Cumulative (dis)advantages in cognitive health: rural/urban residency, household registration status, and cognitive aging among older Chinese adults

Objectives This study examined the relationship between rural/urban residency, household registration (hukou) status, and cognitive aging trajectories among older Chinese adults, aiming to understand how cumulative (dis)advantages across the life course contribute to differences in later-life cognitive health. Methods We used linear growth models to analyze 2011–2020 longitudinal data from the China Health and Retirement Longitudinal Study (N=18,754) to assess associations of rural/urban residency and hukou status with level of cognitive function and age-associated cognitive changes. We further examined how age and method of urban hukou attainment were associated with cognitive aging trajectories. Results Urban residents with continuous urban hukou had the highest level of cognitive function and slowest age-related cognitive decline compared to all other groups. In contrast, rural residents with continuous rural hukou were the most disadvantaged. Rural-to-urban migrants enjoyed some urban advantages, but such advantages depended on whether they attained urban hukou, their age at urban hukou attainment, and the method of attaining urban hukou. Discussion These results support the cumulative (dis)advantages framework and demonstrate that institutional or policy discrimination such as through hukou policies plays a critical role in cognitive disparities among older adults. Taken together, the results suggest that reforms to provide greater resources to rural areas and access to urban hukou could be an important tool to improve cognitive health among rural and migrant populations, and ultimately reduce dementia in China.