Skip to main content
Download PDF

Relationship between hukou conversion and psychological integration of rural older migrants: the mediating effect of accessibility to health resources

BMC Geriatrics volume 24, Article number: 490 (2024) Cite this article

Abstract

Objective

This study investigates the relationship between hukou conversion and the psychological integration of rural older migrants, exploring the mediating role of accessibility to health resources.

Methods

The 3,963 valid samples of rural older migrants included in the study were sourced from the 2017 China Migrants Dynamic Survey (CMDS). The study established a multiple linear regression model for estimation and utilized inverse probability-weighted regression adjustment (IPWRA) method to correct for the selection bias of hukou conversion.

Results

Compared to older migrants with rural hukou, merit-based (β = 0.384, 95% CI: 0.265 to 0.504), family-based (β = 0.371, 95% CI: 0.178 to 0.565) and policy-based (β = 0.306, 95% CI: 0.124 to 0.487) converters have significantly higher psychological integration. These findings remain robust even after addressing the potential issue of endogenous selection bias using the IPWRA method. Bootstrap mediating effect tests indicate that hukou conversion can indirectly affect psychological integration through the mediator role of health resources accessibility.

Conclusion

Accessibility of health resources mediates the association between hukou conversion and psychological integration. Policymakers should enhance the implementation of hukou conversion, strengthen the health resource guarantee system, and achieve a deeper psychological integration among rural older migrants.

Peer Review reports

Introduction

With the acceleration of urbanization and the trend of population aging, the current Chinese population is undergoing significant changes characterized by mobility, separation, and integration. The emergence of rural older migrants is an inevitable result of the development of new urbanization and social modernization [1]. According to the “2018 China Migrant Population Development Report” published by the former National Health Commission, the scale of older migrant population has grown rapidly since 2000, increasing from 5.03 million in 2000 to 13.04 million in 2015, with an average annual growth rate of 6.6% [2]. As a distinct subset within the older population, rural older migrants’ living conditions and health status represent important issues in the context of the new era, including family eldercare, social integration, and policy reform.

As a significant factor influencing the population structure in aging societies, older migrants have attracted attention from western academia since the 1970s [3]. In the cultural context of China, the migration of rural residents to urban areas is the most prominent characteristic of population mobility. Most of these rural-to-urban migrants face strong institutional, economic, cultural, and social barriers, due mainly to the household registration system—hukou [4]. Among them, rural older migrants face unique challenges stemming from the intersection of age-related vulnerabilities and the complexities of adapting to new urban environments [5]. In China, this cohort is more vulnerable due to their relatively poor socio-economic status and accessibility to social welfare, low educational level and differences in lifestyle compared to their urban counterparts [6]. Thus, research on their health outcomes, including mental health and healthcare access, is essential for informing policies and interventions.

Social integration, as a multi-dimensional concept, mainly includes economic, social, cultural, and psychological integration [7]. Among those, psychological integration is defined as the process of undergoing psychological and emotional changes in terms of identification with one’s own social identity and sense of belonging [8], which is widely regarded as the pinnacle and final stage of social integration [9]. Empirical studies have confirmed the association between psychological integration and mental health. Positive psychological integration contributes to preserving the self-esteem of the migrant population [10], enhancing positive self-identity [11], ultimately reducing their psychological distress and promoting their mental well-being [12]. Therefore, for the purpose of maintaining the health of rural older migrants, there is a pressing need to investigate interventions that promote their psychological integration.

According to social identity theory, psychological integration is reflected in an individual’s sense of social identity and belonging [13]. Under the cultural background of China, hukou system has long been a fundamental aspect of the social structure, profoundly shaping citizen’s social identities [14]. The hukou system historically served as a means of controlling internal migration. It was designed to control population mobility and promote the development of heavy industry in cities, helping the government manage resources and maintain social stability [15, 16]. However, it also classified individuals into either rural or urban hukou categories, creating the urban-rural dichotomy that significantly influences access to social services, education, health resources and employment opportunities [17]. Since the hukou system is witnessed as the main institutional obstacle to the social integration of migrants [18], it has undergone reforms aiming to promote citizenization of rural migrants in recent years.

In 2014, China initiated the new-type urbanization. On July 24, 2014, the State Council issued the Opinions of the State Council on Further Promoting Hukou System Reform [19], explicitly pointing out that the distinctions between rural and urban hukou should be eliminated and a unified urban and rural hukou system should be established. Under the policy of relaxing hukou restrictions, numerous migrants have experienced a process of hukou conversion (i.e., transferring rural hukou to urban hukou) mainly through two paths: one is through self-effort, typically accessible to migrants with higher levels of education, skills, and financial resources, while the other is driven by policy changes that incorporate rural residents’ hometowns into urban areas [20].

