The migrating mediators and the interaction associated with the use of essential public health services: a cross-sectional study in Chinese older migrants

Effect of health rights accessibility on the urban integration of minority rural migrants in China: a cross-sectional study

BACKGROUND

Accessing health rights is an integral component of people's aspirations for a better life. Existing discussions and evaluations regarding the accessibility of health rights for minority rural migrants are insufficient. In comparison to objective health conditions, inequalities in health rights lead to chronic and long-term depletion of human capital among minority rural migrants. This study aimed to assess the overall impact, heterogeneity effects, and mechanisms of health rights accessibility on the urban integration of minority rural migrants.

METHODS

Based on the 2017 China Migrants Dynamic Survey Data (CMDS), this study employs OLS models, 2SLS models, conditional mixed process (CMP) methods, and omitted variable tests to estimate the impact of health rights accessibility on the urban integration of minority rural migrants. Additionally, from the perspectives of migration scope and illness experience, this study explored the heterogeneity in the relationship between health rights accessibility and urban integration. Finally, using the Karlson-Holm-Breen (KHB) model, this study dissects the mechanisms through which health rights accessibility influences the urban integration of minority rural migrants.

RESULTS

Health rights accessibility significantly enhances the urban integration of minority rural migrants. Moreover, compared to minority rural migrants who move across provinces and who have no history of illness, those who migrate within the same province and who have experienced illness are more sensitive to the positive impact of health rights accessibility. However, the enhancing effect of health rights accessibility does not significantly differ between the new and old generations of minority rural migrants. Furthermore, health rights accessibility can indirectly improve the urban integration of minority rural migrants by elevating health levels, improving health habits, and reinforcing health behaviors. Among these, the indirect effects mediated by health habits are more pronounced.

CONCLUSION

The research conclusions underscore the issue of health accessibility and urban integration among minority rural migrants, providing a reexamination and clarification of the policy effects of health rights in promoting the urban integration of minority rural migrants. Relevant policy design should commence with improving the health rights of minority rural migrants, enhancing their health integration capabilities, and effectively boosting their ability to integrate into urban life.

Impact of the Essential Public Health Service program on financial protection and health outcomes among hypertensive patients: A quasi-experimental study in China

BACKGROUND

The Chinese government launched the Essential Public Health Service (EPHS) program nationwide in 2009. However, prior studies have not provided clear and integrated evidence on whether the EPHS program improves health outcomes and prevents financial risks among individuals. Because hypertension is the chronic disease with the highest prevalence, this study evaluated the impact of the EPHS program among hypertensive patients to provide evidence for the progress of the program.

METHODS

A cohort of hypertensive patients was identified from the 2011-2018 China Health and Retirement Longitudinal Study (CHARLS). The outcomes assessed included hospitalization expenditure, outpatient expenditure and cardiovascular disease (heart attack and stroke). The key independent variable was whether an individual received EPHS-covered blood pressure measurements in 2013-2015. Based on the International Health Partnership+ (IHP+) common monitoring and evaluation (M&E) framework, a difference-in-differences (DID) method with propensity score matching (PSM) was used to examine the impact of the EPHS program on hypertensive patients.

RESULTS

The results showed that among hypertensive patients covered by the EPHS program, outpatient total costs/OOP costs were reduced by 29.8% and 30.8%, respectively, and hospitalization total costs/OOP costs were reduced by 34.9% and 35.6%, respectively. The EPHS program reduced the probability of heart attack and stroke among hypertensive patients by 3.5% and 2.7%, respectively. Mechanistic tests showed that the EPHS program improved health outcomes by reducing alcohol consumption and increasing physical activity, thereby further reducing health expenditure among hypertensive patients. The impacts of the EPHS program on hypertensive patients varied by age, educational attainment, residential region, and alcohol consumption status.

CONCLUSION

The EPHS program in China significantly improved health outcomes and prevented financial risks for hypertensive patients. This evidence provides a valuable reference for low- and middle-income countries with their essential public health service programs.

