Background: This study aims to determine the change of inequality in functional disability of older populations in China over the period from 2008 to 2018 and decompose the contribution of the personal and environmental predictors to the change.Methods: Data were drawn from two waves (2008 and 2018) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Functional disability was assessed by the basic activities of daily living (ADL) and the instrumental activities of daily living (IADL). Concentration index (CI) was calculated to measure the socioeconomic inequality in ADL and IADL. A two-level linear regression model was established to identify the individual and care environmental predictors and their contribution to the inequality of ADL and IADL, respectively. The Oaxaca-type decomposition technique was adopted to estimate the contribution of these predictors to changes of the inequality in ADL and IADL over the period from 2008 to 2018.Results: Socioeconomic inequality in functional disability of older adults increased over the period from 2008 to 2018, with the CI for ADL changing from − 0.0085 to − 0.0137 and the CI for IADL changing from − 0.0164 to − 0.0276, respectively. Self-rated economic status was the single most powerful predictor of changes in the inequality, although the growing and dominant rating of older persons with fare economic status could offset the detrimental effects of other (rich or poor) ratings on the changes. The enlarged inequality was also attributable to the increasing importance of regular exercise and its distributional changes, as well as the accumulative long-term effect of farming in earlier life. They outweighed the counteracting effects of rural residency, living with chronic conditions and in an institution.Conclusions: Socioeconomic inequality in functional disability of older populations in China increased over the period from 2008 to 2018. Re-distribution of wealth remains to be a powerful instrument for addressing the inequality issue, but alone it is not enough. The detrimental accumulative effect of farming will not disappear any time soon. While rural residents are catching up with their urban counterparts, new challenges such as physical inactivity are emerging.

Objectives: This study aims to identify the dynamic changes in cognitive performance differentials between urban and rural older adults in China from 2008 to 2018 and decomposes determinants affecting such changes.Methods: Two waves (2008 and 2018) of data were extracted from the Chinese Longitudinal Healthy Longevity Survey. The cognitive function was tested using the Chinese Mini-Mental State Examination (MMSE). The effects of the explanatory variables (demographic, economic, neighborhood, environmental events and social and cultural domains) on the changes in the urban-rural inequality of cognitive performance were divided into two components using the Juhn–Murphy–Pierce (JMP) decomposition: quantity effect and price effect.Results: A total of 14,628 (urban respondents: 5,675, rural respondents: 8,953) and 10,311 older adults (urban respondents: 5,879, rural respondents: 4,432) for 2008 and 2018, respectively, were included in our study. A narrowing of 0.071 in the urban-rural disparity in cognitive function score of the older adults from 2008 to 2018 was identified. Quantity and price effects of explanatory variables contributed 65.21 and 46.84%, respectively, to the observed components in explaining the narrowed disparity. Quantity effects of age (35.71%), exercise (56.72%), self-rated economic status (33.19%) and price effect of homeownership (54.97%) contributed significantly to the reduced urban-rural gap. Contrastingly, inequality in pension (−27.31%) and social security (−23.11%) between urban and rural widened cognitive performance differentials. Furthermore, effects of hunger in childhood (−10.53%) and less years of schooling (−77.20%) on the increase in urban-rural inequality seemed to be stronger over time.Conclusion: Economic development and reform of the rural health system are responsible for the decline in the urban-rural disparity in the cognitive performance of older adults. Equalizing the distribution of social security and welfare between urban and rural must be highlighted for eliminating cognitive ability disparity. Additionally, rural older adults who endured hunger and poor education in childhood also deserve further policy interventions.

Background: Continuity of general practitioner (GP) care, widely known as the core value of high-quality patient care, has a positive association with health outcomes. Evidence about the relationship between continuity and health service utilisation has so far been lacking in China. This study aimed to analyse the association of continuity of GP care with utilisation of general practitioner and specialist services in China. Method: A cross-sectional mixed methods study was conducted in 10 urban communities in Hangzhou. Quantitative data were collected from a random sample of 624 residents adopting the self-developed questionnaire. Measurement of continuity of GP care included informational continuity (IC), managerial continuity (MC) and relational continuity (RC). With adjustment for characteristics of residents, multivariate regression models were established to examine the association of continuity of GP care with the intention to visit GP, frequency of GP and specialist visitations. Qualitative data were collected from 26 respondents using an in-depth interview, and thematic content analysis for qualitative data was conducted. Results: Quantitative analysis showed that the IC was positively associated with the intention to visit GP and frequency of GP visitations. Those people who gave a high rating for RC also used GP services more frequently than their counterparts. MC was negatively associated with frequency of specialist visitations. Qualitative analysis indicated that service capabilities, doctor–patient interaction and time provision were regarded as three important reasons why patients chose GPs or specialists. Conclusions: Overall, high IC and RC are independently associated with more GP service utilisation, but a high MC might reduce specialist visitations. Continuity of GP care should be highlighted in designing a Chinese GP system.