The greatest benefit of transferring one’s hukou is access to citizenship rights, including local-urban welfare rights, economic opportunity, and social status [21]. Previous research has demonstrated that hukou converters in urban areas have a clear and significant advantage in healthcare access than their counterparts who have not converted their hukou type [22]. Moreover, the health benefits from hukou conversion have been confirmed. Rural migrants who obtain urban hukou are reported to have better health conditions compared to their rural hukou counterparts [23]. Regarding different types of hukou conversion, policy-based converters generally exhibit better psychological health than family- and merit-based converters who are selected on individual traits [24]. Furthermore, the positive association between the accessibility of health resources and psychological well-being has been theoretically and empirically confirmed [25]. A recent study found that health rights accessibility significantly enhances the psychological integration among minority rural migrants [26]. Therefore, the accessibility of health resources might mediate the association between hukou conversion and psychological integration.

Although existing studies have gained fruitful results, they have the following limitations. First, since previous literature mainly focused on the effect of hukou status (rural vs. urban), it lacks exploration of the hukou conversion (rural-to-urban vs. rural) in the context of Chinese hukou reforms. Second, previous studies have mainly focused on the psychological well-being of migrant adolescents and workers. Little attention has been paid to the rural older migrants, despite their status as a more vulnerable group. Third, while numerous studies have explored multiple dimensions of psychological well-being, few have specifically focused on the psychological integration, which is a crucial element to the overall psychological well-being of migrants. Therefore, the aims of this study were to examine the effect of hukou conversion on psychological integration of rural older migrants, while also exploring the potential mediating role of accessibility of health resources.

Methods

Sample and procedure

The data utilized in this study are derived from the 2017 China Migrants Dynamic Survey (CMDS), a large-scale national survey on the mobile population initiated by the National Health Commission of China. The survey subjects are migrants who have resided in the destination area for one month or more. Encompassing over 340 urban agglomerations across 31 provinces in China, the survey sampled a total of 169,989 migrants in 2017. Rigorous quality control measures were applied, employing a stratified, multi-stage, and proportionally scaled probability proportional to size (PPS) sampling method to ensure the representativeness of the survey samples at both the national and provincial levels. The survey covered fundamental aspects of migrants, including basic demographics, employment and social security, health and public services, and social integration. This comprehensive data set facilitates the exploration of factors influencing and ultimate outcomes related to the psychological integration of rural older migrants.

Data processing includes the following procedure. Firstly, considering the age heterogeneity of older population [27], our study focused on younger older people aged 60 to 74, leading to the exclusion of 163,522 samples outside this age range. A total of 1,108 samples from the “Perpetual urban group”, those born in urban areas with urban hukou and remained so (urban-urban born) [22], were excluded from this study, as well as 269 samples with unclear hukou status. Subsequently, we removed 1,055 cases with missing values in health resource accessibility and 72 cases with missing values for control variables. Additionally, to mitigate the potential impact of outliers on study outcomes, we applied a 1% two-tailed winsorizing procedure to the household income variable. The final analysis was conducted on 3,963 valid samples, and the sample selection process is illustrated in Fig. 1.

Fig. 1
figure 1

The sample selection process

Full size image

Variables

Hukou conversion

Hukou conversion refers to the process in China where rural migrants transfer their rural hukou to urban hukou. This study measures hukou conversion by taking into account both the hukou type and the means of acquiring the urban hukou. Referring to a recent study, hukou conversion was treated as a multi-categorical variable, which contains the following categories: (1) no conversion, where rural migrants did not convert their rural hukou, served as a reference group; (2) merit-based conversion, those acquired urban hukou through further education, joining the army, working, gaining cadre status, or buying a house; (3) family-based conversion, those acquired urban hukou through family ties, usually as a dependent spouse or child; (4) policy-based conversion, those acquired through land requisition or hukou reform; (5) other conversion, those acquired through other means [24]. While merit- and family-based conversion may exhibit higher selectivity due to personal characteristics and achievements, policy-based conversion is non-selective which is driven by policy changes.

Psychological integration

Building upon prior research, we employed the psychological integration scale from the CMDS questionnaire to measure the dependent variable [7, 28, 29]. This scale includes items such as “liking the current city of residence (X1)”, “paying attention to changes in the current city of residence (X2)”, “willingness to integrate into the local community and become a part of it (X3)”, “local residents’ willingness to accept me as one of them (X4)”, “attachment to customs and habits of my hometown (X5)”, “feeling that local residents look down on outsiders (X6)”, “significant differences in hygiene habits between me and local residents (X7)”, and “feeling that I am already a local resident (X8)”. Each item is categorized into four levels based on the degree of agreement: strongly disagree = 1, disagree = 2, agree to some extent = 3, strongly agree = 4.

