Gender and health in rural China: evidence from Hebei Province

Influence of Socioeconomic Gender Inequality on Sex Disparities in Prevention and Outcome of Cardiovascular Disease: Data From a Nationwide Population Cohort in China

Background Knowledge gaps remain in how gender-related socioeconomic inequality affects sex disparities in cardiovascular diseases (CVD) prevention and outcome. Methods and Results Based on a nationwide population cohort, we enrolled 3 737 036 residents aged 35 to 75 years (2014-2021). Age-standardized sex differences and the effect of gender-related socioeconomic inequality (Gender Inequality Index) on sex disparities were explored in 9 CVD prevention indicators. Compared with men, women had seemingly better primary prevention (aspirin usage: relative risk [RR], 1.24 [95% CI, 1.18-1.31] and statin usage: RR, 1.48 [95% CI, 1.39-1.57]); however, women's status became insignificant or even worse when adjusted for metabolic factors. In secondary prevention, the sex disparities in usage of aspirin (RR, 0.65 [95% CI, 0.63-0.68]) and statin (RR, 0.63 [95% CI, 0.61-0.66]) were explicitly larger than disparities in usage of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (RR, 0.88 [95% CI, 0.84-0.91]) or β blockers (RR, 0.67 [95% CI, 0.63-0.71]). Nevertheless, women had better hypertension awareness (RR, 1.09 [95% CI, 1.09-1.10]), similar hypertension control (RR, 1.01 [95% CI, 1.00-1.02]), and lower CVD mortality (hazard ratio, 0.46 [95% CI, 0.45-0.47]). Heterogeneities of sex disparities existed across all subgroups. Significant correlations existed between regional Gender Inequality Index values and sex disparities in usage of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (Spearman correlation coefficient, r=-0.57, P=0.0013), hypertension control (r=-0.62, P=0.0007), and CVD mortality (r=0.45, P=0.014), which remained significant after adjusting for economic factors. Conclusions Notable sex disparities remain in CVD prevention and outcomes, with large subgroup heterogeneities. Gendered socioeconomic factors could reinforce such disparities. A sex-specific perspective factoring in socioeconomic disadvantages could facilitate more targeted prevention policy making.

Impacts of boarding on primary school students' mental health outcomes - Instrumental-Variable evidence from rural northwestern China

This paper estimates the impacts of boarding on primary school students' health outcomes, using data on 7606 students from rural areas of two northwestern provinces (Qinghai and Ningxia) of China. Exogenous variations in students' home-to-school distance are exploited to address potential endogeneity in their boarding status. Instrumental variable estimates suggest that while boarding has little impact on students' physical health (measured by height-for-age and BMI-for-age z-scores and hemoglobin concentration levels), it has a significantly detrimental effect on their mental health status, amounting to 0.455 standard deviations (SDs) of the distribution of scores on a Mental Health Test (a modified version of the Children's Manifest Anxiety Scale). The effect of boarding is more pronounced for students with relatively advantageous backgrounds. For example, boarding boys scored 0.544 SDs higher on the Mental Health Test (suggesting more anxiety problems) than nonboarding boys, and boarders from relatively wealthier families scored 0.754 SDs higher than wealthier nonboarders. '.

Sex Differences in Factors Affecting Hospital Outpatient Department Visits: Korea Health Panel Survey Data from 2009 to 2016

This study intends to inspect the sex differences in proportion of hospital outpatient department (OPD) visits in overall outpatient (OP) visits using national panel data and to explore factors that influence the proportions by sex. This study analyzed data of the 2009–2016 Korea Health Panel Survey. Fractional logit regression was applied to analyze factors that affect proportion of hospital visits among outpatient visits. Analysis of related factors was carried out first for all analysis subjects and then by sex. The study data were provided by 7470 women (52.2%) and 6846 men (47.8%). The overall average number of OP visits was 13.0, and women showed a much higher frequency of visits (15.8) than men (9.9). The average proportion of hospital OPD visits among overall OP visits was 21.9%, and men showed a higher rate (25.1%) than women (19.5%). The analysis model including sociodemographic factors, economic factors, and health-related factors confirmed that men showed a higher rate of hospital usage than women. Type of medical security, household income, participation in economic activities, disability, and serious illnesses were significant variables for both sexes. Age, education level, marital status, and subscription to voluntary private health insurance were significant only for women, whereas region of residence was significant only for men. This study confirmed that there is a sex difference in proportion of hospital OPD visits and in the factors that affect the proportion of hospital OPD visits. Universal health coverage is provided through social health insurance, but there is a sex difference in hospital OPD visits, and factors related to socioeconomic status have a significant effect, especially on women’s selection of health care institutions. More attention should be given to sex differences in factors affecting health care utilization.

