Local-Migrant Gaps in Healthcare Utilization Between Older Migrants and Local Residents in China

Impact of family doctor contracted services on the health of migrants: a cross-sectional study in China

This study investigates the impact of the family doctor contracted service system on the health of migrants in China, utilizing data from the 2018 China Migrants Dynamic Survey (CMDS). The study employs a double machine learning model to estimate the effect of family doctor contracted services (FDCS) on migrants' self-rated health (MSRH). The sample consists of 137,851 migrants, with family doctor service contract status, health education, and health records as key variables. To address potential endogeneity issues, an instrumental variable approach using the regional family doctor contracting rate was implemented. Mediation analysis was conducted to examine the roles of health education and health records in this relationship. The findings indicate that FDCS significantly improve MSRH. This positive effect is robust across various machine learning models, including Lassocv, Random Forest, and Gradient Boost. The instrumental variable approach confirms the validity of these results, mitigating concerns about endogeneity. Mediation analysis reveals that the positive impact of FDCS on MSRH is fully mediated by health education and health records, highlighting their critical roles in enhancing health outcomes. The FDCS play a crucial role in improving the health of migrants by providing continuous and comprehensive care. Enhanced health education and effective health records management are significant pathways through which these services exert their positive effects. Policy recommendations include expanding access to family doctor services, enhancing health education programs, and improving health records management to optimize healthcare delivery for migrants. Future research should consider longitudinal studies to further validate these findings and explore their applicability to specific subgroups or regions.

Can public health services promote the settlement intention of migrant workers: empirical analysis from China

Introduction

Enhancing migrant workers' settlement intention in cities requires ensuring they have equal public health rights as urban residents. Full access to public health services can strengthen their sense of belonging and improve the well-being of this vulnerable group. Evaluating the welfare impact of public health services from the perspective of city identification offers valuable insights and informs policies aimed at improving the quality of public health service provision.

Methods

This study utilizes data from the 2017 China CMDS survey. We employed various analytical methods, including the Probit model, IV-Probit model, Propensity Score Matching, and KHB decomposition, to empirically examine the impact of public health services on the settlement intention of migrant workers. Additionally, we explored the underlying mechanisms and heterogeneity of this impact.

Results

Public health services such as health records management and public health education significantly increase the settlement intention of migrant workers. The positive effect of public health services on the settlement intention is more pronounced among migrant workers who have moved across provinces and those who are married. Public health services indirectly enhance the settlement intention by improving urban satisfaction and sense of belonging, with the latter having a more substantial indirect effect.

Discussion

The current provision of basic public health services in China for migrant workers still needs improvement. This highlights the necessity of enhancing health record management, increasing health education and training, and tailoring services to better meet the needs of migrant workers. By improving the supply of public health services, we can effectively raise migrant workers' urban satisfaction and sense of belonging, thereby indirectly increasing their willingness to settle in cities. The findings of this study contribute to further optimizing the implementation of public health service policies and provide meaningful guidance for improving the urban integration of migrant workers.

Heterogeneity in public health service utilization and its relationship with social integration among older adult migrants in China: a latent class analysis

Background

The older adult migrant population in China is on the rise, which presents challenges for the national public health service system. However, the heterogeneity of public health service utilization and its relationship with social integration among the older adult migrant population remains unclear. This study aims to explore the heterogeneity the public health service utilization and how it relates to their social integration.

Methods

A total of 6,178 older adult migrants from the China Migrants Dynamic Survey (CMDS) in 2017 were included in this study. Exploratory factor analysis was used to categorize social integration into four dimensions. Latent class analysis (LCA) was used to identify different sub-groups of public health service utilization. ANOVA and multivariate logistic regression were used to determine the characteristics of different sub-groups.

Results

Three potential classes of public health service utilization were identified: low utilization of basic public health services class (N = 3,264,52.756%), medium utilization of basic public health services class (N = 1,743,28.172%), and high utilization of basic public health services class (N = 1,180,19.072%). Gender, education, extent of mobility, and move alone or not, flow time were all predictors of the class of public health service utilization. There were significant differences in social integration across potential categories (p<0.0001).