Principal Component Analysis (PCA) was utilized to construct the main factors of psychological integration. Initially, each indicator underwent standardization. The KMO of psychological integration is 0.8327, and P values of the Bartlett test of sphericity are 0.000. With all eight indicators having KMO values exceeding 0.7, meeting the criterion for reasonable data structure, three principal components were ultimately extracted, contributing to a cumulative variance of 69.51%. Finally, the weighted sum of the variance contributions of each main factor, based on the ratio of each main factor’s variance contribution to the cumulative variance contribution, was calculated as the comprehensive score for psychological integration.

Accessibility of health resources

The mediating variable is the accessibility of health resources. Health documents, which collect and record individual disease and treatment histories, and health education, which aims to provide health knowledge and foster health awareness, are both regarded as crucial health resources [30]. Urban basic medical insurance provides insured individuals with a higher level of medical security, including reimbursement and payment of basic medical expenses, and is also considered a part of health resources [31]. This study selected three indicators as proxy variables for the accessibility of health resources for rural older migrants. These indicators include “whether a health document has been established locally”, “in the past year, whether you have received health education in the current city of residence”, and “whether you participate in basic medical insurance for urban employees or urban residents”. All the mentioned indicators are binary variables (0–1), where 1 indicates access to the respective health resources, and 0 indicates no access. On this basis, the paper constructed health resource accessibility as the dependent variable, calculated by summing up the actual obtained health project indicators. The score ranges from 0 to 3, with higher scores indicating better accessibility to health resources.

Covariates

Individual characteristics, family characteristics, and migration features may affect both the hukou conversion and psychological integration among rural older migrants [32,33,34,35]. Therefore, this study controlled for covariates in these three domains. Individual characteristics primarily include gender (0 = female; 1 = male), age (continuous variable from 60 to 74), years of schooling (educational level converted to years: never attended school = 0; primary school = 6; junior high school = 9; high school/technical school = 12; bachelor’s degree = 16; master’s degree = 20), party membership status (0 = others; 1 = CPC member), and marital status (1 = with spouse; 0 = without spouse); family characteristics include whether living with offspring (0 = no; 1 = yes) and average monthly household income (convert the total household income of continuous variables into natural logarithm); migration features include migration range (1 = cross-provincial; 2 = cross-city; 3 = cross-county), duration of migration (continuous variable of migration years), and number of migrated cities (continuous variable of migrated cities).

Statistical analysis

Data description and analysis were performed using Stata 17. Mean, standard deviation and percentages were used to present the characteristics of the study participants. The association between hukou conversion and psychological integration was examined by a multiple linear regression model. To further address for selection into hukou conversion, a doubly robust inverse probability-weighted regression adjustment (IPWRA) method was employed [24]. Next, three regression models were conducted to test the mediating effect of the accessibility of health resources between hukou conversion and psychological integration. The bootstrap method with the SPSS PROCESS Macro (model 4) was used to estimate the 95% confidence interval for the mediating effect by sampling 5000 times. The mediating effect was considered statistically significant if the 95% bootstrap CI did not contain 0.

Results

Characteristics of study participants

Participants’ characteristics are presented in Table 1. The average psychological integration score of the participants was − 0.01 ± 1.16 (ranged − 6.01–2.09); except for 2,968 (74.89%) of participants who did not convert their rural hukou, 538 (13.58%) were merit-based converters, 143 (3.61%) were family-based converters, 165 (4.16%) were policy-based converters, and 149 (3.76%) were other converters; 2,363 (59.63%) were male; the average age was 64.89 ± 3.82 (ranged 60–74); Most people were with spouse (87.33%, n = 3,461), and few were members of the Communist Party of China (11.20%, n = 444); the average years of schooling were 7.08 ± 4.05 (ranged 0–19); approximately 43.55% of the participants (n = 1,726) were cross-provincial migrants; the average log household income was 8.25 ± 0.87 (ranged 4.09–10.31); the average number of migrated cities and duration of migration were 1.53 ± 1.70 and 10.47 ± 8.00 respectively; 1,089 (27.48%) of the participants were living with their offspring; the average score of health resources accessibility was 1.24 ± 0.94 (ranged 0–3).