Rural-urban disparities in age trajectories of depression caseness in later life: The China Health and Retirement Longitudinal Study

BACKGROUND

No consensus has been reached on whether depression decreases or increases with age in later life. Majority of the evidence comes from Western societies, while little is known about this relationship and its rural-urban disparities in the Chinese context.

METHODS

Three waves of data from 15,501 Chinese adults aged 45-85 years from the China Health and Retirement Longitudinal Study, Chinese sister study of Health and Retirement Study, were used. Depression caseness was identified using the 10-item Center for Epidemiologic Studies Depression Scale (score ≥12). Urbanisation levels were determined by combining rural-urban residence and rural-urban Hukou (a household registration system). Odds ratios and predicted probabilities of depression caseness were estimated using generalised linear mixed models.

RESULTS

For both men and women and across all ages, the crude predicted probability of depression caseness was the highest in the rural group, followed by the semi-urban group, and the lowest in the urban group. The probability was stable over age among urban men (around 0.05), but it increased at an accelerated rate with age among semi-urban men (0.25 at age 85, 95% confidence interval [CI]: 0.13-0.44) and rural men (0.29 at age 85, 95% CI: 0.22-0.39). Among women the age pattern was similar between the urbanisation groups: the probability increased with age, reached a peak at ages 75-80 (urban women: 0.16, 95% CI: 0.13-0.20; semi-urban women: 0.28, 95% CI: 0.20-0.39; rural women: 0.41, 95% CI: 0.36-0.46), and decreased slightly afterwards. These differences were significantly attenuated when socio-demographic characteristics and physical disability, but not when behaviour-related factors, were controlled for.

CONCLUSION

The age trajectories of later-life depression caseness varied by gender and urbanisation levels, and were not U-shaped as in many Western societies. The increasing depression caseness with age and the large rural disadvantage were substantially driven by socio-demographic characteristics and physical disability.

The double edge sword of John Henryism: Impact on patients' health in the People's Republic of China

The People's Republic of China has experienced extraordinary economic growth, which is associated with increases in chronic health stressors. We examined the impact of John Henryism-a coping mechanism-on various health indicators in a sample of patients (n = 642) in China. John Henryism significantly related to increased medical adherence (B=.03,p<.001) and health-promotional behaviors (B=.02,p<.001). John Henryism predicted several indicators of psychological health through social support. John Henryism was also related to increased alcoholism (B=.04,p<.05). The findings highlight the complexity and paradoxical implications of John Henryism on health. Implications are discussed in relation to China's epidemiological and age demographic shifts.

Landless female peasants living in resettlement residential areas in China have poorer quality of life than males: results from a household study in the Yangtze River Delta region

Background

Urbanization has accelerated in China, and a large amount of arable land has been transformed into urban land. Moreover, the number of landless peasants has continually increased. Peasants lose not only their land, but also a series of rights and interests related with land. The problems of landless peasants have been long-standing; however, only a few studies have examined their health or quality of life (QOL). This paper assesses the QOL of landless peasants in the Yangtze River Delta (YRD) region, analyzes gender differences, and explores health inequity.

Methods

Data are derived from household samples in six resettlement residential areas of three cities (Nanjing, Hangzhou, and Yangzhou) in the YRD region (N = 1,500; the effective rate = 82.4%). This study uses the short version of World Health Organization Quality of Life questionnaire (WHOQOL-BREF) scale to measure the QOL of landless peasants, and performs confirmatory factor analysis (CFA) and analyze gender differences in QOL on the basis of CFA.

Results and conclusion

First, we use Analysis of Variance and Non-parametric Tests to test if the differences of mean value of testing generals have statistical significances. Results shows significant differences occur between the impacts of different genders on the four domains of QOL (physical health, psychological health, social relationships, and environment). The internal reliability of the WHOQOL-BREF scale is good (Cronbach’s alpha > 0.8), and the four domains of QOL are connected with each other. Second, scores in each QOL domain are commonly low, whereas the scores of females are much lower, indicating a poorer QOL than that of males. Third, results of the CFA of the QOL domains and their related observed variables indicate a good model fit. Fourth, results imply that the order of importance of the four domains (psychological health (males = 26.74%, females = 27.17%); social relationships (males = 26.23%, females = 25.35%); environment (males = 25.70%, females = 24.40%); and physical health (males = 21.33%, females = 23.08%)) affecting QOL from high to low is the same for landless male and female peasants, whereas the proportion of importance is different between genders. The results highlight the importance of government intervention to improve the QOL of Chinese landless peasants, ultimately reducing health inequity.

