Retirement and health among urban and rural men in China: evidence from a fuzzy regression discontinuity design

To investigate the causal effects of retirement around the statutory retirement age of 60 years on medical service utilization and health among middle-aged and older men using data from the China Health and Retirement Longitudinal Study (CHARLS), and to examine whether these effects differ between rural and urban populations. Using data from the 2015 and 2018 waves of CHARLS, this study included rural and urban men aged 50–70 years, excluding observations at age 60. The final sample comprised 4,062 rural men and 2,441 urban men, contributing 7,250 and 4,372 observations, respectively. A fuzzy regression discontinuity design was employed, with an indicator for being aged 60 years or older serving as the instrumental variable for retirement status. Two-stage least squares estimation was used to estimate the local average treatment effect of retirement on outpatient utilization, inpatient utilization, cognitive function, self-rated health, and health-related behaviors. The robustness of the identification strategy was assessed using the McCrary density test, control-variable continuity tests, and placebo tests. The first-stage estimates showed that crossing the age-60 threshold increased the probability of retirement by 6.6% points among rural men and 26.6% points among urban men. The Kleibergen–Paap F statistics exceeded 10. Among rural men, retirement was associated with a 6.20-point increase in cognitive function scores ( p < 0.05), indicating improved measured cognitive function. The reported number of chronic diseases increased by 0.63 ( p < 0.1), indicating a greater disease burden, while self-rated health scores increased by 1.39 points ( p < 0.1), indicating improved perceived health. No statistically significant changes were observed in activities of daily living (ADL), instrumental activities of daily living (IADL), depression, life satisfaction, or health-related behaviors. No statistically significant changes were detected in the examined health outcomes among urban men. The estimated health effects of retirement differed between rural and urban men and across health dimensions. These findings highlight the importance of considering urban–rural differences when evaluating the health implications of retirement policy.