Abstract
BACKGROUND: The reciprocal relationship between social isolation (SI) and self-rated health (SRH) among older adults remains insufficiently understood. This study investigates bidirectional associations between SI and SRH and explore their variation across demographic groups. METHODS: Using longitudinal data from a nationally representative sample of older Chinese adults, this study applied a cross-lagged panel model to assess bidirectional links between SI and SRH, examining pattern variations across age, gender, education, marital status, and urban-rural residence. RESULTS: Baseline SI predicted subsequent declines in SRH, and poorer SRH predicted increased SI over time. SRH influenced SI only among women and less-educated older adults. Unmarried individuals showed stronger SI-SRH links, and urban-rural differences revealed distinct directional pathways. CONCLUSIONS: SI and SRH are reciprocally linked in older adults, with meaningful variation across demographic strata. Tailored public health strategies that address both social and health dimensions are needed to support healthy aging.