Depression among Chinese older adults: A perspective from Hukou and health inequities

Previous studies have suggested that socioeconomic status is linked to health status. However, most of these studies have been conducted in developed countries, whose social settings are different from those in China. Hukou (household registration) status, one of China's main socioeconomic indicators, has received limited attention in the literature.

The objective of this study was to examine the relationship between different Hukou statuses, and depression, among older adults in China.

The data were obtained from the China Health and Retirement Longitudinal Study (CHARLS). In total, 7409 Chinese older adults aged 60 and over were included in the survey. The Center for Epidemiologic Studies Depression Scale (CESD-10) was used to assess depressive symptoms. The various Hukou statuses were coded into four categories: villager, temporary rural-to-urban migrant, permanent rural-to-urban migrant and urban local citizen.

The results indicated that the level of depressive symptoms was significantly higher among villagers (beta [ß] 1.40, 95%CI 0.83-1.96), temporary migrants (beta [ß] 0.97 95%CI 0.38-1.56) and permanent migrants (beta [ß] 0.52 95%CI 0.04-1.00) than among urban local citizens. In addition, people who had experienced changes in their Hukou status before age 16 were more likely to have depressive symptoms (beta [ß] 1.39, 95% CI 0.20-2.58).

Being cross-sectional, this study is insufficient for determining causal relationships between Hukou status and depression.

Our findings suggest that deeper reform of the Hukou system, and greater efforts to eliminate the health disparities associated with that system, are needed in China.