Ageism, ableism, and their associated factors among international undergraduate medical students in China: a cross-sectional study

Abstract

Background Ageism and ableism are common attitudes that have significant effects on the quality of healthcare provided to older adults and people with impairments. Despite growing concern, research into these biases among undergraduate medical students is limited, particularly in Asian educational contexts. As future healthcare providers, medical students’ early views on aging and disability must be addressed; however, little research has investigated the interrelationship between ageism and ableism in this population. Methods A cross-sectional survey was conducted among 199 undergraduate medical students at Qingdao University in China. Data were gathered using the Relational Aging Anxiety Scale, which has five subscales: affinity for older adults, internalized ageism, relational ageism, internalized ableism, and relational ableism. All subscales showed Variable internal consistency (0.429–0.861), with three subscales meeting acceptable thresholds and two falling below the conventional 0.70 criterion. Pearson correlation analysis and four multiple linear regression models were used to investigate Factors associated with ageism and ableism outcomes, with demographic variables (age, gender, year of study, and prior experience) and attitudinal subscales serving as independent variables. Results Positive correlations have been identified between internalized and relational ageism (r = 0.41, p < 0.01) and internalized and relational ableism (r = 0.50, p < 0.01), suggesting that internalized and relational variants of each bias coexist. The results showed strong cross-construct correlations between ageism and ableism subscales (r = 0.26–0.40, p < 0.01). Among four regression models, ageism and ableism subscales were significantly associated with each other (R 2 = 0.140–0.226, all p < 0.001), Affinity for Older People was significantly associated with relational ageism ( β = 0.226, p = 0.001). Younger age was the only demographic variable significantly associated with outcomes across models, linked with higher levels of internalized ableism ( β = −0.156, p = 0.038). Gender, year of study, and prior experience were not significant in any of the models. Conclusion Among undergraduate medical students, ageism and ableism are closely related, with attitudinal indicators outperforming demographic ones. In order to address both biases concurrently in undergraduate medical education and advance fair, inclusive patient care, these findings underscore the critical need for focused educational interventions, such as structured experiential learning, reflective practice, and disability-focused curriculum content.

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