Table 1 Characteristics of participants (N = 3,963)
Full size table

Association between hukou conversion and psychological integration

The results of OLS and IPWRA estimators are presented in Table 2. The results of the OLS model indicate that, compared to rural migrants who retain their rural hukou, merit-based (\(\beta\)= 0.384, 95% CI: 0.265 to 0.504), family-based (\(\beta\)= 0.371, 95% CI: 0.178 to 0.565) and policy-based (\(\beta\)= 0.306, 95% CI: 0.124 to 0.487) converters have significantly higher psychological integration. However, other conversion is not significantly associated with psychological integration at the 5% level. These results remain robust even after addressing the endogenous selection bias issue using the IPWRA method. The results of the IPWRA model show that the coefficients of highly selective merit- and family-based conversion have decreased (0.384 vs. 0.353, 0.371 vs. 0.300, respectively), while the coefficient of non-selective policy-based conversion remains in line with the OLS model (0.306 vs. 0.305). This suggests that the psychological integration benefits of hukou conversion would be overestimated if selection bias is not accounted for.

Table 2 Association between hukou conversion and psychological integration (OLS and IPWRA)
Full size table

Accessibility of health resources as a mediator between hukou conversion and psychological integration

The results of the mediation analysis and bootstrap mediating effect test are presented in Tables 3 and 4. It showed that all types of hukou conversion are positively associated with accessibility of health resources. After accounting for accessibility of health resources, the direct prediction effects of merit- and family-based conversion on psychological integration are significant (merit-based conversion: \(\beta\)= 0.230, 95% CI: 0.108 to 0.353; family-based conversion: \(\beta\)= 0.230, 95% CI: 0.036 to 0.423). The coefficient estimation results of policy-based conversion are not significant at the 5% level, indicating that hukou conversion in this subgroup does not have a direct impact on psychological integration. Similarly, for the subgroup of other conversions, we also did not find significant direct effects. In addition, the upper and lower limits of the bootstrap 95% interval for the indirect effects of all types of hukou conversion on psychological integration did not include 0 (see Table 4). This suggests that hukou conversion can indirectly affect psychological integration through the mediating effect of health resources accessibility.

Table 3 The mediating role of accessibility of health resources between hukou conversion and psychological integration
Full size table
Table 4 Bootstrap test for mediating effect
Full size table

Discussion

This study investigates the underlying mechanisms of hukou conversion on psychological integration from the perspective of a representative sample of rural older migrants in China. The results indicate that hukou conversion positively predicts psychological integration, and the accessibility of healthcare resources plays a significant mediating role in this process. These findings contribute to a deeper understanding of the influencing factors of psychological integration among rural older migrants, thereby contributing to the improvement of people’s well-being and the establishment of mechanisms for integrated urban-rural development.

To start with, our study extends the literature on the impact of the hukou system on psychological integration among rural older migrants. First, existing literature predominantly focused on discussing the effects of the static hukou system. A recent study pointed out that having urban hukou makes it easier to access more public services and social welfare compared to rural hukou [36]. Another study, based on empirical data from 1,100 rural migrants, found that the hukou system perpetuates the long-term marginalization of rural migrants, leading to continuous barriers in social/cultural and identity integration [37]. However, little is known about the health impacts of dynamic hukou conversion currently. This study contributes to this gap by estimating the health impacts of dynamic hukou conversion for rural-to-urban migration. Second, existing literature primarily focused on migrant adolescents and workers rather than the older population. With increasing age, older adults tend to invest more in their original social networks, resulting in higher psychological integration costs associated with migration [38], making this group both important and unique. Our study further focused on the older adults, aged 60 to 74, showing that conversion from rural hukou to urban hukou significantly enhances the psychological integration level of older migrants compared to those who have consistently held rural hukou, aligning with the conclusions drawn in existing literature [39, 40].

Moreover, this study classified the “rural to urban” population based on different ways of obtaining urban hukou. We found that merit-based, family-based, and policy-based conversions all lead to higher levels of psychological integration. The health benefits of merit- and policy-based conversion are consistent with the findings of existing research focusing on psychological well-being [24]. Since policy-based conversion is theoretically the least selective type of hukou conversion, its health benefits show almost no difference after correcting for selection bias using the IPWRA method, compared with a significant difference of the more selective merit- and family-based conversion. A previous study stated that merit- and family-based converters experienced a migration process, which may introduce a variety of risk factors for individual well-being, such as the stress associated with adapting to a new physical and social environment, while policy-based converters do not involve a migration process [24]. Hence their findings demonstrated that policy-based conversion had the largest health benefits, which is inconsistent with our findings. However, another study confirmed the advantages of selectivity, stating that highly selected hukou converters might have the best outcomes because this subset tends to comprise individuals who excel among those with rural hukou, often having achieved higher levels of schooling and be healthier [41]. Our findings showed that the health benefits of highly selected merit- and family-based conversion are greater than policy-based conversion. Since we focused on psychological integration, we believed that merit- and family-based converters, who have higher human and social capital, are more proactive in hukou conversion, and they will enhance their sense of identity and psychological integration in this process.

