that of the total population;

as a result, older people represented 10.4 percent of the total

population in 2000, up from 

7.3 percent in 1953 (Figure 1-1).

The aging process is projected to

accelerate in the next few decades;

growth of the older population will

be especially pronounced during

the period 2010–2040 (Du and

Phillips, 2004). By 2030, it is projected that about 25 percent of the

total population will be aged 60

and over; and by 2050, about 

32 percent, or nearly 1 in 3

Chinese, will be an older person.

U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 3

CHAPTER 1.

INTRODUCTION

1 In this report, older population is

defined as people aged 60 and over. 2 China conducted censuses in 1953,

1964, 1982, 1990, and 2000. 3 The Census Bureau constructs population estimates and projections for every

country with a population of more than

5,000 in the world, utilizing available demographic data from censuses, vital registrations, demographic and health surveys, and

other sources. Published data are adjusted

where appropriate and assumptions are made

regarding future trends in fertility, mortality,

and migration. The resulting population estimates and projections are available in the

International Data Base at

<www.census.gov/ipc/idbnew.html>. For

more information on the projections, see

<www.census.gov/ipc/www/idbr0210.html>.

Unforeseen events can rapidly modify the

demographic environment. As with any projection data, uncertainties about the levels

and directions of future fertility, mortality,

and net migration levels mean that the actual

future population is unlikely to be identical

to the projected population. 

Figure 1-1.

Population Aged 60 and Over: 1953 to 2050

Note: Intervals between the census years of 1953 and 2000 are not even.

Sources: For 1953, 1964, 1982, 1990, and 2000, China State Council and National 

Bureau of Statistics, 1982, 1985, 1993, and 2002; for 2010 to 2050, 

U.S. Census Bureau, 2006.

Population aged 60 and over

Percent of total population

0

50

100

150

200

250

300

350

400

450

500

1953 1964 1982 1990 2000 2010 2020 2030 2040 2050 0

5

10

15

20

25

30

35

Millions Percent of total population
In the international context, China

will age more rapidly than many

European countries and the United

States in the near future. One measure of the speed of aging is the

number of years required for the

percent of the population aged 65

and over to rise from 7 percent to

14 percent of the total population

(Figure 1-2).4 France completed this

process in 1980, taking 115 years.

The U.S. older population is

projected to reach 14 percent in

2014, 70 years after it reached 7

percent. China’s 65 and older population is projected to reach 14 percent in 2027, doubling in only 

27 years. 

Another important aspect of population aging is the growth of people

aged 80 and over (the oldest old).

The oldest old are much more likely

than the younger old (ages 60 to

79) to need help with daily living,

and they utilize medical care and

other services and receive government and private transfers out of

proportion to their numbers (Zeng

et al., 2002). China’s oldest-old

population has been increasing at a

faster pace than the total older population. In 2000, 12.0 million people aged 80 and over were reported

in the census, or 9.2 percent of the

older population (Figure 1-3). This

percentage was twice as high as in

1953. The number of oldest old will

continue to grow and is expected to

reach 44.5 million in 2030 and

116.4 million in 2050. By 2050,

about 25 percent of older people

are projected to be 80 and older. 

4 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

This report examines the physical health, mental

health, and health care of the older Chinese population, based on data from the nationally representative Sample Survey on Aged Population in

Urban/Rural China (SSAPUR), conducted by the

China Research Center on Aging (CRCA) in

December 2000.

To set the context for discussion of SSAPUR results,

Chapter 1 provides an overview of the population

aging process in China, followed by general information regarding the health status of the Chinese

population and the financing of health care. This

chapter also describes the design of the SSAPUR and

presents basic demographic (age, sex, marital status) and socioeconomic (education, income, living

arrangements) information from the survey. 

Chapter 2 investigates older people’s ability to perform activities of daily living (ADL) and instrumental

activities of daily living (IADL), and looks at mobility

limitations as well. The text examines chronic disease

status, self-assessed health, and the use of assistive

devices and considers several lifestyle behaviors that

influence health. 

Chapter 3 assesses the mental health status of older

people in China. The SSAPUR data do not include

measures directly comparable with those commonly

used in Western research (e.g., depression scales)

but do contain questions regarding psychological

distress. This study examines self-reported life satisfaction and happiness—including measures of

social integration and participation—as well as negative mental states associated with loneliness, feelings of being a burden to family and society, and

concerns about finances, health care, and informal

support in older age. 

The final chapter focuses on health care and old-age

care, looking at visits to doctor’s offices, home-visits

by doctors, hospitalization, and assistance with activity limitations. Health-care utilization is examined via

a framework that analyzes predisposing factors,

enabling or impeding factors, and the need for care.

Affordability is a key issue in China’s current healthcare reform, and the chapter also evaluates older

people’s financial arrangements for health care by

examining sources of medical expense payments.

A majority of older Chinese live in rural areas.

Because health status and access to health care

often differ considerably between city and countryside, this report differentiates the older population

by urban/rural residence. Attention also focuses on

health differences by age and gender. Where appropriate, distinctions are drawn by marital status, educational attainment, money income, and living

arrangements. 

Box 1-1.

Outline of the Report

4 This figure retains the age group 65 and

over from the original source.
Decline of Fertility and

Mortality Rates

Aging of a population is determined almost entirely by the

decline of fertility rates and adult

mortality rates. Generally speaking,

a population begins to age when

people have fewer children and

adults live longer, resulting in a

society with increasingly smaller

cohorts of children and youth and

progressively larger cohorts of

older people. At the early stages of

demographic transition, a decline

in infant and childhood mortality

results in more children and a

younger population.

U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 5

Figure 1-2.

Speed of Population Aging, Selected Countries

Sources: Kinsella and Velkoff, 2001; U.S. Census Bureau, 2006.

Singapore (2001-2019)

Thailand (2003-2024)

Chile (2000-2025)

Japan (1970-1996)

China (2000-2027)

United Kingdom (1930-1975)

Hungary (1941-1994)

Canada (1944-2010)

United States (1944-2014)

Australia (1938-2011)

Sweden (1890-1975)

France (1865-1980)

(Number of years required or expected for percent of population aged 65

and over to rise from 7 percent to 14 percent)

18

115

85

73

70

66

53

45

27

26

25

21

Figure 1-3.

Percent Distribution of Population Aged 60 

and Over: 1953 to 2050

Note: Intervals between the census years of 1953 and 2000 are not even.

Sources: For 1953, 1964, 1982, 1990, and 2000, China State Council and National 

Bureau of Statistics, 1982, 1985, 1993, and 2002; for 2010 to 2050, 

U.S. Census Bureau, 2006.

Percent 80 and over

Percent 60 to 79

1953 1964 1982 1990 2000 2010 2020 2030 2040 2050

25.3

95.5 95.7 93.4 92.1 90.8 88.8 88.1 87.3 82.3 74.7

4.5 4.3 6.6 7.9 9.2 11.2 11.9 12.7 17.7
China launched a fertility reduction

effort in the mid 1950s with mass

production and distribution of contraceptives, which was followed by

a second family planning effort in

the early 1960s (Banister, 1987).

However, its fertility level did not

fall notably until implementation of

the nationwide family planning policy in the 1970s.5 The campaign

started with the emphasis on 

“wan, xi, shao”—later marriage,

longer intervals between births,

and fewer births. By the end of the

decade, realizing that the large

population was hindering economic development and acting on

a desire to improve China’s living

standard to the level of Western

industrialized societies, the

Chinese government began implementing the one-child policy (Lee

and Feng, 1999). This initiative

was accompanied by rapid socioeconomic development that came

with economic reform that started

in the early 1980s (Poston, 2000).

As a result, China’s total fertility

rate (TFR) dropped from 5.8 in

1950, to 2.7 in 1979, to under the

replacement level in 1991 (2.0),

and it has remained below replacement since then (Figure 1-4).6

6 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

Figure 1-4.

Total Fertility Rates: 1953 to 2005

Note: The sharp drop in the total fertility rate from 1959 to 1961 was due to famine and natural disasters during that period. 

Sources: For 1953–1989, Banister, 1987 and 1992; for 1990–1995, U.S. Census Bureau, 2004; for 1996–2005, U.S. Census Bureau, 2006.

0

1

2

3

4

5

6

7

8

1953 1957 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001 2005

Births per woman

Replacement level: 2.1

6 TFR is defined as the average number of

children that would be born per woman if all

women lived to the end of their childbearing

years and bore children according to a given

set of age-specific fertility rates. The replacement level is the total fertility rate at which

women would have only enough children to

replace themselves and their partner. The

true replacement level will depend upon the

level of mortality, especially infant, childhood, and maternal. However, the commonly

used replacement level fertility is 2.1 children

per woman. 

5 Some have argued that the Chinese fertility decline among the better educated and

in more developed urban areas began well

before the introduction of major government

family planning programs in the 1970s. For

examples, see Lavely and Freedman, 1990

and Coale and Freedman, 1993.
In the early 1950s, the Chinese

government launched the first of

several public health campaigns to

improve environmental sanitation

conditions, eradicate parasitic diseases, control infectious diseases,

and enhance maternal and child

health (Banister, 1987). The 

government established networks

of hospitals and clinics for medical

services and social organizations

for public health education (Salaff,

1973). The improved medical and

sanitation conditions greatly

reduced mortality rates, especially

infant mortality rates (Banister and

Preston, 1981). The crude death

rate in 1954 was 29.7 It declined

steadily (with the exception of the

great famine in the late 1950s and

early 1960s) to below 10 in 1967

and has remained lower than 10

since then (Figure 1-5). 

U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 7

Figure 1-5.

Crude Death Rates: 1953 to 2005

Note: The sudden increase in the mortality rate from 1959 to 1961 was due to famine and natural disasters during that period.

Sources: For 1953–1981, Coale, 1984; for 1982–1989, U.S. Census Bureau, 2004; for 1990–2005, U.S. Census Bureau, 2006.

0

5

10

15

20

25

30

35

40

1953 1957 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001 2005

Deaths per 1,000 population

7 The crude death rate is the number of

deaths per 1,000 people.
Improvements in infant and childhood mortality have contributed to

extended life expectancy. China’s

life expectancy at birth has

improved from 55.9 years in 1964

to 70.7 years in 2005 for males

and from 57.4 years in 1964 to

74.1 years in 2005 for females

(U.S. Census Bureau, 2004 and

2006). Better health conditions

have led to longer lives for older

people. Men at age 60 in 1964

could expect to live another 13.4

years and in 2005, 17.3 years;

women at that age could expect to

live another 15.1 years and 20.0

years, respectively (Figure 1-6).

This upward trend is expected to

continue, and both older men and

women are projected to gain one

more year of life expectancy for

every decade in the next 50 years. 

Age Structure and 

Support Ratios

The rapidly falling and sustained

low fertility levels and extended

life expectancy have changed

China’s age structure, illustrated in

the form of age-sex population

pyramids in Figure 1-7. The 1953

population pyramid has the classic

shape for a developing country:

the youngest age groups form a

broad base and the size of other

groups shrinks progressively with

increasing age. 

8 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

Figure 1-6.

Life Expectancy at Age 60: 1964 to 2005

Note: Intervals between the years of 1964 and 2005 are not even. 

Sources: U.S. Census Bureau, 2004 and 2006.

Female

1964 1970 1980 1990 2000 2005

(In years)

20.0

13.4 14.1

15.2 16.0 16.8 17.3

15.1

16.0

17.6

19.0 19.1

Male
U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 9

Figure 1-7. 

Population by Age and Sex: 1953 and 2000

80 60 40 20 0 0 20 40 60 80

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80+

Age

Male Female

Sources: China State Council and National Bureau of Statistics, 1982 and 2002.

80 60 40 20 0 0 20 40 60 80

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80+

Millions Millions

1953

2000
The picture in 2000 is different. It

is no longer the typical pyramid

shape but somewhat rectangular,

and the base is much smaller than

the middle age groups. The effects

of the fertility restrictions in the

1980s and 1990s can be seen in

the jagged shape of the pyramid,

especially the abrupt shrinking of

the age group 20 to 24 in 2000.

The cohort born just before the

one-child policy, aged 30 to 34 in

2000, is the largest. Compared

with 1953, the older age groups of

the 2000 age distribution grew in

both absolute numbers and in proportion of the total population,

reflecting the combination of low

fertility and improvements in

longevity.

As a result of the changed age

structure, China’s societal support

ratios have declined. In this report,

the total support ratio is defined as

the number of young people (aged

0 to 14) and older people (aged 60

and over) for every 100 workingage people (aged 15 to 59). The

total support ratio comprises the

older support ratio (the number of

older people for every 100 working-age people) and the youth support ratio (the number of young

people for every 100 working-age

people). The total support ratio is a

broad indication of the degree to

which the economically active population needs to support the young

and the old on a societal level, and

it has implications for a government’s policies on tax, old-age

security, and other issues.8

As shown in Figure 1-8, China’s

total support ratios from 1964 to

2050 form a U-shaped curve. The

total support ratio fell from a high

of 89 in 1964 to 50 in 2000,

indicating a relatively low current

societal support burden. Total support ratios are projected to rise

after 2010, reaching 90 in 2050,

when there will be nearly one

working-age person supporting

each non-working-age person. 

Figure 1-8 also demonstrates

changes in the composition of the

total support ratio. In the 30 years

after 1953, the youth support ratio

made up more than 80 percent of

the total support ratio. Since 1982,

as a result of the much-lowered

fertility, China’s youth support

ratios were significantly reduced.

Although there were twice as many

people of working age as there

were old and young combined in

2000, the composition of the

support ratio has changed. The

older support ratio made up an

increasing proportion of the total

support ratio, from 17 percent in

1953 to 32 percent in 2000. If the

current low fertility and mortality

trends continue, the total support

ratio composition will reverse.

Between 2020 and 2030, although

the total support ratio is projected

to remain well below 100, the

older component is expected to

surpass the youth component for

the first time. This pattern is likely

to continue into the middle of the

twenty-first century.

The changing composition of the

total support ratio indicates that fertility policies have limited the size

of birth cohorts relative to previous

10 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

Figure 1-8.

Support Ratios: 1953 to 2050

Notes: Total support ratio is defined here as the number of people aged 0 to 14 and 

60 and over per 100 people aged 15 to 59. It is composed of the older support ratio, 

which is the number of people aged 60 and over per 100 people aged 15 to 59, 

and the youth support ratio, which is the number of people aged 0 to 14 per 100 people 

aged 15 to 59. Intervals between the census years of 1953 and 2000 are not even.

Sources: For 1953, 1964, 1982, 1990, and 2000, China State Council and National 

Bureau of Statistics, 1982, 1985, 1993, and 2002; for 2010, 2020, 2030, 2040, and 2050, 

U.S. Census Bureau, 2006.

Youth support ratio

Older support ratio

Total support ratio 

1953 1964 1982 1990 2000 2010 2020 2030 2040 2050

90

13 12 13 13 16

18

27

40

50

61

64

77

57

43

34 29

30

28

26

29

77

89

70

56

50

47

57

68

76

8 This report recognizes that there is

debate over the usefulness of the concept of

“support ratio,” given that the term implies a

sense of dependency at certain ages that

may not be entirely warranted. For further

discussion, see Kinsella and Phillips, 2005.
generations. China may soon face a

situation where there are too few

working adults to support a rapidly

aging population (Kaneda, 2006).

The very speed of the fertility transition has given the country little

time to develop a nonfamilial oldage support system to replace the

traditional family (Poston and Duan,

2000). According to the philosophy

embedded in Chinese culture and

mandated by China’s 1982

Constitution, “children who have

come of age have the duty to support and assist their parents” (Shi,

1993: 469). The family and adult

children will bear the main responsibility of taking care of older people.

Without siblings to share the

responsibility, young couples born

since the one-child policy often are

shouldering the task of taking care

of four older parents today. Their

children, if the current one-child

policy continues to the time of their

marriage in 20 years, will possibly

be facing the task of taking care of

four parents and in some cases

even eight grandparents.

Health Status and 

Health Care 

Health Status and Health Sector 

One of the major concerns about

an aging population is the health

and health care of older people.

The World Health Organization

(WHO) reported that China made

remarkable gains in health and life

expectancy from the 1950s

through the 1980s (WHO, 2004a).

To provide primary health care to

its populace, the health sector

established a three-tier health care

system in both rural and urban

areas: in rural areas, the tiers are

village doctors and clinics, township health centers, and general

hospitals; in urban areas, they are

community health centers, district

hospitals, and tertiary hospitals

(Meng et al., 2004). By the end of

2004, there were 296,492 health

care institutions in China, including

60,867 hospitals and township

hospitals; 207,933 clinics; 3,586

epidemic prevention stations; and

other health-care institutions

(National Bureau of Statistics of

China, 2005). 

Disease Profile

The provision of public health care

in the past five decades, especially

from the early 1950s to the mid

1980s, resulted in considerable

progress in key health indicators

and enabled the epidemiological

transition to begin.9 By the 1990s,

chronic diseases in middle and

older age were the most important

health problems in parts of the

country (Popkin et al., 1993). There

is evidence that now “China’s disease profile resembles that of a

developed country: 85%–90% of

deaths are due to noncommunicable diseases and injuries” (WHO,

2005: 2). 

This disease profile has important

public health implications now that

the population is aging, because

the old and the young are affected

by different diseases. In general,

stroke, cancer, ischemic heart disease, and chronic lung disease

account for most of the mortality

among middle-aged and older people, while children generally die

from a short list of infections, most

of which are relatively inexpensive

to treat or prevent (World Bank,

1996). The fact that older people

are more likely than younger people to have noncommunicable diseases, combined with the rapid

growth of the older population, will

result in an increasing number of

older people with chronic disease.

This will not only affect the older

population’s quality of life but also

result in heavier health care costs

for older people and society.

The physical health of older people

is likely to affect their mental health

status, as disease and physical dysfunction affect emotional well-being

and increase depression (Mirowsky

and Ross, 1992). WHO defines

health as “a state of complete physical, social, and mental well-being,

and not merely the absence of disease or infirmity” (WHO, 1998:1).

The WHO has estimated that mental

health problems in China account

for 20 percent of the total disease

burden (WHO, 2004b).

Health Care Costs 

and Financing

Health care costs are rapidly rising.

The World Bank reported that while

during the 1960s and 1970s China

performed well in providing affordable essential care, in the 1980s it

faltered, and in the 1990s, it

slipped still further (World Bank,

2005a). The cost of care has risen

such that a single hospitalization

cost about 4,000 yuan10 on average

in 2003, equivalent to 43 percent

of the average national income and

nearly 200 percent of the average

income for a person in the poorest

one-fifth of the population (World

Bank, 2005a). 

Chinese government spending on

health has risen in real terms during

the last two decades but slower

than the rise in gross domestic

product (GDP) and slower than the

increase in private health expenditures. Between 1978 and 2003,

private health spending increased

U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 11

9 Epidemiological transition commonly

refers to the general shift from acute infectious and parasitic diseases characteristic of

underdevelopment to chronic noncommunicable diseases characteristic of modernization and advanced levels of development

(Wahdan, 1996).

10 From 1995 to 2005, the Chinese government maintained a pegged exchange rate

between its currency, the yuan, and the U.S.

dollar, with $1 = 8.28 yuan (United States

Congress, 2005).
from 20 percent of total health

spending to nearly 60 percent

(World Bank, 2005b). Much of this

was a result of the market-oriented

reforms that transformed public

hospitals and clinics into profitmaking enterprises. “With stagnant

government subsidies and restrictions on medical service charges,

public hospitals maximized revenues through loosely regulated

drug sales” (WHO, 2004c: 4).

Health-care costs are particularly

heavy for poor and rural residents

because, as the World Bank

reported, inequalities have been

generated by government spending

that largely focused on urban

health insurance schemes and on

subsidies to city hospitals (World

Bank, 2005c). Chinese Minister of

Health Gao Qiang acknowledged in

August 2005 that, “China has failed

to provide adequate health care to

most of its citizens” (China Daily,

2005:1).11 Health care reform has

been ongoing in recent years, and

one of the government’s stated top

priorities is to narrow urban-rural

disparities. As part of the budget

for 2006, the central government

will provide almost 5 billion yuan

for health insurance for rural residents, compared with less than 1

billion yuan in 2005 (China Daily,

2006a).

12 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

Data in this report, unless otherwise noted, come

from the Sample Survey on Aged Population in

Urban/Rural China (SSAPUR), conducted by the

China Research Center on Aging (CRCA) in

December 2000. The SSAPUR was the first national

survey of the older population conducted and sponsored solely by the Chinese government. Special

provincial offices were created to implement the

SSAPUR. Training was conducted for provincial and

city/county officials as well as the survey interviewers, and efforts were made to give the survey high

visibility at the local government level. Reflecting

these efforts, the SSAPUR achieved an extremely

high response rate of 99.3 percent. 

The survey contained two questionnaires, one for

urban residents and one for rural residents.

Categories in the two questionnaires were similar—

information was collected on personal background,

employment and income, housing conditions and

household assets, residential community/village elderly services and activities, living arrangements and

intergenerational transfers, physical health, health

care access and cost, mental health, and religious

beliefs. The two questionnaires differ mainly with

regard to certain questions about work, retirement,

and economic activities, as these variables may

have different meanings in urban and rural areas.

A second SSAPUR was fielded by the CRCA in

June–August 2006. The 2006 survey has a sample

size similar to that in 2000 (approximately 20,000

respondents) and a sampling frame that includes all

31 provinces. The 2006 survey made improvements

in questionnaire design by including detailed categories or measures of some health variables (e.g.,

chronic diseases and depressive symptoms) and

household economic information. When the 2006

data become available, the two SSAPUR surveys will

provide a valuable resource for analyzing trends in

older people’s health status and health care utilization. In addition, 9,380 respondents from the 2000

survey were reinterviewed in 2006. This subsample

will permit longitudinal analyses of the same individuals over time, enabling researchers to better

understand the dynamics of health status and transitions to and from different health states.

Detailed tabulations from SSAPUR 2000 provide

demographic characteristics of China’s older population vis-à-vis physical health, mental health, and

health care in 2000. Many of the SSAPUR data in this

report are shown in figures, text tables, and/or the

detailed tables in Appendix A. Other SSAPUR data discussed in this report are available as part of an

Internet table package that can be accessed on the

Census Bureau’s Internet site <www.census.gov>. In

the site’s “Subjects A–Z” area, click on “O,” then “Older

(55+) Population Data,” and then on “Health and

Health Care of China’s Older Population Data.”

Box 1-2.

The Sample Survey on Aged Population in Urban/Rural China

11 China Daily, an official English-language

newspaper issued by the Chinese government, is one of the main sources for up-todate official policies, published documents,

and speeches/statements by high-level government officials.
Survey Design and

Estimation Procedures

Sample Design

For the SSAPUR, a stratified multistage sample design was used to

select the primary sampling units

for the 27 provinces included in

the sampling frame (for more

detailed information on SSAPUR’s

sampling method, see Appendix

B).12 These provinces were stratified into six regions.13 Within each

region, the sample provinces were

selected with probability proportional to size (PPS), where the

measure of size was based on the

population aged 50 and older from

the Fourth China Census (1990)

data. Twenty sample provinces

were selected from the sampling

frame. The PPS sampling methods

were used to select four cities and

four counties within each sample

province, then a random sample of

16 urban blocks from each sample

city and 16 rural townships from

each sample county. At the next

sampling stage, 50 urban residential committees and 50 rural village

committees were selected within

each province, and a sample of 10

households from each residential

committee or village was selected

systematically with a random start

from the list of all households having members aged 60 and older.