Conclusion

The utilization of public health services of the older adult migrants is affected by many aspects. Social integration deserves attention as a significant influencing factor in the utilization of public health services. The government should pay attention to the characteristics of the older adult migrants and formulate relevant policies in a targeted manner in order to improve the utilization of public health services of the older adult migrants.

Research on the health status and influencing factors of the older adult floating population in Shanghai

Introduction

Over the past decade, against the dual background of population aging and mobility, the older adult/adults floating population has become a new type of mobile group in China, continually congregating in large cities, posing significant challenges to the socio-economic development, eldercare services, and public management of these metropolises. Shanghai, as a mega-city and the economic center of the China, is typically representative of the national population.

Methods

Based on the dynamic monitoring data of Shanghai's floating population in 2018, this research uses mathematical statistics and binary Logistic regression models.

Objective

This research analyzes the demographic characteristics and health status of the older adult/adults floating population in Shanghai in the new era and reveals its primary influencing factors.

Results and discussion

(1) A prominent contradiction in the scale and structure of the older adult/adults floating population, with widowed and low-educated mobile older adult/adults requiring attention. (2) There is a lack of health knowledge, and the proportion of local reimbursement is low. Over 90% of migrant older adult/adults self-assessed their health (with a very few unable to care for themselves), far higher than the proportion of older adult/adults who are not sick (injured) or uncomfortable (actually healthy), which exceeds 70%. The health status of migrant older adult/adults deteriorates with age, and those who have never attended school and live alone have the worst health status. (3) Older adult/adults people with advanced age and low educational levels are at risk of health issues, while a better living environment can reduce the risk of illness in the older adult/adults floating population. Low family income, poor housing affordability, and the medical burden brought about by illness can easily lead to older adult/adults floating populations falling into the trap of older adult/adults poverty, and older adult/adults people from central regions and those who migrate along have difficulty adapting to city life, leading to poor self-assessed health. Meanwhile, community/enterprise health education helps to enhance the health protection awareness of the older adult/adults floating population. Finally, based on the governance concept of "mobility publicness," several public management and service optimization strategies for social support for the older adult/adults floating population in Shanghai are proposed.

Association between social capital and utilization of essential public health services among elderly migrants: a multilevel logistic study based on the 2017 China migrant dynamic survey (CMDS)

BACKGROUND

As the number of elderly migrants in China continues to grow, it is necessary to pay closer attention to their health and health services. Some studies have confirmed that social capital plays a significant role in the utilization of health services. Therefore, an in-depth exploration of the relationship between social capital and the utilization of essential public health services (EPHS) by elderly migrants will not only contribute to improving their overall health but also facilitate a more balanced development of public health service system in China.

METHODS

Based on the cross-sectional data from the 2017 China Migrants Dynamic Survey (CMDS), this study examined the impact of social capital on the utilization of EPHS among elderly migrants. We evaluated social capital at two distinct levels: the individual and the community, and considered two dimensions of social capital: structural social capital (SSC) and cognitive social capital (CSC). The study aimed to delve into the impact of these forms of social capital on the utilization of EPHS among elderly migrants, and whether the migration range moderates this impact by multilevel logistic regression analysis.

RESULTS

A total of 5,728 migrant elderly individuals were selected. The health records establishment rate and health education acceptance rate were approximately 33.0% and 58.6%, respectively. Social capital influenceed the utilization of EPHS among elderly migrants. Specifically, individual-level SSC and CSC have impacts on both the establishment of health records (OR = 1.598, 95%CI 1.366-1.869; OR = 1.705, 95%CI 1.433-2.028) and the acceptance of health education (OR = 1.345, 95%CI 1.154-1.567; OR = 2.297, 95%CI 1.906-2.768) among elderly migrants, while community-level SSC only affected the acceptance of health education (OR = 3.838, 95%CI 1.328-11.097). There were significant differences in individual-level SSC, health records, and health education among different migration range subgroups among elderly migrants. Migration range moderated the effect of social capital on the utilization of EPHS, crossing provinces could weaken the relationship between SSC and health education.

CONCLUSIONS

Social capital is associated with a higher utilization rate of EPHS among elderly migrants. It is necessary to encourage them to actively participate in social activities, strengthen public services and infrastructure construction in the area, and improve their sense of belonging and identity.

