Social Indicators Research (2023) 165:163–180

https://doi.org/10.1007/s11205-022-03008-2

ORIGINAL RESEARCH

Income and Health in Predicting Older Adults’ Social

Capabilities in China: The Mediating Role of Social
Engagement

Yalu Zhang1   · Qin Gao2   · Fuhua Zhai3   · Paul Anand4 

Accepted: 23 September 2022 / Published online: 6 October 2022

© The Author(s), under exclusive licence to Springer Nature B.V. 2022

Abstract
Despite an established positive link among income, health, and social capabilities among
older adults, the relationship mechanisms of these factors are understudied. Using the
WHO Study on Global Ageing and Adult Health data and a capabilities approach, this
paper provides new evidence on the effects of income (measured by total household
income) and health (measured by physical and cognitive functioning) on the social capa-
bilities of older adults (aged 55 or older) in China and the possible mediating role of social
engagement in this relationship. Findings from the study show that both income and health
showed consistent and positive effects on social capabilities of older adults in China, and
the effects varied between rural and urban older adults. The mediation analysis results show
that social engagement accounted for a substantial proportion of the effects of income and
health on social capabilities, but income and health still had strong, positive direct effects
of their own. In particular, social engagement was found to play important mediating roles
in the associations between physical and cognitive functioning and the social capabili-
ties of freedom of expression (9.46%) and the sense of safety (36.33%) among rural older
adults. Findings from this study highlight the need for more social policies and services to
enhance older adults’ social engagement, income, and health conditions.

Keywords  Financial resources · Physical functioning · Cognitive functioning · Social

capability approach · Mediation analysis

* Yalu Zhang
yalu.zhang@pku.edu.cn
1
Institute of Population Research, Peking University, No. 5 YiHeYuan Road, Beijing 100871, China
2
School of Social Work, Columbia University, New York, USA
3
Graduate School of Social Service, Fordham University, New York, USA
4
Faculty of Arts and Social Sciences, The Open University, Milton Keynes, UK

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 164 Y. Zhang et al.

1 Introduction

The importance of research on older adults’ wellbeing and quality of life has long
been recognized. In recent years, the concept of successful aging frames "the better
than average" aging process as compressing illness and disability, maintaining high
levels of physical and cognitive function, and continuing to participate in social and
productive activities (Rowe & Kahn, 1987, 1997). Considerably promoted by geron-
tologists and policymakers, successful aging is regarded as a response to the call in
the current aging society for older adults to extend their contributions to human capi-
tal by improving their health status and maintaining social participation. Neverthe-
less, the idea of successful aging has been criticized for discriminating against and
oppressing older adults who do not possess good health and ideal physical function-
ing, and it shifts the responsibility of improving health from society to individuals
(Stephens, 2016; Stowe & Cooney, 2015).
As an alternative, the capability approach has been extensively used in fields such
as human development, public economics, and social policy to study people’s well-
being in recent years. This approach was first proposed by Amartya Sen (1993) and
Martha Nussbaum (1987) and further developed by others (e.g., Anand et al., 2009). It
provides a different perspective for studying how income and health might be related
to individuals’ capacities for accessing and utilizing resources.
In this study, we apply the capability approach to investigate the relationship
mechanisms among income, health, and capabilities related to social functioning
among rural and urban older adults in China. In particular, this paper answers the
following three research questions. First, what is the status of social capabilities, as
measured by interpersonal relationships, freedom of expression, and sense of living
safety of rural and urban older adults in China? Second, what is the effect of income
(as measured by financial resources) and health (as measured by physical and cogni-
tive functioning) on social capabilities among rural and urban older adults in China?
Third, does social engagement play a mediating role in the relationships of financial
resources and physical and cognitive functioning with social capabilities in rural and
urban areas? This paper, to our knowledge, is the first to examine the mediating effect
of social engagement on the relationships between income, health, and social capa-
bilities among older adults in China. It adds additional value to this field by making
comparisons between rural and urban older adults and the relationship mechanisms
across the rural–urban divide.
This study made three major contributions. First, it explored the status of social
capabilities of Chinese older adults using the capability approach. Second, it exam-
ined the mediating role of social engagement on the associations between income
and health and social capabilities. Third, this paper extended the literature by making
comparisons between rural and urban older adults regarding their functioning, social
capabilities, and the mediated effect of social engagement to inform future policy
development and program implementation related to urban–rural disparities.