As a final selection step, interviewers randomly selected one eligible

person from households with older

householders. This resulted in a

sample of about 500 urban older

people and 500 rural older people in

each province, for a total sample of

approximately 20,000 older people.

Estimation Procedures

To obtain correct estimates based

on the sample design of SSAPUR,

respondent weights were created.

First, basic weights were calculated,

taking into account all stages of

sample selection. The basic weights

were then adjusted using 2000 census data, which have the same reference year as the SSAPUR, for the

older population by region,

urban/rural stratum, sex, and age.

These final weights enabled the

weighted distribution of the older

population from the SSAPUR data to

be close to the 2000 census figures

for the older population for each

region by urban/rural stratum, sex,

and age, and at the same time

reflect the different stages of the

sample design to provide statistically unbiased survey estimates.

Basic Demographic 

and Socioeconomic

Characteristics of

China’s Older Population

Table 1-1 and Table A-1 show general demographic and socioeconomic characteristics of China’s population aged 60 and over in 2000

based on the SSAPUR data. These

characteristics are used as independent or control variables in this

report to examine their association

with the health status and health

care of China’s older population. 

U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 13

12 In 2000 when SSAPUR was conducted,

there were a total of 31 provinces,

autonomous regions, and centrally administered municipalities in China mainland (Taiwan

is not included in the SSAPUR), as well as the

two special administrative regions of Hong

Kong and Macao. SSAPUR did not include the

two Special Administrative Regions. The SSAPUR sampling frame excluded four provinces

(Nei Mongol, Guangxi, Guizhou, and Xizang)

for lack of administrative survey-conducting

capability or other reasons. Therefore, SSAPUR

is representative of the national population,

with the exception of the aforementioned

areas. China’s 2000 census data show that, all

combined, the population aged 60 and over of

these four provinces represented about 8 percent of China’s total older population in 2000. 13 The six regions of China are: North

(Beijing, Tianjin, Hebei, Shanxi, and Nei

Mongol); Northeast (Liaoning, Jilin, and

Heilongjiang); East (Shanghai, Jiangsu,

Zhejiang, Anhui, Fujian, Jiangxi, and

Shandong); South Central (Henan, Hubei,

Hunan, Guangdong, Guangxi, and Hainan);

Southwest (Chongqing, Sichuan, Guizhou,

Yunnan, and Xizang); and Northwest (Shaanxi,

Gansu, Qinghai, Ningxia, and Xinjiang). 
Age, Sex, and 

Urban/Rural Residence

Age in this report is disaggregated

into three groups: 60 to 69, 70 to

79, and 80 and older. Among

China’s overall older population in

2000, more than half (58.7 percent) was young old, aged 60 to

69. The proportion of young old

was slightly higher in urban areas

(61.5 percent) than in rural areas

(57.9 percent).14, 15 The oldest old

(80 and over) constituted about

one in ten older people (9.2 percent) nationwide. 

There were more older women

than older men (51.3 percent and

48.7 percent, respectively). The

sex ratio (the number of men per

14 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

Table 1-1.

Population Aged 60 and Over by Residence and Selected Characteristics for China: 2000

Characteristic

Total Urban Rural

Number

(thousands)

Percent

Number

(thousands)

Percent

Number

(thousands)

Percent

Estimate

Margin of

error (±)

1 Estimate

Margin of

error (±)

1 Estimate

Margin of

error (±)

1

Total . . . . . . . . . . . . . . . . . 118,983 100.0 (X) 27,643 100.0 (X) 91,340 100.0 (X)

Age

60 to 69 . . . . . . . . . . . . . . . . . . . . . . . 69,847 58.7 1.2 16,990 61.5 3.3 52,856 57.9 1.1

70 to 79 . . . . . . . . . . . . . . . . . . . . . . . 38,160 32.1 0.9 8,353 30.2 2.0 29,808 32.6 0.9

80 and over . . . ................. 10,977 9.2 0.9 2,300 8.3 1.7 8,676 9.5 0.9

Sex

Male . . . ....................... 57,954 48.7 1.6 13,428 48.6 2.4 44,526 48.7 2.0

Female . . . ..................... 61,030 51.3 1.6 14,216 51.4 2.4 46,814 51.3 2.0

Marital Status

Currently married2 .............. 78,577 66.0 1.9 20,674 74.8 3.0 57,903 63.4 1.9

Widowed . . . ................... 37,396 31.4 1.8 6,498 23.5 2.8 30,898 33.8 1.8

Other3 . . . . . . . . . . . . . . . . . . . . . . . . . 3,011 2.5 0.4 472 1.7 0.3 2,539 2.8 0.5

Educational Attainment4

Illiterate. . . . . . .................. 62,001 52.1 2.4 7,209 26.1 3.0 54,792 60.0 1.8

Primary school5

................. 40,866 34.3 1.7 9,359 33.9 1.9 31,507 34.5 2.0

Junior high school or above . . . . . . 16,116 13.5 1.8 11,075 40.1 2.6 5,041 5.5 1.2

Money Income (in Yuan)6, 7

Low . . . . . . . . . . . . . . . . . . . . . . . . . . 35,645 30.0 2.7 8,193 29.6 3.7 31,836 34.9 3.6

Medium. . . . . . .................. 48,580 40.8 2.7 10,897 39.4 2.9 39,198 42.9 1.9

High. . . ........................ 34,759 29.2 2.9 8,554 30.9 3.4 20,306 22.2 3.1

Living Arrangement

Living alone . . . . . . . . . . . . . . . . . . . . 9,325 7.8 0.9 1,919 6.9 1.3 7,406 7.8 0.9

Living with spouse only . . . . . . . . . . 36,676 30.8 2.3 9,588 34.7 2.1 27,088 30.8 2.9

Living with children and/or

others8 ....................... 72,982 61.3 2.8 16,137 58.4 2.0 56,846 61.3 3.5

(X) Not applicable.

1 The margin of error, when added to and subtracted from the estimate, provides the 90-percent confidence interval around the estimate. 2 ‘‘Currently married’’ refers to people who were currently married and living with their spouse. 3 ‘‘Other’’ includes people who were divorced, separated, or never married. 4 ‘‘Illiterate’’ is defined as people aged 15 and older who are unable to read. Primary school in China is equivalent to elementary school in the United States,

and junior high school is equivalent to middle school or junior high school. 5 ‘‘Primary school’’ includes ‘‘primary school’’ and ‘‘old-style private school.’’ 6 ‘‘Money Income’’ is monthly income in Chinese yuan. In 2000, the exchange rate between the U.S. dollar and the Chinese yuan was $1 = 8.28 yuan. 7 In this table, for total China, ‘‘Low’’ monthly money income is less than 50 yuan, ‘‘Medium’’ is 50 to 199 yuan, and ‘‘High’’ is 200 yuan or above. For urban

China, ‘‘Low’’ is less than 300 yuan, ‘‘Medium’’ is 300 to 749 yuan, and ‘‘High’’ is 750 yuan or above. For rural China, ‘‘Low’’ is less than 50 yuan, ‘‘Medium’’ is

50 to 149 yuan, and ‘‘High’’ is 150 yuan or above. 8 ‘‘Living with children and/or others’’ may include spouse, children, grandchildren, parents, or any other family or nonfamily members.

Source: Sample Survey on the Aged Population in Urban/Rural China, 2000.

14 The proportions for total young olds

and urban young olds are not statistically different from each other. 15 The estimates in this report (which may

be shown in text, figures, and tables) are

based on responses from a sample of the population and may differ from actual values

because of sampling variability or other factors. As a result, apparent differences between

the estimates for two or more groups may not

be statistically significant. All comparative

statements have undergone statistical testing

and are significant at the 90-percent confidence level unless otherwise noted.
100 women) was 95, reflecting a

higher share of older men compared with the United States and

many other nations.16

The majority of China’s older population live in the rural areas. In

2000, there were 27.6 million older

urban residents and 91.3 million

older rural residents.

Marital Status

A small proportion (2.5 percent) of

China’s older people were divorced,

separated, or never married in

2000. Most older people were married (66.0 percent) or widowed

(31.4 percent). 

Women were more likely to experience widowhood. Nearly half of

older women (45.9 percent) were

widowed, compared with 16.2 percent of older men. The gender difference in marital status is particularly marked among urban residents.

Urban men were much less likely to

be widowed than were older urban

women (7.2 percent and 38.9 percent, respectively), and older urban

men were more likely to be married

than older urban women (91.3 percent, compared with 59.2 percent).

Urban older people, regardless of

gender, were more likely than rural

older people to be married and less

likely to be widowed. One reason for

the higher marriage rates of men

and urban residents may be that

“currently married with spouse” in

this report does not distinguish first

marriage from remarriage, and men

or urban residents may be more

likely to remarry after being widowed or divorced.

Education and Income

People born before 1940 (aged 60

and older in 2000) had received relatively little formal education. About

half (52.1 percent) were illiterate,

and another one-third (34.3 percent)

had only primary education.17 Older

women were less educated than

older men. A majority of women

(71.0 percent) were illiterate, compared with about one-third (32.2

percent) of men. 

The urban/rural differential was

more striking. Eight in ten (79.6 percent) rural older women could not

read, and very few (1.7 percent) had

received education after primary

school.18 In comparison, more than

half of urban older women had

some education—33.7 percent had

completed primary school and 

23.5 percent went on to junior high

school or beyond. Among urban

older men, 8.4 percent could not

read; among rural older men, the

proportion was 39.4 percent.

There was a marked difference in

the personal money income of

urban and rural older people.19 In

2000, average annual personal

money income for urban older

Chinese was 7,480 yuan and for

older rural residents, 1,493 yuan.

This report therefore groups money

income into three categories (low,

medium, high) for urban and rural

residents separately. The categories

were determined based on the percent distribution of money income

for total China, urban China, and

rural China to present a relatively

nonskewed balance. 

For total China, 30.0 percent of

older people had personal money

income of less than 600 yuan (low

income as defined in this report),

40.8 percent had 600 to 2,399

yuan (middle income), and 29.2

percent had 2,400 yuan or more

(high income) for the year.

For urban China, 29.6 percent of

older people had personal money

income of less than 3,600 yuan (low

urban income), 39.4 percent had

3,600 to 8,999 yuan (middle urban

income), and 30.9 percent of older

people had 9,000 yuan or more

(high urban income) for the year.

In rural areas, about one-third of

older people (34.9 percent) had an

income of less than 600 yuan (low

rural income), 42.9 percent made

600 to 1,799 yuan (middle rural

income), and 22.2 percent had

income of 1,800 yuan or more

(high rural income) for the year.

Living Arrangements

With whom older people live is an

important factor in their health

care and old-age care. Coresidence

with adult children may provide

older people with emotional, financial, and physical support, particularly for those in poor health or

with disabilities (DaVanzo and

Chan, 1994).

China’s older people largely live

with their adult children. In 2000,

7.8 percent of older people lived

alone, 30.8 percent lived with

spouse only, and the majority, 

61.3 percent, lived with children

and/or others.20 Older women were

more likely than older men to live

alone (9.9 percent and 5.7 percent,

respectively) and to live with children and/or others (65.2 percent

and 57.3 percent). Urban older men

were less likely than their rural

counterparts to live alone (3.3 percent compared with 6.4 percent),

while urban and rural older women

had no difference in the likelihood

of living alone (around 10 percent).

U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 15

16 The sex ratio was 78 for the population

aged 60 and over in the United States in

2000 (U.S. Census Bureau, 2001). 

17 Illiterate refers to people aged 15 and

older who are unable to read (National

Bureau of Statistics of China, 2005). 18 Primary school in China is equivalent to

elementary school in the United States, and

junior high school is equivalent to middle

school or junior high school. 19 Personal money income in this report

includes earnings (wages or agricultural

income), pension or retirement income, business income, interest, dividend, rents, government or collective subsidies, social or collective old-age insurance, and money given

by children or grandchildren or other relatives or friends.

20 In this report, “Living with children

and/or others” may include spouse, children,

grandchildren, parents, or any other family or

nonfamily members.

With the accelerated growth of its

aged population, China will experience an increase in the number of

older people with physical health

problems, including chronic conditions, functional limitations, and

disability. These physical conditions,

in turn, are likely to increase the

risk of old age dependency, need

for care, and hospitalization. In light

of increased population aging

worldwide, considerable research

effort in recent decades has been

devoted to creating measures that

summarize the health of older people. This chapter seeks to extend

our understanding of health at older

ages by assessing the health of

China’s older population. The chapter provides an overview of physical

health and functioning among older

Chinese and outlines the role of certain behaviors—smoking, drinking,

and physical activity—that may promote or protect from chronic conditions and functional limitations.

Disability and 

Activity Limitations

Earlier studies have conceptualized

and used diverse measures to summarize functional status among

older people (Freedman et al., 2002;

Fried et al., 2000; Katz et al., 1963;

Lawton and Brody, 1969; Murray et

al., 2002; Nagi, 1965, 1991; Reuben

et al., 2004; Rosow and Breslau,

1966). The Global Burden of Disease

Project has combined mortality

information and nonfatal health outcomes to measure “disabilityadjusted life expectancy” as the

expected number of years to be

lived in “full health.” In the late

1990s and early 2000s, the World

Health Organization (WHO) estimated that China had a healthy life

expectancy at birth of about 65

years for females and 63 years for

males. Men and women who had

reached age 60 could expect

another 13 and 15 years of healthy

life, respectively (WHO, 2004d). At

age 60, about 35 percent of remaining years would likely be lived 

with disability.

Although definitions of disability

vary, researchers agree that disability in old age is a phenomenon

that involves medical, physiological, and psychological changes taking place within the context of

one’s environment, socioeconomic

position, cultural norms, and social

support network. The disablement

process usually begins with a

pathological condition that relates

to chronic disease(s) or an injury

that inflicts impairment(s) to the

body, leading to difficulty in performing basic body movement,

resulting further in a functional disability or diminished capacity to

perform tasks that are necessary to

live an independent life within

one’s environment. Progression

from pathology to a disabled state

may be affected and modified by

one’s physical environment, availability of short-term and long-term

medical care, family support, and

lifestyle habits (Fried and Guralnik,

1997; Verbrugge and Jette, 1994). 

Functional disability typically is

measured by various self-reported

limitations in activities and more

recently by using performancebased evaluations of functioning

(Suthers and Seeman, 2003). These

include basic personal care activities of daily living (ADL), such as

eating, bathing, toileting, transferring in and out of bed, and dressing, and instrumental activities of

daily living (IADL), such as cooking,

shopping, and managing money

(Katz and Stroud, 1989). 

Based on previous research conducted mostly in Western developed

countries, and on the availability of

comparable and culturally suited

measures from the Sample Survey

on Aged Population in Urban/Rural

China (SSAPUR), this chapter

addresses three categories of disability among older Chinese: limitations in ADL, mobility difficulty, and

limitations in household activities.

The self-reported ADL measures are

comparable with those in Western

surveys and include difficulty with

bathing, eating, toileting, dressing,

and transferring in and out of bed.

The mobility measures are Nagistyle situation-free limitations, such

as lifting, walking, and climbing

stairs.21, 22 Household activities are a

combination of IADL-type activities,

such as meal preparation and grocery shopping, and other culturally

appropriate tasks that are necessary

for independently residing within a

community, such as sweeping and

washing clothes.23 Among the three

measures of functional disability

used in this report, mobility difficulty was most commonly reported

by older Chinese, followed by

household activity limitations and

ADL limitations—39.6 percent, 26.0

percent, and 18.9 percent, respectively. Research in the United States

has shown similar patterns, indicating that functional ability is lost

hierarchically, with ADL limitations

being the most severe and experiU.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 17

CHAPTER 2.

PHYSICAL HEALTH

21 See Nagi, 1965 for more information on

mobility measures. 22 Limitation in climbing stairs is reported

only for urban residents. 23 Limitation in grocery shopping is

reported only for urban residents.
enced by the most disabled (Dunlop

et al., 1997). 

Limitations in ADL

Limitations in ADL often indicate

relatively severe forms of disability

and are generally considered precursors of long-term care and institutionalization (Guralnik et al.,

1995). Evidence from both developed and developing countries

indicates that the incidence and

prevalence of ADL increase with

age, and that the experience and

reporting of disability is higher

among women than men (Leveille

et al., 2000; Rahman and Liu,

2000; Sengupta and Agree, 2002;

Wu et al., 1999; Yount and Agree,

2005; Zhang et al., 2005). These

studies attribute gender differences

to a combination of a higher prevalence of non-life-threatening debilitating illnesses among older

women and social disadvantages

such as lower income and education that are more common among

older women than older men. 

Older Chinese women more commonly reported ADL limitations

than did older men—15.0 percent

of men and 22.5 percent of women

reported at least one ADL limitation. ADL limitations were also

more common in rural areas than

in urban areas—10.7 percent and

17.8 percent of urban men and

women, respectively; 16.3 percent

and 24.0 percent of rural men and

women, respectively.24 ADL limitations increased with age, with 10.0

percent, 24.6 percent, and 55.6

percent of those in the age groups

60 to 69, 70 to 79, and 80 and

older, respectively, reporting difficulty with at least one such activity. Figure 2-1 shows that in both

urban and rural areas, in each age

18 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

Figure 2-1.

Percent of Population Aged 60 and Over With

Limitations in Activities of Daily Living, Mobility, 

and Household Activities: 2000

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

Female

80 and

over

80 and 60 to 69 70 to 79

over

60 to 69 70 to 79

80 and

over

80 and 60 to 69 70 to 79

over

60 to 69 70 to 79

80 and

over

80 and 60 to 69 70 to 79

over

60 to 69 70 to 79

Male

Urban Rural

Urban Rural

Urban Rural

Limitations in activities of daily living (ADL)

Limitations in mobility

Limitations in household activities

5.5

9.0

15.2

22.6

40.1

56.9

9.1 12.7

22.1

29.7

51.9

60.1

18.3

30.4

39.1

62.0

67.0

92.4

17.5

33.6

42.7

64.7

72.8

90.9

13.0 11.9

27.2 28.9

58.1

66.6

20.5

11.9

37.1 34.4

68.0 65.4

24 Fifteen percent of men is not statistically significantly different from 16.3 percent

of rural men, and 22.5 percent of women is

not statistically significantly different from

24.0 percent of rural women.
group, women were more likely

than men to report ADL

limitations.25

About 80 percent of older Chinese

reported no ADL limitations, about

12 percent had difficulty with one

activity, and about 7 percent found

it difficult to perform two or more

of these tasks. The number of

limitations increased with age. For

instance, 6.9 percent, 16.2 percent,

and 32.7 percent of those 60 to

69, 70 to 79, and 80 and older,

respectively, had one ADL limitation; 1.7 percent, 4.2 percent, and

11.4 percent respectively in the

same three successive age groups

had two to three ADL limitations;

and 1.3 percent, 4.0 percent, and

11.4 percent of older people in

these successive age groups had

four to five ADL limitations 

(Table 2-1).26 Women were more

likely than men to report limitations, regardless of the number of

limitations (Figure 2-2). 

Among the five ADL limitations

addressed in this report, the most

commonly reported was trouble

with bathing—16.5 percent of

older Chinese had difficulty

bathing. The prevalence of other

limitations was relatively low and

they did not differ statistically: eating (4.5 percent), dressing (4.4 percent), toileting (4.9 percent), and

getting in and out of bed (4.7 percent). In both urban and rural settings, women were consistently

more likely than men to report difficulties (Table 2-2).27

Limitations in 

Mobility-Related Activities 

Disability at older ages manifests

itself in various and often complex

ways, the complete spectrum of

which may not be captured by ADL

or IADL limitations alone. Unlike

ADL measures, which capture the

most severe forms of disability,

mobility difficulty is more inclusive

and related to difficulty in moving

the upper or lower body. Mobility

difficulty is a common limitation

among older people and also an

important risk factor for the onset

of disability and poor self-rated

health (Clark et al., 1998; Guralnik

et al., 1993; Jylha et al., 2001;

Sengupta and Agree, 2003). 

U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 19

25 The male/female difference is not statistically significant for rural residents aged

80 and older.

Table 2-1.

Percent of Population Aged 60 and Over With Limitations

in Activities of Daily Living by Number of Limitations and

Selected Characteristics for China: 2000

Characteristic 1 ADL

limitation

2–3 ADL

limitations

4–5 ADL

limitations

Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.2 3.4 3.1

Age

60 to 69 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.9 1.7 1.3

70 to 79 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.2 4.2 4.0

80 and over. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32.7 11.4 11.4

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.9 2.5 2.5

Female. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.4 4.3 3.7

Residence

Urban . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.7 3.3 2.4

Rural. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.3 3.5 3.3

Source: Sample Survey on the Aged Population in Urban/Rural China, 2000.

Figure 2-2.

Percent of Population Aged 60 and Over With One or 

More Limitations in Activities of Daily Living: 2000

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

Female

4 to 5

ADL

limitations

2 to 3

ADL

limitations

1

ADL

limitation

4 to 5

ADL

limitations

2 to 3

ADL

limitations

1

ADL

limitation

Male

Urban Rural

4.0 6.2

11.0

2.4 4.1 2.0 2.7

11.0

15.5

2.5 4.3 2.7

26 There are no statistically significant differences between all people aged 60 and

older and those who were between the ages

of 70 to 79 who had difficulty with either

one activity or two to three activities or four

to five activities. Among those aged 60 to

69, there are no statistical differences

between those who had two to three limitations and those who had four to five limitations. In the 70-to-79 age group, there are no

statistical differences between those who had

two to three limitations and those who had

four to five limitations. 27 Men and women were not statistically

significantly different in rural settings for the

limitation of eating.
Overall, 39.6 percent of the older

population reported mobility limitations. Mobility difficulty increased

with age—25.0 percent, 53.6 percent, and 83.8 percent of those

aged 60 to 69, 70 to 79, and 80

and older. Mobility limitations were

more common among older

women than older men, with about

30 percent of men and 50 percent

of women reporting some difficulty. The gender difference was

found in both urban and rural

areas (Figure 2-1).

Among mobility-related activities,

35.2 percent of older Chinese

reported difficulty with lifting 10

kilograms, 30.8 percent with walking 1.5 to 2 kilometers, 21.0 percent with climbing stairs, and 

5.3 percent with walking indoors.

Difficulty with lifting and walking

were more common in rural than

urban areas.28 More women than

men reported difficulty with lifting,

walking outdoors, and climbing

stairs. More rural women than men

also reported difficulty walking

indoors. 

20 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

Box 2-1.

Physical Limitations and Accessibility Issues

Limitations in ADL generally equate with certain health conditions. At

the same time, there may be environmental and accessibility barriers

to carrying out some self-care activities, especially in rural areas. For

example, living in a house without a bathroom may contribute to

more limitations on bathing than would otherwise be the case.

Difficulties with food preparation and washing may be related to the

presence of modern cooking devices and washing machines. The use

of assistive devices (Box 2-3) such as eyeglasses and hearing aids

likely affects people’s perceptions of physical limitation. Reported

disability levels, particularly when comparing urban and rural areas,

may be influenced by more factors than health alone.

Table 2-2.