Exploring differences in the utilization of the emergency department between migrant and non-migrant populations: a systematic review

BACKGROUND

Migrants face several barriers when accessing care and tend to rely on emergency services to a greater extent than primary care. Comparing emergency department (ED) utilization by migrants and non-migrants can unveil inequalities affecting the migrant population and pave the way for public health strategies aimed at improving health outcomes. This systematic review aims to investigate differences in ED utilization between migrant and non-migrant populations to ultimately advance research on migrants' access to care and inform health policies addressing health inequalities.

METHODS

A systematic literature search was conducted in March 2023 on the Pubmed, Scopus, and Web of Science databases. The included studies were limited to those relying on data collected from 2012 and written in English or Italian. Data extracted included information on the migrant population and the ED visit, the differences in ED utilization between migrants and non-migrants, and the challenges faced by migrants prior to, during, and after the ED visit. The findings of this systematic review are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines.

RESULTS

After full-text review, 23 articles met the inclusion criteria. All but one adopted a quantitative methodology. Some studies reported a higher frequency of ED visits among migrants, while others a higher frequency among non-migrants. Migrants tend to leave the hospital against medical advice more frequently than the native population and present at the ED without consulting a general practitioner (GP). They are also less likely to access the ED via ambulance. Admissions for ambulatory care-sensitive conditions, namely health conditions for which adequate, timely, and effective outpatient care can prevent hospitalization, were higher for migrants, while still being significant for the non-migrant population.

CONCLUSIONS

The comparison between migrants' and non-migrants' utilization of the ED did not suggest a clear pattern. There is no consensus on whether migrants access EDs more or less than non-migrants and on whether migrants are hospitalized at a higher or lower extent. However, migrants tend to access EDs for less urgent conditions, lack a referral from a GP and access the ED as walk-ins more frequently. Migrants are also discharged against medical advice more often compared to non-migrants. Findings of this systematic review suggest that migrants' access to care is hindered by language barriers, poor insurance coverage, lack of entitlement to a GP, and lack of knowledge of the local healthcare system.

Disparities in awareness and utilisation of National Essential Public Health Services between the floating population and the registered residents: a cross-sectional study in China

OBJECTIVE

There are differences between the floating population and the registered population in the awareness and use of the National Essential Public Health Services (NEPHS) due to the influence of China's household registration system. The Equalization of Basic Public Health and Family Planning Services (EBPHFPS) policy aims to reduce disparities among populations by enhancing the migrant population's access to basic public health services. The aim of this study is to examine the relationship between the EBPHFPS targeted at the floating population and the disparities in access to and utilisation of NEPHS between registered residents and the floating population.

DESIGN

A cross-sectional study.

SETTING

8 cities (regions, autonomous prefectures) in China.

PARTICIPANTS

13 998 floating population and 14 000 registered residents in eight cities (regions, autonomous prefectures) were included in the analysis.

OUTCOME MEASURES

Three binomial variables, including awareness of NEPHS, acceptance of health education and establishment of health records, were used as outcome indicators to examine the relationship between the EBPHFPS and the disparities between the floating and registered populations.

METHODS

A linear regression model, fairness gap calculation and propensity score matching were used to explore the associations.

RESULTS

The areas that implemented EBPHFPS exhibited an 8.3% increase in awareness of the NEPHS (p<0.01) and a 4.0% increase (p<0.05) in the likelihood of individuals having received health education within the previous year compared with the areas without the policy implementation. In contrast to registered residents, however, the floating population still faces significant disparities in NEPHS awareness and utilisation. Compared with areas without the equalisation policy, the inequality of opportunity in health education of the floating population in implementation areas is significantly lower (p<0.01), whereas no significant difference is observed in the inequality of opportunity regarding NEPHS awareness among the floating population (p>0.1). The floating population in the pilot areas of the policy encountered greater disparities in the establishment of health records (p<0.01).

CONCLUSIONS

Positive associations between the EBPHFPS policy and NEPHS awareness and utilisation among the floating population were demonstrated to some extent; however, the floating population was still confronted with a degree of inequality of opportunity. The government needs to develop target-oriented policies and a guaranteed mechanism to ensure access to NEPHS among the floating population.

