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Singh A, Singh A, Chakrabarty M, Singh S, Tripathi P. Wealth-based disparities in the prevalence of short birth interval in India: insights from NFHS-5. Popul Health Metr 2024; 22:14. [PMID: 38992717 PMCID: PMC11238510 DOI: 10.1186/s12963-024-00334-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/01/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Short birth interval (SBI) has profound implications for the health of both mothers and children, yet there remains a notable dearth of studies addressing wealth-based inequality in SBI and its associated factors in India. This study aims to address this gap by investigating wealth-based disparities in SBI and identifying the underlying factors associated with SBI in India. METHODS We used information on 109,439 women of reproductive age (15-49 years) from the fifth round of the National Family Health Survey (2019-21). We assessed wealth-based inequality in SBI for India and its states using the Erreygers Normalised Concentration Index (ECI). Additionally, we used a multilevel binary logistic regression to assess the factors associated with SBI in India. RESULTS In India, the prevalence of SBI was 47.8% [95% CI: 47.4, 48.3] during 2019-21, with significant variation across states. Bihar reported the highest prevalence of SBI at 61.2%, while Sikkim the lowest at 18.1%. SBI prevalence was higher among poorer mothers compared to richer ones (Richest: 33.8% vs. Poorest: 52.9%). This wealth-based inequality was visible in the ECI as well (ECI= -0.13, p < 0.001). However, ECI varied considerably across the states. Gujarat, Punjab, and Manipur exhibited the highest levels of wealth-based inequality (ECI= -0.28, p < 0.001), whereas Kerala showed minimal wealth-based inequality (ECI= -0.01, p = 0.643). Multilevel logistic regression analysis identified several factors associated with SBI. Mothers aged 15-24 (OR: 12.01, p < 0.001) and 25-34 (2.92, < 0.001) were more likely to experience SBI. Women who married after age 25 (3.17, < 0.001) and those belonging to Scheduled Caste (1.18, < 0.001), Scheduled Tribes (1.14, < 0.001), and Other Backward Classes (1.12, < 0.001) also had higher odds of SBI. Additionally, the odds of SBI were higher among mothers in the poorest (1.97, < 0.001), poorer (1.73, < 0.001), middle (1.62, < 0.001), and richer (1.39, < 0.001) quintiles compared to the richest quintile. Women whose last child had passed away were also significantly more likely to have SBI (2.35, < 0.001). Furthermore, mothers from communities with lower average schooling levels (1.18, < 0.001) were more likely to have SBI. Geographically, mothers from eastern (0.67, < 0.001) and northeastern (0.44, < 0.001) regions of India were less likely to have SBI. CONCLUSION The significant wealth-based inequality in SBI in India highlights the need for targeted interventions focusing on economically disadvantaged women, particularly in states with high SBI prevalence. Special attention should be given to younger mothers and those from socially disadvantaged groups to enhance maternal and child health outcomes across the country.
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Affiliation(s)
- Aditya Singh
- Department of Geography, Banaras Hindu University, Varanasi, Uttar Pradesh, India
- Girl Innovation, Research, and Learning Center, Population Council, New York, USA
| | - Anshika Singh
- Department of Geography, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
| | | | - Shivani Singh
- Independent Researcher, Lucknow, Uttar Pradesh, India
| | - Pooja Tripathi
- Department of Geography, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Halder M, Kasemi N, Roy D, Majumder M. Impact of indoor air pollution from cooking fuel usage and practices on self-reported health among older adults in India: Evidence from LASI. SSM Popul Health 2024; 25:101653. [PMID: 38495804 PMCID: PMC10940171 DOI: 10.1016/j.ssmph.2024.101653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/22/2024] [Accepted: 03/05/2024] [Indexed: 03/19/2024] Open
Abstract
This research aims to explore the impact of various components of Indoor air pollution (IAP) on the Self-Reported Health (SRH) of older adults in India. Using a sample of 27,090 from the Longitudinal Aging Study in India (LASI) Wave-1, a multiple binary logistic regression model was employed to identify specific risk factors associated with poor SRH among older adults. Adjusting for demographic, socioeconomic, and IAP-related components, it was revealed that IAP significantly contributes to poor SRH. The adjusted model indicated that individuals using solid cooking fuels face a higher risk of poor SRH compared to those using liquid fuels. Additionally, individuals not using electric chimneys and cooking near windows are associated with an elevated risk of poor SRH, highlighting the importance of adequate ventilation. Health risk factors, including lung disease, diabetes, cough, and depression, further contribute to poor SRH among older adults exposed to IAP. Overall, the study offers crucial insights for policymakers, healthcare professionals, and environmentalists to improve the well-being of the vulnerable older population in India.