Percent of Population Aged 60 and Over With Limitations in Various Activities by

Residence, Sex, and Type of Activity for China: 2000

Type of activity

Total Urban Rural

Male Female Male Female Male Female

Limitations With Activities of Daily Living

Eating. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5 5.5 1.9 3.1 3.9 6.2

Dressing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.4 5.4 2.6 3.4 3.6 6.0

Toileting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.0 5.8 3.4 5.1 4.2 6.1

Getting in and out of bed. . . . . . . . . . . . . . . . . . . 3.8 5.7 3.3 5.4 3.9 5.8

Bathing . . . ............................... 13.2 19.7 10.0 15.9 14.2 20.8

Limitations With Mobility

Lifting 10 kilograms or more . . . . . . . . . . . . . . . . 24.6 45.4 22.7 41.2 25.1 46.7

Walking 1.5 to 2 kilometers . . . . . . . . . . . . . . . . . 22.0 39.0 18.8 35.7 23.0 40.1

Walking indoors . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6 7.0 4.7 5.5 3.3 7.4

Climbing stairs1 . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.4 6.2 14.8 26.8 (NA) (NA)

Limitations With Household Activities

Sweeping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.5 10.5 7.1 8.8 7.6 11.0

Cooking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.4 4.1 14.2 16.8 19.9 17.0

Washing . . . .............................. 18.6 17.0 19.3 21.0 27.5 24.8

Grocery shopping1 ........................ 25.6 23.9 10.4 17.7 (NA) (NA)

(NA) Not available.

1 Limitations reported only for urban residents.

Source: Sample Survey on the Aged Population in Urban/Rural China, 2000.

28 There are no statistically significant differences between all older people who

report difficulty with lifting weights and

those reporting the same difficulty in rural

areas. Also, there are no statistically

significant differences between older people

reporting difficulty with walking 1.5 to 2

kilometers and those reporting the difficulty

with the same activity in rural and urban

areas, separately. 
Limitations in 

Household Activities

Household activity limitations used

in this study are similar to taskrelated IADL measures, with no

particular hierarchy. Some studies

have shown that such limitations

are associated with frailty and mortality at older ages, and that

women who have IADL limitations

are more likely to be frail, have

poor cognitive function, and have

more frequent falls (Fati et al.,

2001; Kawamoto et al., 2006;

Keller and Potter, 1994; Schupf et

al., 2005). About one-fourth of

older Chinese reported one or

more household activity limitations, with no significant difference

by gender. Difficulty performing

household activities was more

common in rural than urban areas,

perhaps due to the generally

poorer living conditions in rural

areas.29 As with other measures of

disability, the percentages of older

men and women with household

activity limitations increased

markedly with age in both urban

and rural settings (Figure 2-1). 

The most common limitation

involved washing clothes 

(24.7 percent), followed by cooking (17.8 percent), grocery shopping (14.2 percent), and sweeping 

(9.0 percent). Older rural residents

were more likely than urban residents to report difficulty with

cooking (18.4 percent compared

with 15.5 percent) and washing

(26.1 percent compared with 20.2

percent).30 In rural China, more

women than men reported difficulty with sweeping, while in

urban China, more women than

men reported difficulty with grocery shopping (Table 2-2). These

differences may be related to the

gender-specific nature of these

activities, and men and women

may have reported difficulty with

performing those activities that

they do not perform routinely. 

Activity Limitations and 

Marital Status

Apart from age and sex, which

consistently show an association

with disability, earlier studies in

different countries have shown a

positive association between marital status and health among older

people (Goldman et al., 1995;

Schoenborn, 2004). The marital

advantage is generally attributed

either to the selection of healthy

people into marriage or to “marital

protection” related to sharing of

economic resources, less indulgence in negative behavior, and

care and support from a spouse. 

U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 21

Figure 2-3.

Percent of Married and Unmarried People Aged 60 

and Over With Activity Limitations: 2000

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

Unmarried

Household

activity

limitations

Mobility

limitations

ADL

limitations

Household

activity

limitations

Mobility

limitations

ADL

limitations

Household

activity

limitations

Mobility

limitations

ADL

limitations

Household

activity

limitations

Mobility

limitations

ADL

limitations

Married

Male Female

Urban Rural

10.3

26.6 30.1

58.2

18.1

33.9

14.6

29.9 31.1

56.5

22.2

36.3

12.7

24.4 25.7

42.7

24.8

36.3

14.6

31.3

38.3

62.3

15.4

35.4

29 There is no statistically significant difference between the percentage of the total

older population who reported household

activity limitations and the percentage of

those living in rural areas with household

activity limitations.

30 The percentage of the total older population that had washing limitations is not statistically significantly different from the percentage of older rural residents. The

percentage of the total older population that

had cooking limitations is not statistically

significantly different from that of older rural

residents.
In China, fewer married older people than their unmarried counterparts reported limitations with

activities. For instance, 30.8 percent of married people reported

limitations with mobility-related

activities compared with 56.7 percent of unmarried people. Data in

Figure 2-3 confirm earlier studies

that established a positive relationship between marriage and functioning—older adults in China

demonstrate a marital advantage

that holds true for all activities in

both urban and rural settings. 

Although marriage is associated

with good health and longevity for

both men and women, some studies

in Western countries have concluded that since women are more

often the primary caregivers for

their spouses, not having a spouse

is worse for men than for women

(Hu and Goldman, 1990; Verbrugge,

1985, 1989). Studies in non-Western

settings, however, have suggested

that in patriarchal kinship systems,

where women often face disadvantages in access to resources and are

dependent on their spouses for economic support, not having a spouse

may have a stronger link with poor

health for women than for men

(Kuate-Defo, 2006). Figure 2-3

shows the percentages of older

married and unmarried men and

women who have activity limitations. These data confirm that both

married men and women reported

better functional ability than the

unmarried. 

These data are not appropriate to

assess the direction of the relationship between marital status and

activity limitations, and it is not

clear whether the marital advantage is an artifact of marital selection or protection, as explained

above. Given that marriage is

nearly universal in China, particularly among older cohorts, it is

more likely that the marital advantage is related to protection rather

than selection. Also, due to the

small sample size of divorced, separated, and never-married individuals, activity limitations among

these groups could not be separately examined. 

Older people’s functional ability

also varied according to their living

arrangement. Coresidence with

spouse only was associated with

lower odds of disability—about 15

percent of those living with their

spouse reported ADL limitations,

compared with about 21 percent

each of those who lived alone or

with children and/or others.

Similarly, about 33 percent of those

living with their spouse reported

mobility difficulty, compared with

52 percent of those who lived

alone and 41 percent of those who

lived with children and/or others.

Activity Limitations, Education,

and Income

A consistent and robust association

between socioeconomic status and

health at older ages exists in

Western societies, while studies in

some Asian countries have indicated the same positive relationship

but with variations in the strength

of the relationship depending on

the measures used: education,

income, and occupation (De Vos,

2005; Jiang et al., 2002; Matthews

et al., 2006; Melzer et al., 2001;

Preston and Elo, 1995; Yu et al.,

2000; Zimmer and

Amornsirisomboon, 2001; Zimmer

et al., 2004). Most studies attribute

the education advantage to a combination of the economic implications of education (e.g., better jobs

and living conditions) and the psychosocial influences of education

(related to healthy behavior, nutritional status, and medicaltreatment-seeking behavior). Earlier

studies in China found that both

income and education have an

inverse association with certain

activity limitations, mobility decline,

and disability (Anson and Sun,

2002; Beydoun and Popkin, 2005;

Ho et al., 1997; Liang et al., 2001).

Consistent with other findings in

China, the SSAPUR shows that activity limitations vary by household

income. For instance, 24.4 percent,

19.2 percent, and 12.7 percent of

22 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

Figure 2-4.

Percent of Population Aged 60 and Over With

Activity Limitations: 2000

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

Junior high school or higher

Household

activity

limitations

Mobility

limitations

ADL

limitations

Household

activity

limitations

Mobility

limitations

ADL

limitations

Illiterate Primary school

Urban Rural

24.9

13.1

8.6

56.8

34.0

27.1

32.8

22.3

14.9

24.8

13.611.5

48.6

29.5

19.6

30.7

22.323.1
older people who had low, medium,

and high income, respectively,

reported having at least one ADL

limitation. These income-related differences held true in urban and

rural settings. Mobility limitations

also varied by household income,

with those in the highest-income

category being least likely to report

such limitations. 

The prevalence of activity limitations also varied by educational

attainment. Overall, ADL and

mobility limitations were highest

among the illiterate and decreased

progressively with each level of

education. The largest difference

was observed between the illiterate

and the primary schooled, indicating that even a few years of education may be associated with better

physical functioning at older ages

(Figure 2-4). Differences by education were evident for ADL and

mobility-related limitations in

urban and rural areas.32

Chronic Diseases

Chronic diseases are primary risk

factors for old-age functional limitation and disability. To date, there

is a lack of comprehensive data on

the incidence and prevalence of

chronic diseases among older

Chinese. The few studies that have

examined chronic conditions suggest an increase in the prevalence

of noncommunicable diseases in

the general population and a predominance of hypertension,

ischemic heart disease, stroke,

osteoporosis, and dementia in the

older population (Wang et al.,

2005). These studies also suggest

that noncommunicable diseases

account for about 60 percent of

the disability among older people.

U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 23

Box 2-2.

Gender Differences in Functioning 

Among Older Chinese

Studies in various countries have shown that older women report

higher rates of poor health than do older men. Given that women in

China have traditionally experienced socioeconomic and cultural disadvantages throughout their lives, older Chinese women may experience disadvantages in functioning similar to or even larger than

those of older women in Western countries. Table 2-3 shows results

from logistic regression models that examine the association

between gender and health. For the purposes of this analysis, three

separate measures of health are used: functional health (ADL/

mobility limitations), chronic conditions, and self-assessed health.31

Controlling for a host of confounding factors (e.g., age, urban/rural

residence, income, educational status, and a combination of marital

status and living arrangements), results show that older Chinese

women are more likely than older men to report poor health (Figure

2-5). Older women are 1.9 times more likely to report functional disability and 1.3 times more likely to report chronic conditions. Older

women are significantly less likely than older men to perceive their

health as being good and 1.2 times more likely to assess their health

as being poor. Individuals with some education (primary education or

higher) were less likely than those illiterate to report any ADL/

mobility difficulty. The odds of reporting activity limitations and poor

health decreased with increasing income (Table 2-3).

31 Household activity limitations are excluded since they refer to activities that may

be related to gender.

Figure 2-5.

Association Between Gender and Health Measures

for Population Aged 60 and Over: 2000

Note: Odds ratios from logistic regression models, controlling for confounding factors.

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

Self-assessed

poor health

Self-assessed

good health

Any chronic

disease

Any ADL/mobility

limitation

(Odds that an older woman is more likely than an older man 

to report measures of health) 

1.9

1.3

0.8

1.2

32 In rural China, there is no statistically

significant difference in ADL limitations

among those who have primary school education and those who are educated at the

junior high level.
Among the largest contributors to

disability are stroke, dementia,

osteoporotic fractures, Parkinson’s

disease, and diabetes mellitus

(Chen et al., 1995).

The SSAPUR provides information

about the prevalence of chronic

conditions among older Chinese

without specifying the type of disease. In 2000, 59.0 percent of

older women and 51.7 percent of

older men reported having a

chronic condition. Also, 24.3 percent reported one or more ADL limitations if they had a chronic condition, compared with 12.2 percent if

they did not. Similar patterns were

seen for mobility and household

activity limitations—more people

reported mobility and household

activity limitations if they had

chronic conditions than those who

did not have chronic conditions. 

The prevalence of chronic conditions was higher in urban than

rural areas—64.1 compared with

47.9 percent among men and 72.2

compared with 55.0 percent

among women. Chronic conditions

were more commonly reported by

those aged 70 and older than by

those aged 60 to 69. Surprisingly,

older people in the high income

group (64.6 percent) reported more

chronic conditions than did those

in the middle-income or lowincome groups (about 51 percent

each). These differences may

reflect better recognition of symptoms and better diagnosis due to

increased use of medical care by

older people who have relatively

higher income.

Self-Assessed Health

Self-assessment of health is recognized as a simple, multifaceted,

and effective indicator not only of

current health and functional ability but also of future health outcomes (Benyamini and Idler, 1999;

Ferraro et al., 1997; Idler and Kasl,

1995; Kaplan et al., 1993; Simon et

al., 2005). Self-reported health

appears to be significantly associated with measures of physical

performance obtained from standard clinical examinations and may

be independent of age and gender

effects (Rahman and Barsky, 2003). 

24 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

Table 2-3.

Odds Ratios Predicting the Association Between Health

Measures and Gender for Population Aged 60 and Over

for China: 2000

Variable

Any

ADL/mobility

difficulty

Chronic

disease

Self-assessed health

Good Bad

Sex (reference group: Male)

Female. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ***1.9034 ***1.3177 ***0.7554 **1.2047

Residence (reference group: Rural)

Urban. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.9188 ***0.5236 0.9877 1.0663

Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ***1.1364 ***1.0124 **0.9850 ***1.0381

Income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ***0.9997 *1.0002 1.0001 *0.9997

Education (reference group: Illiterate)1

Primary school . . . . . . . . . . . . . . . . . . . . . . . ***0.7833 0.9338 1.0771 *0.8321

Junior high school and higher. . . . . . . . . . ***0.7760 0.9536 0.9663 0.7516

Marital Status and Living Arrangement

(reference group: Living alone)

Currently married and living with spouse

only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.9012 0.9049 1.0256 1.1224

Currently unmarried and living with

children and/or others2 . . . . . . . . . . . . . . ***1.2820 *0.7754 0.9670 0.9585

Currently married and living with

spouse, children and/or others3. . . . . . . 0.8781 ***0.6605 1.2355 0.9094

* Significant at .05 level. ** Significant at .01 level. *** Significant at .001 level.

1 ‘‘Illiterate’’ is defined as people aged 15 and older who are unable to read. Primary school in China

is equivalent to elementary school in the United States, and junior high school is equivalent to middle

school or junior high school. 2 ‘‘Currently unmarried and living with children and/or others’’ may include children, grandchildren,

parents, or any other family or nonfamily members. 3 ‘‘Currently married and living with children and/or others’’ may include spouse, children,

grandchildren, parents, or any other family or nonfamily members.

Source: Sample Survey on the Aged Population in Urban/Rural China, 2000.

Figure 2-6.

Percent of Population Aged 60 and Over by 

Self-Assessed Health: 2000

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

Female

Poor Average Good Poor Average Good

Male

Urban Rural

22.6

17.4

27.8

45.8 47.8

36.8

24.5 24.4

33.1

44.3 44.3

31.3
About 45 percent of older Chinese

reported being in average health,

more than those who reported

good health or poor health (about

27 percent each). Self-assessed

good health declined with age—

36.2 percent, 28.0 percent, and

20.6 percent of older men aged 60

to 69, 70 to 79, and 80 and older,

respectively, and 25.7 percent,

20.6 percent, and 16.7 percent,

respectively, of older women in

those age groups.33 In both urban

and rural areas, women were more

likely than men to report poor

health, while men were more apt

than women to consider their

health to be good (Figure 2-6).

These differences by age and sex

mirror findings from other Asian

countries as well as the United

States (He et al., 2005). 

Self-assessed health also varied by

socioeconomic factors and by living

arrangements. Education and

income were associated with good

health. For instance, 23.6 percent of

illiterate older Chinese reported

their health as being good, lower

than those who had primary or middle school education (about 32 percent each). Similarly, 23.7 percent of

low-income, 27.5 percent of middleincome, and 31.9 percent of highincome older people reported themselves to be in good health.

Marriage also was associated with

good self-perceived health—30.6

percent of married respondents

reported being in good health, compared with 21.9 percent of the

unmarried. Those who lived alone

were less likely than those who

lived with their spouse only or with

children and/or others to report

good health.

Over half of the 60-and-older population (53.5 percent) considered

themselves to be in worse health

than in the previous year, 39.9 percent considered their health to be

the same as in the previous year,

and 6.6 percent reported improvement. The percentage of people

who reported worse health than in

the previous year was higher in

rural than urban areas. 

Lifestyle Behaviors

While genetics and environmental

factors influence health and predispose older people to certain

chronic conditions, individual

behaviors also contribute (U.S.

Centers for Disease Control and

Prevention, 2005). Risky behaviors,

such as smoking and alcohol

abuse, can make people vulnerable

to the development and progression of chronic diseases, while

behaviors such as regular exercise

and eating a balanced diet are

related to disease prevention.

Smoking

Worldwide, cigarette smoking is

associated with preventable mortality and morbidity (Burns, 2000;

Wingo et al., 1999). Smoking is a

major risk factor for heart disease,

stroke, and chronic lung disease

and a causal factor in the development of several types of cancer

(Lopez, 1998). In a study on the

emerging hazards of tobacco use

in China, Liu et al. (1998) reported

that smokers experienced a high

risk of death from numerous

causes. For example, male smokers

between the ages of 35 to 69

experienced excess deaths from

cancer (51 percent), respiratory illnesses (31 percent), and vascular

diseases (15 percent). The study

also found that lung cancer deaths

among Chinese male and female

smokers between the ages of 35 to

69 were three times that of nonsmokers. 

The SSAPUR provides information

about the prevalence of smoking

but not the amount smoked in a

given time period or the number of

years smoked. More than half of

older Chinese (54.9 percent) were

nonsmokers, 31.8 percent were

current smokers, and 13.3 percent

had smoked in the past but were

no longer smoking at the time of

the 2000 survey.34 Given the relatively recent increase in smoking in

China (Liu et al., 1998), it is not

surprising that the percentage of

people who have never smoked is

higher in the oldest age group

(63.9 percent) than among those

aged 60 to 69 and 70 to 79 (53.1

percent and 55.5 percent, respectively). The percentage of current

smokers decreased with increasing

age—34.2 percent of those aged

60 to 69, 30.0 percent of those

aged 70 to 79, and 22.1 percent of

those 80 and older.35 Figure 2-7

shows that current smoking was

most common among rural men

(58.2 percent), followed by urban

men (39.5 percent). About 10 percent of women in the sample

smoked, reflecting gender differences in the cultural acceptance of

smoking. Current smoking also

was more common among the married than the unmarried. 

In terms of current smoking behavior and education, the highest

prevalence of smoking (42.3 percent) was observed among people

with primary-level education. The

U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 25

33 There are no statistically significant differences between men and women reporting

good health among those aged 80 and older.

34 There are no statistically significant differences between an overall 54.9 percent of

nonsmokers, 53.1 percent of those between

the ages of 60 to 69 years, and 55.5 percent

of those between the ages of 70 and 79

years. 35 There are no statistically significant differences between all current smokers and

those between the ages of 60 to 69 or 70 

to 79.
proportion of smokers among illiterate respondents was 24.0 percent,

and the proportion among those

with junior high school or higher

education was 35.0 percent. The

percentage of people who had

smoked in the past but had given

up the habit at the time of the

survey was highest among those

who were educated at the junior

high school or higher levels 

(20.2 percent, compared with 

15.5 percent among those with primary school education and 10.1

percent among those who were illiterate), suggesting that education

may have created an awareness

about the negative health implications of smoking. 

Alcohol Consumption

Moderate alcohol consumption can

be beneficial to health, but overuse, misuse, and the increased sensitivity to alcohol with aging can

negatively affect health and cognition at older ages (National

Institute on Alcohol Abuse and

Alcoholism, 1998). China has a

long history of alcohol production

and use, and alcohol is a component of traditional medicine.

Recently, researchers have issued

warnings about a rise in alcohol

consumption, dependence, and

related health problems in the

Chinese population (Cochrane et

al., 2003; Hao et al., 2004). Studies

have linked chronic gastritis, peptic

ulcers, hepatitis, cirrhosis, fatty

liver, cognitive impairments, sexually transmitted diseases, traffic

accidents, suicides, burns, drowning, and violent crimes to alcohol

abuse in the general population

(Shen and Wang, 1998; Zhang et

al., 2000). However, few studies

have addressed alcohol use among

older people.

According to the SSAPUR, 26.7 percent of older Chinese reported

being alcohol consumers at the

time of the survey, 14.7 percent

reported having consumed alcohol

in the past, and 58.6 percent had

never consumed alcohol. A higher

proportion of the oldest old (aged

80 and over) than the young old

(aged 60 to 69) had never consumed alcohol. Alcohol consumption varied by age—29.0 percent of

those aged 60 to 69 were current

consumers, compared with 24.7

percent at ages 70 to 79 and 19.2

percent at ages 80 and over.36 The

SSAPUR data do not document the

frequency or amount of alcohol

consumed.37

Figure 2-7 shows that, consistent

with the traditional acceptance of

drinking among men but not

among women, a higher

percentage of older women than

older men had never consumed

alcohol. About 45 percent of rural

men and 39 percent of urban men

reported being current consumers

of alcohol. Older adults who were

married reported higher current

alcohol consumption rates than

those who were unmarried. The

measures of current consumption

also varied by education—20.3 percent of illiterate older adults compared with about 34 percent each

of those with a primary school

education and those with a junior

high school or higher education. 

Physical Activity

A lifestyle that incorporates regular

exercise can help maintain healthy

weight and cardiovascular health

and reduce the likelihood of many

chronic diseases, including diabetes, cancer, and heart disease

(U.S. Centers for Disease Control

and Prevention, 2005). Chinese

medicine has long recognized that

physical activities are beneficial for

the proper functioning of the body

and building resistance to diseases

26 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

Figure 2-7.

Percent of Population Aged 60 and Over With

Selected Behaviors: 2000

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

Currently

Used to

but not

currently

Never

Urban Rural Urban Rural

Smoking Alcohol consumption

Male Female Male Female Male Female Male Female

31.9

86.0 28.7

39.5

4.0

10.0

20.7

21.2

58.2

84.7

4.3

11.1

39.1

22.1

38.8

87.8

5.1

7.2

31.7

23.4

44.9

80.9

7.2

11.9

36 The percentage of the 80 and older

population that never consumed alcohol is

not statistically different from the percentage

of the population aged 70 to 79 who never

consumed alcohol. There are no statistically

significant differences between all alcohol

consumers and consumers between the ages

of 60 to 69 or 70 to 79. 37 The SSAPUR question about alcohol

consumption read “Do you drink alcohol?”

and respondents were allowed to select

from three options: never, used to, and

currently drink.
(Liu, 1995). Studies show that regular leisure-time activity, including

balance and coordination exercises

such as Tai Chi, increases physical

balance, reduces the risk of chronic

ADL limitations and falls, and helps

to maintain healthy body mass (Hu

et al., 2002; Wong et al., 2001). 

The SSAPUR asked respondents

whether they participated in certain

leisure activities. Activities that

involved physical movement (for

example, Tai Chi, physical exercise,

playing ball, and walking) were

grouped together to assess the

extent to which older people

engaged in physical exercise. About

63 percent of older Chinese

reported some recreational activities

involving physical exercise. People

aged 80 and older were less likely

to participate in such activities 

(55.7 percent) than those aged 60

to 69 and 70 to 79 (64.3 percent

and 63.4 percent, respectively).38

Exercise levels were lower for older

women than men in urban areas,

but in rural settings the rates for

men and women were not statistically different (Figure 2-8). The gender difference in urban China may

result from more older men

participating in leisure activities

after retirement than women, who

are mostly homemakers and less

likely to experience retirementrelated changes in schedules and

activities. This difference also

underscores the need to include

productive activity categories when

assessing levels of physical exercise, particularly in traditional societies like China, where the continuity in older women’s homemaker

status may involve caring for young

grandchildren, dependent adult

care, and housekeeping, all of

which involve physical exercise. 

Several sociodemographic factors

were seen to be associated with

regular exercise. Two-thirds 

(66.1 percent) of married respondents engaged in leisure-time

physical activities, compared with

57.7 percent of the unmarried.