The Migrant-Local Difference in the Relationship Between Social Support, Sleep Disturbance, and Loneliness Among Older Adults in China: Cross-Sectional Study

BACKGROUND

Driven by the accelerated aging of the population of China, the number of older adults has increased rapidly in the country. Meanwhile, following children, migrant older adults (MOA) have emerged as a vulnerable group in the process of fast urbanization. Existed studies have illustrated the association between social support and loneliness and the relationship between sleep disturbance and loneliness; however, the underlying mechanisms and the migrant-local difference in the association between social support, sleep disturbance, and loneliness have not been identified.

OBJECTIVE

This study aimed to clarify the migrant-local difference in the relationship between social support, sleep disturbance, and loneliness in older adults in China.

METHODS

Multistage cluster random sampling was used to select participants: 1205 older adults (n=613, 50.9%, MOA and n=592, 49.1%, local older adults [LOA]) were selected in Weifang City, China, in August 2021. Loneliness was assessed with the 6-item short-form University of California, Los Angeles Loneliness Scale, social support was evaluated with the Social Support Rating Scale, and sleep disturbance was measured with the Pittsburgh Sleep Quality Index. The chi-square test, t test, and structural equation modeling (SEM) were adopted to explore the migrant-local difference between social support, sleep disturbance, and loneliness among the MOA and LOA.

RESULTS

The mean score of loneliness was 8.58 (SD 3.03) for the MOA and 8.00 (SD 2.79) for the LOA. SEM analysis showed that social support exerts a direct negative effect on both sleep disturbance (standardized coefficient=-0.24 in the MOA and -0.20 in the LOA) and loneliness (standardized coefficient=-0.44 in the MOA and -0.40 in the LOA), while sleep disturbance generates a direct positive effect on loneliness (standardized coefficient=0.13 in the MOA and 0.22 in the LOA).

CONCLUSIONS

Both MOA and LOA have a low level of loneliness, but the MOA show higher loneliness than the LOA. There is a negative correlation between social support and loneliness as well as between social support and sleep disturbance among the MOA and LOA (MOA>LOA), while loneliness is positively associated with sleep disturbance in both populations (MOA Collapse

Key Words

• loneliness
• migrant-local difference
• older adults
• sleep disturbance
• social support
• structural equation modeling

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MESH Headings

• Child
• Humans
• Aged
• Cross-Sectional Studies
• Loneliness
• Transients and Migrants
• China/epidemiology
• Sleep Wake Disorders/epidemiology
• Social Support
• Sleep

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Affiliation(s)

Mingli Pang Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Jieru Wang Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Mingyue Zhao Human Resource Department, The Second Hospital of Shandong University, Jinan, China
Rui Chen Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Hui Liu Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Xixing Xu Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Shixue Li Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Fanlei Kong Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China

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Relationship between social interaction and health of the floating elderly population in China: an analysis based on interaction type, mode and frequency

BACKGROUND

Although the health of the floating elderly population is an important part of active and healthy ageing, it is neglected in current Chinese society. Based on the general consensus that social interaction can affect the health of the floating population, this study explored whether the interaction type, mode and frequency influenced the health of the floating elderly population in China and investigated the variability of these influential effects.

METHODS

This study used the China Migrant Population Dynamic Survey Data 2017 and selected 5239 floating elderly individuals over 60 years old. Self-rated health was used to assess the comprehensive health status of respondents. Social interaction was measured by the interaction type, mode and frequency. Descriptive statistical analysis was used to analyse the health and social interaction status. An ordinal probit model was used to estimate the influential effects and differences on health caused by social interaction. The 2SLS model was used to examine the mutual causality relationship between interaction frequency and health, and a robustness test was conducted.

RESULTS

A total of 44.6% interacted with local residents, 14.2% participated in interaction activities based on geographical relations, and only 4.3% and 7% participated in interactions based on business and interest, respectively. Interacting with natives improved individuals' self-rated health by 18.5%; specifically, geographical interaction increased self-rated health by 40.9%, occupational interaction increased it by 25.2%, interest-based interaction increased it by 41.2%, and interaction frequency improved the self-rated health (β = 0.128). In addition, sex, education level, personal income, and floating into the eastern region had a positive effect on individuals' health. However, age, spouse and hukou exerted a negative effect.

