BACKGROUND: Negative self-perceptions of aging among older adults have been associated with higher mortality in developed countries. However, it is unclear whether an association exists in developing countries where living to older age is more selective. DESIGN AND METHODS: Using five waves of data (2000, 2002, 2005, 2008, and 2011) from a national survey of adults aged 65 and older in China (n=30,948), this study investigates how self-perceived feelings of uselessness are associated with subsequent mortality. Analyses were stratified by sex and age group (65-79, 80-89, 90-99, and 100+), and adjusted for a wide range of covariates. RESULTS: Compared with women who never reported perceived uselessness, results from adjusted models shows that women who always reported perceived uselessness had 42% (p<0.001), 31% (p<0.001), and 24% (p<0.001) higher risks of mortality in each of the three oldest age groups, respectively. These associations were only slightly attenuated when covariates were adjusted, but non-significant once baseline health was further controlled for. For men, compared with those who never reported perceived uselessness, the adjusted models for those who always reported perceived uselessness had 62% (p<0.001), 62% (p<0.001), 69% (p<0.001), and 25% (p<0.1) higher risks of mortality in each of the four sequential age groups, respectively. The association was only slightly diminished-and many remained statistically significant-with further adjustments for psychological disposition and baseline health. CONCLUSIONS: Self-perceived uselessness is associated with higher mortality risks in older adults in China. The association is stronger in men than in women and persists at very old ages.