This study estimated overall survival (OS) among gastric cancer patients stratified by age and rural-urban residence after radical gastrectomy. Patients (n = 286) undergoing curative gastrectomy were categorized into four groups based on age (older >= 60 years or younger < 60 years) and residence (rural or urban), including rural older (G1), urban older (G2), rural younger (G3) and urban younger (G4) groups. G1 presented with significantly more males, upper stomach cancers and total gastrectomies, while less patients receiving >= 4 cycles of adjuvant chemotherapy. The 5-year OS rates were 39.9% for G1, 61.1% for G2, 73.1% for G3, and 71.2% for G4, with a median OS of 47 months in G1 and not reached for other groups. OS was significantly worse in G1 than other groups (P < 0.05). Multivariate Cox regression identified age, type of gastrectomy, adjuvant chemotherapy, perineural invasion, pT category and pN category as independent prognostic factors. After propensity score matching, rural older patients continued to show significantly inferior OS compared to urban older (hazard ratio = 2.269 [1.274-4.042], P = 0.005) and rural younger (hazard ratio = 2.103 [1.116-3.961], P = 0.021) patients. Rural older patients suffered poorer OS after radical gastrectomy, highlighting the need for special attention and comprehensive treatment strategies.