CONCLUSIONS

This study demonstrated that interacting with local residents could improve the health of floating elderly population, and revealed that interest-based interaction and their frequency had a positive impact on health. The government should speed up the construction of the voluntary service system and encourage the floating elderly population to realize their personal value in social interaction. In addition, the reform of the hukou system should be further promoted, so as to remove institutional barriers to the social interaction.

Factors influencing utilization of communicable disease prevention and treatment education among the floating population: a cross-sectional study in China

BACKGROUND

In China, communicable diseases (CD) have a negative impact on public health and economic stability. The influx of migrants, who make up a substantial portion of China's population and continue to rapidly expand, has seriously hampered CD prevention and control, needing special care. This study aimed to identify key factors influencing the utilization of CD prevention and treatment education (CDPTE) among the floating population. We are confident that the findings will highlight obstacles facing CDPTE among the migrants, and guide future development prevention, treatment of CD, and health education services.

METHODS

A sample of migrants aged 15 years and above in 32 provincial units nationwide in 2018 was recruited by stratified multi-stage proportional to population size sampling (PPS). A structured questionnaire survey was conducted via face-to-face interviews. Subsequently, the Anderson health service utilization model was used as the theoretical framework and SPSS 26.0 statistical software was applied to analyze the data. The statistical description of the current situation of CDPTE acceptance and the chi-square test were used to compare the differences in CDPTE acceptance by different characteristics. Multivariate logistic regression was used to analyze key factors affecting the use of CDPTE among migrants.

RESULTS

A total of 40.1% of the recruited participants reported receiving education on CD prevention and treatment, primarily delivered through traditional transmission media. Multilevel logistic regression results revealed that male migrants, aged 30-49 years, unmarried, with higher educational attainment, an average monthly household income of CNY 7,500-9,999 (or US$1,176-1,568), working more than 40 h per week, flowing into the Central and Western regions, migrated in the province, self-rated health, contracted family doctors and those with health records were more likely to receive CDPTE (p < 0.05).

CONCLUSION

Our findings revealed unsatisfactory acceptance of education on CD prevention and treatment among migrants, implying that health education should be strengthened further. Publicity of relevant policies and works should be strengthened and specific interventions should be developed for key regions as well as vulnerable groups to enhance CDPTE. More financial support should also be provided to improve the quality of health education.

Voting with Your Feet: The Impact of Urban Public Health Service Accessibility on the Permanent Migration Intentions of Rural Migrants in China

The accessibility of urban public health services is not only relevant to the health status of rural migrants but also plays an increasingly important role in their migration decisions. Most existing studies have focused on the effects of the level of public health service provision and parity on rural migrants' migration behavior, ignoring the role of public health service accessibility. This paper systematically examines the overall impact, heterogeneous impact and mechanism of action of public health service accessibility on rural migrants' intentions to migrate permanently based on data from the 2017 China Mobile Population Dynamics Monitoring Survey using probit, IVprobit, eprobit, omitted variable test model and KHB mediating effect model. It was found that: (1) public health service accessibility significantly increased rural migrants' intentions to migrate permanently, and the results remained robust after using instrumental variables to mitigate endogeneity problems and omitted variable tests. (2) Heterogeneity analysis shows that public health service accessibility has a greater effect on enhancing the intentions to migrate permanently among females and rural migrants born in 1980 and later. (3) Further mechanism testing revealed that public health service accessibility could indirectly increase rural migrants' intentions to migrate permanently by improving health habits, health status, identity, and social integration, with identity playing a greater indirect effect. The findings of this paper not only provide empirical evidence for the existence of Tiebout's "voting with your feet" mechanism in China but also contribute to the scientific understanding of the role of equalization of public health services in the process of population migration.

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.

