Urban–rural disparities in cardiovascular disease risks among middle-aged and older Chinese: two decades of urbanisation

Abstract

China has been undergoing dramatic socio-economic and demographic changes in the last few decades. The rapid growth of the ageing population will pose tremendous challenges to its public health and social welfare system. This study aims to examine how urbanisation has impacted cardiovascular disease (CVD) risks among middle-aged and older Chinese in two decades, from 1991 to 2011. Data were drawn from a nationwide longitudinal data-set of the China Health and Nutrition Survey (CHNS) (sweeps 1991, 1993, 1997, 2000, 2004, 2006, 2009 and 2011). Participants aged ⩾45 years old were included. A dynamic urbanisation index was created for each community (village or neighbourhood) based on community-level data that can reveal the heterogeneity within and across places and capture dimensions of social, economic and physical characteristics of urban living over time and space. Multi-level modelling analyses (level 1: occasions; level 2: individuals; level 3: households; level 4: communities) were performed on outcomes of CVD risks such as body mass index, waist circumference, and systolic and diastolic blood pressure. The results show upward trends in all CVD risks for both genders over 20 years of urbanisation after adjustment for socio-economic and demographic confounders. Urbanisation in China is associated with absolute increases in CVD risks over time among its middle-aged and older people, despite its contribution to relative reduction of the rural–urban gap over time. This is particularly true for women from the least urbanised areas. It is relevant to inform policy-making processes to target the most vulnerable groups of older people in China during its rapid urbanisation process. There is a possibility for policy intervention to reduce inequality during the process of China's planned urbanisation.

Spatiotemporal Variation of the Association between Urbanicity and Incident Hypertension among Chinese Adults

“…Consistently, a prior study reported that rural Chinese had a more apparent increase in HTN incidence than their urban counterparts during 1991-2009 [36]. Zhang (2019) also showed that the association between urbanicity and prevalent HTN shifted from positive to negative during 1991-2011 [25].…”

“…Instead of categorizing the degree of urbanicity into tertiles [25], we categorized it into quartiles that represent low (urbanicity scores < 57.15), medium-to-high (57.15 ≤ urbanicity scores < 75.09), and high urbanicity (urbanicity scores ≥ 75.09). The low urbanicity was the reference.…”

“…Additionally, the Northeastern, East Coastal, Central, and West Regions vary substantially with respect to economic development and population health [1,19,21]. The effect of urban environments on HTN might be different among these regions.Empirical studies in the Chinese context regarding the association between the degree to which a place exhibits urban features and HTN prevalence have provided mixed results [22][23][24][25]. One possible explanation for the inconsistent findings is the secular change in the association, as has been reported in a recent study [21].…”

“…Empirical studies in the Chinese context regarding the association between the degree to which a place exhibits urban features and HTN prevalence have provided mixed results [22][23][24][25]. One possible explanation for the inconsistent findings is the secular change in the association, as has been reported in a recent study [21].…”

“…Exploring subnational regional heterogeneity in the association is critical to a better understanding of the influences of urbanization on the burden of HTN in different social contexts and for developing region-specific strategies for HTN prevention. Moreover, although prevalent HTN is an important measure of HTN burden and it has been widely examined in previous studies [22][23][24][25], it is a less useful measure in etiological studies than incident HTN [26]. Additionally, the urban-rural distribution of HTN and related risk factors seems to be inconsistent in men and women in developing nations [27,28].…”