Objective To examine the impact of chronic diseases on labor participation among rural older adults in China and test the mediating role of the New Rural Cooperative Medical Scheme (NRCMS) in this relationship, thereby providing evidence for formulating policies to enhance the health and labor welfare of rural seniors. Methods Data from 6,584 rural older adults aged ≥60 years were obtained from the 2023 China Longitudinal Aging Social Survey (CLASS). Statistical analyses were conducted using Stata 17.0 software, including t -tests, chi-square tests, and binary logistic regression. Robustness checks were performed using inverse probability weighting regression and by altering the measurement of the independent variable. The mediating effect of the NRCMS was tested using a two-step regression approach. Results The prevalence of chronic diseases among rural older adults was 76.6%, and the labor participation rate was 57.9%. After controlling for confounding factors, chronic diseases significantly reduced the risk of labor participation (OR = 0.61, 95%CI: 0.53–0.70). Among specific conditions, cerebrovascular disease had the strongest negative impact (OR = 0.59, 95%CI:0.49–0.71), followed by musculoskeletal disorders (OR = 0.70, 95% CI: 0.61–0.81) and hypertension (OR = 0.77, 95% CI: 0.68–0.87), with all results being statistically significant ( p 0.001). Mediation analysis indicated that the NRCMS partially mediated the relationship between chronic diseases and labor participation. This mediating effect showed heterogeneity across income levels and disease burden: it was significant only in the low-income group, and when the number of chronic diseases exceeded three, the proportion of the mediating effect increased to 41.9%. Conclusion Chronic diseases constitute a major health risk factor that inhibits labor participation among the rural older adults. The NRCMS plays a significant mediating role in this process. Therefore, targeted measures are recommended, such as strengthening medical insurance coverage and chronic disease management for low-income individuals with multiple comorbidities. These measures would help mitigate the negative impact of health shocks on the labor capacity of the older adults and promote the rational utilization of the older rural workforce.
Meng et al. (2025) studied this question.