Furthermore, our study found that hukou conversion significantly improves the accessibility of health resources, while the accessibility of health resources also promotes the psychological integration of rural older migrants. On the one hand, the urban-rural gap in China is an important institutional background [42]. The inequality in public welfare and health care caused by strict household registration restrictions has been widely confirmed [14, 43], with only those holding local urban hukou being able to access more generous social insurance [44]. A recent study found that lifting barriers to local citizenship significantly increases the participation rate of migrant workers in medical services, significantly improving the accessibility of welfare benefits and public services [39]. This study confirms and extends this conclusion, showing that merit-based, family-based, and policy-based conversion all significantly enhance the accessibility of health resources. On the other hand, previous study found that immigrants’ inability to access healthcare services equally not only affects physical health but also leads to negative mental health outcomes [45]. Previous scholars have found that health insurance can promote the social integration of migrants and have discussed the positive correlation between the social integration of migrants and the utilization of basic public health services in a broad scope (all migrants above 15 years old) [46, 47]. Our study takes a more comprehensive approach to assess the accessibility of health resources and focuses on the rural older migrants. We confirm that the attainment of accessibility to health resources significantly predicts psychological integration positively, providing insights for safeguarding the quality of life for rural older adults.

The results of the Bootstrap analysis suggest that the indirect effect mediated by accessibility of health resources was significant between all types of hukou conversion and psychological integration. Compared with individuals holding rural hukou, hukou converters have pronounced advantages in accessing healthcare throughout their life, shaping better health outcomes [22]. In addition, the direct effect of policy-based conversion on psychological integration is not significant at the 5% level, suggesting that accessibility of health resources has a full mediation effect on the relationship between policy-based conversion and psychological integration. Since policy-based conversion is due to the incorporation of villages into urban areas [41], they can enjoy urban services by acquiring urban hukou but do not experience a migration process. Therefore, hukou conversion may not directly increase their psychological integration, only through the benefits of healthcare access.

Limitation

This study utilized cross-sectional data from the 2017 CMDS. Limited by the availability of research data, we were unable to observe the long-term effects of hukou conversion on the psychological integration of rural older migrants, including the sustainability of effects, trends in changes, and potential stage differences. Therefore, future research could consider employing longitudinal data to further explore the long-term impact mechanisms of hukou conversion on the psychological integration level of rural older migrants. Moreover, since mediation consists of causal processes that unfold over time, the cross-sectional design may generate biased estimates. Future studies are required to employ alternative longitudinal mediation models to establish robust causality. Finally, although we attempted to address the selection bias of hukou conversion using the IPWRA method, this approach also has limitations, including the correct simulation of all factors involved in selective entry analysis. While we have included a large number of covariates in our model, we cannot completely eliminate the possibility of unobserved confounders. Further research is needed to seek additional validation and confirmation in the future.

Conclusion

The results of this study demonstrate a significant correlation between hukou conversion, accessibility to healthcare resources, and the psychological integration of rural older migrants. Accessibility to healthcare resources plays a mediating role in the impact of hukou conversion on psychological integration. These findings hold important implications for improving the psychological integration level of rural older migrants and promoting social harmony and stability.

Hukou conversion has a crucial impact on the social adaptability and psychological well-being of rural older migrants, underscoring its significance in fostering their psychological integration. It is imperative to strengthen the implementation of hukou reform policies, establish a unified hukou system between urban and rural areas, and provide equalized public services and welfare. Policymakers should focus on enhancing the healthcare rights protection system for rural older migrants, improving the accessibility of healthcare resources. Efforts should be made to ensure that older migrants in destination areas enjoy the same benefits as local residents, thereby promoting deeper psychological integration among rural older migrants.

Data availability

The datasets generated and/or analysed during the current study are available in the CMDS repository, https://www.chinaldrk.org.cn/wjw/#/data/classify/population/yearList. The webpage requires registration to access the data. You can register an account yourself and download the data through public channels. Alternatively, you can directly contact the author Tianxin Cai (51254403013@stu.ecnu.edu.cn), and we would be happy to provide you with the original data for academic exchange.

References

  1. Zhong R, Sun X. Types of rural older migrants and their influencing factors: a study based on the cognitive-behavioral dual-dimensional framework. J Northeastern Univ (Soc Sci). 2022;24(1):70–8. https://doi.org/10.15936/j.cnki.1008-3758.2022.01.009

    Article  Google Scholar 

  2. National Health Commission of the People’s Republic of China. Report on China’s migrant population development. 2018. http://www.nhc.gov.cn/wjw/xwdt/201812/a32a43b225a740c4bff8f2168b0e9688.shtml. Accessed 12 Dec 2023.

