Disparity in Self‐Reported Sleep Quality Between Old Adults in Urban and Rural Areas of China: A Fairlie Decomposition Analysis

ABSTRACT Objective Identify drivers of urban–rural sleep quality disparities among Chinese older adults. Methods Data were derived from the Chinese Longitudinal Healthy Longevity Survey. Univariate and logistic regression and Fairlie model analyzed correlations and disparity contributors. Results In urban groups, female (OR = 1.84, 95% CI = 1.59–2.15), poor self‐reported health (OR = 2.31, 95% CI = 1.90–2.80), and chronic disease comorbidity (OR = 1.28, 95% CI = 1.09–1.49) were significant predictors of impaired sleep quality. In rural groups, female (OR = 2.30, 95% CI = 1.64–3.21) and poor self‐reported health (OR = 2.13, 95% CI = 1.48–3.06) were associated with higher odds, while alcohol consumption was protective (OR = 0.72, 95% CI = 0.52–0.99). Rural older adults had a 2.94% higher probability of impaired sleep quality than urban counterparts. The measured factors explained 67.7% of disparities, primarily driven by self‐reported health status (73.4%), gender (15.0%), chronic disease comorbidity (5.7%), and smoking (5.9%), with 32.3% remaining unexplained. Conclusion Self‐reported health, gender, chronic disease comorbidity, and smoking are key factors leading to inequality. Findings inform policies bridging urban–rural health gaps and improving elderly sleep health.