Elderly Health Inequality in China and its Determinants: A Geographical Perspective

Abstract

Inter-regional health differences and apparent inequalities in China have recently received significant attention. By collecting health status data and individual socio-economic information from the 2015 fourth sampling survey of the elderly population in China (4th SSEP), this paper uses the geographical differentiation index to reveal the spatial differentiation of health inequality among Chinese provinces. We test the determinants of inequalities by multilevel regression models at the provincial and individual levels, and find three main conclusions: 1) There were significant health differences on an inter-provincial level. For example, provinces with a very good or good health rating formed a good health hot-spot region in the Yangtze River Delta, versus elderly people living in Gansu and Hainan provinces, who had a poor health status. 2) Nearly 2.4% of the health differences in the elderly population were caused by inter-provincial inequalities; access (or lack of access) to economic, medical and educational resources was the main reason for health inequalities. 3) At the individual level, inequalities in annual income served to deepen elderly health differences, and elderly living in less developed areas were more vulnerable to urban vs. rural-related health inequalities.

Surveillance study of the prevalence, species distribution, antifungal susceptibility, risk factors and mortality of invasive candidiasis in a tertiary teaching hospital in Southwest China

“…The medium and small cities were defined in accordance with the new standard for city-size classification in China (http://www.gov.cn/zhengce/content/2014-11/20/content_9225.htm). The urban population proportion, gross domestic product, income of residents, educational resources, sports resources, medical resources and air pollution in medium and small cities are less than those in large cities [23–25]; all the data are illustrated in the Additional file 1: Table S1.…”

Trend of Gini coefficient of healthcare resources in China from 1998 to 2016

“…Other studies by Yan et al and Zhang et al analyzed the current situation of rural-urban disparities in healthcare resources in China (16,17). Fan et al reported that there were significant health differences in the elder population on an inter-provincial level, and nearly 2.4% of these health differences in the elder population were caused by inter-provincial inequalities (18). Zhu et al assessed the changes of regional disparities in traditional Chinese medical (TCM) healthcare resources before and after 2009 healthcare reforms, and reported that although TCM hospital number, scale, and doctors' workload increased in 2004-2016, the regional disparities in healthcare resources, especially between the eastern and western regions, were not significantly changed (19).…”

Spatial Variability of Health Inequalities of Older People in China and Related Health Factors

“…Other characteristics addressing SES include martial status and living arrangements. It has been demonstrated that being divorced or widowed is associated with poorer health because of marriage protection and selection effects [14]. As people grow older, they tend to benefit more from the impacts of marriage.…”

“…What is more, unlike western countries, the Chinese household registration system is a dual system. Within this system, urban residents enjoy a range of social, economic, and cultural benefits, whereas rural residents do not receive the same benefits [14]. This system is closely associated with the social security system that excludes rural residents/migrant workers from the city-wide social security system [23].…”