Effects of childcare disagreement with children, social support, and health status on unmet healthcare-seeking behavior among the migrant older with children to Jinan, China

Due to the acceleration of China's urbanization, the number of migrant older with children (MOC) continued to increase. This study aimed to clarify the effects of childcare disagreement with children, social support, and health status on unmet healthcare-seeking behavior among the MOC to Jinan, China. A cross-sectional study included 656 MOC (36.3% men and 63.7% women) using multi-stage cluster random sampling in Jinan, China. Childcare disagreement was evaluated by the differences between parents and grandparents on the diet, dressing, education, and childcare consumption. Social support was assessed using the social support rating scale (SSRS). Descriptive analysis, chi-squared test, and binary logistic regression were applied to analyze the association between childcare disagreement with children, social support, health status, and unmet healthcare-seeking behavior of the MOC. Approximately 41.3% of participants had unmet healthcare-seeking behavior. Logistic regression analysis showed that the MOC whose health status compared to last year get better were more likely to have unmet healthcare-seeking behavior, while who were women, had partial will of migration, hired a nanny, had smaller childcare disagreement with children on dressing, had smaller childcare disagreement with children on consumption, and had moderate social support, were less likely to experience unmet healthcare-seeking behavior. Recommendations were given to the government and family members to improve the health services-seeking behavior of the MOC.

Impact of public health education on the health status of the older migrant population

Background

Due to an increasing aging population, China has experienced a rapid expansion in its internal older migrant population who face greater health risks and who have a relatively high demand for health education. Public health education is an important means of preventing diseases and promoting health. However, many studies have focused on the utilization, with few studies examining the impact of public health education on the health of the older migrant population in China.

Objectives

This study analyzed the impact of public health education on the health of the older migrant population in China.

Methods

Based on data obtained from the National Migrant Population Health and Family Planning Dynamic Monitor Survey (2018), logistic models and propensity score matching were used to analyze the impact of public health education on the health of the older migrant population.

Results

The self-assessed health of China's older migrant population was good, and the acceptance rate of public health education was 40.81%. The public health status of the older migrant population receiving public health education significantly improved (p < 0.05). After correcting for endogeneity among the variables, public health education increased the probability of improving the older migrant population's self-assessed health by 5.4-6.1% (p < 0.01). Heterogeneity analysis found that public health education had a greater impact on the health of older men with an education level of middle school and below, and especially on the older migrant population in the eastern region of China.

Conclusions

Public health education positively affected the health status of the older migrant population. The characteristics and preferences of the older migrant population involving different genders, regions, and educational levels need to be considered, public health education needs to be standardized, and appropriate education methods need to be adopted that suit the older migrant population. Reference suggestions are provided for improving the health level of the older migrant population.

How Different Is the Annual Physical Examination of Older Migrants than That of Older Nonmigrants? A Coarsened Exact Matching Study from China

It has become a top priority to ensure equal rights for older migrants in China. This study aims to explore how different the annual physical examination of older migrants is compared to that of older nonmigrants in China by using a coarsened exact matching method, and to explore the factors affecting annual physical examination among older migrants in China. Data were drawn from the China Migrants Dynamic Survey 2015 and China Health and Retirement Longitudinal Survey 2015. The coarsened exact matching method was used to analyse the difference in the annual physical examination of older migrants and nonmigrants. A logistic regression was used to analyse the factors affecting annual physical examination among older migrants. The annual physical examination of older migrants was 35.6%, which was significantly lower than that of older nonmigrants after matching (Odds ratios = 0.91, p < 0.05). It was affected by education, employment, hukou, household economic status, health, health insurance, main source of income, type of migration, range of migration, years of migration, having health records in local community and number of local friends among older migrants in China. Older migrants adopted negative strategies in annual physical examination compared to older nonmigrants. Active strategies should be made to improve the equity of annual physical examination for older migrants in China.

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.