Older Chinese educated at the junior high school or higher level were

more likely to report such activities

(85.0 percent) than were the illiterate (63.1 percent) or those who

had completed primary school only

(57.7 percent). A similar association is observed between income

and regular exercise—77.6 percent

of the high income group, and

55.9 percent and 59.2 percent of

the middle and low income groups,

respectively.39

U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 27

Figure 2-8.

Percent of Population Aged 60 and Over Engaging in 

Physical Activity: 2000

Note: Physical activity includes Tai Chi, physical exercise, playing ball, and walking.

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

Female

Urban Rural

Male

86.6

74.9

59.9

56.1

38 Among older adults who reported some

recreational activities, there are no statistical

differences between total older adults, those

aged 60 to 69, and those aged 70 to 79.

39 There are no statistically significant

differences between the middle and low

income groups.
28 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

Assistive devices are common among older people

with functional limitations in Western countries and

are used either alone or in combination with other

personal care arrangements (Agree and Freedman,

2000; Agree et al., 2004). Intended to reduce disability and slow the process of functional decline while

decreasing the need for personal care, these devices

run the gamut from simple tools (canes and

handrails) to fairly complex machines (computerized

wheelchairs). The Sample Survey on Aged Population

in Urban/Rural China (SSAPUR) provides information

about the use of simple sensory (glasses, hearing

aids) and mobility (canes, crutches, wheelchairs)

devices among China’s older people. 

Sensory Devices

Overall, about half of the older

population reported using sensory devices—53.4 percent of

older men and 49.4 percent of

older women. Use of sensory

devices was much more common in urban than rural areas

(Figure 2-9) and more common

in the youngest age group

(aged 60 to 69) than among

older respondents. Use of

these devices increased with

level of education—39.0 percent of the illiterate, 59.8 percent of the primary school

educated, and 77.3 percent of

the junior high school or

higher educated. Use also was

more common among married

than unmarried older people

and among those in the highest income group relative to

other groups.

Mobility Devices

About 15 percent of older Chinese used mobility

devices, with use having a sharp age gradient—

52.6 percent among those aged 80 and over, 21.0

percent among those aged 70 to 79, and 6.0 percent among people aged 60 to 69. The majority of

mobility aids were simple canes and crutches.

Mobility devices were most commonly used by rural

women (19.9 percent), followed by rural men 

(13.8 percent), urban women (10.0 percent), and

urban men (8.0 percent). Mobility device use

decreased with education—20.2 percent among the

illiterate, 10.5 percent among the primary schooled,

and 7.1 percent among those with education at the

junior high school or higher level. 

Box 2-3.

Assistive Devices

Figure 2-9.

Percent of Population Aged 60 and Over Using 

Assistive Devices: 2000

Note: Sensory devices include eyeglasses and hearing aids. Mobility devices include 

canes, crutches, and wheelchairs.

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

Female

Mobility

devices

Sensory

devices

Mobility

devices

Sensory

devices

Male

Urban Rural

19.9

78.0

69.4

8.0 10.0

45.9 43.4

13.8
Mental well-being is an important

aspect of older people’s health.

Aging researchers are paying

increasing attention to the concept

of successful aging, focusing on the

variability of mental health status

among older people and the mechanisms that may cause mental distress (Carstensen and Hartel, 2006;

Crosnoe and Elder, 2002; Stern and

Carstensen, 2000). This chapter

examines older Chinese people’s

positive mental states, such as life

satisfaction, happiness, and socialization, and negative mental states,

such as loneliness, burdensome

feelings, and financial and old-age

care worries. The chapter also

considers the association between

mental health and demographic and

socioeconomic characteristics. 

Life satisfaction or happiness is

indicated by positive answers to

survey questions on whether the

respondent is satisfied with life or

feels happy compared with when

young, compared with peers, and

U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 29

CHAPTER 3.

MENTAL HEALTH

Social research on aging and mental health draws

on two main perspectives—a life course perspective

and a stress paradigm.40 A U-shaped age pattern of

psychological distress, with depression falling in

early adulthood and rising in late life, has been documented by various studies using the life course

approach (Miech and Shanahan, 2000; Mirowsky

and Ross, 1992; Moen et al., 1995; Schieman et al.,

2001). This perspective holds that aging is a lifelong process, and each stage of the life cycle provides or loses opportunities that can make one’s life

happy. Changes in employment, income, marriage,

and health have different impacts at different stages

of the life course, especially for the very old.

Maturity gained from age may buffer but not necessarily cancel the negative effects of aging.

Successful adaptation to adverse circumstances is a

crucial component of a high quality of life.

The stress paradigm, on the other hand, emphasizes the stress process—stressors, stress mediators, and stress outcomes. In reviewing the stress

process, Pearlin (1989) pointed out that measurement of stressors should seek to observe and

assess over time constellations of stressors made

up of both events and strains. Stress mediators

(coping and social support) influence the effects of

stressors, and attention to social surroundings is

needed when studying the stress process. Pearlin

also drew attention to variations in people’s manifestation of stress and warned that the vulnerability

of some groups may be exaggerated if research

does not consider multiple outcomes. 

Research on aging and stress has identified three

main stressor categories: status strains, role strains,

and personal resources (Aneshensel et al., 1993;

Angel et al., 2003; Ross and Drentea, 1998; Ross

and Mirowsky, 2002; Smith et al., 1991; Turner and

Lloyd, 1999). Status strains include socioeconomic

status, education, employment/retirement, and

health. Role strains are typically associated with

gender, marital status, and caregiving. Personal

resources include factors such as mastery/sense of

control and participation in religious activities. 

For older people in particular, the role of caregiver

may be a major stressor. A spouse is commonly the

primary caregiver for his or her mate, often providing almost full-time care. Providing care to people

with physical limitations, and especially to those

with dementia or Alzheimer’s disease, has been

shown to adversely affect caregivers’ mental health.

Anxiety and feelings of hopelessness about the

future, as well as “loss of self” or “role engulfment”

can occur when the caregiving activities disrupt normal family life and restructure or overwhelm the life

of the caregiver (Lieberman and Fisher, 1995; Skaff

and Pearlin, 1992). Caregiving can be particularly

burdensome for older women because women are

more likely than men to provide care and more

likely to be under stress because of it (Kramer and

Kipnis, 1995).

Box 3-1.

Aging and Mental Health

40 For more discussion on the two perspectives, see Miech and

Shanahan, 2000.
compared with the previous generation. Psychological distress is indicated by various negative feelings

and emotional states, including

whether the respondent feels

lonely or feels like a burden to

society or family.41 This chapter

also considers socialization by

looking at whether older people

enjoy talking with other people

and are willing to participate in

community recreational activities,

and examines stressors for older

people such as worries about

finance, health care, and 

old-age care.

Life Satisfaction 

and Happiness

Life Satisfaction

Most of China’s older people (62.9

percent) reported they were satisfied with their life (Table 3-1;

Figure 3-1), with a higher proportion (64.2 percent) of the young

old than the oldest old (58.4 percent) expressing satisfaction.42, 43

An urban/rural differential was

apparent in older people’s life satisfaction, favoring urban residents

(70.8 percent of urban older people, compared with 60.5 percent of

rural older people). 

Research on gender and mental

health in Western countries has

found gender differences but has

yielded mixed conclusions on

which gender is advantaged or

more vulnerable to negative life

events or role stress. Some studies

found that women suffer more distress than men and that this gender gap increases with age (Delbes

and Gaymu, 2002; Horwitz et al.,

1996; Mirowsky, 1996; Mirowsky

and Ross, 1995). Other studies

suggested that men are more vulnerable to emotionally distressing

events and more affected by undesirable life events (Thierry, 2000;

Umberson et al., 1992). Still other

research maintained that gender

differences are disorder specific

and do not indicate that women

and men are different in susceptibility to stress (Aneshensel et al.,

1991). Life satisfaction levels did

not differ statistically between

China’s older men and women. This

was true in both urban and rural

areas, and there also was no gender difference between men and

women who reported being “very

satisfied” with life (about 14 percent of men and women).

30 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

Table 3-1.

Percent of Population Aged 60 and Over Satisfied With

Life by Residence and Selected Characteristics for China:

2000

Characteristic Total Urban Rural

Total. . . . . . . . . . . ................. 62.9 70.8 60.5

Sex

Male . . . ................................. 64.3 72.8 61.8

Female. . . . .............................. 61.6 68.9 59.3

Marital Status

Currently married1 . . . . . . . . . . . . . . . . . . . . . . . . 65.0 73.3 62.1

Not married2 ............................. 58.8 63.3 57.8

Educational Attainment3

Illiterate . . . .............................. 59.2 64.8 58.4

Primary school4 . . . . . . . . . . . . . . . . . . . . . . . . . . 64.0 65.8 63.4

Junior high school or above . . . . . . . . . . . . . . . 74.5 78.8 65.1

Money Income (in Yuan)5, 6

Low . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54.3 58.3 53.8

Medium . . . . ............................. 62.0 66.5 61.8

High . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72.9 73.6 71.8

Living Arrangement

Living alone. . . ........................... 49.2 57.7 47.0

Living with spouse only . . . . . . . . ........... 64.9 72.4 62.3

Living with children and/or others7 . . . . . . . . . . 63.6 71.4 61.4

Self-Assessed Health

Good . . . ................................ 79.5 81.1 78.9

Poor . . . ................................. 51.1 60.8 48.7

Activity Limitations

One or more limitations . . . . . . . . . . . . . . . . . . . 56.8 66.0 54.4

No limitations . . . ......................... 67.9 74.0 65.8

1 ‘‘Currently married’’ refers to people who were currently married and living with their spouse. 2 ‘‘Not married’’ includes people who were widowed, divorced, separated, or never married. 3 ‘‘Illiterate’’ is defined as people aged 15 and older who are unable to read. Primary school in China

is equivalent to elementary school in the United States, and junior high school is equivalent to middle

school or junior high school. 4 ‘‘Primary school’’ includes ‘‘primary school’’ and ‘‘old-style private school.’’ 5 ‘‘Money Income’’ is monthly income in Chinese yuan. In 2000, the exchange rate between the U.S.

dollar and the Chinese yuan was $1 = 8.28 yuan. 6 In this table, for total China, ‘‘Low’’ monthly money income is less than 50 yuan, ‘‘Medium’’ is 50 to

199 yuan, and ‘‘High’’ is 200 yuan or above. For urban China, ‘‘Low’’ is less than 300 yuan, ‘‘Medium’’ is

300 to 749 yuan, and ‘‘High’’ is 750 yuan or above. For rural China, ‘‘Low’’ is less than 50 yuan,

‘‘Medium’’ is 50 to 149 yuan, and ‘‘High’’ is 150 yuan or above. 7 ‘‘Living with children and/or others’’ may include spouse, children, grandchildren, parents, or any

other family or nonfamily members.

Source: Sample Survey on the Aged Population in Urban/Rural China, 2000.

41 The Sample Survey on Aged Population

in Urban/Rural China (SSAPUR) includes some

questions on depression comparable to standard questions commonly used in Western

countries, but it does not contain measurable

scales of depression. 42 The question on life satisfaction in 

SSAPUR includes a five-point scale—very dissatisfied, dissatisfied, so so, satisfied, very

satisfied. This report collapsed the scales into

a yes/no categorical answer, combining “very

satisfied” and “satisfied” into “yes” and “so

so,” “dissatisfied,” and “very dissatisfied” into

“no.”43 The percentage aged 70 to 79 satisfied

with life is not statistically different from the

percentages of the other two age groups (60

to 69, 80 and older).
A higher percentage (65.0 percent)

of married older people were satisfied with life than their unmarried

(mostly widowed) counterparts

(58.8 percent). Older people living

with their spouse or with children

and/or others were more likely to

be satisfied with life than those living alone.44 Socioeconomic status

(education, income) was positively

associated with life satisfaction;

the higher the educational attainment or money income, the more

likely older people were to be satisfied with their life.

Health also was positively associated with older people’s life satisfaction. A large majority (79.5 percent)

of those who regarded their health

as good were satisfied with life,

compared with half (51.1 percent)

of those who assessed their health

as poor. Among those without activity limitations, 67.9 percent were

satisfied with life, compared with

56.8 percent of those who had one

or more activity limitations.45

Several socioeconomic and demographic variables each showed

association with life satisfaction. To

better assess the relationship

between these variables and life

satisfaction, five multivariate logistic regression models were used to

control for confounding effects.

Model 1 examined whether gender

made a difference. Model 2 examined how urban/rural residence

affected older people’s life satisfaction. Models 3, 4, and 5 were progressive models with various control variables added to the

preceding models. Model 3 added

age to sex and urban/rural residence, and, after age was controlled, investigated whether sex

and urban/rural residence still had

the same relationship with life satisfaction as when they were examined alone. Model 4 added other

socioeconomic and demographic

variables (marital status, education,

money income) in addition to

urban/rural residence. The full

Model 5 included all previous variables and added two health variables—activity limitations and selfassessed health status.46

Regression results are presented in

Figure 3-2 and Table 3-2. An odds

ratio greater than “1” indicates that

people were more likely to be satisfied with life than was the reference group and an odds ratio less

than “1” indicates the opposite.47

Models 1 and 2 show that, taken

alone, women were 10 percent less

U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 31

Figure 3-1.

Percent of Population Aged 60 and Over 

Satisfied With Life: 2000

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

With activity limitations

Without activity limitations

Poor health

Good health

Living with children

and/or others

Living with spouse only

Living alone

Not married

Married

Female

Male

Rural

Urban

Total

56.8

62.9

70.8

60.5

64.3

61.6

65.0

58.8

49.2

64.9

63.6

79.5

51.1

67.9

44 The satisfaction rates of older people

living with their spouse and those living with

children and/or others are not statistically

different.

46 This full model did not include living

arrangement because of the small sample

size of the segment living alone and possible

colinearity between living arrangement and

marital status. 47 The reference category for “sex” is male

(i.e., the estimates show women’s likelihood

to be satisfied with life as compared with

men), for “residence” the reference category

is rural, for “age” it is 60 to 69 years, for

“marital status” it is not married, for “education” it is illiterate, for “money income” it is

low income, for “activity limitations” it is no

limitation, and for “self-assessed health status” the reference category is good health.

45 See Chapter 2 for more information on

activity limitations.
likely than men to be satisfied with

life, and urban residents were 60

percent more likely than rural residents to express life satisfaction.

These results are consistent with

the descriptive findings.

Age was negatively associated with

life satisfaction (Model 3, Table 3-2).

The older age groups (70 to 79

years and 80 and older) were less

likely than the young old (60 to 69

years) to be satisfied with life, with

the strongest negative effects

among the oldest old. Age did not

change the direction of the relationship of gender or urban/rural

residence with Chinese older people’s likelihood of being satisfied

with life.

Model 4 shows that money income

had a strong positive association

with life satisfaction, as people

with high income were twice as

likely as people with low income to

be satisfied with life. Results controlling for marital status and education are also consistent with

descriptive findings, i.e., that married and/or literate older people

were more likely to be satisfied

with life than were unmarried

and/or illiterate people. 

The two health-related variables in

the full model (Model 5) reversed

the negative relationship between

age and life satisfaction in Models 3

and 4. In Model 5, the older a person, the more likely he or she was

to be satisfied with life. This reversal of direction indicates that people

in older age groups were more

likely than the young old to have

health concerns. After health status

is controlled, i.e., if older respondents had the same health status as

the young old, the former would

have been more satisfied with life

than their younger counterparts.

32 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

Figure 3-2.

Association Between Gender or 

Urban/Rural Residence and Life Satisfaction for 

Population Aged 60 and Over: 2000

* The reference group is men. ** The reference group is rural residents. 

Note: Model 1 controls for sex. 

 Model 2 controls for urban/rural residence. 

 Model 3 controls for sex, urban/rural residence, and for age. 

 Model 4 controls for the same factors as Model 3 and also for marital status, education, 

 and money income. 

 Model 5 controls for the same factors as Model 4 and also for activity limitations and 

 self-assessed health status. 

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

Model 1 Model 2 Model 3 Model 4 Model 5

(Odds that an older woman or an older urban resident is more likely than 

their reference group to be satisfied with life)

Women* Urban residents**

1.1

0.9

1.6

0.9

1.6

1.1 1.1

1.2

Table 3-2.

Odds Ratios Predicting Likelihood to Be Satisfied With Life

for Population Aged 60 and Over for China: 2000

Variable Model 1 Model 2 Model 3 Model 4 Model 5

Sex (reference group: Male) . . . . . . . . . . . 0.8886 0.8965 1.0752 1.1598

Residence (reference group: Rural) . . . . . 1.5824 1.5766 1.1028 1.0964

Age (reference group: 60 to 69)

70 to 79 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.9146 0.9970 1.1106

80 and over. . . . . . . . . . . . . . . . . . . . . . . . 0.8056 0.9492 1.1628

Marital status (reference group: Not

married) . . . ........................ 1.1871 1.1463

Educational attainment (reference

group: Illiterate)1

..................... 1.1484 1.0967

Money income (reference group: Low)

Medium . . . . . ...................... 1.3752 1.3424

High . . . ........................... 2.0255 1.9567

Activity limitations (reference group: No

limitation). . . ........................ 0.8650

Self-assessed health status (reference

group: Good)

Average . . . ........................ 0.3980

Bad . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3036

1 ‘‘Illiterate’’ is defined as people aged 15 and older who are unable to read.

Notes: All odds ratios significant at .001 level.

Odds ratios greater than ‘‘1’’ indicate that these people are more likely to be satisfied with life

compared with the reference group; e.g., the reference category for ‘‘sex’’ is male, therefore the odds

ratio of 0.8886 indicates that women are less likely to be satisfied with their life than men.

Source: Sample Survey on the Aged Population in Urban/Rural China, 2000.
When socioeconomic and demographic variables were controlled

(Model 4), women were seen to be

more likely than men to be satisfied

with life. This indicates that the

gender difference in life satisfaction

may largely be explained away by

other factors. Had older women had

the same marital status, education,

and money income as older men,

they might have reported greater

life satisfaction. The health variables

in Model 5 further increased the

likelihood of older Chinese women

being more satisfied than their male

counterparts. 

In contrast to the gender difference, the direction of the

urban/rural difference in life satisfaction remained statistically

unchanged after age, socioeconomic status, and health variables

were controlled. Urban older people still were more likely than rural

older people to be satisfied with

life. Model 3 shows that age did

not change the direction of the

relationship between urban/rural

residence and life satisfaction.

Model 4 reveals that the differential

in socioeconomic and demographic

characteristics between urban and

rural older people accounted for

much of the difference in life satisfaction; while urban residents were

still more likely than rural residents

to be satisfied with life, the difference was to a lesser degree (from

1.6 times more likely to 1.1). With

the addition of the health variables

in the full model (Model 5), urban

residents were still more likely

than rural residents to be satisfied

with life, although to an even

lesser degree than in Model 3 or

Model 4.

Happiness

Another indication of life satisfaction for older people is that they

feel happy compared with when

they were young, with their parents’ generation, or with their

peers. Most older Chinese 

(59.7 percent) felt they were happier than when they were young.

There was no statistically

significant gender difference, but

urban older people were more

likely than rural older people to

report they were happier than

when they were young (Figure 3-3).

Compared with the previous generation, the majority of older people

believed that they were happier

than their parents’ generation.

When compared with their peers,

about two-thirds of older urban

residents felt their lives were happier, but less than half of older

rural residents felt the same way. 

That rural older people were less

happy than urban older people in

all three comparisons supports the

Chinese media’s reporting that

older people in rural areas often

feel that their life is unsatisfactory.

This may partly stem from urbanrural differences in economic wellbeing. It has been argued (Yang,

1999) that the widening ruralurban income differentials have

been the driving factor behind rising overall inequality in China, and

that government financial transfer

programs for state enterprises as

well as for urban residents have

contributed to this growing disparity. Yang (1999) also reported that

there could be an increasing differential within rural areas as a consequence of rural economic reforms. 

Socialization

Enjoying talking with people and

participating in community recreational activities were the measures used to indicate whether older

people were engaged in social networks. In order to help older people be better connected with their

community and have a richer social

life, the Chinese government in

recent years has built community

centers for older people that provide activities such as reading, fitness exercises, playing cards,

painting pictures, calligraphy, and

courses targeted to older people.

U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 33

Figure 3-3.

Percent of Population Aged 60 and Over 

Feeling Happy: 2000

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

Rural

Happy compared

with peers

Happy compared with

previous generation

Happy compared

with when young

Urban

43.8

67.7

57.2

91.0 87.9

65.6
Most older Chinese said they

enjoyed talking with people, and

there was no urban/rural or gender difference (Figure 3-4).

However, men and women were

quite different in their willingness

to participate in community recreational activities. Older men were

more interested in going out and

joining community activities. In

rural areas, 63.0 percent of men

compared with 44.9 percent of

women reported being willing to

participate in community

activities.48 This might be a consequence of traditional cultural

norms, particularly in rural areas,

that say a woman’s place is at

home and discourage female participation in public activities.

Psychological Distress

Feeling Lonely

In 2000, 29.7 percent of older

Chinese reported feeling lonely and

this proportion rose with age. A

smaller proportion of the young

old (60 to 69 years) felt lonely

(25.9 percent) compared with

those aged 70 to 79 (34.4 percent)

or those aged 80 and older (38.0

percent). The same age pattern

could be found regardless of gender or urban/rural residence

(Figure 3-5).49 Consistent with

results mentioned earlier, marriage

had a protective effect against

loneliness; married older Chinese

were significantly less likely than

the unmarried to feel lonely (22.3

percent of married and 44.2 percent of unmarried). This was true

in both urban and rural areas and

for both men and women. 

Research on gender and loneliness

has generated mixed findings.

Some have concluded that loneliness is associated with being

female because women are more

likely to be widowed and to live

alone (Chen et al., 2004; Li and

Zhang, 1997). Other research counters the “double jeopardy” hypothesis that being female and old

makes older women particularly

disadvantaged, arguing instead

that in some settings (especially

multigenerational households)

older women may be more valued

than nonworking elderly men. Men

may be more likely to feel rejection

or reduced self-esteem when they

are no longer able to earn a living

(Knodel and Ofstedal, 2003). In

China, SSAPUR data showed a

slight gender difference in experiencing loneliness; women (31.9

percent) were more likely than men

(27.5 percent) to report feeling

lonely. 

Not surprisingly, living with one’s

spouse or with children and/or

others was found to reduce the

feeling of isolation compared with

living alone.50 Half of older Chinese

who lived alone in 2000 felt lonely,

compared with about one-quarter

of those living with their spouse or

with children and/or others. A

higher percentage of older men

(58.5 percent) than older women

living alone (46.3 percent) reported

feeling lonely (Figure 3-5), suggesting that older men may be more

vulnerable than women when dealing with emotional isolation. As

China ages and millions of older

people find themselves to be

“empty nesters,” loneliness may

become more common. 

34 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

Figure 3-4.

Percent of Population Aged 60 and Over Enjoying 

Talking With People and Willing to Participate in 

Community Recreational Activities: 2000

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

Female

Willing to

participate in

community activities

Willing to Enjoy talking

participate in

community activities

Enjoy talking

Male

44.9

71.5 70.2

62.2

50.4

74.1 70.7

63.0

Urban Rural

48 The gender differences in willingness

to participate in community activities

between urban and rural areas are not statistically different. 49 The percentage of people aged 70 to 79

feeling lonely is not statistically different

from the percentage of people 80 and older

feeling lonely within urban, rural, male, and

female subgroups. 

