A Comparison of Urban and Rural Senior Citizens' Health and Well-Being Across Income Spectrum

Background and Purposes: Past public health research has documented a difference between urban and rural health care, usually expressed in terms of health care access and utilization, cost, and geographic distribution of providers and services. Recently, however, a new research focus has begun to direct its attention toward differences in population health, public health, environmental health, and the differences between urban and rural health behaviors. By utilizing a framework that examines determinants of health, this study aimed to identified environment(urban/rural) and/or income (low/average) factors that may contribute to different health and wellness outcomes for seniors older than 65.

Methods: The 2007 Korea Investigation into Actual Conditions of the Aged Data (KIACAD) was utilized to constitute the sample. KIACAD, based on the Korea’s Welfare of the Aged Act, conducts an investigation and records dataset of the behaviors of the respondents triennially across the country. Respondents belonging to 65 years and above age group were firstly retained for analysis (N=10,551). Next, in order to cross tabulate the sample by individual-level income and residential area, one’s income levels below 150% minimum cost of living (MCL) was defined as ‘low’ and above 150% MCL was referred to ‘average’. Residential area was divided into two: Seoul and other than Seoul (city/rural). Thus, the sample was categorized into four sub-groups: (1) city/low, (2) city/average, (3) rural/low, and (4) rural/average. Descriptive statistics, Anova and T-test were conducted to compare four separate senior group’s heath and well-being in the areas of subjective and objective health status, leisure, social network, and safety.

Results: Study result revealed relative variations between groups and more importantly, the gap between urban seniors across low-average income spectrum was significantly wider than that of rural seniors. To illustrate, differences between city/low versus city/average group with ‘past two year’s medical service visitation’, ‘assistance with ADL services’, and ‘participation in cultural activities’ were above 20 percent (p<.005) whereas variations were about 8-9 percent among rural/low and rural/average group. City/low elderly were less likely than their counterparts (city/average) to see a doctor every two years and to involve cultural events while having more needs for ADL. There was considerable variation in the observed proportion across city elderly with subjective health status, from a high of 50.3 percent in city/average to a low of 28 percent in the city/low (p <.005).

Conclusions and Interpretations: The findings demonstrate that the income disparity is a crucial factor to be considered especially when bridging the gap between health and subjective well-being among urban seniors. More support for public sector services needs to be implemented to urban low-income seniors. Future studies should explore in greater detail the relationship between income inequality and other contextual variables and their influence on health and well-being in the urban senior community.