Fifteen-year disability trends among older persons in the Beijing municipality of China

OBJECTIVE

The aim of this study was to examine disability trends among men and women aged 70+ in Beijing, China; determine whether trends are impacted upon by changes in population composition; and investigate whether trends are experienced similarly across socio-demographic subgroups.

METHOD

Fifteen-year panel data were used to model probability of reporting activities of daily living (ADLs) disability adjusting for age, sex, marital status, residence, and education. Predicted probabilities and average annual percent change in probabilities are reported.

RESULTS

The results showed increasing disability trends experienced by men, and stable or decreasing trends by women. Trends would be less favorable had education of older population not increased over time. Trends are much worse when bathing is excluded as an ADLs item. This is because trends in bathing were favorable whereas trends in other activities were not.

DISCUSSION

On balance, results are not overly encouraging for reductions in population-level disability given population aging and increasing life expectancy in China. But, future increasing education could mitigate some increases in disability rates.

Self-reported functional and general health status among older respondents in China: the impact of age, gender, and place of residence

This study made comparisons of self-reported functional and general health status between Chinese women and men in different age-groups in rural and urban settings and examined multiple factors relating to these health statuses in older adults. This study included a sample of 4017 respondents, aged 55 years and older, from the Hubei subsample of the Chinese National Health Service Survey III in 2003. The results illustrate that the differences in self-rated functional and general health status between genders and between urban and rural areas diminished with age. Access to health care was strongly associated with health status. The quality of the local environment, measured by access to tap water, was a significant factor for rural residents. Our study suggests that improving access to health care services and reducing environmental health risks are critical for improving physical functioning, psychological functioning, and self-rated general health for older adults in China.

Population health status in China: EQ-5D results, by age, sex and socio-economic status, from the National Health Services Survey 2008

PURPOSE

To measure and analyse national EQ-5D data and to provide norms for the Chinese general population by age, sex, educational level, income and employment status.

METHODS

The EQ-5D instrument was included in the National Health Services Survey 2008 (n = 120,703) to measure health-related quality of life (HRQoL). All descriptive analyses by socio-economic status (educational level, income and employment status) and by clinical characteristics (discomfort during the past 2 weeks, diagnosed with chronic diseases during the past 6 months and hospitalised during the past 12 months) were stratified by sex and age group.

RESULTS

Health status declines with advancing age, and women reported worse health status than men, which is in line with EQ-5D population health studies in other countries and previous population health studies in China. The EQ-5D instrument distinguished well for the known groups: positive association between socio-economic status and HRQoL was observed among the Chinese population. Persons with clinical characteristics had worse HRQoL than those without.

CONCLUSIONS

This study provides Chinese population HRQoL data measured by the EQ-5D instrument, based on a national representative sample. The main findings for different subgroups are consistent with results from EQ-5D population studies in other countries, and discriminative validity was supported.

Relationships between age and gender differentials in health among older people in China

The objective of this paper is to specify the relationships between age and gender differentials in health among older people in China. The data were drawn from the 2002 Chinese Longitudinal Health Longevity Study (CLHLS), which included 15,789 respondents aged 65 or more years. The health indicators included the Activities of Daily Living (ADL) and Instrumental ADL scores, cognitive ability (using the Mini Mental State Examination), visual function, hearing or auditory function, number of natural teeth, self-reported health, and self-reported quality of life. The statistical significance of the age relationships was examined using Mann-Whitney U tests and Spearman's rank correlation coefficients. The principal results were that above 65 years of age, gender differentials were observed in most of the health indicators at most ages, although self-rated quality of life was an exception. For most of the objective (observer-rated) health indicators, the gender differentials increased with greater age, but that for the number of natural teeth decreased with age. Gender differentials in the two subjective health measures had no significant relationship with age. It is concluded that older Chinese women have poorer health than men and are in many ways disadvantaged, and that the relative disadvantage increases with age. Chinese women tend to live longer and suffer ill-health more than men.

