Leisure activity patterns and health vulnerability among older adults in China: a nationwide analysis of urban-rural differences based on CHARLS data

Leisure activity patterns and health vulnerability among older adults in China: a nationwide analysis of urban-rural differences based on CHARLS data | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Leisure activity patterns and health vulnerability among older adults in China: a nationwide analysis of urban-rural differences based on CHARLS data Feifei Yin, Jieting Chen, Xiaoge Fan, Xiangwei Wu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7158419/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 31 Jan, 2026 Read the published version in BMC Geriatrics → Version 1 posted 12 You are reading this latest preprint version Abstract Background With the deepening of global aging, health vulnerability has become a key indicator of multidimensional health risks in older adults. Existing studies have explored factors influencing health vulnerability but lack systematic analysis of the mechanisms and population heterogeneity of leisure patterns, especially in the context of China’s urban-rural dual structure. This study aimed to investigate the impact of different leisure patterns on health vulnerability among older adults and examine the role of urban-rural differences, educational level, and life satisfaction in moderating these relationships. Methods Data were derived from the 2018 China Health and Retirement Longitudinal Study (CHARLS), including 5,778 older adults aged ≥ 60 years. Systematic cluster analysis was used to classify leisure patterns. Ordered Probit models were applied to assess the effects of leisure patterns on health vulnerability, and stratified regression analyses were conducted to explore population heterogeneity. Results Three distinct leisure patterns were identified: entertainment-oriented (50.23%), social-oriented (41.15%), and beneficial-improvement-oriented (8.62%). Compared with the social-oriented pattern, both entertainment-oriented (β=-0.109, P < 0.01) and beneficial-improvement-oriented (β=-0.185, P < 0.01) patterns significantly reduced health vulnerability, with robust results confirmed by model replacement and variable adjustment. Heterogeneity analyses revealed: (1) In urban and peri-urban areas, entertainment-oriented (β=-0.320, P < 0.01) and beneficial-improvement-oriented (β=-0.319, P < 0.01) patterns reduced vulnerability, whereas in rural areas, these patterns increased vulnerability (β = 0.317, 0.319; both P < 0.01). (2) Among individuals with middle school education or higher, both patterns reduced vulnerability (β=-0.074, -0.074; both P < 0.05), but among illiterate individuals, they increased vulnerability (β = 0.122, 0.121; P < 0.01, P < 0.05). (3) Life satisfaction showed a U-shaped moderating effect: the protective effect was strongest in the high-satisfaction group (β=-0.232, P < 0.01), but reversed to increase risk in the low-satisfaction group (β = 0.199, P < 0.05). Conclusion Participation in entertainment-oriented and beneficial-improvement-oriented leisure activities can reduce health vulnerability among older adults. However, attention should be paid to the moderating roles of urban-rural resource disparities, educational level, and life satisfaction to develop targeted interventions. leisure patterns health vulnerability systematic clustering ordered Probit model older adults Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 31 Jan, 2026 Read the published version in BMC Geriatrics → Version 1 posted Editorial decision: Revision requested 06 Nov, 2025 Reviews received at journal 28 Oct, 2025 Reviews received at journal 30 Sep, 2025 Reviews received at journal 29 Sep, 2025 Reviewers agreed at journal 29 Sep, 2025 Reviewers agreed at journal 28 Sep, 2025 Reviewers agreed at journal 09 Sep, 2025 Reviewers invited by journal 08 Sep, 2025 Editor invited by journal 19 Aug, 2025 Editor assigned by journal 04 Aug, 2025 Submission checks completed at journal 01 Aug, 2025 First submitted to journal 01 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7158419","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":513280845,"identity":"5246b832-5c88-4cd8-b740-d7cbdce83651","order_by":0,"name":"Feifei Yin","email":"","orcid":"","institution":"Shihezi University","correspondingAuthor":false,"prefix":"","firstName":"Feifei","middleName":"","lastName":"Yin","suffix":""},{"id":513280846,"identity":"c7215f2f-5e30-4907-b9a5-02955b7ddd83","order_by":1,"name":"Jieting Chen","email":"","orcid":"","institution":"Shihezi University","correspondingAuthor":false,"prefix":"","firstName":"Jieting","middleName":"","lastName":"Chen","suffix":""},{"id":513280847,"identity":"8e36adbd-5591-4510-926b-90d1780cfaaf","order_by":2,"name":"Xiaoge Fan","email":"","orcid":"","institution":"Shihezi University","correspondingAuthor":false,"prefix":"","firstName":"Xiaoge","middleName":"","lastName":"Fan","suffix":""},{"id":513280849,"identity":"c7ef6d4e-e0c4-4334-a35f-58d5961168d7","order_by":3,"name":"Xiangwei Wu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAArElEQVRIiWNgGAWjYJACZgYGGx5+9gbStKTJSPYcIE3LYRuDGw5EKje4kWP8ueDPeR6GGwyMHz7mEKPlzBkz6Rk8t3kYZzcwS87cRoQWs+O925h5JG7zMMscYGPmJUrLYd7Nn3kMzvGwSSQQq+V47wZpnoQDPDxEa7E/c/6bNM+BZB4JnoPNxPlFckZa8meeP3b29sebD374SIwWJMDYQJr6UTAKRsEoGAW4AQBpZDJ0ABhuBwAAAABJRU5ErkJggg==","orcid":"","institution":"Shihezi University","correspondingAuthor":true,"prefix":"","firstName":"Xiangwei","middleName":"","lastName":"Wu","suffix":""}],"badges":[],"createdAt":"2025-07-18 14:08:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7158419/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7158419/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12877-026-07056-y","type":"published","date":"2026-01-31T15:58:16+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":101690489,"identity":"6342ed54-d465-404d-877b-1dcd6c3dfe4c","added_by":"auto","created_at":"2026-02-02 16:03:55","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":450713,"visible":true,"origin":"","legend":"","description":"","filename":"2LeisureActivityPatternsandHealthVulnerabilityamongOlderAdultsinChinaANationwideAnalysisofUrbanRuralDifferencesBasedonCHARLSData.