Association between the location of social medical insurance and social integration among China's elderly rural migrants: a nationwide cross-sectional study

BACKGROUND

Universal social medical insurance coverage is viewed as a major factor in promoting social integration, but insufficient evidence exists on the integration of elderly rural migrants (ERM), generally aged 60 years and above, in low- and middle-income countries. To address this problem, we explore the relationship between the location of social medical insurance (SMI), such as a host city, and social integration in the context of Chinese ERM.

METHODS

This study is based on data from the 2017 National Internal Migrant Dynamic Monitoring Survey in China. The study participants were Chinese ERM. An integration index was constructed to measure the degree of social integration in a multi-dimensional manner using a factor analysis method. This study used descriptive statistics and one-way analysis of variance to explore the differences in social integration between ERM with SMI from host cities and hometowns. Stepwise multiple linear regression analysis was used to test the correlation between SMI location and social integration level in the overall sample. Finally, the results were verified by propensity score matching.

RESULTS

It was found that 606 (18.2%) of the insured ERM chose host city SMI, while 2727 (81.8%) chose hometown SMI. The level of social integration was lower among ERM with hometown SMI (-1.438 ± 32.795, F = 28.311, p ≤ 0.01) than those with host city SMI (6.649 ± 34.383). Among the dimensions of social integration, social participation contributed more than other factors, with a contribution rate of 45.42%. Host city SMI increased the probability of the social integration index by 647% among ERM (k-nearest neighbor caliper matched (n = 4, caliper = 0.02), with a full sample ATT value of 6.47 (T = 5.32, SE = 1.48, p < 0.05)).

CONCLUSIONS

ERM with host city SMI have a higher social integration level than those with hometowns SMI. That is, host city SMI positively affects social integration. Policymakers should focus on the access of host city SMI for ERM. Removing the threshold of host city SMI coverage for ERM can promote social integration.

The mortality risk after myocardial infraction in migrants compared with natives: a systematic review and meta-analysis

Background and Objective

The evidence on the risk of mortality after myocardial infarction (MI) among migrants compared with natives is mixed and limited. The aim of this study is to assess the mortality risk after MI in migrants compared to natives.

Methods

This study protocol is registered with PROSPERO, number CRD42022350876. We searched the Medline and Embase databases, without time and language constraints, for cohort studies that reported the risk of mortality after MI in migrants compared to natives. The migration status is confirmed by country of birth, both migrants and natives are general terms and are not restricted to a particular country or area of destination or origin. Two reviewers separately screened searched studies according to selection criteria, extracted data, and assessed data quality using the Newcastle-Ottawa Scale (NOS) and risk of bias of included studies. Pooled estimates of adjusted and unadjusted mortality after MI were calculated separately using a random-effects model, and subgroup analysis was performed by region of origin and follow-up time.

Result

A total of 6 studies were enrolled, including 34,835 migrants and 284,629 natives. The pooled adjusted all-cause mortality of migrants after MI was higher than that of natives (OR, 1.24; 95% CI, 1.10-1.39; I2 = 83.1%), while the the pooled unadjusted mortality of migrants after MI was not significantly different from that of natives (OR, 1.11; 95% CI, 0.69-1.79; I2 = 99.3%). In subgroup analyses, adjusted 5-10 years mortality (3 studies) was higher in the migrant population (OR, 1.27; 95% CI, 1.12-1.45; I2 = 86.8%), while adjusted 30 days (4 studies) and 1-3 years (3 studies) mortality were not significantly different between the two groups. Migrants from Europe (4 studies) (OR, 1.34; 95% CI, 1.16-1.55; I2 = 39%), Africa (3 studies) (OR, 1.50; 95% CI, 01.31-1.72; I2 = 0%), and Latin America (2 studies) (OR, 1.44; 95% CI, 1.30-1.60; I2 = 0%) had significantly higher rates of post-MI mortality than natives, with the exception of migrants of Asian origin (4 studies) (OR, 1.20; 95% CI, 0.99-1.46; I2 = 72.7%).

Conclusions

Migrants tend to have lower socioeconomic status, greater psychological stress, less social support, limited access to health care resources, etc., therefore, face a higher risk of mortality after MI in the long term compared to natives. Further research is needed to confirm our conclusions, and more attention should be paid to the cardiovascular health of migrants.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier: r CRD42022350876.

