Analysis of urban-rural population dynamics of China: a multiregional life table approach

Hospital based infectious disease related proportional mortality study

Objective:

To understand the temporal trends in mortality in Rural Central India.

Design:

Retrospective review of physician issued death certificates from a rural teaching hospital.

Materials and Methods:

Physician issued death certificates from 1979 to 2008, available with a rural teaching hospital were analyzed and information on age, gender, date, and cause of death was abstracted. We estimated cause-specific, proportional mortality ratio (PMR) stratified by age, and gender. We compared the difference in PMR in first fifteen years of the study period (period A, 1979-1993) with the later (period B, 1994-2008).

Results:

We found 20494 death certificates between 1979 and 2008. Proportion of infectious disease related mortality declined from 35% in 1979-1983-26% in 2004-2008. In the same periods, injury related mortality increased from 4.6% to 13.4%, and chronic disease mortality from 19% to 28%. The absolute difference in PMR (per 1000 deaths) was statistically significant between period B and period A, for infections (a decline of 80.67 [95% CI 66.97-94.03]), chronic diseases (an increase of 45.85 [95% CI 33.49-58.55]), and injuries (an increase of 42.98 [95% CI 33.87-52.26]).

Conclusion:

Temporal trend in mortality from a single hospital in rural Central-India over the past three decades shows decline in infectious diseases, and rise in injuries and chronic diseases.

Assessing potential spatial accessibility of health services in rural China: a case study of Donghai County

INTRODUCTION

There is a great health services disparity between urban and rural areas in China. The percentage of people who are unable to access health services due to long travel times increases. This paper takes Donghai County as the study unit to analyse areas with physician shortages and characteristics of the potential spatial accessibility of health services. We analyse how the unequal health services resources distribution and the New Cooperative Medical Scheme affect the potential spatial accessibility of health services in Donghai County. We also give some advice on how to alleviate the unequal spatial accessibility of health services in areas that are more remote and isolated.

METHODS

The shortest traffic times of from hospitals to villages are calculated with an O-D matrix of GIS extension model. This paper applies an enhanced two-step floating catchment area (E2SFCA) method to study the spatial accessibility of health services and to determine areas with physician shortages in Donghai County. The sensitivity of the E2SFCA for assessing variation in the spatial accessibility of health services is checked using different impedance coefficient valuesa. Geostatistical Analyst model and spatial analyst method is used to analyse the spatial pattern and the edge effect of potential spatial accessibility of health services.

RESULTS

The results show that 69% of villages have access to lower potential spatial accessibility of health services than the average for Donghai County, and 79% of the village scores are lower than the average for Jiangsu Province. The potential spatial accessibility of health services diminishes greatly from the centre of the county to outlying areas. Using a smaller impedance coefficient leads to greater disparity among the villages. The spatial accessibility of health services is greater along highway in the county.

CONCLUSIONS

Most of villages are in underserved health services areas. An unequal distribution of health service resources and the reimbursement policies of the New Cooperative Medical Scheme have led to an edge effect regarding spatial accessibility of health services in Donghai County, whereby people living on the edge of the county have less access to health services. Comprehensive measures should be considered to alleviate the unequal spatial accessibility of health services in areas that are more remote and isolated.

Modelling urban-rural population growth in China

"The population of China is still growing despite a dramatic decline in fertility in the past two decades. There are marked urban-rural differentials in fertility and, as a result, the pace of urbanization has significant effects on population growth. In this research an attempt is made to model urban-rural population growth in China. A demoeconomic model of urban and rural sectors is calibrated to account for the long-term trend of urbanization in China.... An accounts-based urban-rural population model, in which rural to urban migration and transition are driven by the foregoing demoeconomic model, is established.... These models are used to make urban-rural population projections for the period 1988-2087 under various fertility rate assumptions."