50 A feeling of loneliness when living with

one’s spouse only is not statistically different

from when living with children and/or others.
U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 35

Figure 3-5.

Percent of Population Aged 60 and Over Feeling Lonely: 2000

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

Rural

Urban

Female

Male

Rural

Urban

Female

Male

60 to 69

70 to 79

80 and over 

Living alone

Living with spouse only

Living with children and/or others

39.9

24.6

31.4

34.7

27.2

37.1

40.1

18.5

26.0

31.0

29.3

36.7

31.8

58.5

25.0

26.0

46.3

25.6

32.1

41.8

19.5

20.7

53.0

27.3

Researchers studying Chinese psychological wellbeing and mental health have warned of possible

underreporting of emotional states. A combination of

(1) Chinese thinking that tends to link psychological

symptoms to physical elements, (2) cultural norms

that emphasize emotional self-control, and (3) the

tendency to express feelings only to people within

the close-knit circle of family and friends may make

people reluctant to report their psychological wellbeing in general and distress in particular (Lai,

1995).51 Studies have found that although Asians

(including Chinese) may have lower levels of control

over their personal lives than non-Asians, the negative relationship between personal control and

psychological distress is less for Asians than for 

non-Asians (Sastry and Ross, 1998). In a collectivist

culture (e.g., China), it is viewed as violating norms if

one pursues individual happiness and self-interests. 

In urban China, Western-type ideas about the effects

of psychosocial stress are gradually changing people’s understanding of psychological disorders and

the accompanying stigma (Phillips, 1998). Rural

Chinese, however, may not be readily willing to

report their feelings to people outside their family.

SSAPUR interviewers reported that in some rural

sample areas, local custom mandated that older

women not talk to strangers without the presence

of their husband or another male member of the

family. When interpreting the assessment of psychological well-being of older Chinese in this report,

especially of rural older women, cultural effects

should be considered.

Box 3-2.

Chinese Culture and Psychological Distress

51 For more detailed discussions of how Chinese culture determines and affects emotionality, see Sun, 1991.
Among those living with children

and/or others, women (32.1 percent) were more likely than men

(26.0 percent) to feel lonely.

Multigenerational living arrangements may be a stressor for some

older people in China because of

intergenerational conflict related to

decision-making authority, and it

may affect women more than men.

Feeling Like a Burden to

Society or Family

Feeling like a burden to society or

family is another stressor for older

people. About 6 in 10 (59.4 percent) of China’s older people

reported feeling like a burden to

society. A slightly higher share of

the oldest old (62.9 percent) than

the young old (58.2 percent) felt

that way. There was no statistical

difference between older men and

women, but rural older people

were more likely than those in

urban settings to feel like a burden

to society (61.7 percent and 51.8

percent, respectively) (Figure 3-6).

Slightly more than 6 in 10 (62.8

percent) of China’s older people felt

like a burden to their family, with

no difference by gender or by marital status. A higher proportion of

rural (67.3 percent) than urban

(48.2 percent) older people felt

burdensome to their family. Rural

married people (68.0 percent) felt

they were a burden more commonly than urban married people

(43.8 percent). Among people with

one or more activity limitations,

feeling like a burden to family was

more common in rural (68.4 percent) than urban (56.9 percent)

areas, suggesting that the rural old

rely more heavily on family for

health care and/or old-age care. 

SSAPUR living arrangement data

revealed that older people living

alone felt more burdensome to

their family than those living with

36 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

Figure 3-6.

Percent of Population Aged 60 and Over Feeling 

Like a Burden to Society: 2000

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

80 and Male Female Urban Rural

over

70

to 79

60

to 69

61.7 58.2 60.6 62.9

58.4 60.3

51.8

Figure 3-7.

Percent of Population Aged 60 and Over Feeling 

Like a Burden to Family: 2000

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

Rural residents with

activity limitations

Urban residents with

activity limitations

Without activity limitations

With activity limitations

Good health

Poor health

Living with children

and/or others

Living with spouse only

Living alone

Not married

Married

Female

Male

Rural

Urban

68.4

63.7

62.1

61.7

65.1

48.2

67.3

71.1

63.2

61.6

69.0

56.9

66.0

60.2

56.9
their spouse or with their children

and/or others (Figure 3-7).52 Other

research on aging in developing

countries (including urban China)

has shown that older people (especially women) who live alone often

have adult children living in adjacent dwellings or nearby, and that

these children typically provide

some degree of physical assistance

or in-kind financial contributions

(Bian et al., 1998; Knodel and

Ofstedal, 2003). It may be that

older Chinese who live alone

require more help from their family

than do their peers who live with

their spouse and/or children. Older

people who live with their spouse

and/or children often help with

housework and other chores

(Whyte, 1997), and they may feel

that their relationship with their

adult children is one of reciprocity

(Ng et al., 2002) rather than a

burden.

Figure 3-7 also shows that 69.0 percent of SSAPUR respondents with

poor self-assessed health felt they

were a burden to their family, compared with 56.9 percent of older

people in good health. The presence

or absence of activity limitations did

not make a large difference in feeling burdensome—66.0 percent of

individuals with one or more limitations viewed themselves as a burden, compared with 60.2 percent of

those without a limitation. A larger

proportion of rural older people

with activity limitations felt burdensome to their family than did their

urban counterparts.

Old-Age Worries

The concept “old-age worries”

refers to people’s negative feelings

about being old and their concerns

about problems that grow more

salient as one ages. The two main

types of worries involve financial

strains, as older people typically no

longer work for pay, and old-age

care needs, especially for those

with health concerns or activity

limitations. The association

between financial strain and poor

health on the one hand, and

depression, impaired cognitive

capacity, and lowered self-esteem

on the other, has been documented

(e.g., Angel et al., 2003). Research

also has shown that older disabled

people have relatively low levels of

control over their activities, and

that long-term disabilities are

chronic sources of stress for older

people (Schieman and Turner,

1998).

Resources for Daily Living. When

asked if they worry about not having enough resources for daily living, 4 in 10 older Chinese answered

affirmatively, with no significant differences by age, sex, or urban/rural

residence. This major financial

worry was more pronounced among

older people who lived alone. About

half of those living alone (48.8 percent) worried about not having

enough money for daily needs,

higher than those who lived with

their spouse only (42.2 percent) or

who lived with children and/or others (41.7 percent). The same pattern

was seen among older men and

women, and in urban and rural

areas (Figure 3-8).53 The vast majority (86 percent) of older people living alone in 2000 were widowed,

and most widows/widowers have at

most one direct income (their own)

to live on since there are no widows’ pensions in China. 

U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 37

52 The percentage of those living with

their spouse only who felt burdensome to

their family is not statistically different from

those living with their children and/or others.

Figure 3-8.

Percent of Population Aged 60 and Over Worrying 

About Financial Resources for Daily Living: 2000 

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

Living alone

Living with spouse only

Living with children and/or others 

40.8

50.6

42.1 41.2

47.9

42.2 42.1

47.9

41.5 44.7

49.1

42.4

Male Female Urban Rural

53 The percentage with financial worries

for those living with their spouse only is not

statistically significantly different than for

those living with their children and/or others

among the total older population, as well as

among urban, rural, male, and female subgroups. In addition, for the urban older population, the percent living alone with financial

worries is not statistically different from

those living with children and/or others.
Affordability of Health Care.

Another financial worry for older

people is whether they will have

money to pay for medical care if

they get sick. About half of men

and women alike worried that they

would not have the financial ability

to cover their medical needs. People

with perceived poor health were

much more worried about not being

able to afford health care than those

who were in good health (61.4 compared with 36.0 percent).

The young old (aged 60 to 69) were

more likely than the older old (aged

70 to 79) to worry about their ability to pay for health care; this was

particularly true for urban residents

(58.5 percent of those aged 60 to

69, 52.2 percent aged 70 to 79, and

46.7 percent aged 80 and over).54

This may be attributed partly to differences in old-age security resulting from recent pension reforms

that, in urban areas, eliminated the

original pension scheme and established a three-pillar old-age insurance system, and in rural areas,

replaced the commune system with

minimal social safety net transfers.55

The urban older old, who retired

before the new system began, continue to enjoy full pension benefits

under the prior system, while the

young old, who were not retired,

were caught in the transition and

had to start contributing to their

individual savings accounts at a

much older age than others in the

work force.

The urban young old (58.5 percent)

were more likely than rural young

old (49.9 percent) to worry about

the affordability of medical care.

Urban older women were more

likely to have this concern 

(59.3 percent) than were urban

older men (51.7 percent) or rural

older women (48.9 percent).

Medical care is more expensive in

urban than in rural areas.

People with low income (57.4 percent) were more likely to worry

about the affordability of health

care than were people with medium

income (47.5 percent) or high

income (46.8 percent) (Figure 3-9).

In urban areas, 61.1 percent of

older people with low income were

concerned about having enough

money to pay for medical care,

compared with 42.0 percent of

those with high income. The respective figures in rural areas were 56.7

and 35.8 percent.56

38 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

54 The percentage of older old that worry

about their ability to pay for health care is not

statistically significantly different than the percentage of oldest old, for the total older population as well as urban older population. 55 For more information on China’s pension reform and old-age insurance system,

see Heller, 2006, and Sin, 2005.

56 Among people who worry about the

affordability of health care, there are no statistical differences between the percentages

for those with median income and those with

high income. Also, there are no statistical

differences between the percentages for

urban residents with low income and rural

residents with low income.

Figure 3-9.

Percent of Population Aged 60 and Over Worrying 

About Not Having Money for Medical Care: 2000

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

Poor health

Good health

Not a government official

Current/former government official

High income

Medium income

Low income

61.4

57.4

47.5

46.8

42.4

50.8

36.0

Figure 3-10.

Percent of Population Aged 60 and Over Worrying 

About Not Getting Care When Needed: 2000

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

Living with children and/or others

Living with spouse only

Living alone

Rural

Urban

Female

Male

36.3

37.0

38.8

41.9

36.7

49.7

38.0
SSAPUR data show that fewer current/retired government officials

(42.4 percent) worried about getting medical care than those who

were not or had never been government officials (50.8 percent).

This finding may reflect the fact

that in China, retired government

officials enjoy certain benefits that

came with their previous positions. 

Ability to Get Care When Needed.

About 4 in 10 older people (37.9

percent) were worried that there

may not be anyone to take care of

them when needed. Urban residents (41.9 percent) were more

concerned than rural residents

(36.7 percent) about old-age care

(Figure 3-10). More of those who

lived alone (49.7 percent) worried

about getting care than did those

who lived with their spouse (38.0

percent) or their children and/or

others (36.3 percent).57 While there

was no overall gender difference in

worrying about care, older men

who lived alone were more likely

than older women living alone to

have old-age care concerns (57.7

percent and 45.3 percent, respectively). 

Filial Piety. Concerns about care in

old age are influenced by whether

people think that they can depend

on their children. Traditional

Chinese culture emphasizes filial

piety and mandates that adult children take care of older parents.58

This traditional filial obligation has

been substantially weakened due

to economic development and

modernization. In present-day

China, influences from Western culture and a trend toward small

nuclear families are said to have

changed the primary focus of

Chinese family life from children’s

obligations to their parents to the

husband-wife bond (Ng et al.,

2002; Whyte, 1997). 

When asked whether they were

concerned that their children lack

filial piety, 30.9 percent of the 

SSAPUR respondents said “yes.”

Sociodemographic characteristics

(age, sex, marital status,

urban/rural residence, living

arrangements) did not affect older

people’s views of filial piety.59

While rural older people were considerably more likely than urban

older people to feel like a burden

to society and family, they were no

more likely than urban people to

express a negative view of their

children’s loyalty.

U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 39

57 The percentage living with their spouse

only who worried about getting care is not

statistically different from those living with

their children and/or others.

58 The concept of filial piety does not dictate a one-way flow from children to parents,

but rather embraces reciprocal arrangements. The parental and child reciprocity is

found in some Asian countries where an

increasing reevaluation of filial piety is evident (Phillips, 2000). 

59 Older people living alone (33.7 percent)

were more likely than those living with their

spouse (28.9 percent) to worry that their children lack filial piety. 

Available and affordable health care

is essential to older people’s quality

of life. This chapter examines several aspects of health care—formal

medical care (visits to doctor’s

offices, home-visits by doctors, hospitalization), informal care, health

service utilization, and health care

financing. While China’s health care

reform is well under way, utilization

of health care services by older people has not been widely researched.

The Sample Survey on Aged

Population in Urban/Rural China

(SSAPUR) data contribute to our

empirical knowledge regarding the

characteristics of older people who

use various types of health care and

the determinants of health care

service utilization.

Medical Care

Visits to Doctor’s Offices

Doctor-office visits in this report

include visits to outpatient offices in

hospitals, clinics, and elsewhere.60

In 2000, 73.0 percent of older people made one or more visits to a

doctor in the last year (Figure 4-1).

The younger old and oldest old did

not differ in their propensities to

visit a doctor, though older women

(75.3 percent) were somewhat more

likely than older men (70.5 percent)

to see doctors. There was no statistically significant difference by

urban/rural residence. 

U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 41

CHAPTER 4.

HEALTH CARE

Figure 4-1.

Percent of Population Aged 60 and Over Visiting a 

Doctor's Office in the Last Year: 2000

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

Without chronic disease

With chronic disease

Without activity limitations

With activity limitations

Good health

Poor health

Without chronic disease

With chronic disease

Without activity limitations

With activity limitations

Good health

Poor health

Rural

Urban

Female

Male

80 and over

70 to 79

60 to 69

Total

89.2

73.0

72.0

74.1

75.2

70.5

75.3

74.1

72.6

59.9

84.7

67.9

78.0

54.9

87.7

55.2

82.8

69.3

81.3

55.9

Urban

Rural

60 In China, doctor’s offices are mostly

located in various hospital departments. In

this report, “doctors” refer to any medical

practitioners and are not restricted to those

trained in medical schools.
Among people with self-assessed

poor health, 88.0 percent saw a

doctor at least once in 2000, compared with 55.1 percent of those

who regarded themselves in good

health. A larger proportion of older

people with at least one activity limitation (78.7 percent) visited a doctor’s office than did those with no

difficulty in activities (68.3 percent).

Among those who had any chronic

disease, 84.2 percent visited a doctor’s office at least once in 2000,

compared with 59.1 percent of

those without chronic disease.

Similar patterns were seen in urban

and rural areas (Figure 4-1).61

The average number of visits to a

doctor’s office is another measure of

formal health care utilization.

Chinese people aged 60 and older

made an average of 5.1 visits to a

doctor’s office in 2000 (Table 4-1).

Urban or rural residence affected

the frequency with which older people saw a doctor—7.3 average visits

for urban respondents compared

with 4.4 for rural respondents. 

Education and money income

affected older people’s likelihood of

visiting doctors. Older people with

junior high school education or

above visited doctors 7.0 times in

2000, compared with 4.7 times by

those with primary school education and 4.9 times by the illiterate.62

Similarly, the higher the money

income, the more doctor visits (6.7

visits for those with high income,

4.8 visits for medium income, and

3.9 visits for low income). Current

or former government officials (11.3

visits) were more than twice as

likely as other older people (4.8 visits) to visit doctors. 

Home-Visits by Doctors

Doctors in China often come to

older people’s homes to provide

medical examinations or treatment.

In 2000, about one-third (35.7 percent) of older people had doctors

visit them at least once at home.

The oldest old were the most likely

to have doctors treat them at home

(46.6 percent), followed by those

aged 70 to 79 (39.4 percent) and

people aged 60 to 69 (31.9 percent). 

Regardless of health status, rural

older people were much more

likely than urban older people to

have doctors visit them at home

(41.7 percent and 15.6 percent,

respectively). Among people

reporting poor health, about 6 in

10 (58.4 percent) rural residents

had doctor home-visits, compared

42 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

Table 4-1.

Average Number of Visits to Doctor’s Office Last Year for

Population Aged 60 and Over by Residence and Selected

Characteristics for China: 2000

Characteristic Total Urban Rural

Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1 7.3 4.4

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.9 7.5 4.1

Female. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.3 7.0 4.8

Age

60 to 69 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1 7.3 4.4

70 to 79 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.3 7.9 4.6

80 and over. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.3 4.5 4.3

Marital Status

Currently married1 . . . . . . . . . . . . . . . . . . . . . . . . 5.0 7.6 4.1

Not married2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.2 6.2 5.0

Educational Attainment3

Illiterate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.9 6.0 4.7

Primary school4 . . . . . . . . . . . . . . . . . . . . . . . . . . 4.7 7.3 3.9

Junior high school or above . . . . . . . . . . . . . . . 7.0 8.0 4.7

Money Income (in Yuan)5, 6

Low . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.9 5.1 3.8

Medium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.8 5.3 4.7

High . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.7 7.9 5.0

Living Arrangement

Living alone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.5 6.1 5.3

Living with spouse only . . . . . . . . . . . . . . . . . . . 5.4 8.3 4.4

Living with children and/or others7 . . . . . . . . . . 4.9 6.8 4.4

Government Official Status

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.3 11.9 10.2

No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.8 6.5 4.3

1 ‘‘Currently married’’ refers to people who were currently married and living with their spouse. 2 ‘‘Not married’’ includes people who were widowed, divorced, separated, or never married. 3 ‘‘Illiterate’’ is defined as people aged 15 and older who are unable to read. Primary school in China

is equivalent to elementary school in the United States, and junior high school is equivalent to middle

school or junior high school. 4 ‘‘Primary school’’ includes ‘‘primary school’’ and ‘‘old-style private school.’’ 5 ‘‘Money Income’’ is monthly income in Chinese yuan. In 2000, the exchange rate between the U.S.

dollar and the Chinese yuan was $1 = 8.28 yuan. 6 In this table, for total China, ‘‘Low’’ monthly money income is less than 50 yuan, ‘‘Medium’’ is 50 to

199 yuan, and ‘‘High’’ is 200 yuan or above. For urban China, ‘‘Low’’ is less than 300 yuan, ‘‘Medium’’ is

300 to 749 yuan, and ‘‘High’’ is 750 yuan or above. For rural China, ‘‘Low’’ is less than 50 yuan,

‘‘Medium’’ is 50 to 149 yuan, and ‘‘High’’ is 150 yuan or above. 7 ‘‘Living with children and/or others’’ may include spouse, children, grandchildren, parents, or any

other family or nonfamily members.

Source: Sample Survey on the Aged Population in Urban/Rural China, 2000.

61 A person may have one or more health

conditions, and therefore, the percentages of

people with different health conditions seeking health care are not mutually exclusive. For

example, a person may report having activity

limitations and also a chronic disease. 62 The average number of visits to a doctor’s office for people with primary school

education (4.7 times) and illiterate people

(4.9 times) are not statistically different from

each other.
with nearly 3 in 10 (29.6 percent)

urban residents. Similar patterns

were seen among people with

activity limitations and chronic diseases (Figure 4-2). 

The popularity of doctor homevisits in rural areas at least partly

reflects access barriers—distances

to doctor’s offices, transportation

difficulties, and other physical

inconveniences—that are less

severe in urban areas. Given that

doctor home-visits are a common

form of health care for rural older

people, it is important to ensure

the quality of the medical staff and

the accessibility of medical supplies in rural areas. Research has

indicated that rural doctors, many

of them village medical practitioners, receive little supervision and

professional training (Liu, 2004).

Hospitalization

In 2000, 8.0 percent of China’s

older people were hospitalized at

least once. Urban residents (11.1

percent) were more likely than

rural residents (7.0 percent) to be

hospitalized (Figure 4-3). Sex or

age did not affect older people’s

likelihood of being hospitalized.

People with any chronic disease

were about three times as likely as

those without chronic disease to

be hospitalized (11.6 percent and

3.6 percent, respectively). 

Informal Care

Informal care for older people

involves assistance with various

activities at home, including activities of daily living (ADL), mobility

activities, and household activities.63

In 2000, 13.6 percent of older peoU.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 43

Figure 4-2.

Percent of Population Aged 60 and Over Visited by a 

Doctor at Home in the Last Year: 2000

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

Without chronic disease

With chronic disease

Without activity limitations

With activity limitations

Good health

Poor health

Without chronic disease

With chronic disease

Without activity limitations

With activity limitations

Good health

Poor health 29.6

31.2

51.8

34.6

49.7

28.4

58.4

9.3

18.6

10.4

23.4

9.4

Urban

Rural

Figure 4-3.

Percent of Population Aged 60 and Over 

Hospitalized in the Last Year: 2000

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

Without chronic disease

With chronic disease

Without activity limitations

With activity limitations

Good health

Poor health

Rural

Urban

3.6

11.1

7.0

13.8

3.1

10.4

5.9

11.6

63 The time frame for receiving assistance

with activity limitations was not clearly specified in the SSAPUR 2000 questionnaire.

Therefore, this study is not able to examine

the sources of assistance because some

spouses may have provided assistance in the

past but were deceased at the time of the survey. SSAPUR 2006 has corrected this data

shortcoming.
ple with activity limitations said that

they received assistance. As

expected, the oldest old were much

more likely to receive assistance

(24.5 percent) than were people

aged 60 to 69 (9.3 percent) and

aged 70 to 79 (13.0 percent).

Assistance was more common in

urban than rural areas (Figure 4-4). 

The fact that 6 out of 7 survey

respondents with activity limitations did not receive any kind of

assistance implies unmet need

among China’s older population.64

The relatively low proportion of

SSAPUR respondents receiving

assistance for activity limitations

may partly be due to the wording

of the survey question.65

Health Service

Utilization

Easy Access to Medical Care

Easy access to medical care facilitates utilization of health services,

and service availability is an important factor in health care systems.

SSAPUR asked respondents whether

it was convenient for them to see

doctors, and most (74.5 percent)

said that they had easy access to

medical care. About 1 in 10 (10.8

percent) stated that it was not convenient for them to see doctors.66

The oldest old were somewhat less

likely than the young old to report

easy access to medical care 

(Figure 4-5) and more likely than

younger respondents to say that it was inconvenient to see a doctor

(14.8 percent, compared with 10.7

percent among those aged 70 to

79 and 10.3 percent among those

aged 60 to 69).67, 68

China’s Ministry of Health has

stated that the difficulty rural people have when seeking medical

care, especially people in remote or

poor areas, is one of the main reasons for unmet need (China

Ministry of Health, 2004). SSAPUR

data showed a 10 percentage-point

difference in easy access according

to residence—72 percent of rural

older people said that medical care

was convenient, lower than the 82

percent among urban dwellers. 

44 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

Figure 4-4.

Percent of Population Aged 60 and Over With Activity 

Limitations and Receiving Assistance: 2000

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

80 and Male Female Urban Rural

over

70

to 79

60

to 69

Total

12.0 13.6

9.3 13.0

24.5

13.6 13.6

19.7

Figure 4-5.

Percent of Population Aged 60 and Over Having 

Easy Access to Medical Care: 2000

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

80 and Male Female Urban Rural

over

70

to 79

60

to 69

Total

74.5 75.9 73.4 70.0

76.2 73.0

82.3

72.2

64 According to various studies, the majority (80 to 90 percent) of older people with

activity limitations in the United States

receive some type of assistance. For more

information, see Desai et al., 2001 and

Verbrugge and Sevak, 2002. 65 The SSAPUR question on receiving assistance, following a series of questions on

activity limitations, was: “Have you ever had

someone fu si you with daily activities?” A literal translation of the Chinese word “fu si” is

“wait upon/attend” and sounds stronger than

“assist.” This may make the respondent less

likely to answer “yes” to the question. 66 The other 14.7 percent answered “so

so” to the survey question.

