Urban-Rural Differences in Self-Reported Physician-Diagnosed BPH and Associated Factors Among Older Men: A Cross-Sectional Analysis of a National Survey

Benign prostatic hyperplasia (BPH) is highly prevalent among older men, yet its population-level assessment often depends on physician diagnosis, which may vary by healthcare access and reporting behavior. In China, substantial urban-rural differences in healthcare utilization raise questions about whether reported differences in BPH reflect true variation or diagnostic patterns. This study therefore examined urban-rural differences in self-reported physician-diagnosed BPH and associated factors using nationally representative data. We conducted a cross-sectional analysis of 8455 men aged 45 years and older using data from Wave 4 (2018) of the China Health and Retirement Longitudinal Study (CHARLS). BPH status was defined based on self-reported physician diagnosis. Urban-rural differences in reported BPH were compared, and multivariable logistic regression models were used to examine factors associated with reported BPH diagnosis. Of 8455 participants, the overall proportion reported a physician diagnosis of BPH was 11.9%, with subgroup-specific proportions of 18.4% in urban men and 10.1% in rural men. After adjustment for sociodemographic, lifestyle, and health-related variables, rural residence was associated with lower odds of reporting BPH (aOR 0.61, 95% CI 0.51-0.72). Several associations differed by residence, including a positive association between moderate physical activity and reported BPH in urban men, and inverse associations for longer sleep duration and regular alcohol consumption in rural men ( P < .05). Urban men were more likely than rural men to report a physician diagnosis of BPH. Multiple sociodemographic and lifestyle factors were statistically associated with reported BPH, with some variation by residence. Given the cross-sectional design and self-reported measures, these findings reflect patterns of reporting and diagnosis rather than confirmed differences in underlying disease prevalence. Longitudinal studies using validated clinical assessments are needed to further clarify these relationships.