  3. Litwak E, Longino CF. Jr. Migration patterns among the elderly: a developmental perspective. Gerontologist. 1987;27(3):266–72. https://doi.org/10.1093/geront/27.3.266

    Article  CAS  PubMed  Google Scholar 

  4. Chen Z, Liu K. Assimilation of China’s rural-to-urban migrants: a multidimensional process. Chin J Sociol. 2018;4(2):188–217. https://doi.org/10.1177/2057150X18764232

    Article  Google Scholar 

  5. Yang W, Li D, Gao J, Zhou X, Li F. Decomposing differences in depressive symptoms between older rural-to-urban migrant workers and their counterparts in mainland China. BMC Public Health. 2020;20(1):1442. https://doi.org/10.1186/s12889-020-09374-1

    Article  PubMed  PubMed Central  Google Scholar 

  6. Cheng Y, Rosenberg M, Winterton R, Blackberry I, Gao S. Mobilities of older Chinese rural-urban migrants: a case study in Beijing. Int J Environ Res Public Health. 2019;16(3):488. https://doi.org/10.3390/ijerph16030488

    Article  PubMed  PubMed Central  Google Scholar 

  7. Yang G, Zhou C, Jin W. Integration of migrant workers: differentiation among three rural migrant enclaves in Shenzhen. Cities. 2020;96:102453. https://doi.org/10.1016/j.cities.2019.102453

    Article  Google Scholar 

  8. Yang L, Wu Q. Group differences in the psychological integration path of the rural-to-urban migrants: a conditional process analysis. Int J Environ Res Public Health. 2021;18(21):11463. https://doi.org/10.3390/ijerph182111463

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lin S, Wu F, Li Z. Social integration of migrants across Chinese neighbourhoods. Geoforum. 2020;112:118–28. https://doi.org/10.1016/j.geoforum.2020.04.008

    Article  Google Scholar 

  10. Sam DL. Psychological adaptation of adolescents with immigrant backgrounds. J Soc Psychol. 2000;140(1):5–25. https://doi.org/10.1080/00224540009600442

    Article  CAS  PubMed  Google Scholar 

  11. Lin Y, Zhang Q, Chen W, Shi J, Han S, Song X, et al. Association between social integration and health among internal migrants in Zhongshan, China. PLoS ONE. 2016;11(2):e0148397. https://doi.org/10.1371/journal.pone.0148397

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Chiang Y-C, Chu M, Zhao Y, Li X, Li A, Lee C-Y, et al. Influence of subjective/objective status and possible pathways of young migrants’ life satisfaction and psychological distress in China. Front Psychol. 2021;12. https://doi.org/10.3389/fpsyg.2021.612317

  13. Froehlich L, Brokjøb LG, Nikitin J, Martiny SE. Integration or isolation: social identity threat relates to immigrant students’ sense of belonging and social approach motivation in the academic context. J Soc Issues. 2023;79(1):264–90. https://doi.org/10.1111/josi.12548

    Article  Google Scholar 

  14. Afridi F, Li SX, Ren Y. Social identity and inequality: the impact of China’s hukou system. J Public Econ. 2015;123:17–29. https://doi.org/10.1016/j.jpubeco.2014.12.011

    Article  Google Scholar 

  15. Long C, Han J, Guo B. Transcending hukou barriers effectively unleashes the income-raising effect of education: based on an agricultural to non-agricultural hukou conversion perspective. Soc Sci China. 2023;44(3):153–80. https://doi.org/10.1080/02529203.2023.2254115

    Article  Google Scholar 

  16. Guo J, Guan L, Fang L, Liu C, Fu M, He H, et al. Depression among Chinese older adults: a perspective from hukou and health inequities. J Affect Disord. 2017;223:115–20. https://doi.org/10.1016/j.jad.2017.07.032

    Article  PubMed  Google Scholar 

  17. Peng X. The household registration system reform and social integration of the migrant population. In: Peng X, editor. Household Registration System Reform in China’s megacities. Singapore: Springer Nature Singapore; 2023. pp. 135–75.

    Chapter  Google Scholar 

  18. Li T, Ren Y. The reform of hukou system in Chinese cities and the social inclusion of floating population. S China Popul. 2011;26(3):17–24.

    Google Scholar 

  19. The State Council of the People’s Republic of China. The opinions of the state council on further promoting hukou system reform. 2014. https://www.gov.cn/zhengce/content/2014-07/30/content_8944.htm. Accessed 15 Dec 2023.

