Socioeconomic disadvantage and health in later life: associations and potential pathways in rural China

Socioeconomic status (SES) is a key determinant of health. Its relationship with health among older adults in rural China—particularly among vulnerable subgroups—remains insufficiently understood. This study examined the association between SES and multiple health dimensions among rural older adults, assessed subgroup disparities, and explored mediating pathways involving physical exercise, nutrition, and living conditions. Data was drawn from 1077 rural older adults in Shaanxi Province, including both general and vulnerable welfare-recipient groups. Health outcomes covered self-rated health (SRH), cognitive function, and depressive symptoms. Multivariable regression combined with propensity score matching was used to improve comparability between SES groups, and exploratory mediation analysis was conducted to examine potential pathways. Lower SES was associated with poorer SRH (β = 0.367, P < 0.001), poorer cognitive function (β = 1.927, P < 0.001), and more severe depressive symptoms (β = −0.471, P < 0.001). The SES-cognitive function association was stronger among the vulnerable population, whereas SES associations for SRH and depressive symptoms were larger in the general population. Living conditions accounted for the largest share of the observed SES-health association (8.3–25.1%), followed by physical exercise (3.9–9.8%) and nutrition (3.2–13.2%). The association between SES and depressive symptoms appeared stronger among those living alone (β = −0.587, P < 0.001), with no gender differences. SES is strongly associated with multiple health outcomes among rural older adults in China, with physical exercise, nutrition, and living conditions potentially contributing to these associations. Efforts to reduce the health costs of poverty in later life may benefit from comprehensive policies that improve living environments, promote healthy behaviors, and prioritize support for vulnerable groups such as welfare recipients and those living alone.