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Income and Health in Predicting Older Adults’ Social Capabilities… 165

2 Literature Review

2.1 A Social Capability Approach

Social capability is defined by the moral relevance of people’s ability to live the kinds
of lives they value. More specifically, it contains the availability of means to the desired
life and subjective wellbeing. Compared to other human development theories, the
social capability approach is more flexible and encompassing. As a conceptual frame-
work, it emphasizes individuals’ functioning, freedom, and opportunities to realize
their potentials and thus goes beyond measures based on income and spending alone.
The conceptualization and assessment of functioning and capabilities vary across time
and scholars. For example, Sen (1993) and Nussbaum (1987) assessed individual capa-
bilities by focusing on the range of potential paths an individual can choose to real-
ize functioning in life. Anderson (1999) held that the assessment of capabilities should
concentrate on only essential functioning as a citizen. Drydyk (2012) argued that the
assessment should focus on reducing the shortfalls of capabilities instead.
The components of capabilities have also varied across studies. In general, the elements
focus on people’s choices and freedoms rather than achievements, which are generally cat-
egorized into beings and doings (Robeyns, 2005). Beings are living status, including hous-
ing conditions, having an accessible and loving relationship with others, social network,
nourishment, and others. Doings are activities, including traveling, caregiving, health-seek-
ing behaviors, and others.
In this paper, guided by prior studies (Clavin, 2011; Mitra, 2006) and based on what
measures available in the data, social capabilities are measured by three components—per-
sonal relationship (being), freedom of expression (doing), and sense of safety (being). More
specifically, social capabilities in this study are defined as a person’s freedom or opportuni-
ties to be part of a positive personal relationship with friends, strangers, and neighbors; to
be able to express opinions freely without fear; and to live in a safe community.

2.2 Existing Evidence on Social Capabilities Among Older Adults

Studies have applied the capability approach to examine the wellbeing of older adults quan-
titatively or qualitatively. A set of studies have focused on western developed countries.
For example, Nordbakke (2013) found that in Norway, urban older women’s capabilities
to choose the time and location of their daily activities and travels were influenced by their
opportunities for mobility. Grewal et al. (2006) found that older adults’ quality of life in the
United Kingdom was limited by a wide set of capabilities of being independent rather than
just by poor health conditions alone. Yeung and Breheny (2016) used a structural equa-
tion modeling method to examine the causality and potential paths among commodities,
capabilities, and wellbeing of older adults in New Zealand. They found that worse health
conditions did not always cause worse wellbeing, because causality could be altered by the
effects of capabilities.
Based on the importance of social capabilities found by the prior studies, this paper
takes a further step to investigate the potential effect of health and financial resources on
older adults’ capabilities and the mechanism which could improve the social capabilities of
older adults with poor health conditions or lower level of income. The application of Sen’s
capability approach in China has mainly occurred in the field of innovative technology

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 166 Y. Zhang et al.

devices, which enable users to realize remote health care services (Zheng et  al., 2008).
In social science studies, Sen’s capability approach has been applied in the fields of hous-
ing (Li et al., 2013), education (Wang, 2011), and gender inequality (Li, 1995). Neverthe-
less, Chinese older adults’ wellbeing, functioning, and capabilities have rarely been studied
using Sen’s capability approach.

2.3 Income in Predicting Social Capabilities

The associations between financial resources and interpersonal relationship or sense of liv-
ing safety have been widely studied, but seldom explored its relationship with freedom of
expression. Millns and Wong (2017) systematically examined how debt, income, and asset
ownership affect close interpersonal relationship such as between couples and among intra-
household family members in several European countries. They found that wealth mat-
tered in maintaining personal relationships within families especially by reducing gender
inequalities.
In terms of the studies focusing on the associations between income and the sense of
safety, Collins and Guidry (2018) found that relatively higher or lower income is associ-
ated with a lower sense of environmental safety. In China, one study has examined the
associations between wealth indicators and the sense of safety (Song et al., 2020). It found
that African migrants in Guangzhou and Foshan with higher income satisfaction are more
likely to have higher personal safety perceptions in China significantly.

2.4 Health in Predicting Social Capabilities

Findings regarding the associations between functioning and domains of social capabilities
are mixed. Zunzunegui et al. (2005) found that a lower level of activities of daily living was
associated with a better family relationship in Spain, Netherlands, and Finland. However,
in terms of the sense of security, Cramm and Nieboer (2013) found that community-dwell-
ing older adults with lower levels of frailty were more likely to have more sense of security
in Rotterdam. The association between physical functioning and freedom of expression is
still missing in the existing literature.
The association between cognitive functioning and the sense of safety is not as con-
sistent as other associations indicated above. Adults with cognitive impairment reported a
mixed sense of safety with different experience. Instead, the sense of safety or vulnerability
largely depended on community accommodations (Walker, 1999). No study has explored
the association between cognitive functioning and freedom of expression.