Experience of Chinese Recent Retirees on the Effects of Retirement on Healthy Ageing in Shenzhen and Hong Kong

This study examined perspectives of recent retirees in Shenzhen and Hong Kong on how retirement influenced their healthy ageing. It investigated retirees' perceptions of healthy ageing and the ways in which healthy ageing connected with retirees' transition into retirement. A qualitative design with narrative interviews was used to interview twelve recent retirees in Shenzhen and thirteen in Hong Kong. The participants elaborated their perspectives on healthy ageing, which covered physical, mental, social, and financial domains. Retirees in both cities identified healthy ageing as maintaining an independent life and avoiding becoming a burden on family members. This study found that retirement declined physical health (in parallel with raised awareness of health promotion), posed both negative and positive influences on mental health, and shrank peripheral social networks of retirees. In addition, regional social welfare systems have different impacts on retirees' financial security and social participation. Retirees in Hong Kong reported higher stress of financial security and a strong desire for labor participation. Migrant-local welfare gaps were documented by retirees in Shenzhen. This study suggested that retirement planning, establishing a multi-pillar retirement-protection system, and narrowing the welfare gap between migrants and local residents should be implemented to reinforce healthy ageing.

Health service behaviors of migrants: A conceptual framework

Universal health coverage is vital to the World Health Organization's (WHO's) efforts to ensure access to health as a human right. However, it has been reported that migrants, including both international immigrants and internal migrants, underuse health services. Establishing a conceptual framework to facilitate research on the health service behaviors (HSB) of migrants is particularly important. Many theoretical frameworks explaining the general population's HSB have been published; however, most theoretical frameworks on migrants' HSB only focus on international immigrants without the inclusion of internal migrants. Of note, internal migrants are much more abundant than immigrants, and this group faces similar barriers to HSB as immigrants do. Based on theoretical frameworks of immigrants' HSB and Anderson's behavior model, the author proposes a new conceptual framework of migrants' HSB that includes both immigrants and internal migrants. The new conceptual framework divides the determinants into macro-structural or contextual factors, health delivery system characteristics, and characteristics of the population at risk and describes subgroup-specific factors. The author added some variables and reclassified variables in some dimensions, including characteristics of health delivery systems and access to healthcare. The characteristics of health delivery systems comprise the volume, organization, quality, and cost of the health delivery system, while the characteristics of access to healthcare include time accessibility, geographic accessibility, and information accessibility. The outcomes of HSB have been expanded, and relationships between them have been reported. The mediating effects of some variables have also been described. This conceptual framework can facilitate a deep and comprehensive understanding of the HSB determination process for migrants, including internal migrants.

Inequalities in the Access to Health Services Among Older Migrants: Evidence From the China Migrant Dynamic Monitoring Survey

Objectives: To identify differences in healthcare use between older migrant workers (OMWs) and older migrants (OMs) and explore associated factors and paths of healthcare use. Methods: The data came from the 2015 China Migrant Dynamic Monitoring Survey (CMDMS). CMDMS used a multi-stage stratified probability proportionate to size method as the sampling technique and conducted a desk review. The samples include OMWs, OMs for caring offspring (N = 4,439), and OMs for receiving care from family (N = 4,184). We built logistic regression and path analysis models to analyze the data. Results: Social health insurance (SHI) in current place of residence is associated with less expenditure among all subgroups. OMWs and OMs for receiving care from family with SHI in current place of residence are more likely to use healthcare. Conclusion: OMWs are particularly vulnerable in healthcare use and socioeconomic status. Having SHI registered in current place of residence helps decrease expenditure among OMs. We urge policymakers to consider a united health financing scheme across OMWs and other urban employees and streamline policies for migrants to enroll in SHI in current place of residence.

