The impact of city size and basic eldercare services on the disability risk of older adults: empirical evidence from 122 cities in China

Based on the follow-up survey data of two phases of the China Health and Retirement Longitudinal Study, this study empirically examines the impact of city size and basic eldercare services on older adults’ disability risk, as well as their synergy, using a panel-ordered logit model, stepwise analysis method, and Karlson–Holm–Breen method. We discuss their potential transmission mechanism and find that city size and basic eldercare services have a significant positive effect on older adults’ activities of daily living. Together, city size and basic eldercare services play a regulating role; however, the urban sprawl index significantly reduces the role of city size and basic eldercare services in mitigating disability risks and shows significant group heterogeneity in terms of age, registered residence, and income. City size and basic eldercare services act as transmission mechanisms through the resource, social participation, and income effects of medical and health services. Their contribution to the cumulative medium effect of city size, number of eldercare service institutions, eldercare beds, and eldercare beds per thousand people reached 53.90%, 61.39%, 66.66%, and 15.27%, respectively. The findings confirm that city size and basic eldercare services have an important impact on older adults’ disability risk. They also help reduce older adults’ disability risk through joint efforts. However, with the gradual increase in urban sprawl, the impact of city size and basic eldercare services has weakened significantly.