2.5 Wealth and Health in Predicting Social Engagement

The predicting roles of income and health on social engagement vary across cultures and
populations. In China, Xu (2007) found that lower-income families were more likely to
have a higher preference for community participation in urban Beijing. In contrast, Plum-
mer and Taylor (2004) found that the poorest and the most vulnerable households in
rural China are least likely to have social participation. Beyond China, people with cer-
tain physical activity limitations, such as poststroke, chronic kidney diseases, and Parkin-
son’s disease, are more likely to have lower social engagement (Foster et al., 2013; Mayo
et al., 2002; Seidel et al., 2014). However, wheelchair usage could be a protective factor

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between this negative association (Barker et al., 2006). Similarly, people with schizophre-
nia or dementia are also found to have lower levels of social participation (Beaglehole
et al., 2008; Stubbs et al., 2014). Better cognitive functioning is found to be associated with
higher frequency and intensity of social engagement is associated (Ellwardt et al., 2015).

2.6 Associations Between Social Engagement and Social Capabilities

The understanding of how social engagement affects social capabilities is more extensive
than the existing literature of other associations which were reviewed above. The domains
of social engagement include social networks and social activity participation (Park et al.,
2013). The forms of social engagement range from virtual programs to actual communities
specially designed for older adults. Zhu and Stephens (2019) found that participating in
online support activities is strongly associated with interpersonal bonds with other partici-
pants among women with breast cancer concerns. Greenfield and Franfz (2016) found that
the older adults living in seven Naturally Occurring Retirement communities developed the
better interpersonal relationship and social networks by engaging in community activities.
A similar positive association between social participation and the interpersonal relation-
ship has also been found among older adults with vision impairment (Alma et al., 2012)
and older adults living in nursing homes (Drageset, 2004).
The associations between social engagement and a sense of safety vary by population
and regions. A qualitative study in Albert, Canada, revealed that older adults enhanced
their feelings of security if connected to other tenants through social engagement when
relocating to institutions (Betancourt et al., 2005; Dupuis-Blanchard et al., 2009). De Don-
der et al. (2012) found that more neighborhood involvement was associated with a higher
sense of unsafety among people aged 60 and above in Belgium. However, no significant
association was found between social participation and a sense of safety among residents in
Oklahoma City (Baba & Austin, 1989).

2.7 Potential Mediating Role of Social Engagement

According to the available research and taking into account human and social dynamics,
under the Theory of Change framework, the associations between health or wealth and
social capabilities may have two pathways. One is that lower functioning or socioeconomic
status is associated with lower social capabilities (Cramm & Nieboer, 2013; Millns &
Wong, 2017; Song et al., 2020). The other is that a higher level of social engagement could
improve the beings of people with lower functioning (Alma et al., 2012). Different routes
indicate possible variations in the outcome of social capabilities (Connell & Kubisch,
1998). Social engagement may play an essential mediating role in the relationship between
income, health, and social capabilities of older adults. Despite no direct exploration of this
role in the literature, existing studies have established that income and health could influ-
ence social engagement, which in turn could impact social capabilities.
The mediating effects of social engagement were examined in multiple disciplines and
associations. Collins and Guidry (2018) detected the mediating role of social engagement
in the associations between income inequality and residents’ sense of safety in the United
States. Social engagement was also found to be a mediator in the association between
socioeconomic status and physical and mental health among Chinese older adults (Zhang
et al., 2022). Fu et al. (2018) found that social engagement performed as a mediator in the
relationship between psychological wellbeing and self-efficacy of nursing home residents

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 168 Y. Zhang et al.

among Chinese older adults. Park et al. (2021) detected that social engagement and physi-
cal activity are mediating pathways to connect urinary incontinence and psychological
wellbeing, including depressive symptoms. However, none of the studies have tested if
social engagement is a mediator in the effect of functioning on social capabilities, nor the
effect of income on social capabilities.

2.8 The Hypothesis of the Current Study

In summary, literature regarding the associations between income/health and freedom of

expression is minimal. Among the studies which tested associations between income/health
and social capabilities, very few focused on Chinese older adults and even rare explored
the disparities between rural and urban older adults in China. This paper extends this body
of existing literature by considering financial resources, social engagement, physical and
cognitive functioning, and social capability in one framework. We hypothesized that higher
levels of financial resources, physical functioning, and cognitive functioning would all
have predictive significant effects on better social capabilities among older adults in China.
The positive relationships are hypothesized to be with no difference between the rural and
urban older adults. We also hypothesized that social engagement plays a mediating role in
these associations for both rural and urban older adults.

3 Methods

3.1 Data

This study uses the World Health Organization Study on Global Aging and Adult Health
(WHO-SAGE) data which surveyed six developing countries: Ghana, India, Mexico, Rus-
sia, South Arica, and China. In China, data were collected between 2007 and 2010 from
10,218 households with 15,066 adults randomly selected in eight provinces (one munici-
pality and two central, two western, and three eastern provinces) through multistage cluster
sampling procedures. Consistent with prior gerontological studies in China, we excluded
4522 individuals younger than 55 years old. The analytic sample featured 10,544 observa-
tions, including 5270 rural older adults and 5274 urban older adults. Given the very differ-
ent social and policy structures in rural and urban areas, we first run the analyses among
the full sample and then separately for the respective rural and urban areas. The results
from the two areas are contrasted to draw policy implications.