Effects of Health Service Utilization and Informal Social Support on Depression, Anxiety, and Stress among the Internal Migrant Elderly following Children in Weifang, China

This study explored the relationship between health service utilization, informal social support and depression, anxiety and stress among the internal migrant elderly following children (IMEFC) in Weifang, China. A total of 613 IMEFC were selected using multistage cluster random sampling. The Depression Anxiety and Stress Scale 21 (DASS-21) was used to assess the depression, anxiety and stress of the IMEFC. Descriptive analysis and univariate and binary logistic regression analyses were used to clarify the correlation between health service utilization and social support and depression, anxiety and stress of the IMEFC. The prevalence of depression, anxiety and stress of the IMEFC was 6.9%, 7.7% and 3.4%, respectively. Logistic regression analysis showed that the IMEFC who having financial stress on medical costs were more likely to feel depressed than those haven't financial stress on medical costs (OR = 6.557), while those unemployed and having no income were less likely to feel depressed than those employed (OR = 0.262), having children support were less likely to feel depressed than those haven't children support (OR = 0.257) and having comfort support were less likely to feel depressed than haven't comfort support (OR = 0.018). Trans-city migration were more likely to feel anxious than trans-county migration (OR = 3.198), having outpatient service were more likely to feel anxious than haven't experienced inpatient service (OR = 3.818), having financial stress on medical costs were more likely to feel anxious than haven't financial stress on medical costs (OR = 3.726), while having children support were less likely to feel anxious than haven't children support (OR = 0.198). Those who migrate to cure disease or rehabilitation were more likely to feel stressed than those migrated to taking care of grandchildren (OR = 12.702) and having financial stress on medical costs were more likely to feel stressed than haven't financial stress on medical costs (OR = 32.155), while having children support were less likely to feel stressed than haven't children support (OR = 0.055) and having economic support in troubles were less likely to feel stressed than haven't economic support in troubles (OR = 0.012). More effective measures should be taken to improve the accessibility and efficiency of cross-regional health insurance reimbursement, and family members should spend more time with the IMEFC to lower their psychological tension in a new environment.

Relationship between Intergenerational Emotional Support and Subjective Well-Being among Elderly Migrants in China: The Mediating Role of Loneliness and Self-Esteem

With the augmentation of family migration, the number and proportion of elderly migrants have increased dramatically in China. The well-being of this group has a profound impact on the whole society. Subjective well-being is a comprehensive reflection of whether a person's needs are met. In this cross-sectional study, we established a multiple mediation model to evaluate the mediating effects of loneliness and self-esteem on intergenerational emotional support and, consequently, on subjective well-being in elderly migrants. The study population consisted of 728 elderly migrants living in Nanjing (Jiangsu, China), including 219 men (30.1%) and 509 women (69.9%). The participants' loneliness and self-esteem were measured using the R-UCLA Loneliness Scale, the Rosenberg Self-Esteem Scale, and the Philadelphia Senior Center Confidence Scale. Multiple regression analyses revealed a significant correlation between intergenerational emotional support and subjective well-being, and mediation analysis revealed that intergenerational emotional support indirectly influenced subjective well-being through three mediators: loneliness (mediating effect, 0.149), self-esteem (mediating effect, 0.136), and loneliness and self-esteem (mediating effect, 0.041). We conclude that loneliness and self-esteem mediate the relationship between intergenerational emotional support and subjective well-being in elderly migrants and can be regulated to improve elderly migrants' subjective well-being. Great attention should be paid to the emotional needs of elderly migrants, and communication and exchange with elderly migrants should be emphasized to enhance their subjective sense of well-being.

The positive association between internal migration and hospitalization among the older adults in China: Regional heterogeneity and chronic disease management

Background

Post-retirement migrants are rapidly increasing in China, but the impact of internal migration on hospitalization among older adults remains under-researched. Understanding this impact is essential for health policies development and improvement. This study aims to identify the most vulnerable population, evaluate the association between migration and hospitalization, and discuss potential causes of the association.

Methods

14,478 older adults were extracted from the 2018 to 2019 Chinese Longitudinal Healthy Longevity Survey (CLHLS) database and divided into four groups according to migration experience and age at migration: non-migrants, pre-adulthood migrants, pre-retirement migrants, and post-retirement migrants. Post-retirement migrants were key research subjects. We employed Pearson's chi-square test to compare group differences in outcome and covariates, and multivariate logistic regression analysis to examine the association between migration and hospitalization by regions and chronic conditions.

Results

Significant intergroup differences were observed in demographic characteristics, socioeconomic factors, health habits, and health-related factors. Post-retirement migrants displayed following characteristics: female predominance (61.6%; 1,472/2,391), tending toward urban areas (80.9%; 1,935/2,391), and the highest prevalence rate of chronic disease (46.7%; 1,116/2,391). Urban migrants in eastern China were more likely to be hospitalized (OR = 1.65; 95% CI: 1.27-2.15), especially those who were diagnosed with chronic disease (OR = 1.51; 95% CI: 1.04-2.19) or with unconfirmed chronic conditions (OR = 1.98; 95% CI: 1.36-2.89).