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7158419/v1_covered_a034f933-e4ac-461c-9f19-464e3bbce515.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eLeisure activity patterns and health vulnerability among older adults in China: a nationwide analysis of urban-rural differences based on CHARLS data\u003c/strong\u003e\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"leisure patterns, health vulnerability, systematic clustering, ordered Probit model, older adults","lastPublishedDoi":"10.21203/rs.3.rs-7158419/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7158419/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eWith the deepening of global aging, health vulnerability has become a key indicator of multidimensional health risks in older adults. Existing studies have explored factors influencing health vulnerability but lack systematic analysis of the mechanisms and population heterogeneity of leisure patterns, especially in the context of China\u0026rsquo;s urban-rural dual structure. This study aimed to investigate the impact of different leisure patterns on health vulnerability among older adults and examine the role of urban-rural differences, educational level, and life satisfaction in moderating these relationships.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eData were derived from the 2018 China Health and Retirement Longitudinal Study (CHARLS), including 5,778 older adults aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years. Systematic cluster analysis was used to classify leisure patterns. Ordered Probit models were applied to assess the effects of leisure patterns on health vulnerability, and stratified regression analyses were conducted to explore population heterogeneity.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThree distinct leisure patterns were identified: entertainment-oriented (50.23%), social-oriented (41.15%), and beneficial-improvement-oriented (8.62%). Compared with the social-oriented pattern, both entertainment-oriented (β=-0.109, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and beneficial-improvement-oriented (β=-0.185, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) patterns significantly reduced health vulnerability, with robust results confirmed by model replacement and variable adjustment. Heterogeneity analyses revealed: (1) In urban and peri-urban areas, entertainment-oriented (β=-0.320, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and beneficial-improvement-oriented (β=-0.319, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) patterns reduced vulnerability, whereas in rural areas, these patterns increased vulnerability (β\u0026thinsp;=\u0026thinsp;0.317, 0.319; both P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). (2) Among individuals with middle school education or higher, both patterns reduced vulnerability (β=-0.074, -0.074; both P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), but among illiterate individuals, they increased vulnerability (β\u0026thinsp;=\u0026thinsp;0.122, 0.121; P\u0026thinsp;\u0026lt;\u0026thinsp;0.01, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). (3) Life satisfaction showed a U-shaped moderating effect: the protective effect was strongest in the high-satisfaction group (β=-0.232, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), but reversed to increase risk in the low-satisfaction group (β\u0026thinsp;=\u0026thinsp;0.199, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eParticipation in entertainment-oriented and beneficial-improvement-oriented leisure activities can reduce health vulnerability among older adults. However, attention should be paid to the moderating roles of urban-rural resource disparities, educational level, and life satisfaction to develop targeted interventions.\u003c/p\u003e","manuscriptTitle":"Leisure activity patterns and health vulnerability among older adults in China: a nationwide analysis of urban-rural differences based on CHARLS data","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-12 23:03:59","doi":"10.21203/rs.3.rs-7158419/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-06T08:23:47+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-28T04:42:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-01T01:38:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-30T02:48:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"246750520887966878462712916012312522450","date":"2025-09-30T01:51:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"267966475477617682007229919452066604813","date":"2025-09-28T07:55:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"243308447140204165700547744185031822184","date":"2025-09-09T13:24:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-08T06:05:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-19T12:59:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-04T11:31:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-01T04:37:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-08-01T04:20:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f5b667b8-8234-48a5-b958-601b6ef75475","owner":[],"postedDate":"September 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-02T16:01:14+00:00","versionOfRecord":{"articleIdentity":"rs-7158419","link":"https://doi.org/10.1186/s12877-026-07056-y","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2026-01-31 15:58:16","publishedOnDateReadable":"January 31st, 2026"},"versionCreatedAt":"2025-09-12 23:03:59","video":"","vorDoi":"10.1186/s12877-026-07056-y","vorDoiUrl":"https://doi.org/10.1186/s12877-026-07056-y","workflowStages":[]},"version":"v1","identity":"rs-7158419","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7158419","identity":"rs-7158419","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}