3.2 Measurement

In this study, the outcome measures included three social capabilities: interpersonal rela-
tionships, freedom of expression and a sense of living safety. The social capability of
interpersonal relationships captured respondents’ experiences with interpersonal relation-
ships in the community, including dealing with conflicts with others, making or maintain-
ing friendships, and interacting with strangers in the prior 30  days before the interview.
The capability of freedom of expression indicated how respondents thought they could
express themselves "without fear of government reprisal," ranging from 1 (not free at all)
to 5 (completely free). The last measure of capability, sense of safety, described how safe

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Income and Health in Predicting Older Adults’ Social Capabilities… 169

respondents felt when being alone at home and walking on the street alone after dark. Simi-
larly, the composite score ranged from 1 (not safe at all) to 5 (completely safe).
The mediator, social engagement, following the work of Park et al. (2013) stated ear-
lier, was constructed with two domains—social network and social activity participations.
Respondents were asked how often they attended various types of social activities (public,
personal, organizational, religious, and social events and gatherings). Additionally, partici-
pants also reported the frequency of meetings and visiting with friends, coworkers, neigh-
bors, and families in the prior 12  months (network). Participants who did not complete
more than two of the nine questions (n = 472) were omitted from the analysis. The compos-
ite score of social engagement was scaled as 1 (never), 2 (once or twice per year), 3 (once
or twice per month), 4 (once or twice per week), and 5 (daily).
As previously discussed, we sought to investigate two sets of key explanatory varia-
bles: income and health. Income, or financial resources, was measured as the amount of
self-reported household annual income. In the associational and mediation analyses, we
used the natural logarithm of household annual income to reduce the impact of outliers and
make income more normally distributed. Health was measured in physical and cognitive
functioning. Physical functioning was measured by 22 questions from the WHO Disability
Assessment Schedule-II. The overall score was converted to 1 (extremely difficult) to 5 (no
difficulty). Cognitive functioning was calculated from four memory tests: verbal recall, ver-
bal fluency, forward digit span, and backward digit span. Similarly, the composite score of
cognitive functioning was transformed into five scales (from lowest to highest functioning).
The measurement of all the composite scores described above is shown in Appendix 1.
For the convenience of interpretation, all variables were recoded to reflect the same
direction. As a result, a higher score meant better health, less difficulty in an interper-
sonal relationships, greater trust in others, or a greater sense of safety. For all variables,
the responses of "do not know" or "not applicable" did not exceed 3% and were coded as a
missing value.
A rich array of individual and household sociodemographic characteristics, includ-
ing age, marital status, educational attainment, gender, and religious identity, were con-
trolled for in all regressions. The variable of age was measured by three age groups: 55–64,
65–74, and 75 and above. Marital status included three categories: never married, currently
married or cohabiting, and separated, divorced, or widowed. Educational attainment was
measured by five levels of schooling: illiterate, less than primary school, primary school,
secondary school, and high school and above. A dummy variable of religion (yes or no)
was also included.

3.3 Empirical Strategy: A Mediation Analysis

We used mediation analyses to examine the possible relationship mechanisms among the
independent, dependent, and mediating variables. Baron and Kenny (1986) suggested four
steps in establishing mediation: The first step is to present the correlation between the pre-
dictor and the outcome. The second step is to present the correlation between the predictor
and the mediator. The next step is to present the correlation between the mediator and the
outcome. The final step is to present the reduced or eliminated correlation between the pre-
dictor and the outcome by having the mediator in the analysis. Following these steps, we
first examined whether financial resources, physical functioning, and cognitive function-
ing were associated with social capacities using ordinary least squares (OLS) regressions
(i.e., path c showed in Fig.  1). To test the validity of mediation analyses, we examined

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 170 Y. Zhang et al.

c
Income, physical and Capability indicators
cognitive functions

Social engagement
a b

Income, physical and c'

Capability indicators
cognitive functions

Fig. 1  Notes: Path a represents the association between the potential mediator of social engagement and
the three key explanatory variables including the income, physical and cognitive functions. Path b stands
for the correlation between the potential mediator of social engagement and social capabilities. Path c is the
association between the social capabilities and income, physical function, and cognitive function. Path c′,
however, is the direct effects of income, physical function, and cognitive function on the social capabilities

the associations between the three key explanatory variables and the potential mediator
of social engagement (i.e., path a in Fig. 1) in the second step. In the third step, we tested
the correlation between the potential mediator of social engagement and social capabilities
(i.e., path b in Fig. 1).
To further explore the possible mediating role of social engagement in the associations
of financial resources, physical functioning, and cognitive functioning with social capabili-
ties, we conducted Sobel-Goodman mediation tests with bootstrap replications. The media-
tion analysis not only provided evidence of whether financial resources, physical function-
ing, and cognitive functioning had both direct effects (i.e., path c′ in Fig. 1) and indirect
effects (i.e., either c–c′ or a*b in Fig. 1) on social capabilities among older adults in China,
but also indicated what proportion of the total effects (i.e., path c) were accounted for by
the mediator of social engagement (path (c–c′)/c in Fig. 1). Given that the significant dif-
ference between rural and urban older adults, we conduct the mediation analysis in the full
sample first, followed by rural and urban separate samples.