Conclusions

Internal migration is associated with the hospitalization of post-retirement migrants moving to eastern China. Improved chronic disease management and early interventions might lower the hospitalization. Effective policies should be formulated to reduce the disparity in primary care services across China, thereby facilitating the access of migrants to these services.

Health status and public health education for internal older migrants in China: Evidence from a nationally representative survey

Background

Self-rated health has been widely used as a useful screening tool to subjectively evaluate individuals' health status. Under the context of the rapid growth of aging, there was a dramatic rapid expansion in internal older migrants in China. Serious concerns on the issues of health status continue to attract quite a lot of attention over the past decades. Public health education is one of the most important health care services and methods to improve individuals' health status. However, most previous studies focus on the utilization of public health services such as visiting to doctors, physical examination, and hospitalization. There was limited evidence on the self-rated health and public health education of older migrants.

Objectives

The study aimed to evaluate self-rated health and the associated determinants in older migrants, as well as to gain a deeper insight into the current status of public health education received by older migrants.

Methods

We derived the data from the National Migrants Population Health and Family Planning Dynamic Monitor Survey 2018, a cross-sectional study, for secondary analysis. Internal migrants aged 60 years old or over were included in the study. Self-rated health was the dependent variable, while sociodemographic characteristics were the independent variable. The univariate and multivariate analyses were performed by Stata 15.1.

Results

A total of 5,589 older migrants were included in the study. Eighty-two percentage of older migrants reported healthy self-rated health. There was a significant association between age, gender, minzu, education level, monthly income, public health education, and self-rated health (P < 0.5). However, the proportion of older migrants that received specific public health education was <50%. The most common approach to receiving public health education was through the leaflet, while <20% of older migrants received public health education through public consultation and one-to-one education.

Conclusions

It was necessary to promote the publicity of public health education in older migrants through easy access and diverse approaches in order to effectively spread health-related knowledge to older migrants to satisfy their health needs and maintain their health.

Effect of Morbidities, Depression, Anxiety, and Stress on Oral Health-Related Quality of Life among Migrant Elderly Following Children in Weifang, China

This study explored the relationship between depression, anxiety, stress, morbidity, and oral health-related quality of life (OHRQoL) in the migrant elderly following children (MEFC) in Weifang, China. A total of 613 MEFC were selected using multistage cluster random sampling. The GOHAI scale was used to evaluate oral health-related quality of life. The DASS-21 scale was used to assess levels of depression, anxiety, and stress. Univariate analysis and binary logistic regression were used to analyze the correlation between these indicators and oral health-related quality of life, of which 43.9% were classified as having poor oral health. Logistic regression analysis showed that the MEFC who were of older age (OR = 0.965, p = 0.039), with hypertension (OR = 0.567, p = 0.004), with gastroenteropathy (OR = 0.263, p = 0.007), had received an outpatient service in the past year (OR = 0.669, p = 0.048), were depressed (OR = 0.338, p = 0.012), and anxious (OR = 0.414, p = 0.026) were less likely to report good oral health status. On the other hand, the MEFC with a high school education or above (OR = 1.872, p = 0.020) were more likely to report good oral health than those with primary school education and below. In conclusion, with regard to depression, anxiety, and stress: the results indicated that the fewer morbidities, the lower the level of depression and anxiety and the better the OHRQoL of MEFC. Targeted measures for government, communities, and family members were given to improve the OHRQoL of MEFC.

Association between resident status and patients' experiences of primary care: a cross-sectional study in the Greater Bay Area, China

OBJECTIVES

Patients' experiences are important part of health services quality research, but it's still unclear whether patients' experiences are influenced by resident status. This study aimed to evaluate the association between resident status and patients' primary care experiences with the focus on migrants vs local residents.

DESIGN

A cross-sectional study using multistage cluster random sampling was conducted from September to November 2019. The data were analysed using general linear models.

SETTING

Six community health centres in Guangzhou, China.