Family Support and Social Support Associated with National Essential Public Health Services Utilization among Older Migrants in China: A Gender Perspective

China provides National Essential Public Health Services (NEPHS) free of charge to all citizens to ensure access to essential health services. The present study aimed to explore the associations between different sources of support and NEPHS service utilization among older migrants in China with a gender perspective. We used a national cross-sectional dataset derived from the 2015 China Migrants Dynamic Survey. Participants were included if they were aged ≥60 years and without household registration at the residence. Among 1989 participants, 35.2% enrolled in a free physical examination in the past year: 34.6% for males and 35.9% for females. Among male participants, having more local friends (OR = 1.47, 95% CI: 1.09, 1.99) and having insurance at the residence (OR = 1.75, 95% CI: 1.03, 2.96) were associated with enrolment in a free physical examination after controlling for age, education, and self-reported health status. Two additional factors, marital status and family structure, were found for female participants to be associated with enrolment in a free physical examination. NEPHS service utilization was far from satisfactory among older migrants in China, and both family support and social support played a role in it. There are common and unique factors associated with NEPHS service utilization in terms of gender.

Sociodemographic disparities in the establishment of health records among 0.5 million migrants from 2014 to 2017 in China: a nationwide cross-sectional study

BACKGROUND

Migrants account for a large part of China's population. Many policies and inventions have been taken to improve access to public health services and the health of migrants. China's Basic Public Health Services(BPHS) are a series of public health services in this policy domain, which aims at promoting the access of public health sevices and improve health equity of residents. The establishment of health records is the fundamental service of BPHS. However, there is little known about the establishment of health records among migrants in China, which hinders the more efficient provision of health services for migrants, and health equity is difficult to achieve. Based on the research gap, this study aims at showing the sociodemographic disparities in the establishment rate of health records, and identifying priorities and recommendations for promoting health equity of migrants in China.

METHODS

This study used national data from China Migrants Dynamic Survey (CMDS) from 2014 to 2017 to evaluate the sociodemographic disparities in the establishment rate of health records and utilization of relevant public health services. The study included 539,926 respondents. Following the descriptive statistics of migrants, we showed the establishment rate of health records by sociodemographic characteristics and migrating related characteristics. Multivariate analysis was conducted to explore the associations between sociodemographic charicteristics, migrating related charicteristics and the establishment of health records.

RESULTS

The establishment rate of health records among migrants in the sampled years were 22.99, 38.44, 27.29% respectively, and 29.18% in general, and there existed heterogeneity in the establishment rate of health records by sociodemographic charicteristics and migrating related charicteristics. Female migrants who were older, from middle age, married or living with partner, with higher educational attainment, with urban household registration, migrated for longer time, migrated for the reason of studying or family issues, migrated in province were more likely to establish health records.

CONCLUSION

There existed sociodemographic disparities in the establishment rate of health records and inequalities in the utilization of health records services among migrants in China. Migrating related characteristics also had impact on the establishment status. Policies should take both supply side and demand side of health services to improve the health equity of migrants, which means that relative departments should continue to invest in primary healthcare centers to improve their ability to provide services as well as migrants' health literacy.

Effects of Living Conditions, Subjective Integration, and Social Networks on Health-Related Quality of Life among the Migrant Elderly Following Children in Jinan, China

With accelerated urbanization in China, an increasing number of the migrant elderly following children (MEFC) have appeared. This study aims to explore the effects of living conditions, subjective integration, and social networks on the health-related quality of life (HRQOL) of MEFC in Jinan, China. HRQOL was assessed by the 12-item Short-Form Health Survey, which included the mental component summary (MCS) and the physical component summary (PCS). Univariate analyses and binary logistic regression were used to investigate the association between the above indicators and HRQOL. A total of 656 MEFC were selected by multi-stage cluster random sampling, 25.2% and 25.0% of whom were defined as poor MCS and poor PCS, respectively. Those who understood the local dialect, could trust others, and connected with friends were more likely to have good MCS; those with a nanny, faulty elevator, and no support from their spouse were the reverse. MEFC who were trans-city, had no elevator or a faulty elevator, and went to the hospital alone were more likely to have poor PCS; those who approved of living conditions in their hometowns were the reverse. Results indicated that better living conditions, stronger subjective integration, and wider social networks led to higher HRQOL of MEFC. Implications of the government, communities, and families of MEFC were given to improve their HRQOL.