4 Results

4.1 Descriptive Statistics

Table  1 presents the detailed distributions of social capabilities, income, health, social
engagement, and demographic factors of national, rural, and urban samples respectively.
In the national sample, over 48% were between 55 and 64 years old and less than 19% were
75 years old and above. The majority of respondents (80.36%) were married or cohabiting
when interviewed, and about one in five (18.66%) were separated, divorced, or widowed.
Over 30% of respondents were illiterate (never been to school), and the rest of the sample
were almost evenly distributed across the remaining four categories of educational attain-
ment—less than primary school (18.20%), primary school completed (19.80%), second-
ary school completed (17.06%), and high school or above (14.86%). Consistent with other
aging studies in China, the sample size for male (47.19%) was slightly smaller than for
female. Only 8.46% reported that they had religious identity.

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Income and Health in Predicting Older Adults’ Social Capabilities… 171

Table 1  Descriptive statistics for national, rural, and urban samples

Variable National Rural Urban

(N = 10,544) (n = 5270) (n = 5274)

Mean SD Mean SD Mean SD

Dependent variable
Social capabilities
Personal relationship 4.84 0.45 4.83 0.48 4.86 0.41 ***
Freedom of expression 3.72 0.85 3.75 0.85 3.68 0.84 ***
Sense of living safety 3.79 0.71 3.87 0.74 3.71 0.67 ***
Independent variables
Financial resource
Total income (thousand) 29.5 137.7 14.8 40.5 44.1 189.3 ***
Health
Physical function (ADLs) 4.71 0.46 4.66 0.5 4.75 0.42 ***
Cognitive function 3.05 0.48 2.94 0.45 3.17 0.49 ***
Mediating variable
Community participation 1.62 0.41 1.65 0.41 1.58 0.40 ***
Control variables
Age group (%) ***
 55–64 48.05 53.13 42.97
 65–74 33.01 29.91 36.12
 75+ 18.94 16.96 20.91
Marital status (%) ***
 Never married 0.98 0.99 0.97
 Currently married cohabiting 80.36 79.94 80.77
 Separated/divorced/widowed 18.66 19.06 18.25
Educational attainment (%) ***
 Illiterate 30.08 41.67 18.49
 Less than primary school 18.20 26.08 10.32
 Primary school 19.80 21.41 18.20
 Secondary school 17.06 8.79 25.33
 High school or above 14.86 2.05 27.66
Male (%) 47.19 49.47 44.92 ***
With religion (%) 8.46 9.11 7.82 *

Means with standard deviations (SDs) are presented in table; all variables are recoded in a way that higher
scores stand for better conditions, such as better health, less difficulties, more sense of safety, and less
impairment. The range for difficulty in personal relationship, feeling free to express, sense of living safety,
overall health status, community participation, ADLS and cognition function is 1–5; for total income is
0–12,000 thousand. The variable of religion does not include those who refused this question
***p < 0.001; **p < 0.01; *p < 0.05; †p < 0.1

The comparisons demonstrated huge disparities between rural and urban older adults in
social capabilities, resources, and personal traits. The urban sample, in general, reported
significantly better social capabilities and higher frequent social engagement. More spe-
cifically, urban older adults, on average, had less freedom of expression, lower sense of

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 172 Y. Zhang et al.

safety, and less frequent social engagement, yet had higher physical and cognitive function-
ing, more household income, and higher educational background than their rural peers.
We used t-test to test the significance of differences between rural and urban samples. The
t-test results show that all variables listed in Table 1 were statistically significant at the 99%
level between rural and urban older adults except religious identity.

4.2 Associations of Income and Health with Social Capabilities and Social

Engagement

Following Baron and Kenny’s mediation method, the first four columns of Table 2 present
the results of the association between income and health and social capabilities (i.e., path
c in Fig. 1). Overall, higher natural logarithm of household income, physical functioning,
and cognitive functioning were statistically associated with higher social capabilities and
more frequent social engagement, except the association between household income and
sense of safety, after controlling for other personal traits.

