Inequity in the healthcare utilization among latent classes of elderly people with chronic diseases and decomposition analysis in China

Zhao, Jie; Yan, Chaoyang; Han, Dan; Wu, Yunyi; Liao, Hui; Ma, Ying; Zhang, Mei; Li, Sangsang; Wang, Jing

doi:10.1186/s12877-022-03538-x

Cited by 5 publications

(4 citation statements)

References 69 publications

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“…Previous studies also identified higher health inequality in western China in comparison with eastern and central China 5 70. The rapid urbanisation process in China has been accompanied with large scales of internal migration, which led to the serious polarisation in underdeveloped areas, resulting in increased ‘left behind’ children and elderly in China 71 72. Overall, however, regional and urban–rural disparities have now played a less significant role in inequality of HRQoL than others: their contributions to CI do not exceed 3.00% according to the findings of our current study.…”

Section: Discussionsupporting

confidence: 63%

Decomposing income-related inequality in health-related quality of life in mainland China: a national cross-sectional study

Yao,

Zhang,

et al. 2023

BMJ Glob Health

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IntroductionHealth equity is an important indicator measuring social development and solidarity. However, there is a paucity in nationwide studies into the inequity in health-related quality of life (HRQoL) in mainland China, in particular using the most recent data measuring HRQoL using the EuroQol 5-Dimension-5 Level (EQ-5D-5L). This study aimed to address the gap in the literature by estimating and decomposing income-related inequality of the utility index (UI) of EQ-5D-5L in mainland China.MethodsData were extracted from the Psychology and Behaviour Investigation of Chinese Residents (2022), including 19 738 respondents over the age of 18 years. HRQoL was assessed by the UI of the EQ-5D-5L. Concentration index (CI) was calculated to measure the degree of income-related inequality in the UI. The contributions of individual, behavioural and context characteristics to the CI were estimated using the Wagstaff decomposition method.ResultsThe CI of the EQ-5D-5L UI reached 0.0103, indicating pro-rich inequality in HRQoL. Individual characteristics made the greatest contribution to the CI (57.68%), followed by context characteristics (0.60%) and health behaviours (−3.28%). The contribution of individual characteristics was mainly attributable to disparities in the enabling (26.86%) and need factors (23.86%), with the chronic conditions (15.76%), health literacy (15.56%) and average household income (15.24%) as the top three contributors. Educational level (−5.24%) was the top negative contributor, followed by commercial (−1.43%) and basic medical insurance (−0.56%). Higher inequality was found in the least developed rural (CI=0.0140) and western regions (CI=0.0134).ConclusionPro-rich inequality in HRQoL is evident in mainland China. Targeted interventions need to prioritise measures that aim at reducing disparities in chronic conditions, health literacy and income.

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Section: Discussionsupporting

confidence: 63%

Decomposing income-related inequality in health-related quality of life in mainland China: a national cross-sectional study

Yao,

Zhang,

et al. 2023

BMJ Glob Health

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“…[ 41 ] Another study revealed 5 latent classes based on 14 chronic conditions in a representative sample of older adults with at least 1 chronic disease in China, including the musculoskeletal system (19.91%), hypertension (10.36%), respiratory system (12.91%), digestive system (12.39%), and cardiovascular system (44.3%). [ 36 ] In addition, intervertebral disc disease, a locally prevalent chronic condition, was included and analyzed, which has not been covered in the literature. Multimorbidity patterns vary according to age group, region, and objective.…”

Section: Discussionmentioning

confidence: 99%

“…Five latent classes were identified based on 14 chronic conditions of the China Health and Retirement Longitudinal Study in 2018, including musculoskeletal system, hypertension, respiratory system, digestive system, and cardiovascular system. [ 36 ] This study was conducted using LCA to identify the multimorbidity patterns.…”

Section: Introductionmentioning

confidence: 99%

Relationship between the health poverty vulnerability and multimorbidity patterns identified with latent class analysis aged 45 years or more adults in Northwestern China: A cross-section study

