Urban-rural disparities in living arrangement and older adults care service supply in China: a cross-sectional study

Background China's rapidly aging population was placing growing pressure on both families and the government to ensure adequate older adults care. Consequently, delivering comprehensive and high-quality services for the aged had become a pressing social issue. Objective This study aimed to examine the living arrangement and older adults care service supply among older adults in China, identify urban-rural disparities, and explore potential directions for the future development of older adults care services. Methods Data were obtained from the 2018 cross-sectional dataset of CLHLS, 15,087 older adults were included for analysis. Differences in the distribution of categorical characteristics among older adults with different living arrangement and hukou types were first examined. Logistic regression models were employed to identify factors associated with living arrangements. Differences in the distribution of availability of social security and of older adults care services between older adults with different hukou types were also examined by χ 2 test and logistic regression. Results Most of the participants (80.41%, n = 12,131) lived with house member(s), and 46.45% ( n = 6,970) indicated that their main source of financial support came form their child(ren). Compared with rural older adults, urban older adults were more likely to be in an institution ( OR = 4.782, 95% CI = 3.795–6.025, P < 0.001), less likely to be alone ( OR = 0.694, 95% CI = 0.603–0.799, P < 0.001). As age increased, they were less likely to be alone or in in an institution ( OR = 0.950, 95% CI = 0.945–0.954, P < 0.001; OR = 0.984, 95% CI = 0.974–0.994, P = 0.001). Male were more likely to be alone or in an institution than female ( OR = 1.190, 95% CI = 1.072–1.322, P = 0.001; OR = 1.332, 95% CI = 1.095–1.622, P = 0.004). There were urban-rural disparities in the accessibility of older adults care services among older adults ( P < 0.001). Conclusions It was found that the primary living arrangement for older adults in China was co-residence with family members. And significant urban-rural differences existed, primarily reflected in economic status, insurance systems, and the availability of older adults care services. In particular, hukou type exerted a statistically significant effect on older adults care service supply.