Influence of socioeconomic status, wealth and financial empowerment on gender differences in health and healthcare utilization in later life: evidence from India

Empirical studies from developed countries observe that women report worse health and higher healthcare utilization than men, but the health disadvantage diminishes with age; gender differences in self-rated health often vanish or are reversed in older ages. Comparable assessments of health during later life from developing countries are limited because of the lack of large-scale surveys that include older women. Our study attempts to address the shortage of developing country studies by examining gender differences in health and healthcare utilization among older adults in India. Both ordered and binary logit specifications were used to assess significant gender differences in subjective and objective health, and healthcare utilization after controlling for demographics, medical conditions, traditional indicators of socioeconomic status like education and income, and additional wealth indicators. The wealth indicators, measured by property ownership and economic independence, are regarded as financially empowering older adults to exercise greater control over their health and well-being. Data are drawn from a nationally representative decennial socioeconomic and health survey of 120,942 Indian households conducted during 1995-1996. The study sample comprises 34,086 older men and women aged >or= 60 years. Our results indicate that older women report worse self-rated health, higher prevalence of disabilities, marginally lower chronic conditions, and lower healthcare utilization than men. The health disadvantage and lower utilization among women cannot be explained by demographics and the differential distribution of medical conditions. While successive controls for education, income, and property ownership narrows the gender gap in both health and healthcare utilization, significant differentials still persist. Upon controlling for economic independence, gender differentials disappear or are reversed, with older women having equal or better health than otherwise similar men. Financial empowerment might confer older women the health advantage reflected in developed societies by enhancing a woman's ability to undertake primary and secondary prevention during the life course.

Exploring China's rural health crisis: Processes and policy implications

China today is experiencing a rural health crisis, one that has uncomfortable echoes of the past. Within China's 'second society' of the peasantry, a resurgence of historical health problems (including vulnerability of the rural poor to epidemics such as schistosomiasis and tuberculosis and high rates of infant and maternal mortality) merge with contemporary concerns over HIV/AIDS, respiratory problems and the threat of Avian Flu to seriously threaten the health and welfare of people in rural areas. This review illustrates and explores the roots of this crisis in terms of key processes of social and environmental change and state health care policy. We argue that this crisis can only be resolved via a fundamental rethink of health provision across China, one that focuses especially on the poorest, most remote parts of the nation (both spatially and socially), and in which the privatisation of health care is more evenly balanced by increased state investment in basic health provision.

A sense of autonomy is preserved under Chinese reproductive policies

China has had a one-child family policy since 1979 and a National Family Planning Law since 2002. This paper presents analysis of comments from members of the general public and experts in China on the question of reproductive autonomy. The Chinese concept of 'Yousheng' (healthy birth) is more appropriate than eugenics as an expression of Chinese social policy and public attitudes. The widespread support for healthy birth has policy implications. None of the persons interviewed said that they had ever used ultrasound to choose the gender of their child nor had an abortion for the reason of a fetus's gender. Despite the bad impression of abortion from their experience, most would abort a fetus with a genetic disease. Respondents in rural areas were less likely to use prenatal care, pointing to more important social problems in reproduction in China. The impressions given from the survey stands in contrast to the implications of the majority of Western papers on the Chinese situation, and indicate that people are generally satisfied with the ethical balance towards the societal needs over individual autonomy, but they still have a sense of reproductive autonomy. There needs to be further study into these issues with larger surveys and interview studies.

Utilization of maternal care in rural HeBei Province, the People's Republic of China: individual and structural characteristics

PURPOSE

To study the effect of individual's socio-economic characteristics and the structure of the health services in the village on utilization of maternal care in rural HeBei, the People's Republic of China (PRC).

DATA

Data were collected from 4273 women who gave birth to one child at least, living in a stratified sample of 288 villages in HeBei Province.

FINDINGS

54.8% of the women had at least one pre-natal care visit, 27.5% gave birth in a health care facility, and 18.1% had post-natal check-up. Utilization was inversely related to age and parity and positively to education. Occupation was related to use of pre- and post-natal services, but not to home birth. Per-capita income and living arrangement are not related to utilization. MCH worker in the village promote pre- and post-natal care, but also home delivery. Village doctors promote pre-natal care and hospital delivery but do not promote post-natal check-up. Women tend to avoid the maternal services in the township health centers but some are ready to travel to city hospitals for delivery and post-natal care.

CONCLUSIONS

Health education programs regarding the importance of all three maternal care services are clearly needed. These programs should address not only women of child bearing age but also care providers, MCH workers in particular. Township health center should reach-out and motivate women to use their accessible services.

Health inequalities in rural China: evidence from HeBei Province

The purpose of this study was to examine the degree to which commonly used social class indicators-education, income, and occupation-are associated with health in the context of rural China. Data were collected from 10,226 individuals of working age (16-60) living in HeBei Province, the PRC. The association between education and income observed resembles the patterns documented in industrial societies, but the health status of farmers is quite similar to that of white collar employees. Persons in other than mainstream occupations report the poorest health status. Social selection and the costs of relative deprivation appear to be useful to the understanding of health inequality in rural China, though in a manner shaped by the particular social context.