67 The SSAPUR question on easy access

was, “Do you think it’s convenient for you to

see doctors?” and it was asked prior to questions about types of health care. The access

question did not differentiate between doctor’s office visits and home visits, and it is

unclear whether respondents referred to both

types or just doctor’s office visits. 68 The percent reporting inconvenience

among those aged 70 to 79 is not statistically

different from that of people aged 60 to 69.
Utilization of Health Services 

The use of health care services by

older people in China has not been

widely studied. To facilitate understanding of the situation, we

applied multivariate regression

analysis to examine the determinants of health service utilization.

The analyses in this report apply a

commonly used framework for

studying health service utilization—Andersen’s Behavioral Model

of Health Services Use (Box 4-1).

Health service utilization is measured by visits to doctor’s offices,

home-visits by doctors, and hospitalization. Independent variables are

grouped into three categories—predisposing characteristics, enabling

resources, and need. Predisposing

characteristics include age, sex,

urban/rural residence, marital status, and educational attainment.70

Enabling resources include money

income, government-official status,

health insurance coverage, and easy

access to health care. Need is measured by chronic disease, selfassessed health status, ADL limitations, and mobility limitations.

Table 4-2 shows results from the

multivariate analysis of the

dependent variables—doctor’s

office visits, home-visits by doctors, and hospitalization. Most predisposing and enabling variables

have an opposite effect on visits to

doctor’s offices than they do on

doctor home-visits. Gender has a

small effect on the probability of

seeking medical treatment. The

regression results support the

descriptive findings that urban

older people are more likely than

their rural counterparts to go to

doctor’s offices but less likely to

have in-home medical care.

Some enabling variables are strong

determinants of doctor’s office visits. Older Chinese who are current

or former government officials are

most likely to visit a doctor. Having

easy access to health care enhances

the probability of both visiting a

doctor and having a doctor homevisit. Health insurance coverage is

positively associated with visits to

doctor’s offices but negatively

related to home visits. After controlling all other factors, income is a

weak predictor, with only minimal

impact on older people’s probability

of utilizing health services.

Most health-related variables

(except for ADL limitations) have

positive predictive power both for

visits to doctor’s offices and doctor

home-visits. Among the need

measures, chronic disease and selfassessed health status have the

largest impact on the probability of

utilizing health services.

Those most likely to have home

visits by doctors are older, rural,

poorer, and/or without health

insurance coverage. Health conditions predetermine the probability

of health service utilization, and

these SSAPUR results imply that

underprivileged older people with

poor health status need structured

health care.

U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 45

The Behavioral Model of Health Services Use was

designed initially in 1968.69 The model suggested that

“people’s use of health services is a function of their

predisposition to use services, factors which enable

or impede use, and their need for care” (Andersen,

1995: 1). Predisposing characteristics include demographic factors such as age and gender; social structural factors such as education, occupation, and ethnicity; and health beliefs such as people’s attitudes

and knowledge about health and health services.

Enabling resources include availability of health personnel, facilities, and other sources of care; personal

income; and health insurance coverage. The need for

health service is indicated by self-assessed health,

functional state, and illness symptoms.

The initial model has gone through two major revisions. In the 1970s, growing recognition of the

importance of national health policy as a determinant of service use led Andersen and his colleagues

to add the health care system to the model. A consumer satisfaction component also was added during this Phase 2 revision. Phase 3 evolved during

the 1980s and 1990s. Personal health practices

such as diet, exercise, and self care were added to

the health behavior component, and perceived and

evaluated health status were added to the health

outcomes. Andersen’s framework has been applied,

tested, and expanded by various studies of health

service utilization (Institute of Medicine, 2001;

Coulton and Frost, 1982; Lix et al., 2005; Wolinsky

et al., 1983). 

Box 4-1.

Andersen’s Framework

70 Living arrangement is not included in

the regression models because of its colinearity with marital status.

69 See Andersen, 1995, for a comprehensive discussion of the

original Behavioral Model of Health Services Use and its evolution.
Financing Health Care

Public Expenditure on Health

With health care costs increasing

rapidly and expanded publicity

about health care system deficiencies in recent years, health care

reform has become one of the

Chinese government’s current policy foci and a much-debated topic

in China (World Bank, 2005c).

Government health expenditure as

a share of gross domestic product

(GDP) has been increasing. In

1980, total government health

expenditure accounted for 3.2 percent of GDP. It rose to 4.0 percent

in 1990, 5.1 percent in 2000, and

5.6 percent in 2004 (China Ministry

of Health, 2006). Private spending

on health grew at an annual rate of 

20 percent during the 1990s

(World Bank, 2005a). 

As China’s economic reform

unfolded in the 1980s, the government made major changes in

health care policy. Analysts have

noted that, while it faced a budget

drain resulting from large losses by

state enterprises, the government

severely limited public funds available for health care and took a

hands-off approach to the development of private medical care

(Hsiao, 1995). The government

allowed an unrestrained private

health care market in rural areas—

fee-for-service private practitioners

provided most rural health

services, and patients’ ability to

pay determined supply and

demand. The government also

gave hospitals and township health

centers a large degree of financing

independence, cut financing to

cover only basic personnel wages

and new capital investments, and

left hospitals to generate their own

operating revenues from user fees.

As reported in the China Daily,

Health Minister Gao Qiang stated in

August 2005 that medical fees

paid by patients were covering not

only the cost of services and medicines, but also the cost of new

apparatuses and hospital facilities

(China Daily, 2005). 

46 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

Table 4-2.

Regression Coefficients of Health Service Utilization for Population Aged 60 and Over for

China: 2000

Variable

Visits to doctor’s office Doctor’s home-visits Hospitalization

B SE B SE B SE

Predisposing Characteristics

Age. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . –0.0900 0.0002 0.0129 0.0000 –0.0012 0.0000

Sex (reference group: Male) . . . . . . . . . . . . . . . . 0.0225 0.0022 –0.0656 0.0005 –0.0264 0.0001

Area of residence (reference group: Rural) . . . 0.7331 0.0034 –1.4173 0.0009 0.0521 0.0002

Marital status (reference group: Currently

married) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.4844 0.0022 –0.0841 0.0005 –0.0275 0.0001

Educational attainment (reference group:

lliterate)1 ................................ –0.2655 0.0022 0.0038 0.0005 0.0043 0.0001

Enabling Resources

Money income (reference group: Low) . . . . . . . 0.0010 0.0000 –0.0004 0.0000 0.0000 0.0000

Government official status (reference group:

No) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.0809 0.0046 0.4086 0.0011 0.0335 0.0003

Health insurance (reference group: No) . ..... 1.5466 0.0030 –0.0591 0.0007 0.0108 0.0002

Easy access to medical care (reference

group: No) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.7086 0.0030 0.3356 0.0007 –0.1104 0.0002

Need

Chronic disease (reference group: No). . . . . . . 3.0032 0.0022 0.5660 0.0005 0.0665 0.0001

Self-assessed health status (reference group:

Good) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.1817 0.0016 0.3647 0.0003 0.0487 0.0001

Limitations in activities of daily living

(reference group: No). . . . . . . . . . . . . . . . . . . . . –0.2568 0.0029 0.3958 0.0006 0.0479 0.0002

Mobility limitations (reference group: No) . . . . . 1.1510 0.0025 0.2084 0.0005 0.0331 0.0001

Constant . . . . . . ........................... 3.9464 –4.0539 0.1865

df. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 13 13

R2 ....................................... 0.104 0.125 0.029

1 ‘‘Illiterate’’ is defined as people aged 15 and older who are unable to read.

Note: All variables significant at .001 level.

Source: Sample Survey on the Aged Population in Urban/Rural China, 2000.
In recent years, the government has

increased spending on health care,

especially on rural health care. Since

2003, the central government has

directed 3 billion yuan toward the

establishment of rural health clinics

in the central and western regions

of the country, and Premier Wen

Jiabao has said that China will

spend more than 20 billion yuan

over the next 5 years on renovating

township hospital buildings and

upgrading equipment (China Daily,

2006b). He also announced that the

central government would double

the allowance to each farmer participating in the rural cooperative

medical care system. 

Health Insurance Coverage 

Figure 4-6 shows health insurance

coverage by age and urban/rural

residence in 1998–2000.71 In 1998,

8 of 10 people in China did not

have health insurance coverage.

This proportion did not differ statistically from the proportion of

older people (79.6 percent) in 2000

without health insurance coverage.

Urban or rural residence made a

large difference in the likelihood of

having health insurance. While

most urban older people were covered by one or more health insurance schemes, 8.8 percent of rural

older people had any type of formal coverage. Within urban areas,

the coverage rate for older people

was 72.2 percent, while for people

of all ages it was 44.9 percent.72

This difference may appear

because retired people were covered under two main health

schemes that were still largely in

place in 2000 (Box 4-2).

Medical Expense Payment

The affordability of medical care

affects a patient’s likelihood to

seek care when needed. The

Ministry of Health has reported

that health care expense has risen

rapidly and is now the third major

expenditure for families, after food

and education. China’s 2003

National Health Survey found that

financial difficulty discouraged

medical care—38.2 percent of outpatients did not follow up with

treatment, and 70.0 percent of

patients did not seek hospitalization when recommended (China

Ministry of Health, 2004). 

U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 47

Figure 4-6.

Percent of Population With Health Insurance 

Coverage: 1998/2000

Note: Data for all ages refer to 1998; data for ages 60 and over refer to 2000.

Sources: For all ages, China Ministry of Health, 2006; for ages 60 and over, Sample 

Survey on Aged Population in Urban/Rural China, 2000.

60 and over

Total Urban Rural

All ages

8.8

18.6 20.4

44.9

72.2

9.7

71 Data for “all ages” come from the second

National Health Survey, conducted in 1998.

These data are comparable with those for people aged 60 and over from the SSAPUR

because health insurance schemes were similar when the two sets of data were collected.

A third National Health Survey was conducted

in 2003, but the data are less comparable

because most cities by then had adopted the

new Basic Medical Insurance Scheme.

72 A statistical significance testing

between the 72.2 percent and the 44.9 percent was not available since data for people

of all ages were obtained from a table published by the China Ministry of Health.
48 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

During the 1960s and 1970s, China was regarded

as an innovator in the health sector, coupling universal insurance coverage with a delivery system

tailored to local needs (World Bank, 2005c). There

were two major public health insurance plans in

urban areas, the Government Insurance Scheme

(GIS) and the Labor Insurance Scheme (LIS), and one

broad plan in rural areas, the Cooperative Medical

System (CMS).73 The GIS covered employees,

retirees, and their dependents in public sector and

government agencies, as well as disabled veterans

and university teachers and students. The LIS covered employees, retirees, and their dependents in

state-owned and collective-owned enterprises. The

CMS covered rural residents. 

The GIS and the LIS were established in the 1950s

and were centrally managed. Current and retired

employees were offered the option of reimbursement of a portion of their medical expenses or a

lump-sum payment. Since the 1980s, along with

changes toward a market economy, these two urban

health insurance schemes also changed to include

copayments and other associated costs borne by

patients themselves. Health insurance coverage in

urban areas fell; by 1998, about half of urban residents did not have health insurance (World Bank,

2005d).

In contrast to the publicly funded urban health

insurance plans, the CMS was financed by voluntary

contributions from villages. The nationwide rural

health insurance system was developed in the

1970s and contributed to China’s remarkable success in improving overall public health during that

decade. The World Bank has reported that beginning

in the 1980s, when the rural agricultural collectives

system transitioned to a household responsibility

system as part of general economic reform, the

financial base of the CMS weakened and in the early

1990s it collapsed (World Bank, 2004). 

The Chinese government has recognized the unintended effects of its economic and health policies

and in 1996 held the First National Health

Conference to guide development of a health care

system for the twenty-first century (Gao et al.,

2002). Several system changes have since been

introduced, including the Basic Medical Insurance

(BMI) scheme that consists of individual medical

savings accounts and a social pooling account in

urban areas. By the end of 2003, most large cities

had implemented the BMI (World Bank, 2005d). A

New Cooperative Medical Scheme, under which

farmers pay premiums and the government contributes matching funds, began as a pilot project in

2004 and is scheduled to roll out nationally in 2008

(China Daily, 2004; World Bank, 2005d). 

Insured people have a strong sense of entitlement

to medical care, while younger workers, rural-urban

migrants, and workers outside the cities have a different perspective (Bloom et al., 2002). The young

and healthy will likely need to contribute to health

care systems that, at least in the medium term, may

benefit older people disproportionately.

Box 4-2.

China’s Health Insurance Schemes

73 While the term “insurance” is used when speaking of China’s

public health schemes, there were no commercial insurance companies or other insurers. The system was employer funded. The

cost of the GIS was considered to be an operating expense and

included as a budget item; the LIS was financed by a governmentmandated premium equivalent to 7.0 percent of basic wages paid

by the employer and maintained as a separate fund by each enterprise (Hsiao, 1995). For more detailed information about China’s

health insurance types and coverage before and since the health

care reform, see Gao et al., 2001; Liu, 2004; World Bank, 2005a;

and Yip et al., 1998.
There are three main sources of

medical expense coverage—insurance, children/family, and patients

themselves. In 2000, the average

annual medical expense for an

older person in China was 654

yuan. Older people themselves

paid about half (51.4 percent) of

their medical expenses, children or

other family members covered 38

percent, and insurance covered

about 11 percent (Table 4-3). 

Insurance coverage and family support for medical expenses differed

according to urban/rural residence.

For urban older people, insurance

policies covered 30.1 percent of

medical expenses, compared with

about 5 percent for rural older people (Figure 4-7). While the out-ofpocket share was slightly higher for

older people in urban areas, they

received less help from children

and/or others (15.7 percent) than

did their rural counterparts (44.8

percent). The oldest old relied more

on their children or family than did

younger older people.

U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 49

Figure 4-7.

Sources of Medical Expense Payment for 

Population Aged 60 and Over: 2000

Source: Sample Survey on Aged Population in Urban/Rural China, 2000.

Urban

Rural

Insurance

30.1%

Children/family

15.7%

Self

54.2%

Insurance

4.7%

Children/family

44.8% Self

50.5%
Gender differences in sources of

medical expense payments also

were evident. Insurance covered a

higher percentage of older men’s

expenses (13.5 percent) than those

of older women (8.0 percent), and

men were more likely to pay for

their own expenses (58.8 percent

compared with 44.6 percent).

Older women received more help

from their children and/or others

than men did (47.4 percent and

27.6 percent, respectively). The

gender differences result at least in

part from lower health insurance

coverage and social security coverage for older women and also from

lower amounts of savings. Older

urban women typically were

unlikely to work for pay when

younger. In rural areas, traditional

cultural norms—that men be in

charge of outside-of-home activities and women be responsible for

household activities—meant that

older women rarely accumulated

large amounts of economic capital.

Table 4-3 indicates that, for older

people with health problems, most

of their medical expense was paid

by themselves or their children

and/or family. Older people with

health problems (activity limitations, chronic disease, and/or poor

self-assessed health) incurred an

average of 845 yuan in medical

expenses in 2000, compared with

654 yuan for the total older population regardless of health status.

50 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

Table 4-3.

Sources of Medical Expense Payment for Population Aged

60 and Over by Selected Characteristics for China: 2000

(In percent)

Characteristic Insurance Children/family Self

Total. . . . . . . . . . . . . . . . . . . . . . . 10.6 38.0 51.4

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.5 27.6 58.8

Female. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.0 47.4 44.6

Age

60 to 69. . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.7 30.6 59.8

70 to 79. . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.8 43.6 44.6

80 and over . . . . . . . . . . . . . . . . . . . . . . . . 12.4 64.1 23.5

Residence

Urban. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30.1 15.7 54.2

Rural . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.7 44.8 50.5

Chronic Disease

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.3 38.5 49.2

No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.6 37.3 55.1

Activity Limitations

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.0 49.2 40.8

No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.2 27.3 61.5

Self-Assessed Health

Poor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.5 47.7 42.8

Good . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.9 29.8 58.3

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58 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau
U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 59

APPENDIX A.

DETAILED TABLES

Table A-1.

Population Aged 60 and Over by Sex, Residence, and Selected Characteristics for China:

2000

(Numbers in thousands)

Characteristic

Both sexes Male Female

Number Percent Number Percent Number Percent

TOTAL POPULATION . . . . . . . . . . . . . . . . . . . . 118,983 100.0 57,954 100.0 61,030 100.0

Age

60 to 69 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69,847 58.7 35,790 61.8 34,057 55.8

70 to 79 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38,160 32.1 18,001 31.1 20,159 33.0

80 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,977 9.2 4,163 7.2 6,814 11.2

Marital Status

Currently married1 ........................ 78,577 66.0 46,530 80.3 32,046 52.5

Widowed . . . ............................. 37,396 31.4 9,372 16.2 28,024 45.9

Other2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,011 2.5 2,051 3.5 960 1.6

Educational Attainment3

Illiterate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62,001 52.1 18,648 32.2 43,353 71.0

Primary school4 .......................... 40,866 34.3 27,333 47.2 13,533 22.2

Junior high school or above . . . . . . . . . . . . . . . . 16,116 13.5 11,972 20.7 4,144 6.8

Money Income (in Yuan)5, 6

Low . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35,645 30.0 14,035 24.2 21,609 35.4

Medium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48,580 40.8 22,874 39.5 25,705 42.1

High . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34,759 29.2 21,044 36.3 13,715 22.5

Living Arrangement

Living alone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,325 7.8 3,306 5.7 6,019 9.9

Living with spouse only . . . . . . . . . . . . . . . . . . . . 36,676 30.8 21,458 37.0 15,218 24.9

Living with children and/or others7 . . . . . . . . . . 72,982 61.3 33,190 57.3 39,793 65.2

URBAN POPULATION . . . . . . . . . . . . . . . . . . . . 27,643 100.0 13,428 100.0 14,216 100.0

Age

60 to 69 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,990 61.5 8,451 62.9 8,540 60.1

70 to 79 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,353 30.2 4,071 30.3 4,282 30.1

80 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,300 8.3 906 6.8 1,394 9.8

Marital Status

Currently married1 ........................ 20,674 74.8 12,255 91.3 8,418 59.2

Widowed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,498 23.5 966 7.2 5,532 38.9

Other2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 472 1.7 206 1.5 266 1.9

Educational Attainment3

Illiterate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,209 26.1 1,127 8.4 6,082 42.8

Primary school4 . . . . . . . . . . . . . . . . . . . . . . . . . . 9,359 33.9 4,568 34.0 4,791 33.7

Junior high school or above . . . . . . . . . . . . . . . . 11,075 40.1 7,732 57.6 3,343 23.5

Money Income (in Yuan)5, 6

Low . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,193 29.6 1,492 11.1 6,701 47.1

Medium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,897 39.4 5,605 41.7 5,291 37.2

High . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,554 30.9 6,331 47.1 2,223 15.6

Living Arrangement

Living alone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,919 6.9 437 3.3 1,482 10.4

Living with spouse only . . . . . . . . . . . . . . . . . . . . 9,588 34.7 5,767 43.0 3,820 26.9

Living with children and/or others7 . . . . . . . . . . 16,137 58.4 7,223 53.8 8,913 62.7

See footnotes at end of table.
60 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

Table A-1.

Population Aged 60 and Over by Sex, Residence, and Selected Characteristics for China:

2000—Con.

(Numbers in thousands)

Characteristic

Both sexes Male Female

Number Percent Number Percent Number Percent

RURAL POPULATION . . . . . . . . ............ 91,340 100.0 44,526 100.0 46,814 100.0

Age

60 to 69 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52,856 57.9 27,339 61.4 25,517 54.5

70 to 79 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29,808 32.6 13,930 31.3 15,877 33.9

80 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,676 9.5 3,256 7.3 5,420 11.6

Marital Status

Currently married1 . . . . . . . . . . . . . . . . . . . . . . . . 57,903 63.4 34,275 77.0 23,628 50.5

Widowed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30,898 33.8 8,406 18.9 22,492 48.0

Other2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,539 2.8 1,845 4.1 694 1.5

Educational Attainment3

Illiterate . . . ............................... 54,792 60.0 17,521 39.4 37,271 79.6

Primary school4 . . . . . . . . . . . . . . . . . . . . . . . . . . 31,507 34.5 22,765 51.1 8,742 18.7

Junior high school or above . . . . . . . . . . . . . . . . 5,041 5.5 4,240 9.5 801 1.7

Money Income (in Yuan)5, 6

Low . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31,836 34.9 13,519 30.4 18,317 39.1

Medium . . . .............................. 39,198 42.9 18,874 42.4 20,325 43.4

High . . . ................................. 20,306 22.2 12,133 27.3 8,172 17.5

Living Arrangement

Living alone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,406 7.8 2,869 6.4 4,537 9.7

Living with spouse only . . . . . . . . . . . . . . . . . . . . 27,088 30.8 15,690 35.2 11,398 24.3

Living with children and/or others7 . . . . . . . . . . 56,846 61.3 25,966 58.3 30,879 65.9

1 ‘‘Currently married’’ refers to people who were currently married and living with their spouse. 2 ‘‘Other’’ in this table includes people who were divorced, separated, or never married. 3 ‘‘Illiterate’’ refers to people aged 15 and older who are unable to read. Primary school in China is equivalent to elementary school in the United States, and

junior high school is equivalent to middle school or junior high school. 4 ‘‘Primary school’’ includes primary school and old-style private school. 5 ‘‘Money income’’ is monthly income, in Chinese currency yuan. In 2000, the exchange rate between the U.S. dollar and the Chinese yuan was $1 = 8.28

yuan. 6 In this table, for total China, ‘‘Low’’ monthly money income is less than 50 yuan, ‘‘Medium’’ is 50 to 199 yuan, and ‘‘High’’ is 200 yuan or above. For urban

China, ‘‘Low’’ is less than 300 yuan, ‘‘Medium’’ is 300 to 749 yuan, and ‘‘High’’ is 750 yuan or above. For rural China, ‘‘Low’’ is less than 50 yuan, ‘‘Medium’’ is

50 to 149 yuan, and ‘‘High’’ is 150 yuan or above. 7 ‘‘Living with children and/or others’’ may include spouse, children, grandchildren, parents, or any other family or nonfamily members.