  20. Wu Q. Social stratification and housing inequality in transitional urban China. Contemp Soc Sci. 2021;16(3):384–99. https://doi.org/10.1080/21582041.2020.1797148

    Article  Google Scholar 

  21. Vortherms SA, Liu GG. Hukou as benefits: demand for hukou and wages in China. Urban Stud. 2022;59(15):3167–83. https://doi.org/10.1177/00420980221074911

    Article  Google Scholar 

  22. Song Q, Smith JP. Hukou system, mechanisms, and health stratification across the life course in rural and urban China. Health Place. 2019;58:102150. https://doi.org/10.1016/j.healthplace.2019.102150

    Article  PubMed  PubMed Central  Google Scholar 

  23. Bengoa M, Rick C. Chinese hukou policy and rural-to-urban migrants’ health: evidence from matching methods. East Econ J. 2020;46(2):224–59. https://doi.org/10.1057/s41302-019-00158-z

    Article  Google Scholar 

  24. Song Q, Smith JP. The citizenship advantage in psychological well-being: an examination of the hukou system in China. Demography. 2021;58(1):165–89. https://doi.org/10.1215/00703370-8913024

    Article  PubMed  Google Scholar 

  25. Liu H, Hai L, Zhao M, Wang H. Does maintaining high accessibility to medical care services increase psychological well-being of Chinese older adults? Health Soc Care Community. 2024;2024:3011392. https://doi.org/10.1155/2024/3011392

    Article  Google Scholar 

  26. Zhao Q, Wu G, Wang H. Effect of health rights accessibility on the urban integration of minority rural migrants in China: a cross-sectional study. BMC Public Health. 2024;24(1):761. https://doi.org/10.1186/s12889-024-18294-3

    Article  PubMed  PubMed Central  Google Scholar 

  27. Jaul E, Barron J. Characterizing the heterogeneity of aging: a vision for a staging system for aging. Front Public Health. 2021;9. https://doi.org/10.3389/fpubh.2021.513557

  28. Que J, Gong Y, Zhao G. How does residential integration affect the psychological integration? Comparison between migrants and locals. Beijing Da Xue Xue Bao Zi Ran Ke Xue Bao. 2022;58(5):897–908. https://doi.org/10.13209/j.0479-8023.2022.054

    Article  Google Scholar 

  29. Ruiz-Tagle J. A theory of socio-spatial integration: problems, policies and concepts from a us perspective. Int J Urban Reg Res. 2013;37(2):388–408. https://doi.org/10.1111/j.1468-2427.2012.01180.x

    Article  Google Scholar 

  30. Chen Y, Huang F, Zhou Q. Equality of public health service and family doctor contract service utilisation among migrants in China. Soc Sci Med. 2023;333:116148. https://doi.org/10.1016/j.socscimed.2023.116148

    Article  PubMed  Google Scholar 

  31. Xie Y, Zhao X. The impact of hukou transition on accessibility of the health rights of the rural migrants. China Labor. 2021;321–37. https://doi.org/10.19390/j.cnki.chinalabor.2021.03.002

  32. Ni C, Wang Z. The impact of internet use on social isolation in older adults. Popul J. 2022;44(3):59–72. https://doi.org/10.16405/j.cnki.1004-129X.2022.03.005

    Article  Google Scholar 

  33. Zhou D, Liu Y, Lu X. How conversion of non-agricultural household registration affects consumption gap of migrant workers: empirical evidence from CMDS. Finance Trade Res. 2022;33(10):33–44. https://doi.org/10.19337/j.cnki.34-1093/f.2022.10.003

    Article  Google Scholar 

  34. Zou J, Deng X. Spatial differentiation and driving forces of migrants’ socio-economic integration in urban China: evidence from CMDS. Soc Indic Res. 2022;159(3):1035–56. https://doi.org/10.1007/s11205-021-02785-6

    Article  Google Scholar 

  35. Zou J, Deng X. To inhibit or to promote: how does the digital economy affect urban migrant integration in China? Technol Forecast Soc Change. 2022;179:121647. https://doi.org/10.1016/j.techfore.2022.121647

    Article  Google Scholar 

  36. Wang J, Ai S, Huang M. Migration history, hukou status, and urban household consumption. Econ Model. 2021;97:437–48. https://doi.org/10.1016/j.econmod.2020.04.012

    Article  Google Scholar 

  37. Wang WW, Fan CC. Migrant workers’ integration in urban China: experiences in employment, social adaptation, and self-identity. Eurasian Geogr Econ. 2012;53(6):731–49. https://doi.org/10.2747/1539-7216.53.6.731

