Demographic Restructuring, Urban Scale, and Cognitive Health among Older Adults in China

Rapid urbanization and population aging are reshaping community composition in China, yet most research relies on static measures of neighborhood disadvantage, overlooking the cognitive consequences of ongoing demographic change. This study examines how community demographic trajectories are associated with cognitive health among older adults in China, and whether these associations vary by rural-urban location and urban community size. Data from the China Family Panel Studies (CFPS; 2010–2014) were analyzed for 9,621 adults aged 50 and older across 510 communities. Communities were classified into typologies based on changes in population size and the proportion of older residents between survey waves. Multilevel linear models estimated associations between community demographic trajectories and standardized cognitive scores, with communities experiencing population decline and aging as the reference group. Community size was examined within urban areas as a proxy for institutional resource availability. In rural areas, community demographic trajectories were not significantly associated with cognitive scores after adjustment for individual and community characteristics. In urban areas, associations varied substantially by community size. Older adults in small urban communities characterized by growth with aging, growth with rejuvenation, or depopulation with rejuvenation scored 0.33 to 0.43 standard deviations lower than those in depopulation-with-aging communities. These disparities diminished in medium-sized urban communities and were absent or reversed in large cities. Findings were robust across sensitivity analyses. These results underscore the importance of conceptualizing communities as dynamic systems and highlight urban community size as a key moderator of demographic change effects on cognitive aging.