All-cause mortality rate in China: do residents in economically developed regions have better health?

Abstract

Background: Urban-rural disparities have been extensively investigated, while most investigators overlooked urbansuburban-rural variations in population health. Although regional disparities in East-West China have been largely discussed, limited attention has been directed to the interaction between regional differences and urban-suburbanrural disparities. This study aims to analyze urban-suburban-rural variations in all-cause mortality rates across four geographic regions in China. Methods: Data came from China's National Census Survey and public statistical yearbooks in 2000 and 2010. Urban districts, county-level cities, and counties were respectively defined as urban, suburban, and rural areas. We obtained 2322 areas, including 2148 areas with two observations and 174 areas with only one observation. Data visualization was performed to depict geographic variations and changes in all-cause mortality rates. Five hierarchical linear regression analyses with generalized estimating equations (GEE) were employed to analyze variations in all-cause mortality rates over time. Demographic and socioeconomic attributes were introduced as covariates. Results: Despite an overall decline in all-cause mortality rate, rural residents generally achieved worse health than urban and suburban counterparts. In contrast, urban-suburban disparities could be fully explained by demographic and socioeconomic differences. In addition, Northeastern and Central residents achieved better health than Eastern and Western residents. Last, there existed urban/suburban-rural disparities in all regions, except Northeastern, where urban/suburban-rural disparities were eliminated after controlling for socioeconomic and demographic attributes. Conclusion: Even though suburban and rural areas were often merged, there exist urban/suburban-rural disparities in population health. Furthermore, urban/suburban-rural disparities vary across regions.

Adequate access to healthcare and added life expectancy among older adults in China

“…Fourth, previous studies have demonstrated the influence of contextual factors on access to healthcare and mortality-such as the level of neighborhood socioeconomic status and development, availability of healthcare facilities in a community, number of medical professionals within the facilities, etc. [51,52]. However, due to the lack of data on such measures in the CLHLS, we were unable to directly model the effects of these potential contextual factors.…”

Geographic Variations of Stroke Incidence in Chinese Communities: An 18-Year Prospective Cohort Study from 1997 to 2015

“…Prior studies provided insufficient evidence on the interaction between the geographic gradient and urban-rural settings, even though the cross-sectional study based on a National Epidemiological Survey of Stroke in China (NESS-China) indicated a general north-to-south geographical gradient in stroke prevalence in conjunction with the heavy disease burdens in rural areas [ 7 ]. As urbanization has been accelerated over the past few decades, the regional differences among urban areas may have diminished over time [ 12 ]. Therefore, more attention should be directed to geographic disparities in rural areas when considering the priority of public health intervention.…”

“…7 As urbanization has been accelerated over the past few decades, the regional differences among urban areas may have diminished over time. 12 Therefore, more attention should be directed to geographic disparities in rural areas when considering the priority of public health intervention.…”

“…Earlier studies, however, have limitations and knowledge gaps that should be addressed and bridged in a comprehensive way. First, prior investigations directed insufficient attention on the interaction between regional variations and urban vs. rural differences in the epidemiologic features of stroke, although empirical evidence on population health indicated that regional disparities in urban China tended to be marginal due to rapid urbanization [ 12 ]. Whether the north-to-south gradient in stroke incidence varies across urban and rural areas in China is unknown.…”

“…First, prior investigations directed insufficient attention on the interaction between regional variations and urban vs. rural differences in the epidemiologic features of stroke, although empirical evidence on population health indicated that regional disparities in urban China tended to be marginal due to rapid urbanization. 12 Whether the north-to-south gradient in stroke incidence varies across urban and rural areas in China is unknown. Furthermore, prior research had a major limitation of retrospective cohort or cross-sectional study-designs, 4,6,7,13 which were not able to provide robust estimates of the attributable risk factors of the disparities.…”