Table 2  Linear regression models on capability indicators and social engagement (N = 9086)

Variables Capability indicators Social engagement
Interpersonal Express Safety

Ln (income) 0.0091* 0.0222* − 0.004 0.0059+

(0.004) (0.009) (0.007) (0.003)
ADLs 0.5127*** 0.0452* 0.1511*** 0.0859***
(0.009) (0.022) (0.018) (0.009)
Cognitive function 0.0487*** 0.1861*** 0.1344*** 0.0680***
(0.009) (0.023) (0.019) (0.009)
Age group − 0.0088 0.0496*** 0.0087 0.0183***
(0.006) (0.014) (0.011) (0.005)
Marital status − 0.0163 − 0.0373 − 0.0104 0.0193*
(0.010) (0.024) (0.020) (0.010)
Educational attainment 0.0085* 0.0272** 0.0076 0.0260***
(0.003) (0.008) (0.007) (0.003)
Male 0.0301*** 0.0326+ − 0.1488*** 0.007
(0.008) (0.019) (0.016) (0.008)
With religion 0.0082 − 0.0829** 0.0587* 0.1091***
(0.013) (0.032) (0.026) (0.013)
Rural 0.0418*** 0.1968*** 0.2026*** 0.1615***
(0.010) (0.023) (0.019) (0.009)
Constant 2.1875*** 2.5405*** 2.6632*** 1.4615***
(0.063) (0.151) (0.125) (0.060)
Observations 9096 9082 9078 9101
R-squared 0.329 0.021 0.052 0.068
Adjusted ­R2 0.328 0.0203 0.0507 0.0667

Standard errors in parentheses

***p < 0.001; **p < 0.01; *p < 0.05; †p < 0.1

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Income and Health in Predicting Older Adults’ Social Capabilities… 173

The last column of Table  2 presents the associations between income and health and
social engagement (i.e., path a in Fig.  1). In general, health, compared to income, had a
stronger association with social engagement. More specifically, every 1% increase in physi-
cal functioning, measured by ADLs, is associated with 8.59% increase in social engage-
ment. Every 1% increase in cognitive functioning is associated with 6.80% increase in
social engagement. Both are at the 99% statistically significant level. For income, measured
by natural logarithm of household income, every 1% increase is associated with 5.92%
increase in social engagement at the 90% significant level.

4.3 The Mediating Role of Social Engagement

The results shown in Table 2 indicate that the mediation effect of social engagement could
be further explored. Table  3 presents the results of mediation analyses. Overall, social
engagement accounted for a substantial proportion of the effects of income and health on
social capabilities. The direct effects of household income, physical functioning, and cog-
nitive functioning on social capabilities—after taking into account the mediating effect of
social engagement (i.e., path c′ as shown in Fig.  1)—were smaller than the total effects
(i.e., the associations without taking into account the mediation effect, referred to as path

Table 3  Effects of income and functionings on capability indicators mediated by social engagement among
older adults in China (N = 9086)
Social Capability indicators Mediated effects
Engage-
ment Interpersonal Express Safety Interpersonal Express Safety

Social engage- 0.0597*** 0.2892*** 0.3593***

ment
(0.011) (0.031) (0.025)
a c and c′ c–c′

Ln (income) 0.0059† 0.0091* 0.0222* − 0.004 0.0003 0.0013

(0.003) (0.004) (0.009) (0.007) (0.000) (0.009)
0.0088* 0.0208* − 0.0061 3.53% 5.93%
(0.004) (0.009) (0.007)
ADLs 0.0859*** 0.5127*** 0.0452* 0.1511*** 0.0047*** 0.0207*** 0.0327***
(0.009) (0.009) (0.022) (0.018) (0.001) (0.003) (0.004)
0.5080*** 0.0245 0.1184*** 0.92% 45.84% 21.63%
(0.009) (0.022) (0.018)
Cognitive 0.0680*** 0.0487*** 0.1861*** 0.1344*** 0.0037*** 0.0155*** 0.0246***
function
(0.009) (0.009) (0.023) (0.019) (0.001) (0.003) (0.004)
0.0450*** 0.1706*** 0.1098*** 7.65% 8.34% 18.30%
(0.009) (0.003) (0.019)

Bootstrapped standard error for path a, b, c and c′ in parentheses; the third line of each mediated effect indi-
cates the proportion of total effect that is mediated
***p < 0.001; **p < 0.01; *p < 0.05; †p < 0.1

13
 174 Y. Zhang et al.

c in Fig.  1). The mediated effects of social engagement are shown in the right panel of
Table 3 (path c–c′ or a*b).
The associations between social engagement and the three social capability indica-
tors (i.e., path b in Fig. 1) are all in a positive direction and statistically significant. One
percent increase in social engagement is associated with 5.97% increase in interpersonal
relationship (p < 0.001), 28.92% increase in freedom of expression (p < 0.001), and 35.93%
increase in sense of safety (p < 0.001). Also, most of the indirect effects (i.e., path c′ in
Fig. 1) between social capabilities and income and health are smaller than direct effects and
maintain their statistical significance, except the association between ADLs and expression
and the association between income and sense of safety.
Overall, we found higher mediated effects of social engagement in the associations
between functioning and social capabilities of freedom of expression and sense of safety.
Comparatively, the mediated effects of social engagement were more substantial in the
associations between cognitive functioning and interpersonal relationships than physical
functioning. Specifically, the proportions of effect sizes of social engagement are 45.84%
for the association between ADLs and freedom of expression, and 21.63% for the associa-
tion between ADLs and sense of safety, but only 0.92% for the associations between ADLs
and interpersonal relationship. In addition, we found that the mediated effects of social