    Article  Google Scholar 

  38. Lim SS. Migration decisions under ambiguity: migration distance effects revisited. Rev Dev Econ. 2019;23(4):1520–39. https://doi.org/10.1111/rode.12623

    Article  Google Scholar 

  39. Dong X, Liang Y, Zhang J. Fertility responses to the relaxation of migration restrictions: evidence from the hukou reform in China. China Econ Rev. 2023;81:102040. https://doi.org/10.1016/j.chieco.2023.102040

    Article  Google Scholar 

  40. Zhu J, Zhu M, Xiao Y. Urbanization for rural development: spatial paradigm shifts toward inclusive urban-rural integrated development in China. J Rural Stud. 2019;71:94–103. https://doi.org/10.1016/j.jrurstud.2019.08.009

    Article  Google Scholar 

  41. Zhang Z, Treiman DJ. Social origins, hukou conversion, and the wellbeing of urban residents in contemporary China. Soc Sci Res. 2013;42(1):71–89. https://doi.org/10.1016/j.ssresearch.2012.08.004

    Article  CAS  PubMed  Google Scholar 

  42. Treiman DJ. The difference between heaven and earth: urban–rural disparities in well-being in China. Res Soc Stratif Mobil. 2012;30(1):33–47. https://doi.org/10.1016/j.rssm.2011.10.001

    Article  Google Scholar 

  43. Liu Z. Institution and inequality: the hukou system in China. J Comp Econ. 2005;33(1):133–57. https://doi.org/10.1016/j.jce.2004.11.001

    Article  CAS  Google Scholar 

  44. Wing Chan K, Buckingham W. Is China abolishing the hukou system? China Q. 2008;195:582–606. https://doi.org/10.1017/S0305741008000787

    Article  Google Scholar 

  45. Gabster A, Jhangimal M, Erausquin JT, Suárez JA, Pinzón-Espinosa J, Baird M, et al. Rapid health evaluation in migrant peoples in transit through Darien, Panama: protocol for a multimethod qualitative and quantitative study. Ther Adv Infect Dis. 2021;8. https://doi.org/10.1177/20499361211066190

  46. Qin L, Chen C-P, Wang W, Chen H. How migrants get integrated in urban China – the impact of health insurance. Soc Sci Med. 2021;272:113700. https://doi.org/10.1016/j.socscimed.2021.113700

    Article  PubMed  Google Scholar 

  47. Wang L, Chao J, Wu Y, Zhang N, Bao M. Social integration and utilization of national basic public health services among China’s internal migrants with chronic diseases: a structural equation modelling approach. Heliyon. 2024;10(3):e25797. https://doi.org/10.1016/j.heliyon.2024.e25797

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Associate Professor Liwen Chen from East China Normal University and Dr. Peng Gao from Gansu Political Science and Law University for their suggestions on the manuscript.

Funding

Major Project of National Social Science Fund of China: Strategic Research on Urban-Rural Coordination and Regional Coordinated Development of Social Pension Service Systems in Responding Positively to Population Aging” (Project Number: 21AZD076).

Author information

Authors and Affiliations

  1. School of Public Administration, East China Normal University, 3663 North Zhongshan Road, Putuo District, Shanghai, China

    Tianxin Cai & Renyao Zhong

  2. School of Public Administration and Emergency Management, Jinan University, Guangzhou, China

    Shilong Ma

  3. Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China

    Vivian W. Q. Lou

Authors
  1. Tianxin Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shilong Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Renyao Zhong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vivian W. Q. Lou
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Cai contributed to the conceptualization of the paper and the overall design of the research framework, and was the primary contributor to manuscript writing. Ma analyzed and interpreted the data, and organized the current state of research. Zhong supervised the quality of the manuscript and provided final approval, and was also the funding recipient. Lou supervised the revision of the paper, aiding in enhancing its logic and structure.

Corresponding author

Correspondence to Renyao Zhong.

Ethics declarations

Ethics approval and consent to participate

The “China Migrants Dynamic Survey” data is publicly available to authorized researchers who have been given permission by the Migrant Population Service Center, and writtern informed consents were obtained from all participants. The analysis of public access data was exempted by Research Ethics Committee of East China Normal University, as this involved analyzing de-identified existing data, ethical approval was not required. All methods were carried out in accordance with relevant guidelines and regulations.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cai, T., Ma, S., Zhong, R. et al. Relationship between hukou conversion and psychological integration of rural older migrants: the mediating effect of accessibility to health resources. BMC Geriatr 24, 490 (2024). https://doi.org/10.1186/s12877-024-05110-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12877-024-05110-1

Keywords

BMC Geriatrics

ISSN: 1471-2318

Contact us