PARTICIPANTS

1568 patients aged 20 years or older.

MAIN OUTCOME MEASURES

Patients' primary care experiences were assessed using the Primary Care Assessment Tool. The 10 domains included in Primary Care Assessment Tool (PCAT) refers to first contact-utilisation, first contact-access, ongoing care, coordination (referral), coordination (information), comprehensiveness (services available), comprehensiveness (services provided), family-centredness, community orientation and cultural competence from patient's perspective.

RESULTS

1568 questionnaires were analysed. After adjusting for age, sex, education, annual family income, self-perceived health status, chronic condition, annual medical expenditure and medical insurance, the PCAT total scores of the migrants were significantly lower than those of local residents (β=-0.128; 95% CI -0.218 to -0.037). Migrants had significantly lower scores than local residents in first contact utilisation (β=-0.245; 95% CI -0.341 to -0.148), ongoing care (β=-0.175; 95% CI -0.292 to -0.059), family-centredness (β=-0.112; 95% CI -0.225 to 0.001), community orientation (β=-0.176; 95% CI -0.286 to -0.066) and cultural competence (β=-0.270; 95% CI -0.383 to -0.156), respectively.

CONCLUSION

Primary care experiences of migrants were significantly worse off than those of local residents, especially in terms of primary care utilisation, continuity and cultural competence. Given the wide disparity in primary care experiences between migrants and local residents, Chinese healthcare system reform should focus on improving quality of primary care services for migrants, overcoming language barriers and creating patient-centred primary care services.

The Promotional Effect of Health Education on the Medical Service Utilization of Migrants: Evidence From China

There were 376 million migrants in China by 2020, who made significant contributions to urban development. However, they used limited medical services and had lower self-reported health status than inflow city residents. Based on this, this study uses the cross-sectional data of the 2017 China Migrants Dynamic Survey (CMDS) to construct a multiple linear regression model to empirically study the role of health education in improving medical services utilization for migrants. It finds that compared to migrants without health education, the probability of the medical service utilization for migrants with health education has increased significantly, and counseling is more effective than other methods for health education. This promotion effect of health education has been established after a series of robustness tests. Furthermore, this study finds that the closer the migrants are to medical service resources, the greater the effect of health education on medical services utilization for migrants. The heterogeneity test shows that the effect of health education on medical services utilization for migrants is greater among the non-elderly and those with lower education levels. From the perspective of health education, the findings in this study provide empirical evidence to support the government in formulating policies to improve the utilization of medical services for migrants and reduce health inequality.

Using Nomogram to Predict the Hospitalization Forgone Among Internal Migrants in China: A Nationally Representative Cross-Sectional Secondary Data Analysis

Background

Migrants are one of the most vulnerable populations facing many health issues. Inadequate health care access and unequal insurance are the most challenging. This study aimed to construct a nomogram to predict the risk of hospitalization forgone among internal migrants in China.

Methods

We analyzed the 2014 Mobile Population Social Integration and Mental Health Survey (MPSIMHS) launched by National Health and Family Planning Commission. Using the Probability Proportionate to Size Sampling method (PPS), MPSIMHS sampled from eight cities (districts) with a total sample size of 15,999. Of total 589 patients who were diagnosed with hospitalization requirement, 116 forwent their hospitalization, 473 had no forgone. Demographics, socioeconomic status, and health conditions were analyzed using univariate analysis and multivariate logistic regression. A nomogram was built and validated by applying bootstrap resampling.

Results

After model selection, gender, age group, marital status, migration range, insurance (having NRMI), and self-evaluated health were chosen into the nomogram to predict the risk of hospitalization forgone. The nomogram that predicted the risk of hospitalization forgone was validated for discrimination and calibration using bootstrap resampling. The calibration curves illustrated optimal agreement between the actual and predicted probabilities of the nomogram. The value of C-index from bootstrap was 0.80 (95% CI: 0.76–0.85).

Conclusion

This study identified some possible factors contributing to migrant’s hospitalization forgone: being single, male and middle-aged, having fixed health insurance, and having bad or great self-evaluated health. By integrating significant and easy-to-get prognostic factors, a nomogram was developed to estimate an individual patient’s risk of hospitalization forgone, which might have practical utility and the potential to assist clinicians in making hospitalization recommendations.