Table 4  Effects of income and functionings on capability indicators mediated by social engagement among
older adults in rural China (n = 4641)
Social Capability indicators Mediated effects
engage-
ment Interpersonal Express Safety Interpersonal Express Safety

Social 0.0700*** 0..3365*** 0.4902***

engage-
ment
(0.016) (0.037) (0.032)
a c and c′ c–c′

Ln (income) − 0.0011 − 0.0027 − 0.0111 − 0.0601***

(0.004) (0.005) (0.011) (0.010)
− 0.0026 − 0.0111 − 0.0592***
(0.005) (0.011) (0.009)
ADLs 0.0704*** 0.5211*** 0.0744** 0.1363*** 0.0049** 0.0242*** 0.0351***
(0.011) (0.013) (0.029) (0.025) (0.001) (0.005) (0.006)
0.5162*** 0.0744* 0.1012*** 9.46% 32.50% 25.74%
(0.013) (0.029) (0.024)
Cognitive 0.1169*** 0.0770*** 0.1918*** 0.1496*** 0.0082** 0.0372*** 0.0543***
function
(0.013) (0.014) (0.033) (0.028) (0.002) (0.006) (0.007)
0.0688*** 0.1918*** 0.0952** 10.63% 19.40% 36.33%
(0.015) (0.033) (0.028)

Bootstrapped standard error for path a, b, c and c′ in parentheses; the third line of each mediated effect indi-
cates the proportion of total effect that is mediated
***p < 0.001; **p < 0.01; *p < 0.05; †p < 0.1

13
Income and Health in Predicting Older Adults’ Social Capabilities… 175

engagement on the associations between household income and all social capabilities were
not significant, which could be because the positive association between the natural loga-
rithm of household income and social engagement was only marginally significant at the
90% level.
We further conducted the mediation analyses among rural and urban older adults sepa-
rately after the analysis in the national sample. For rural older adults (n = 4641), as pre-
sented in Table 4, the natural logarithm of household income was not significantly asso-
ciated with social engagement. Therefore, we did not perform mediation analyses of the
associations. The rest of the results for rural older adults were mainly consistent with the
results of the national sample. Nevertheless, social engagement had a larger mediated effect
size in the rural sample regarding the association between physical functioning and inter-
personal relationships (9.46%) and the association between cognitive functioning and sense
of safety (36.33%) than the national sample (0.92% and 18.30%, respectively).
For the urban sample (n = 4437), as presented in Table 5, the association between social
engagement and cognitive functioning was not statistically significant. Therefore, we did
not test the mediated effects of social engagement on the associations between cognitive
functioning and the three social capabilities. Likewise, the association between physical
functioning and the social capability of freedom of expression was omitted from the medi-
ation analysis for the same reason. In general, the effect sizes of the mediator were smaller

Table 5  Effects of income and functionings on capability indicators mediated by social engagement among
older adults in urban China (n = 4437)
Social Capability Indicators Mediated Effects
engage-
ment Interpersonal Express Safety Interpersonal Express Safety

Social engage- 0.0355* 0.1345*** 0.2499***

ment
(0.015) (0.038) (0.030)
a c and c′ c–c′

Ln(income) 0.0174** 0.0279*** 0.0770*** 0.0870*** 0.0006† 0.0024* 0.0043**

(0.006) (0.006) (0.014) (0.011) (0.000) (0.001) (0.002)
0.0273*** 0.0747*** 0.0827*** 2.21% 3.06% 4.99%
(0.006) (0.014) (0.011)
ADLs 0.1028*** 0.5012*** 0.0137 0.1847*** 0.0036† 0.0258***
(0.013) (0.013) (0.033) (0.026) (0.002) (0.004)
0.4976*** − 0.0001 0.1589*** 0.73% 13.95%
(0.013) (0.033) (0.026)
Cognitive func- 0.0184 0.0187 0.1679*** 0.0937***
tion
(0.013) (0.012) (0.032) (0.025)
0.0180 0.1655*** 0.0892***
(0.012) (0.032) (0.025)

Bootstrapped standard error for path a, b, c and c′ in parentheses; the third line of each mediated effect indi-
cates the proportion of total effect that is mediated
***p < 0.001, ** p < 0.01, * p < 0.05, † p < 0.1

13
 176 Y. Zhang et al.

in the urban sample than the rural sample. All standard errors of mediated effects shown in
Tables 3, 4, and 5 were estimated based on 1000 bootstrap replications using the bootstrap-
ping method.

