Spatial Inequality, Community Social Capital, and Age-Differentiated Health Vulnerabilities Among the Elderly in...

South Korea became a super-aged society in 2024, and this demographic shift is unfolding alongside the depopulation of rural municipalities across the country. How spatial inequality and community social capital jointly relate to elderly health-and whether those relationships look different for younger versus older elderly-remains an open question. We investigated associations between two dimensions of community social capital (sense of belonging and neighbor communication), subjective perception of capital-provincial inequality, and self-rated health among Korean elderly, with separate analyses for the Young-Old (aged 60-69) and Old-Old (aged 70+).

We used the 2024 Social Integration Survey from the Korea Institute of Public Administration (full sample N = 2588; elderly subsample N = 1020). Random intercept hierarchical linear models accounted for the nesting of individuals within 17 metropolitan cities and provinces. Stepwise models examined social capital antecedents, a healthcare satisfaction indirect association pathway, and the direct association of spatial inequality perception with health. The elderly subsample was stratified into Young-Old (N = 289) and Old-Old (N = 731). A mixed-effects ordered logistic regression with Liang-Zeger cluster-robust standard errors was estimated as a robustness check.

Sense of belonging was positively associated with subjective health among the elderly (B = 0.065, p < 0.05) as a net of rurality and socioeconomic controls. Perceived spatial inequality showed a negative association (B = -0.070, p < 0.05). The indirect association pathway through healthcare satisfaction was not supported (Sobel Z = -1.458, p = 0.144). Age-stratified models revealed a striking split: belonging was the dominant predictor for the Young-Old (B = 0.149, p < 0.01), while neighbor communication (B = 0.078, p < 0.05) and spatial inequality perception (B = -0.092, p < 0.01) were significant only among the Old-Old. The ordered logistic robustness check confirmed the negative association of perceived spatial inequality across all specifications.

What predicts health in the younger elderly is not what predicts health in the older elderly. Korea's Integrated Community Care Act, set for nationwide rollout in 2026, should account for this divergence-prioritizing psychological community attachment for the Young-Old and face-to-face social contact combined with regional equity for the Old-Old.