Objective  To examine current situation and disparities of perceptions on food additive-related health risk among urban and rural consumers in Shanxi province for developing education programs on food safety.

  Methods  We carried out a self-administered anonymous questionnaire survey among 3 500 urban and rural consumers recruited with stratified multistage random sampling at 60 study sites in 11 prefectures in Shanxi province from December 2017 to March 2018.

  Results  Valid information were collected from 3 283 (93.8%) of the consumers. The level of concern on food additives among the consumers differed significantly by age (χ² = 73.377, P < 0.001) and occupation (χ² = 192.824, P < 0.001); the consumers aged 41 to 64 years (\bar R = 0.572) and those working in government agencies or public institutions (\bar R = 0.634) paid a higher concern on food additives and the consumers with the education of junior high school and below had the lowest ratio for correct recognition on food additives (\bar R = 0.448). There were significant differences between urban and rural consumers in the level of concern on food additive (χ² = 87.682, P < 0.001) and behaviors of noticing information about food additive on labels of food products (χ² = 20.868, P < 0.001); the proportion of concerning about food additive was higher among urban consumers than that among the rural consumers (55.38% vs. 44.62%, \bar R = 0.507 vs. \bar R = 0.492 ); the Ridit value (R = 0.478) for noticing information about food additive on labels of food products was lower than the standard value for the rural consumers.

  Conclusion  The cognition on food additives is at a low level among urban and rural consumers in Shanxi province, especially among the consumers with low education and at elder ages. The results suggest that targeted education programs on the safety of food additives should be promoted among the public.