5 Discussion

Using WHO-SAGE data, this study applied the capability approach to examine the effects
of financial resources, physical functioning, and cognitive functioning on the social capa-
bilities of older adults in China. This paper additionally examined the possible mediating
role of social engagement in these associations. We found that, as hypothesized, higher
income and better health are consistently associated with better social capabilities, and
social engagement was a significant mediator for most of the associations. Specifically,
the social capabilities of freedom of expression and sense of safety were found to play
important mediating role in the associations between physical and cognitive functioning
and social engagement among rural older adults.
One exception was that higher household income was found to be a protective factor
for personal relationships and freedom of expression among urban older adults, but not
for rural older adults. A possible reason for this difference is that rural older adults resid-
ing in the same villages know one another better and have more frequent interactions than
those who live in urban areas. Interpersonal relationships among rural older adults may be
established regardless of financial condition such as income and socioeconomic status. Our
descriptive analysis results show lower average income and a smaller standard deviation in
the rural sample than the urban sample. This smaller variation in income may be another
reason for the insignificant association.
The cognitive functioning surprisingly had no significant association with interpersonal
relationships among urban older adults. This contradicts some prior studies, such as the
work of Lam Nogueira et al. (2018), which found that cognitive impairment significantly
predicted lower interpersonal relationship among older adults in Macao. This unexpected
result could be due to multiple reasons. First, the definition of cognitive functioning has
varied across studies. For example, in the study by Lam Nogueira et al. (2018), cognitive
impairment was defined as at least 1.5 standard deviations from age-corrected norms, but
we defined this variable using a 5-item scale. Second, as previously stated, urban older
adults in China have fewer interpersonal connections in the community due to their liv-
ing arrangements. This could negatively affect interpersonal dynamics, even for those who
have higher cognitive functioning.
This study has several limitations. First, due to data limitations, this study could not
include more dimensions of social capabilities in the analysis. In addition, by using cross-
sectional data from WHO-SAGE 2010, this study could not deal with the issue of endoge-
neity caused by the reverse causalities. For example, people with higher social capabilities
are potentially more likely to have better health conditions and a higher level of income.
Another example is that people with better interpersonal relationships will be more likely
to participate actively in social activities. Therefore, this study could only draw conclusions
about associational relationships. Also, the cross-sectional data do not allow tracking the
dynamics of functioning and capabilities over time. Another major limitation is that the
dataset does not include information such as the income level and social engagement of
older adults’ children and details about their family relationships, which could affect their
functioning, financial resources, social engagement, and social capabilities.

13
Income and Health in Predicting Older Adults’ Social Capabilities… 177

Despite these limitations, this study adds to the existing literature in several important
ways. First, it explored multiple domains of social capabilities which were seldom studied
among Chinese older adults. Second, this study examined the mediating role of social engage-
ment which provided evidence for future program and social service implementation. Third,
it also specified the different roles of social engagement among rural and urban older adults,
respectively, in buffering the effects of income and health on social capabilities, which pro-
vided evidence for future policy implementation.
To address the issue of endogeneity caused by reverse causality, future studies could use
longitudinal data when available and more rigorous methods, such as the instrumental vari-
able approach, to better approximate the causalities. Future research should also include more
macro-level factors such as societal hierarchies and even environmental conversion factors
such as pollution and primary means of transportation (Sen, 1993) in analyses. This would
enrich the measurement of social capabilities. Policymakers could consider sponsoring more
senior centers, especially in urban areas, to enhance older adults’ interpersonal connections
and interactions. In addition to rural and urban older adults, migrated older adults, especially
those who moved from rural to urban areas for child care, labor force participation, and many
other reasons, could also be studied in terms of changes and predictive factors related to their
social capabilities. Additionally, future studies could conduct qualitative surveys and analyses
to assess more social capabilities. Program designers should consider implementing commu-
nity-based senior programs to encourage more social participation among older adults, which
could further improve their physical and cognitive functioning.
Supplementary Information The online version contains supplementary material available at https://​doi.​
org/​10.​1007/​s11205-​022-​03008-2.

Authors’ Contributions  YZ planned the study, performed all the statistical analyses, and wrote the paper.
QG planned the study and revised the paper. FZ supervised the data analysis and contributed to revised the
paper. PA helped to plan the study and revised the paper.

Funding  The project is funded by China Postdoctoral Science Foundation (No. 2021M690216).

Availability of Data and Materials  The data used in this study is publicly available on WHO Multi-Country
Studies Data Archive https://​apps.​who.​int/​healt​hinfo/​syste​ms/​surve​ydata/​index.​php/​catal​og/​13.

Code Availability  Not applicable.

Declarations 
Conflict of interest  The authors declare no conflicts of interest.

Ethics Approval  The authors declare that this study does not involve human subjects with no need for ethics
approval.

Content to Participate  Not applicable.

Consent for Publication  Not applicable.

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