Du,

Guo,

Wang

et al. 2024

Medicine

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This study aims to identify multimorbidity patterns and examine whether health poverty vulnerability (HPV) varies among adults aged 45 years or more. Data from 4338 participants were extracted from a Chinese cross-sectional study. Latent class analysis was used to identify multimorbidity patterns based on 11 self-reported chronic diseases. A 3-stage feasible generalized least-squares method was used to measure the HPV. The associations and influencing factors were analyzed using the Tobit model. The mean HPV values were 0.105 ± 0.225 and 0.329 ± 0.357, based on extreme poverty and those of low- and middle-income countries’ poverty line, respectively. Four latent multimorbidity patterns were identified, comprising hypertension (57.33%), cardiovascular diseases (19.94%), the musculoskeletal system (13.09%), and spine (9.64%). The HPV value from hypertension (coefficient [Coef] =0.03, 95% confidence interval (CI) = 0.00–0.05) was significantly higher than that of the musculoskeletal system based on extreme poverty. In addition, the HPV values for hypertension (Coef =0.08, 95% CI = 0.05–0.11), spine (Coef =0.06, 95% CI = 0.02–0.11), and cardiovascular diseases (Coef =0.07, 95% CI = 0.03–0.11) were significantly high based on low- and middle-income countries’ poverty line. Age ≥75 years, registered poor households, catastrophic medical expenditure, and toilet style were major risk factors. Although the multimorbidity pattern-induced HPV has been significant improved on extreme poverty, it still poses a very serious challenge with regard to low- to middle-income countries’ poverty line. The sensitivity analysis proved the robustness of the results. Policymakers should focus on adults with 3 multimorbidity patterns, namely, registered poor households, age ≥75 years, and catastrophic health expenditure, to adopt targeted interventions to prevent and eliminate HPV.

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“…By conducting longitudinal comparative analysis, Fu(2020) found that there was a certain degree of inequity in IHSU for middle-aged and elderly patients with chronic diseases, and per capita family consumption expenditure and basic insurance for urban employees alleviated this inequality [21]. Zhao(2022) pointed out that inequalities of medical utilization in elderly patients with chronic diseases still exists, and the speci c performances of inequity vary among latent classes [22]. Currently, scholars have found that inequalities of healthcare utilization varies according to which chronic disease patient suffer, including the types and numbers of diseases.…”

Section: Introductionmentioning

confidence: 99%

Inequalities of Inpatient Health Services Utilization for the Middle-Aged and Elderly with Multiple Chronic Conditions in China

Wang

Liu

2023

Preprint

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Background Despite growing evidence of health inequalities, equity of inpatient health service utilization(IHSU) among middle-aged and elderly people with multiple chronic conditions(MCCs) have received little attention. Therefore, this study aims to access the inequities of IHSU among middle-aged and elderly people with MCCs in China, and determine the contributing social factors and their influences by using the national data. Methods This study used two cross-sectional data from the 2013 and 2018 China Health and Retirement Longitudinal Study(CHARLS) The inequities of IHSU were illustrated and quantified by the concentration curve and normalized concentration index. Multivariate logistic regression was conducted to identify the associated factors of IHSU. And decomposition analysis was further applied to decompose the contribution of each determinant to the observed inequalities of IHSU. Results The study indicated that the rate of IHSU among Chinese middle-aged and elderly people with MCCs was 16.6% in 2013 and 17.7% in 2018. The overall concentration index for IHSU was − 0.0301 in 2013 and 0.0354 in 2018, which suggested a higher concentration of IHSU among economically disadvantaged middle-aged and elderly people with MCCs in recent year. The results showed the rate of IHSU was associated with age, sex, household income per capita, self-rated health, smoking, and drinking. Decomposition results further revealed the contributions of the determinants to the inequalities of IHSU. Specifically, age (43.16%), sex (-12.46%), household income per capita (-8.89%), self-rated health (-35.71%), smoking (63.70%), and drinking (59.90%) have varying degrees of contributions to the inequality in IHSU. Conclusion This study sheds light on the pro-rich inequality in IHSU among Chinese middle-aged and elderly people with MCCs. It suggests that policymakers should pay more attention to middle-aged and elderly adults who are male, old, economically disadvantaged, smoking, and drinking. In addition, more targeted interventions should be taken to improve the economic situation of these vulnerable individuals and strengthen their ability to cope with MCCs.

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Inequity in the healthcare utilization among latent classes of elderly people with chronic diseases and decomposition analysis in China

Cited by 5 publications

References 69 publications

Decomposing income-related inequality in health-related quality of life in mainland China: a national cross-sectional study

Decomposing income-related inequality in health-related quality of life in mainland China: a national cross-sectional study

Relationship between the health poverty vulnerability and multimorbidity patterns identified with latent class analysis aged 45 years or more adults in Northwestern China: A cross-section study

Inequalities of Inpatient Health Services Utilization for the Middle-Aged and Elderly with Multiple Chronic Conditions in China

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