Source: Sample Survey on the Aged Population in Urban/Rural China, 2000.
U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 61 Table A-2. Population Aged 60 and Over Wit

h Limitation

s in Activitie

s of Daily Living by Sex, Type of Limitation, Re

sidence, and

Selected C

haracteri

stic

s for C

hina: 2000

(Numbers in thousands)

Characteristic

el a meF el a M sexes ht oB

Any ADL Eating Dressing Toileting

Getting

in/out

of bed Bathing Any ADL Eating Dressing Toileting

Getting

in/out

of bed Bathing Any ADL Eating Dressing Toileting

Getting

in/out

of bed Bathing

TOTAL POPULATION1 ...... 118,626 118,890 118,890 118,894 118,870 118,542 57,775 57,918 57,920 57,922 57,917 57,754 60,851 60,972 60,970 60,972 60,953 60,788

Number

Having ADL Limitation

Total. . . . . . . . . . . . . . . . . 22,361 5,329 5,235 5,869 5,623 19,578 8,654 2,001 1,945 2,310 2,171 7,618 13,707 3,328 3,289 3,559 3,452 11,960

Age60 to 69 . . . . . . . . . . . . . . . . . 6,952 1,894 1,354 1,420 1,540 5,618 2,942 651 563 685 767 2,528 4,010 1,243 791 734 773 3,09070 to 79 . . . . . . . . . . . . . . . . . 9,352 2,087 2,250 2,432 2,380 8,231 3,682 869 796 961 849 3,214 5,670 1,217 1,453 1,471 1,531 5,01780 and over. . . . . . . . . . . . . . . 6,058 1,348 1,631 2,018 1,703 5,728 2,030 481 586 664 555 1,876 4,028 868 1,045 1,354 1,148 3,852

Marital StatusCurrently married2 .......... 10,555 2,813 2,449 2,513 2,473 9,000 5,886 1,500 1,374 1,624 1,492 5,138 4,669 1,313 1,075 889 981 3,861

Other3................... 11,806 2,516 2,786 3,356 3,150 10,579 2,768 501 571 686 679 2,480 9,038 2,015 2,214 2,670 2,471 8,099

Educational Attainment4

Illiterate.................. 15,342 3,738 3,845 3,949 3,747 13,431 4,016 989 947 994 942 3,571 11,326 2,748 2,898 2,955 2,806 9,860Primary school5 ............ 5,496 1,304 1,157 1,557 1,536 4,751 3,461 765 811 1,036 971 2,964 2,034 540 345 521 565 1,787

Junior high school or above . . . 1,524 287 233 363 340 1,396 1,177 247 187 280 259 1,083 347 40 46 83 82 313Money Income (in Yuan)6, 7

Low . . . . . . . . . . . . . . . . . . . . 8,660 2,214 1,800 2,064 2,100 7,538 2,955 821 576 677 675 2,502 5,705 1,393 1,224 1,387 1,425 5,036Medium.................. 9,305 2,126 2,356 2,379 2,115 8,191 3,633 683 855 917 797 3,367 5,672 1,442 1,501 1,463 1,318 4,824High .................... 4,397 989 1,079 1,425 1,408 3,850 2,066 496 514 717 698 1,749 2,331 493 565 709 710 2,100Living ArrangementLiving alone. . . . . . . . . . . . . . . 1,957 426 519 543 510 1,649 531 119 127 164 183 449 1,426 307 391 379 328 1,200Living with spouse only . . . . . . 5,481 1,198 1,341 1,314 1,376 4,717 2,845 631 620 753 751 2,527 2,636 567 720 561 625 2,190Living with children and/or

others8 ................. 14,923 3,705 3,375 4,012 3,736 13,212 5,277 1,251 1,198 1,393 1,237 4,642 9,646 2,454 2,178 2,619 2,499 8,570

PercentHaving ADL Limitation

Total................. 18.9 4.5 4.4 4.9 4.7 16.5 15.0 3.5 3.4 4.0 3.8 13.2 22.5 5.5 5.4 5.8 5.7 19.7

Age60 to 69 . . . . . . . . . . . . . . . . . 10.0 2.7 1.9 2.0 2.2 8.1 8.2 1.8 1.6 1.9 2.1 7.1 11.8 3.7 2.3 2.2 2.3 9.170 to 79 . . . . . . . . . . . . . . . . . 24.6 5.5 5.9 6.4 6.3 21.7 20.5 4.9 4.4 5.4 4.7 17.9 28.2 6.1 7.2 7.3 7.6 25.080 and over............... 55.6 12.4 15.0 18.5 15.6 52.5 49.3 11.7 14.2 16.1 13.5 45.5 59.4 12.8 15.4 20.0 16.9 56.8Marital StatusCurrently married2 . . . . . . . . . . 13.5 3.6 3.1 3.2 3.2 11.5 12.7 3.2 3.0 3.5 3.2 11.1 14.6 4.1 3.4 2.8 3.1 12.1

Other3. . . . . . . . . . . . . . . . . . . 29.4 6.3 6.9 8.3 7.8 26.3 24.4 4.4 5.0 6.0 6.0 21.8 31.3 7.0 7.7 9.2 8.6 28.1

Educational Attainment4

Illiterate. . . . . . . . . . . . . . . . . . 24.8 6.1 6.2 6.4 6.1 21.7 21.6 5.3 5.1 5.4 5.1 19.3 26.2 6.4 6.7 6.8 6.5 22.8Primary school5 . . . . . . . . . . . . 13.5 3.2 2.8 3.8 3.8 11.7 12.7 2.8 3.0 3.8 3.6 10.9 15.1 4.0 2.6 3.9 4.2 13.2

Junior high school or above . . . 9.5 1.8 1.4 2.3 2.1 8.7 9.9 2.1 1.6 2.3 2.2 9.1 8.4 1.0 1.1 2.0 2.0 7.6Money Income (in Yuan)6, 7

Low . . . . . . . . . . . . . . . . . . . . 24.4 6.2 5.1 5.8 5.9 21.3 21.2 5.9 4.1 4.8 4.8 17.9 26.5 6.5 5.7 6.5 6.6 23.4Medium. . . . . . . . . . . . . . . . . . 19.2 4.4 4.9 4.9 4.4 16.9 15.9 3.0 3.8 4.0 3.5 14.8 22.1 5.6 5.8 5.7 5.1 18.8High . . . . . . . . . . . . . . . . . . . . 12.7 2.8 3.1 4.1 4.1 11.1 9.8 2.4 2.4 3.4 3.3 8.3 17.0 3.6 4.1 5.2 5.2 15.3Living Arrangement

Living alone. . . . . . . . . . . . . . . 21.1 4.6 5.6 5.8 5.5 17.7 16.1 3.6 3.9 5.0 5.6 13.6 23.8 5.1 6.5 6.3 5.5 20.0Living with spouse only . . . . . . 15.0 3.3 3.7 3.6 3.8 12.9 13.3 2.9 2.9 3.5 3.5 11.8 17.4 3.7 4.7 3.7 4.1 14.4Living with children and /or

others8 . . . . . . . . . . . . . . . . . 20.5 5.1 4.6 5.5 5.1 18.2 16.0 3.8 3.6 4.2 3.7 14.0 24.3 6.2 5.5 6.6 6.3 21.6

See footnotes at end of table.
62 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau Table A-2. Population Aged 60 and Over Wit

h Limitation

s in Activitie

s of Daily Living by Sex, Type of Limitation, Re

sidence, and

Selected C

haracteri

stic

s for C

hina: 2000—Con.

(Numbers in thousands)

Characteristic

el a meF el a M sexes ht oB

Any ADL Eating Dressing Toileting

Getting

in/out

of bed Bathing Any ADL Eating Dressing Toileting

Getting

in/out

of bed Bathing Any ADL Eating Dressing Toileting

Getting

in/out

of bed Bathing

URBAN POPULATION1...... 27,565 27,609 27,607 27,607 27,599 27,573 13,414 13,425 13,424 13,424 13,420 13,414 14,151 14,184 14,183 14,183 14,179 14,159

Number

Having ADL Limitation

Total. . . . . . . . . . . . . . . . . 3,959 702 839 1,176 1,203 3,592 1,439 259 351 455 441 1,335 2,520 443 488 720 762 2,256

Age60 to 69 . . . . . . . . . . . . . . . . . 1,228 230 248 370 500 1,088 460 96 115 141 160 437 768 134 132 229 340 65170 to 79 . . . . . . . . . . . . . . . . . 1,576 248 318 438 399 1,424 615 118 161 219 177 542 961 130 157 219 221 88280 and over............... 1,155 224 273 367 304 1,080 364 45 75 95 103 357 791 179 198 273 201 723Marital StatusCurrently married2 . . . . . . . . . . 2,113 404 486 603 757 1,888 1,167 210 311 364 353 1,089 946 194 174 239 404 799

Other3................... 1,846 298 354 573 446 1,703 272 49 40 91 88 246 1,573 249 314 481 358 1,457

Educational Attainment4

Illiterate.................. 1,786 308 381 545 463 1,587 253 53 55 84 83 221 1,532 256 326 461 379 1,366

Primary school5 ............ 1,227 268 292 363 504 1,108 499 120 176 187 201 443 728 148 116 177 302 665

Junior high school or above . . . 946 126 166 268 237 897 687 87 120 185 156 672 259 40 46 83 81 225Money Income (in Yuan)6, 7

Low . . . . . . . . . . . . . . . . . . . . 1,760 214 324 473 583 1,623 223 35 58 52 94 212 1,537 179 265 420 489 1,411Medium.................. 1,445 306 328 478 437 1,321 691 128 155 233 214 630 754 178 173 245 223 692High . . . . . . . . . . . . . . . . . . . . 754 182 188 225 183 647 525 96 138 170 132 493 229 86 50 55 50 154Living ArrangementLiving alone. . . . . . . . . . . . . . . 417 75 56 114 76 362 79 24 10 29 11 67 338 51 46 85 64 295Living with spouse only . . . . . . 1,206 185 250 296 450 1,101 682 128 175 189 191 643 524 57 76 107 259 458Living with children and/or

others8 ................. 2,336 442 533 766 678 2,129 679 108 167 237 239 625 1,657 335 366 529 439 1,504

PercentHaving ADL Limitation

Total................. 14.4 2.5 3.0 4.3 4.4 13.0 10.7 1.9 2.6 3.4 3.3 10.0 17.8 3.1 3.4 5.1 5.4 15.9

Age60 to 69 . . . . . . . . . . . . . . . . . 7.2 1.4 1.5 2.2 2.9 6.4 5.4 1.1 1.4 1.7 1.9 5.2 9.0 1.6 1.6 2.7 4.0 7.670 to 79 . . . . . . . . . . . . . . . . . 19.0 3.0 3.8 5.3 4.8 17.2 15.2 2.9 4.0 5.4 4.4 13.3 22.6 3.1 3.7 5.2 5.2 20.880 and over............... 50.3 9.8 11.9 16.0 13.2 47.0 40.1 5.0 8.2 10.5 11.4 39.4 56.8 12.9 14.3 19.6 14.4 51.9Marital StatusCurrently married2 . . . . . . . . . . 10.2 2.0 2.4 2.9 3.7 9.2 9.5 1.7 2.5 3.0 2.9 8.9 11.3 2.3 2.1 2.9 4.8 9.5

Other3. . . . . . . . . . . . . . . . . . . 26.6 4.3 5.1 8.2 6.4 24.5 23.3 4.2 3.4 7.8 7.5 21.0 27.3 4.3 5.4 8.3 6.2 25.2

Educational Attainment4

Illiterate. . . . . . . . . . . . . . . . . . 24.9 4.3 5.3 7.6 6.5 22.1 22.5 4.7 4.9 7.4 7.4 19.6 25.4 4.2 5.4 7.6 6.3 22.6Primary school5 . . . . . . . . . . . . 13.1 2.9 3.1 3.9 5.4 11.9 10.9 2.6 3.9 4.1 4.4 9.7 15.2 3.1 2.4 3.7 6.3 13.9

Junior high school or above . . . 8.6 1.1 1.5 2.4 2.1 8.1 8.9 1.1 1.6 2.4 2.0 8.7 7.8 1.2 1.4 2.5 2.4 6.8Money Income (in Yuan)6, 7

Low . . . . . . . . . . . . . . . . . . . . 21.5 2.6 4.0 5.8 7.1 19.8 14.9 2.3 3.9 3.5 6.3 14.2 22.9 2.7 4.0 6.3 7.3 21.1Medium. . . . . . . . . . . . . . . . . . 13.3 2.8 3.0 4.4 4.0 12.1 12.3 2.3 2.8 4.2 3.8 11.2 14.2 3.4 3.3 4.6 4.2 13.1High . . . . . . . . . . . . . . . . . . . . 8.8 2.1 2.2 2.6 2.1 7.6 8.3 1.5 2.2 2.7 2.1 7.8 10.3 3.9 2.2 2.5 2.3 6.9Living Arrangement

Living alone. . . . . . . . . . . . . . . 21.8 3.9 2.9 5.9 3.9 18.9 18.1 5.4 2.3 6.7 2.6 15.4 22.8 3.5 3.1 5.7 4.3 19.9Living with spouse only . . . . . . 12.6 1.9 2.6 3.1 4.7 11.5 11.8 2.2 3.0 3.3 3.3 11.2 13.8 1.5 2.0 2.8 6.8 12.0Living with children and/or

others8 . . . . . . . . . . . . . . . . . 14.5 2.7 3.3 4.8 4.2 13.2 9.4 1.5 2.3 3.3 3.3 8.7 18.7 3.8 4.1 6.0 5.0 17.0

See footnotes at end of table.
U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 63 Table A-2. Population Aged 60 and Over Wit

h Limitation

s in Activitie

s of Daily Living by Sex, Type of Limitation, Re

sidence, and

Selected C

haracteri

stic

s for C

hina: 2000—Con.

(Numbers in thousands)

Characteristic

el a meF el a M sexes ht oB

Any ADL Eating Dressing Toileting

Getting

in/out

of bed Bathing Any ADL Eating Dressing Toileting

Getting

in/out

of bed Bathing Any ADL Eating Dressing Toileting

Getting

in/out

of bed Bathing

RURAL POPULATION1 ...... 91,061 91,282 91,284 91,287 91,270 90,969 44,360 44,493 44,496 44,498 44,496 44,341 46,701 46,789 46,788 46,789 46,774 46,628

Number

Having ADL Limitation

Total. . . . . . . . . . . . . . . . . 18,402 4,627 4,395 4,693 4,420 15,987 7,215 1,742 1,594 1,855 1,730 6,283 11,188 2,885 2,802 2,839 2,690 9,703

Age60 to 69 . . . . . . . . . . . . . . . . . 5,724 1,664 1,106 1,049 1,040 4,531 2,482 555 447 544 606 2,092 3,242 1,110 659 505 434 2,43970 to 79 . . . . . . . . . . . . . . . . . 7,776 1,839 1,931 1,994 1,981 6,807 3,066 752 635 741 672 2,672 4,709 1,087 1,296 1,252 1,309 4,13580 and over. . . . . . . . . . . . . . . 4,903 1,124 1,358 1,650 1,399 4,649 1,666 436 511 569 452 1,519 3,236 688 847 1,081 947 3,129

Marital StatusCurrently married2 .......... 8,442 2,409 1,963 1,910 1,716 7,111 4,719 1,290 1,062 1,260 1,139 4,049 3,723 1,119 901 650 577 3,062

Other3................... 9,960 2,218 2,432 2,783 2,704 8,875 2,495 452 532 594 591 2,234 7,465 1,766 1,900 2,189 2,113 6,641

Educational Attainment4

Illiterate.................. 13,556 3,430 3,464 3,404 3,284 11,844 3,762 937 891 910 858 3,351 9,793 2,493 2,572 2,494 2,426 8,493Primary school5 ............ 4,268 1,037 865 1,194 1,032 3,643 2,962 645 636 850 769 2,521 1,306 392 229 344 263 1,122

Junior high school or above . . . 579 161 67 95 104 500 490 161 67 95 103 412 88 – – 1 1 88

Money Income (in Yuan)Low . . . . . . . . . . . . . . . . . . . . 7,830 2,123 1,646 1,853 1,881 6,748 2,851 808 560 667 647 2,402 4,979 1,314 1,087 1,186 1,234 4,346Medium.................. 7,689 1,628 1,711 1,620 1,502 6,759 3,029 560 634 699 590 2,822 4,659 1,068 1,077 921 912 3,938High .................... 2,883 877 1,038 1,220 1,037 2,479 1,334 373 400 488 494 1,060 1,549 503 638 732 544 1,419

Living ArrangementLiving alone. . . . . . . . . . . . . . . 1,540 351 463 429 435 1,287 452 96 117 135 172 382 1,087 255 345 294 263 905Living with spouse only . . . . . . 4,275 1,013 1,090 1,018 927 3,616 2,164 503 446 564 560 1,884 2,112 510 645 454 367 1,732Living with children and/or

others8 ................. 12,587 3,263 2,842 3,246 3,059 11,083 4,599 1,143 1,031 1,156 998 4,018 7,989 2,120 1,811 2,090 2,060 7,066

PercentHaving ADL Limitation

Total................. 20.2 5.1 4.8 5.2 4.9 17.6 16.3 3.9 3.6 4.2 3.9 14.2 24.0 6.2 6.0 6.1 5.8 20.8

Age60 to 69 . . . . . . . . . . . . . . . . . 10.9 3.2 2.1 2.0 2.0 8.6 9.1 2.0 1.6 2.0 2.2 7.7 12.7 4.4 2.6 2.0 1.7 9.670 to 79 . . . . . . . . . . . . . . . . . 26.2 6.2 6.5 6.7 6.7 22.9 22.1 5.4 4.6 5.3 4.8 19.3 29.7 6.9 8.2 7.9 8.3 26.180 and over............... 57.0 13.1 15.8 19.2 16.3 54.0 51.9 13.6 15.9 17.7 14.1 47.3 60.1 12.8 15.7 20.1 17.6 58.1Marital StatusCurrently married2 . . . . . . . . . . 14.6 4.2 3.4 3.3 3.0 12.3 13.8 3.8 3.1 3.7 3.3 11.8 15.8 4.7 3.8 2.8 2.4 13.0

Other3. . . . . . . . . . . . . . . . . . . 29.9 6.7 7.3 8.4 8.1 26.7 24.5 4.4 5.2 5.8 5.8 21.9 32.3 7.6 8.2 9.5 9.2 28.8

Educational Attainment4

Illiterate. . . . . . . . . . . . . . . . . . 24.8 6.3 6.3 6.2 6.0 21.7 21.6 5.4 5.1 5.2 4.9 19.2 26.3 6.7 6.9 6.7 6.5 22.8Primary school5 . . . . . . . . . . . . 13.6 3.3 2.8 3.8 3.3 11.6 13.0 2.8 2.8 3.7 3.4 11.1 15.0 4.5 2.6 3.9 3.0 12.9

Junior high school or above . . . 11.5 3.2 1.3 1.9 2.1 9.9 11.6 3.8 1.6 2.2 2.4 9.7 11.0 – – 0.1 0.1 11.0Money Income (in Yuan)6, 7

Low . . . . . . . . . . . . . . . . . . . . 24.6 6.7 5.2 5.8 5.9 21.2 21.1 6.0 4.1 4.9 4.8 17.8 27.2 7.2 5.9 6.5 6.7 23.7Medium. . . . . . . . . . . . . . . . . . 19.6 4.2 4.4 4.1 3.8 17.2 16.1 3.0 3.4 3.7 3.1 14.9 22.9 5.3 5.3 4.5 4.5 19.4High . . . . . . . . . . . . . . . . . . . . 14.2 4.3 5.1 6.0 5.1 12.2 11.0 3.1 3.3 4.0 4.1 8.7 19.0 6.2 7.8 9.0 6.7 17.4Living Arrangement

Living alone. . . . . . . . . . . . . . . 20.9 4.8 6.3 5.8 5.9 17.4 15.9 3.4 4.1 4.7 6.0 13.4 24.0 5.6 7.6 6.5 5.8 20.0Living with spouse only . . . . . . 15.8 3.7 4.0 3.8 3.4 13.4 13.8 3.2 2.8 3.6 3.6 12.0 18.5 4.5 5.7 4.0 3.2 15.2Living with children and/or

others8 . . . . . . . . . . . . . . . . . 22.2 5.8 5.0 5.7 5.4 19.6 17.8 4.4 4.0 4.5 3.9 15.5 25.9 6.9 5.9 6.8 6.7 22.9

See footnotes on next page.
6

4 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

– Represents or rounds to zero.

1 Population refers to the number of people who reported a valid answer to the question on ADL limitations. 2 ‘‘Currently married’’ refers to people who were currently married and living with their spouse. 3 ‘‘Other’’ includes people who were widowed, divorced, separated, or never married. 4 ‘‘Illiterate’’ refers to people aged 15 and older who are unable to read. Primary school in China is equivalent to elementary school in the United States, and junior high school is equivalent to middle school or junior high school. 5 ‘‘Primary school’’ includes ‘‘primary school’’ and ‘‘old-style private school.’’ 6 ‘‘Money Income’’ is monthly income in Chinese yuan. In 2000, the exchange rate between the U.S. dollar and the Chinese yuan was $1 = 8.28 yuan. 7 In this tabe, for total China, ‘‘Low’’ monthly money income is less than 50 yuan, ‘‘Medium’’ is 50 to 199 yuan, and ‘‘High’’ is 200 yuan or above. For urban China, ‘‘Low’’ is less than 300 yuan, ‘‘Medium’’ is 300 to 749 yuan, and ‘‘High’’ is 750

yuan or above. For rural China, ‘‘Low’’ is less than 50 yuan, ‘‘Medium’’ is 50 to 149 yuan, and ‘‘High’’ is 150 yuan or above. 8 ‘‘Living with children and/or others’’ may include spouse, children, grandchildren, parents, or any other family or nonfamily members.

Source: Sample Survey on the Aged Population in Urban/Rural China, 2000.
U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 65 Table A-3. Population Aged 60 and Over Sati

sfied Wit

h Life by Sex, Age, Re

sidence, and Selected C

haracteri

stic

s for C

hina: 2000

(Numbers in thousands)

Characteristic

el a meF el a M sexes ht oB

60 and

over 60 to 69 70 to 79

80 and

over

60 and

over 60 to 69 70 to 79

80 and

over

60 and

over 60 to 69 70 to 79

80 and

over

TOTAL POPULATION1 .............. 118,514 69,663 38,030 10,821 57,809 35,760 17,970 4,079 60,705 33,903 20,060 6,742

Number

Satisfied With Life

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . 74,545 44,728 23,495 6,323 37,178 23,247 11,524 2,406 37,368 21,480 11,971 3,917

Marital StatusCurrently married2 .................. 50,930 35,241 14,135 1,554 30,496 20,440 8,920 1,136 20,434 14,801 5,214 419

Other3 ............................. 23,616 9,487 9,361 4,768 6,682 2,807 2,604 1,271 16,934 6,680 6,757 3,498

Educational Attainment4

Illiterate . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36,535 18,461 13,752 4,323 11,187 5,728 4,470 989 25,349 12,733 9,282 3,334Primary school5 .................... 25,997 17,367 6,984 1,646 17,159 11,252 4,780 1,126 8,838 6,115 2,203 520

Junior high school or above .......... 12,013 8,900 2,760 354 8,832 6,267 2,274 291 3,181 2,633 486 63

Money Income (in Yuan)6, 7

Low . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19,257 10,338 6,505 2,414 7,583 4,235 2,659 688 11,674 6,103 3,845 1,725Medium . . . ........................ 30,030 18,159 9,558 2,313 14,156 8,861 4,464 831 15,874 9,297 5,094 1,482

High . . . . . . ........................ 25,258 16,231 7,432 1,596 15,439 10,151 4,401 886 9,820 6,079 3,031 709

Living ArrangementLiving alone . . . . . . . . . . . . . . . . . . . . . . . . 4,554 1,766 1,972 816 1,406 795 497 115 3,148 971 1,475 702Living with spouse only . . . . . . . . . . . . . . 23,756 14,895 8,059 802 14,165 8,420 5,099 646 9,590 6,475 2,960 156

Living with children and/or others8 . . . . 46,235 28,067 13,464 4,705 21,606 14,033 5,928 1,645 24,629 14,034 7,536 3,060

Percent

Satisfied With Life

Total . . . . . . . . . . . . . . . . . . . . . . . . . . 62.9 64.2 61.8 58.4 64.3 65.0 64.1 59.0 61.6 63.4 59.7 58.1

Marital StatusCurrently married2 .................. 65.0 65.7 64.2 58.6 65.6 66.1 65.6 58.5 64.1 65.1 61.9 58.6

Other3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58.8 59.3 58.5 58.4 58.9 58.1 59.5 59.4 58.7 59.8 58.1 58.0

Educational Attainment4

Illiterate . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59.2 61.2 57.4 56.5 60.3 62.2 58.5 58.2 58.7 60.8 56.9 56.0Primary school5 ..................... 64.0 63.2 66.3 62.4 62.9 62.7 64.9 57.2 66.1 64.2 69.6 77.6

Junior high school or above . . . . . . . . . . 74.5 74.0 77.7 66.3 73.8 72.9 76.8 70.9 76.8 76.7 82.4 50.9

Money Income (in Yuan)6, 7

Low . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54.3 54.9 51.7 59.5 54.5 54.1 55.0 54.6 54.2 55.4 49.7 61.7Medium . . . . . . . . . . . . . . . . . . . . . . . . . . . 62.0 64.2 61.3 51.4 61.9 63.4 61.5 50.5 62.2 64.9 61.0 52.0High . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72.9 72.0 75.4 70.4 73.5 72.7 74.9 75.7 72.0 71.0 76.2 64.7

Living ArrangementLiving alone . . . . . . . . . . . . . . . . . . . . . . . . 49.2 48.8 49.1 50.5 43.5 47.3 40.6 34.8 52.4 50.1 52.9 54.6Living with spouse only . ............. 64.9 64.9 66.1 55.6 66.1 65.8 67.5 60.0 63.3 63.8 63.7 42.6Living with children and/or others8 . . . . 63.6 65.1 61.7 60.6 65.2 65.9 64.5 61.5 62.3 64.3 59.7 60.1

See footnotes at end of table.
66 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau Table A-3. Population Aged 60 and Over Sati

sfied Wit

h Life by Sex, Age, Re

sidence, and Selected C

haracteri

stic

s for C

hina:

2000—Con.

