BackgroundPopulation ageing in China has brought increasing attention to the health inequalities of the elderly. The purpose of this paper is to measure income-related health inequality among the elderly in China and decompose its causes.MethodsThe data are from the China Health and Retirement Longitudinal Study (CHARLS) survey in 2013, which contains 6176 individuals aged 60 years and above. A multiple linear regression model was used to analyze the influencing factors of self-rated health (SRH) among the elder people. Furthermore, the corrected concentration index were used to measure income-related health inequality. Wagstaff-type decomposition analysis was employed to explore the cause of inequality. The measurement and decomposition of health inequality was also performed separately in the male and female subgroups.ResultsMost elderly declared their health status as “fair” (51.33%) or “poor” (21.88%). Income, gender, residence, region, health insurance and other factors had significant association with SRH (P < 0.05). The corrected concentration index (CCI) was 0.06, indicating pro-rich inequality in health among the elderly. Decomposition analyses revealed that the main contributors to health inequality included income, residence, region, health insurance, and employment. For female elderly, most of the inequality was due to residence (50.78%) and income (49.51%); for male elderly, most of the inequality was due to insurance (38.65%) and income (22.26%); for the total sample, employment had a negative contribution to health inequality (− 25.83%).ConclusionThe findings confirm a high proportion of elderly with poor SRH, and health inequality in the Chinese. Some socioeconomic strategies should be conducted to reduce this health inequality among the elderly, such as reducing income disparities, consolidating health insurance schemes, and narrowing urban-rural and regional gaps. Older females with low incomes in rural areas are a vulnerable subgroup and warrant targeted policy attention.

Abstractobjectives To investigate the use of maternal health care services by internal migrants in view of their migration status.methods Cross-sectional household survey in two cities of Jiangsu Province. Questions elicited data on socioeconomic information and MHC service use (pre-natal examination, post-natal visit, prenatal health education). Chi-square tests and multivariate logistic regression analyses were used to identify factors associated with MHC service use.results A total of 946 married women were recruited, of whom 22.3% were internal migrants. Compared to local residents, migrants were five times less likely to attend pre-natal examinations (84.4% vs. 91.7%; OR = 0.49, P = 0.002), three times less likely to have post-natal visits (15.6% vs. 50.2%; OR = 0.18, P < 0.001) and less likely to attend health education during pregnancy (87.0% vs. 95.7%; OR = 0.30, P < 0.001). Multivariate logistic regression also revealed a lower proportion of MHC use among migrants (ORm 0.52, 0.16, and 0.3, respectively).conclusions Internal migrants in Jiangsu Province underuse MHC services to a significant degree. More attention needs to be paid to pregnant migrant women, as they are vulnerable group in society.keywords maternal health care, internal migrant, health service utilisation, logistic regression

This research investigated how implicit theories of health and consideration of future consequences influence people’s engagement in health-protective behaviors during the COVID-19 pandemic in China. Three hundred and ninety Chinese completed the study during the peak period of COVID-19 pandemic in China. Gender, education level, implicit theories of health, and consideration of future consequences were significant predictors of people’s engagement in health-protective behaviors. Consideration of future consequences mediated the effect of implicit (incremental) theories of health on people’s engagement in health-protective behaviors. Implications of the current research for promoting engagement in health-protective behaviors during pandemics of infectious diseases and directions for future research are discussed.

BackgroundCatastrophic health expenditure (CHE) puts a heavy disease burden on patients’ families, aggravating income-related inequality. In an attempt to reduce the financial risks of rural families incurring CHE, China began the New Rural Cooperative Medical System (NCMS) on a trial basis in 2003 and has raised the reimbursement rates continuously since then. Based on statistical data about rural families in sample area of Jiangsu province, this study measures the incidence of CHE, analyzes socioeconomic inequality related to CHE, and explores the influences of the NCMS on the incidence of CHE.MethodsStatistical data were acquired from two surveys about rural health care, one conducted in 2009 and one conducted in 2010. In 2009, 1424 rural families were analyzed; in 2010, 1796 rural families were analyzed. An index of CHE is created to enable the evaluation of the associated financial risks. The concentration index and concentration curve are used to measure the income-related inequality involved in CHE. Multiple logistic regression is utilized to explore the factors that influence the incidence of CHE.ResultsThe incidence of CHE decreased from 13.62% in 2009 to 7.74% in 2010. The concentration index of CHE was changed from −0.298 (2009) to −0.323 (2010). Compared with rural families in which all members were covered by the NCMS, rural families in which some members were not covered by the NCMS had a lower incidence of CHE: The odds ratio is 0.65 with a 95% confidence interval of 0.43 to 1.00. For rural families in which all members were covered by the NCMS, the increase in reimbursement rates is correlated to the decline in the incidence of CHE if other influencing factors were controlled: The odds ratio is 0.48 with a 95% confidence interval of 0.36 to 0.64.ConclusionsBetween 2009 and 2010, the incidence rate of CHE in the sampled area decreased sharply, CHE was more concentrated among least wealthy and inequality increased during study period. As of 2010, the poorest rural families still had high risk of experiencing CHE. For rural families in which all members are covered by the NCMS, the rise in reimbursement rates reduces the probability of experiencing CHE.Electronic supplementary materialThe online version of this article (10.1186/s12889-017-4713-x) contains supplementary material, which is available to authorized users.

BackgroundPostpartum Family Visits (PFVs) have been advocated as a way to improve health outcomes for puerperal women and their newborns. This study aimed to identify individual factors associated with the utilization of PFVs in rural Jiangsu Province, China.MethodsWe employed responses of the household survey in Jiangsu province, part of the National Health Service Survey (NHSS), a nationally representative survey in China. The data analysis framework was designed based on Andersen’s behavioral model. The outcome variables included nonuse and deficient use of PFVs, and the explanatory variables were organized into three hierarchical levels: predisposing, enabling and need factors. Univariate analysis and multivariate logistic regression analysis were conducted to examine the impact of the three hierarchical levels on PFVs utilization.ResultsA total of 884 rural women who had a childbearing history in the prior five years answered PFVs questions. About 23.4% of them had never received any PFVs, and 40.4% received <3 visits. In the results of multivariate logistic regression, educational level (OR = 0.43, 95% CI: 0.24–0.77), income (OR = 0.62, 95% CI: 0.43–0.88), the distance from the nearest hospital (OR = 1.49, 95% CI: 1.07–2.07) and parity (OR = 2.17, 95% CI: 1.54–3.05) had significant relationship with nonuse. Factors significantly associated with deficient use of PFVs included employment (OR = 0.62, 95% CI: 0.39–0.98), the distance from the nearest hospital (OR = 1.73, 95% CI: 1.26–2.36), level of delivery institution (OR = 1.57, 95% CI: 1.14–2.17), and parity (OR = 1.45, 95% CI: 1.03–2.05).ConclusionThe study found lower Social Economic Status (SES), long distance with primary health institutions, and the increased need for services stemming from multi-parity reduced the likelihood of nonuse or deficient use of PFVs in rural areas. Multiparous, low SES women and those living far away from primary health institutions should be paid more attention to assure the coverage of postpartum care.