(Numbers in thousands)

Characteristic

el a meF el a M sexes ht oB

60 and

over 60 to 69 70 to 79

80 and

over

60 and

over 60 to 69 70 to 79

80 and

over

60 and

over 60 to 69 70 to 79

80 and

over

URBAN POPULATION1 . . . . . . . . . . . . . 27,579 16,983 8,319 2,277 13,396 8,446 4,057 893 14,183 8,537 4,262 1,384

Number

Satisfied With Life

Total . . . ........................ 19,524 12,087 5,893 1,544 9,752 6,134 3,035 583 9,772 5,953 2,858 961

Marital StatusCurrently married2 .................. 15,129 10,437 4,171 521 9,026 5,901 2,726 399 6,103 4,536 1,444 122

Other3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,395 1,650 1,723 1,023 726 233 309 184 3,670 1,417 1,414 839

Educational Attainment4

Illiterate . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,650 1,937 1,866 848 684 256 311 118 3,966 1,681 1,555 730Primary school5 ..................... 6,143 3,666 2,057 420 2,945 1,507 1,200 237 3,198 2,159 857 183

Junior high school or above . . . . . . . . . . 8,731 6,484 1,970 276 6,123 4,371 1,524 228 2,608 2,114 446 48Money Income (in Yuan)6, 7

Low . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,978 2,664 1,588 726 805 378 314 114 4,172 2,286 1,274 613Medium . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,425 4,731 2,241 454 3,627 2,311 1,090 226 3,798 2,420 1,151 228

High . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,121 4,692 2,065 364 5,320 3,445 1,631 243 1,802 1,247 434 120

Living ArrangementLiving alone . . . . . . . . . . . . . . . . . . . . . . . . 1,106 383 515 208 245 91 108 47 860 292 407 161Living with spouse only . . . . . . . . . . . . . . 6,919 4,030 2,566 323 4,245 2,299 1,689 257 2,674 1,731 877 66

Living with children and/or others8 .... 11,500 7,674 2,812 1,013 5,262 3,744 1,238 280 6,238 3,930 1,574 733

Percent

Satisfied With Life

Total . . . . . . . . . . . . . . . . . . . . . . . . . . 70.8 71.2 70.8 67.8 72.8 72.6 74.8 65.3 68.9 69.7 67.1 69.4

Marital StatusCurrently married2 .................. 73.3 72.6 76.1 67.2 73.8 73.3 76.7 63.6 72.7 71.7 75.0 82.3

Other3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63.3 63.2 60.7 68.2 62.3 58.6 61.3 69.4 63.5 64.1 60.5 67.9

Educational Attainment4

Illiterate . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64.8 66.6 61.0 70.2 61.6 62.6 61.0 60.8 65.4 67.3 61.0 72.0Primary school5 .................... 65.8 62.8 72.3 64.3 64.7 60.1 72.1 62.3 66.9 64.9 72.5 67.0

Junior high school or above . . . . . . . . . . 78.8 78.7 81.5 66.5 79.2 79.1 80.9 71.7 78.0 77.9 83.9 49.6Money Income (in Yuan)6, 7

Low . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61.0 62.6 56.8 65.5 54.3 52.3 58.4 51.0 62.5 64.7 56.4 69.2Medium . . . . . . . . . . . . . . . . . . . . . . . . . . . 68.3 66.7 72.4 65.5 64.9 64.2 67.1 61.7 71.8 69.4 78.2 69.7High . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83.4 83.2 85.0 76.6 84.1 83.5 86.0 80.1 81.3 82.4 81.5 70.2

Living ArrangmentLiving alone . . . . . . . . . . . . . . . . . . . . . . . . 57.7 61.9 53.2 63.0 56.6 59.0 52.2 (B) 58.1 62.9 53.5 62.7Living with spouse only . ............. 72.4 67.9 80.7 72.1 73.8 70.4 79.7 69.7 70.3 64.9 82.7 83.2Living with children and/or others8 . . . . 71.4 73.6 67.4 67.6 73.0 74.5 71.5 62.0 70.1 72.7 64.5 70.1

See footnotes at end of table.
U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 67 Table A-3. Population Aged 60 and Over Sati

sfied Wit

h Life by Sex, Age, Re

sidence, and Selected C

haracteri

stic

s for C

hina:

2000—Con.

(Numbers in thousands)

Characteristic

el a meF el a M sexes ht oB

60 and

over 60 to 69 70 to 79

80 and

over

60 and

over 60 to 69 70 to 79

80 and

over

60 and

over 60 to 69 70 to 79

80 and

over

RURAL POPULATION1 ............. 90,938 52,681 29,712 8,545 44,415 27,315 13,913 3,187 46,523 25,366 15,799 5,358

Number

Satisfied With Life

Total . . . ........................ 55,021 32,641 17,602 4,779 27,426 17,114 8,489 1,823 27,595 15,527 9,112 2,956

Marital StatusCurrently married2 .................. 35,801 24,804 9,964 1,034 21,470 14,539 6,194 737 14,331 10,264 3,770 297

Other3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19,220 7,837 7,638 3,745 5,956 2,574 2,295 1,086 13,264 5,263 5,343 2,659

Educational Attainment4

Illiterate . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31,885 16,524 11,886 3,475 10,502 5,472 4,159 871 21,383 11,052 7,726 2,604Primary school5 .................... 19,854 13,701 4,927 1,226 14,214 9,745 3,580 889 5,640 3,956 1,347 337

Junior high school or above .......... 3,283 2,415 789 78 2,710 1,896 750 64 573 519 39 15Money Income (in Yuan)6, 7

Low . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,052 9,150 5,804 2,097 7,326 4,103 2,585 638 9,726 5,047 3,220 1,459Medium . . . . . . . . . . . . . . . . . . . . . . . . . . . 23,700 14,333 7,678 1,689 11,508 7,225 3,720 563 12,193 7,108 3,958 1,126

High . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,269 9,158 4,119 993 8,592 5,786 2,184 622 5,677 3,372 1,934 371Living ArrangementLiving alone . . . . . . . . . . . . . . . . . . . . . . . . 3,449 1,383 1,457 609 1,161 704 389 68 2,288 679 1,068 540Living with spouse only . . . . . . . . . . . . . . 16,837 10,865 5,493 479 9,921 6,121 3,410 390 6,916 4,744 2,083 90Living with children and/or others8 . . . . 34,735 20,393 10,652 3,691 16,344 10,289 4,690 1,365 18,391 10,103 5,962 2,326

Percent

Satisfied With Life

Total . . . . . . . . . . . . . . . . . . . . . . . . . . 60.5 62.0 59.2 55.9 61.8 62.7 61.0 57.2 59.3 61.2 57.7 55.2

Marital StatusCurrently married2 .................. 62.1 63.1 60.3 55.0 62.7 63.5 61.7 56.1 61.1 62.6 58.0 52.4

Other3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57.8 58.5 58.0 56.2 58.5 58.1 59.2 58.0 57.5 58.7 57.5 55.5

Educational Attainment4

Illiterate . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58.4 60.6 56.9 54.0 60.2 62.1 58.3 57.8 57.6 59.9 56.2 52.8Primary school5 .................... 63.4 63.3 64.1 61.8 62.5 63.1 62.8 56.0 65.7 63.7 67.9 84.9

Junior high school or above . . . . . . . . . . 65.1 63.8 69.6 65.4 63.9 61.7 69.7 68.1 71.5 72.4 (B) (B)Money Income (in Yuan)6, 7

Low . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53.8 54.2 51.7 58.8 54.6 54.1 55.6 54.1 53.2 54.3 48.9 61.1Medium . . . . . . . . . . . . . . . . . . . . . . . . . . . 60.5 62.8 60.4 46.7 61.0 62.9 60.6 45.4 60.1 62.7 60.2 47.4High . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71.0 70.6 71.4 72.9 70.8 70.2 70.0 80.9 71.3 71.4 73.1 62.4

Living ArrangementLiving alone . . . . . . . . . . . . . . . . . . . . . . . . 47.0 46.1 47.8 47.3 41.4 46.1 38.2 26.5 50.5 46.0 52.7 52.6Living with spouse only . ............. 62.3 63.9 60.9 48.2 63.3 64.2 62.8 55.0 60.9 63.4 58.0 31.3Living with children and/or others8 . . . . 61.4 62.4 60.4 58.9 63.0 63.3 62.9 61.5 60.0 61.6 58.5 57.5

See footnotes on next page.
6

8 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau

(B) Derived measure not shown where base is less than 75,000.1 Population refers to the number of people who reported a valid answer to the question on whether satisfied with life. 2 ‘‘Currently married’’ refers to people who were currently married and living with their spouse. 3 ‘‘Other’’ includes people who were widowed, divorced, separated, or never married. 4 ‘‘Illiterate’’ refers to people aged 15 and older who are unable to read. Primary school in China is equivalent to elementary school in the United States, and junior high school is equivalent to middle school or

junior high school. 5 ‘‘Primary school’’ includes ‘‘primary school’’ and ‘‘old-style private school.’’ 6 ‘‘Money Income’’ is monthly income in Chinese yuan. In 2000, the exchange rate between the U.S. dollar and the Chinese yuan was $1 = 8.28 yuan. 7 In this table, for total China, ‘‘Low’’ monthly money income is less than 50 yuan, ‘‘Medium’’ is 50 to 199 yuan, and ‘‘High’’ is 200 yuan or above. For urban China, ‘‘Low’’ is less than 300 yuan, ‘‘Medium’’ is 300

to 749 yuan, and ‘‘High’’ is 750 yuan or above. For rural China, ‘‘Low’’ is less than 50 yuan, ‘‘Medium’’ is 50 to 149 yuan, and ‘‘High’’ is 150 yuan or above. 8 ‘‘Living with children and/or others’’ may include spouse, children, grandchildren, parents, or any other family or nonfamily members.

Source: Sample Survey on the Aged Population in Urban/Rural China, 2000.
U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 69 Table A-4. Average Number of Vi

sit

s to Doctor’s Office in La

st Year Among Population Aged 60 and Over by Sex, Age,

Re

sidence, and Selected C

haracteri

stic

s for C

hina: 2000

Characteristic

el a meF el a M sexes ht oB

60 and

over 60 to 69 70 to 79

80 and

over

60 and

over 60 to 69 70 to 79

80 and

over

60 and

over 60 to 69 70 to 79

80 and

over

TOTAL POPULATION1 (in thousands) ........ 117,338 68,952 37,607 10,780 57,231 35,348 17,821 4,062 60,108 33,604 19,785 6,718

Doctor’s Office Visits

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1 5.1 5.3 4.3 4.9 4.7 5.4 4.5 5.3 5.5 5.3 4.2

Marital StatusCurrently married2 . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.0 4.8 5.6 4.7 5.1 4.8 5.6 5.1 4.9 4.7 5.6 3.7

Other3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.2 6.0 5.0 4.2 4.1 3.8 4.6 4.0 5.7 7.0 5.1 4.3

Educational Attainment4

Illiterate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.9 5.0 4.9 4.3 4.0 3.8 4.2 4.2 5.3 5.5 5.3 4.3Primary school5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.7 4.6 5.1 4.1 4.7 4.4 5.5 4.7 4.6 4.9 4.3 2.2

Junior high school or above . . . . . . . . . . . . . . . . . . . 7.0 6.4 8.9 6.1 6.7 6.2 8.2 5.2 7.8 6.9 12.3 9.5Money Income (in Yuan)6, 7

Low . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.9 3.8 4.3 3.5 3.7 3.4 4.2 3.2 4.1 4.0 4.3 3.7Medium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.8 4.8 5.0 4.2 4.0 3.8 4.2 4.6 5.5 5.7 5.6 4.0High . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.7 6.5 7.3 6.0 6.6 6.2 7.8 5.9 6.8 6.9 6.6 6.1Living ArrangementLiving alone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.5 5.5 5.8 4.7 4.1 4.3 4.1 3.1 6.3 6.5 6.6 5.2Living with spouse only . . . . . . . . . . . . . . . . . . . . . . . 5.4 5.2 5.7 5.7 5.4 5.1 5.8 6.6 5.3 5.3 5.6 3.3

Living with children and/or others8 . . . . . . . . . . . . . 4.9 5.0 5.1 4.0 4.6 4.5 5.2 3.9 5.1 5.5 5.0 4.0

URBAN POPULATION1 (in thousands) . . . . . . . 26,950 16,638 8,138 2,174 13,135 8,300 4,001 834 13,815 8,338 4,187 1,340

Doctor’s Office Visits

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3 7.3 7.9 4.5 7.5 7.2 8.6 5.9 7.0 7.4 7.2 3.7

Marital StatusCurrently married2 . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.6 7.3 8.7 5.8 7.8 7.3 9.1 6.5 7.4 7.3 7.9 3.1

Other3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.2 7.2 6.4 3.9 4.9 4.6 5.3 4.4 6.4 7.6 6.6 3.8

Educational Attainment4

Illiterate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.0 6.9 6.3 3.3 5.1 4.6 5.9 3.9 6.2 7.2 6.3 3.2Primary school5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3 7.2 8.0 5.5 7.7 6.9 9.0 7.1 6.9 7.3 6.5 3.3

Junior high school or above . . . . . . . . . . . . . . . . . . . 8.0 7.5 9.8 6.9 7.8 7.5 9.0 5.8 8.6 7.7 12.9 10.2

Money Income (in Yuan)6, 7

Low . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.7 6.1 6.2 2.8 4.9 4.4 6.0 4.0 5.8 6.4 6.2 2.6Medium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.8 7.0 6.6 5.4 6.0 6.2 5.5 6.0 7.6 7.8 7.9 4.6High . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.3 8.6 11.4 7.1 9.5 8.5 12.0 6.9 8.9 8.9 9.4 7.5Living ArrangementLiving alone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.1 5.9 6.8 4.1 4.7 4.5 5.1 3.7 6.5 6.3 7.3 4.3Living with spouse only . . . . . . . . . . . . . . . . . . . . . . . 8.2 7.7 9.3 7.8 8.3 7.4 9.6 9.4 8.1 8.1 8.7 1.8Living with children and/or others8 . . . . . . . . . . . . . 6.8 7.2 7.1 3.7 7.1 7.1 7.8 3.6 6.6 7.2 6.5 3.7

See footnotes at end of table.
70 Health and Health Care of the Older Population in Urban and Rural China: 2000 U.S. Census Bureau Table A-4. Average Number of Vi

sit

s to Doctor’s Office in La

st Year Among Population Aged 60 and Over by Sex, Age,

Re

sidence, and Selected C

haracteri

stic

s for C

hina: 2000—Con.

Characteristic

el a meF el a M sexes ht oB

60 and

over 60 to 69 70 to 79

80 and

over

60 and

over 60 to 69 70 to 79

80 and

over

60 and

over 60 to 69 70 to 79

80 and

over

RURAL POPULATION1 (in thousands) . . . . . . . . 90,389 52,314 29,469 8,606 44,096 27,049 13,820 3,227 46,292 25,266 15,648 5,378

Doctor’s Office Visits

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.4 4.4 4.6 4.3 4.1 3.9 4.4 4.2 4.8 4.9 4.8 4.3

Marital StatusCurrently married2 . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.1 3.9 4.6 4.3 4.1 4.0 4.4 4.5 4.1 3.8 4.9 3.8

Other3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.0 5.8 4.7 4.3 4.0 3.7 4.5 4.0 5.5 6.9 4.8 4.4

Educational Attainment4

Illiterate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.7 4.8 4.7 4.5 3.9 3.8 4.0 4.2 5.1 5.3 5.1 4.5Primary school5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.9 3.9 4.1 3.6 4.1 4.0 4.4 4.2 3.4 3.7 3.0 1.5

Junior high school or above . . . . . . . . . . . . . . . . . . . 4.7 4.1 7.0 4.4 4.8 4.0 7.0 3.7 4.4 4.1 (B) (B)Money Income (in Yuan)6, 7

Low . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.8 3.6 4.1 3.6 3.7 3.4 4.3 3.2 3.9 3.9 3.9 3.9Medium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.7 4.8 4.7 3.9 3.9 3.8 4.1 3.5 5.4 5.7 5.3 4.1High . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.0 4.6 5.6 6.9 4.9 4.5 5.3 6.8 5.3 4.7 6.0 7.1Living ArrangementLiving alone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.3 5.4 5.5 4.9 4.0 4.3 3.8 3.0 6.2 6.6 6.3 5.4Living with spouse only . . . . . . . . . . . . . . . . . . . . . . . 4.4 4.3 4.4 4.9 4.3 4.3 4.3 5.4 4.4 4.3 4.7 3.7Living with children and/or others8 . . . . . . . . . . . . . 4.4 4.3 4.6 4.0 4.0 3.6 4.6 4.0 4.7 5.0 4.6 4.1

(B) Derived measure not shown where base is less than 75,000.

1 Population refers to the number of people who reported a valid answer to the question on visits to doctor’s office. 2 ‘‘Currently married’’ refers to people who were currently married and living with their spouse. 3 ‘‘Other’’ includes people who were widowed, divorced, separated, or never married. 4 ‘‘Illiterate’’ refers to people aged 15 and older who are unable to read. Primary school in China is equivalent to elementary school in the United States, and junior high school is equivalent to middle school or

junior high school. 5 ‘‘Primary school’’ includes ‘‘primary school’’ and ‘‘old-style private school.’’ 6 ‘‘Money Income’’ is monthly income in Chinese yuan. In 2000, the exchange rate between the U.S. dollar and the Chinese yuan was $1 = 8.28 yuan. 7 In this table, for total China, ‘‘Low’’ monthly money income is less than 50 yuan, ‘‘Medium’’ is 50 to 199 yuan, and ‘‘High’’ is 200 yuan or above. For urban China, ‘‘Low’’ is less than 300 yuan, ‘‘Medium’’ is 300

to 749 yuan, and ‘‘High’’ is 750 yuan or above. For rural China, ‘‘Low’’ is less than 50 yuan, ‘‘Medium’’ is 50 to 149 yuan, and ‘‘High’’ is 150 yuan or above. 8 ‘‘Living with children and/or others’’ may include spouse, children, grandchildren, parents, or any other family or nonfamily members.

Note: ‘‘Doctor’s office’’ includes a doctor’s office, health clinic, outpatient office in hospitals, or any other health organization.Source: Sample Survey on the Aged Population in Urban/Rural China, 2000.
The sample for the Sample Survey

on Aged Population in Urban/Rural

China (SSAPUR) represents the civilian noninstitutionalized older population 60 and over in 27 provinces

of China, excluding Nei Mongol,

Guangxi, Guizhou, and Xizang.

The 2000 SSAPUR was based on a

stratified multistage sample

design, described below. In order

to produce accurate estimates from

the survey data, it was necessary

to apply weights to the data that

take into account the sample

design and the population distribution from the 2000 China Census

data. Given that the survey data

are based on a sample of the older

population in China, the results are

subject to sampling errors (or variability) as well as nonsampling

errors from all other sources, such

as response (including recall) errors

and coding and processing errors.

The quality control procedures for

the survey (including supervision

for each operation) were designed

to minimize the nonsampling

errors. The standard error, or

square root of the variance, is used

to measure the sampling error. The

precision of the survey estimates

can also be expressed as confidence intervals based on the standard errors.

The primary sampling units (PSUs)

for the survey were the 27 individual provinces. These provinces

were stratified by the following six

regions: North, Northeast, East,

South Central, Southwest, and

Northwest. The number of sample

provinces allocated to each region

was approximately proportional to

its population.

A total of 20 sample provinces were

selected for the 2000 SSAPUR from

the 27 provinces in the sampling

frame. Within each region, the sample provinces were selected with

probability proportional to size

(PPS), where the measure of size

was based on the population aged

50 and over from the Fourth China

Census (1990) data. A total of

eleven provinces were selfrepresenting (SR), that is, they were

included in the 2000 SSAPUR sample with certainty. Most of these

were SR because of their large population. In the East region, all seven

provinces were SR.

Within each sample province, four

cities (urban areas) and four counties (rural areas) were selected at

the second sampling stage with

PPS using the same measure of

size (population aged 50 and over).

At the third stage, a sample of 16

blocks was selected with PPS from

the combined frame for the four

sample cities within each province,

and 16 rural townships were

selected from the combined frame

for the four sample counties, also

with PPS. All the urban residential

committees within the 16 sample

blocks were combined into one list,

and all the villages in the16 sample

townships in each province were

also listed together. Then a sample

of 50 urban residential committees

and 50 rural villages was selected

with equal probability within the

province at the fourth sampling

stage. A list of all households with

at least one person aged 60 and

older was obtained from each sample residential committee or village, and a sample of 10 households was selected systematically

with a random start from the list at

the fifth sampling stage. In the

case of sample households with

more than one person aged 60 and

older, one of these individuals was

selected at random. This resulted

in a sample of about 500 urban

older people and 500 rural older

people in each sample province,

for a total sample of approximately

20,000 people aged 60 and older.

The weighting procedures depend

on the sampling methodology for

the 2000 SSAPUR. The basic weight

for each sample person was calculated as the inverse of his or her

probability of selection (calculated

by multiplying the probabilities at

each sampling stage). These basic

weights were then adjusted using

the 2000 China Census data for

the total older population by

region, urban/rural stratum, and

sex, which have the same reference year as the 2000 SSAPUR. As

a result, the weighted estimates of

the older population from the survey have a demographic distribution similar to that seen in the

2000 census.

In order to estimate the precision of

results appearing in this report, and

to determine whether differences

were statistically significant, standard errors were calculated taking

into account the stratification and

clustering in the sample design.

U.S. Census Bureau Health and Health Care of the Older Population in Urban and Rural China: 2000 71

APPENDIX B.

SOURCE AND ACCURACY OF DATA