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Affiliation(s)
| | | | - Doli Roy
- Raiganj University, Raiganj, West Bengal, India
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Luo J, Zhao D, Gao T, Sun J, Li P, Wang X, Wang X, Chai S, Li J, Zhou C. Activities of daily living limitations and the use of physical examination among older adults with informal care in China: do gender and residence make differences? BMC Geriatr 2024; 24:87. [PMID: 38262963 PMCID: PMC10807140 DOI: 10.1186/s12877-024-04673-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND This study investigated the relationship between activities of daily living (ADL) limitations and the use of physical examination among older adults receiving informal care, and to further examine whether this relationship varies by gender and urban-rural areas. METHODS The data in this study were obtained from the sixth Health Service of Shandong province, China. In total, 8,358 older adults aged 60 years or older who received informal care were included in the analysis. Binary logistic regression models were conducted to explore the association between ADL limitations and the use of physical examination and examine the differences between gender and urban-rural areas. RESULTS The prevalence of limitations in ADL and physical examination utilization rate among older adults receiving informal care in Shandong Province were 14.12% and 72.31%, respectively. After adjusting for confounders, ADL limitations were negatively correlated with the utilization of physical examination services among older adults receiving informal care (OR = 0.74, 95% CI: 0.64, 0.87, P < 0.001), and there were gender and rural-urban differences. The association between ADL limitations and the use of physical examination was statistically significant in older women receiving informal care (OR = 0.65, 95% CI: 0.53, 0.80, P < 0.001). And only among urban older adults receiving informal care, those with ADL limitations had lower utilization of physical examination services than participants without ADL limitations (OR = 0.59, 95% CI: 0.47, 0.74, P < 0.001). CONCLUSIONS Our study suggested that the relationship between ADL limitations and the use of physical examination among older adults receiving informal care differed by gender and urban-rural areas in Shandong, China. These findings implied that the government should provide more health resources and personalized physical examination service programs, especially to meet the differential needs of women and urban old adults receiving informal care, to contribute to the implementation of healthy aging strategies.
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Affiliation(s)
- Jingjing Luo
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, 250012, Jinan, Shandong, China
| | - Dan Zhao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, 250012, Jinan, Shandong, China
| | - Tingting Gao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, 250012, Jinan, Shandong, China
| | - Jingjie Sun
- Shandong Health Commission Medical Management Service Center, 250012, Jinan, China
| | - Peilong Li
- Shandong Health Commission Medical Management Service Center, 250012, Jinan, China
| | - Xuehong Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, 250012, Jinan, Shandong, China
| | - Xueqing Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, 250012, Jinan, Shandong, China
| | - Shujun Chai
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, 250012, Jinan, Shandong, China
| | - Jiayan Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, 250012, Jinan, Shandong, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, 250012, Jinan, Shandong, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, 250012, Jinan, China.
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Yao Q, Zhang X, Wu Y, Liu C. Decomposing income-related inequality in health-related quality of life in mainland China: a national cross-sectional study. BMJ Glob Health 2023; 8:e013350. [PMID: 38035731 PMCID: PMC10689391 DOI: 10.1136/bmjgh-2023-013350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/12/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Health equity is an important indicator measuring social development and solidarity. However, there is a paucity in nationwide studies into the inequity in health-related quality of life (HRQoL) in mainland China, in particular using the most recent data measuring HRQoL using the EuroQol 5-Dimension-5 Level (EQ-5D-5L). This study aimed to address the gap in the literature by estimating and decomposing income-related inequality of the utility index (UI) of EQ-5D-5L in mainland China. METHODS Data were extracted from the Psychology and Behaviour Investigation of Chinese Residents (2022), including 19 738 respondents over the age of 18 years. HRQoL was assessed by the UI of the EQ-5D-5L. Concentration index (CI) was calculated to measure the degree of income-related inequality in the UI. The contributions of individual, behavioural and context characteristics to the CI were estimated using the Wagstaff decomposition method. RESULTS The CI of the EQ-5D-5L UI reached 0.0103, indicating pro-rich inequality in HRQoL. Individual characteristics made the greatest contribution to the CI (57.68%), followed by context characteristics (0.60%) and health behaviours (-3.28%). The contribution of individual characteristics was mainly attributable to disparities in the enabling (26.86%) and need factors (23.86%), with the chronic conditions (15.76%), health literacy (15.56%) and average household income (15.24%) as the top three contributors. Educational level (-5.24%) was the top negative contributor, followed by commercial (-1.43%) and basic medical insurance (-0.56%). Higher inequality was found in the least developed rural (CI=0.0140) and western regions (CI=0.0134). CONCLUSION Pro-rich inequality in HRQoL is evident in mainland China. Targeted interventions need to prioritise measures that aim at reducing disparities in chronic conditions, health literacy and income.
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Affiliation(s)
- Qiang Yao
- School of Political Science and Public Administration, Wuhan University, Wuhan, Hubei, China
- Centre for Social Security Studies, Wuhan University, Wuhan, Hubei, China
| | - Xiaodan Zhang
- School of Political Science and Public Administration, Wuhan University, Wuhan, Hubei, China
| | - Yibo Wu
- School of Public Health, Peking University, Beijing, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
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Qi X, Feng T, Deng R. Digital health care service reform and health inequity for older people: a quasi-natural experiment in China. Front Public Health 2023; 11:1217503. [PMID: 38026385 PMCID: PMC10662057 DOI: 10.3389/fpubh.2023.1217503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Addressing health inequity (HI) for older people is a pivotal global public health concern, as it impedes the process of healthy ageing. The digital health care service reform (DHSR) emerges as a progressive public health approach to enhance the health and well-being of older adults by providing comprehensive and equitable medical services. This study elucidates the association between DHSR and HI for older individuals to augment comprehension of DHSR implementation. Methods The initiation of the action plan for smart health and eldercare (SHE) in 2017 serves as a quasi-natural experiment. Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018, a propensity score matching (PSM) method was used to select samples, and a difference-in-differences (DID) regression was used to ascertain the net effect of DHSR on HI for older individuals in China. This methodology mitigates selection bias and segregates the DHSR effect from temporal shifts or other occurrences. Results The PSM-DID analysis reveals that DHSR reduced the HI index for older individuals by 0.301 (p < 0.01). Heterogeneity analyses indicate that the effect of DHSR was more pronounced in older males (-0.333, p < 0.01) than females (-0.251, p < 0.05). The impact of DHSR was notably higher for older population in the western (-0.557, p < 0.01) and central regions (-0.318, p < 0.05) compared to the eastern region, where the relationship was statistically non-significant. Conclusion The results demonstrate that DHSR plays a vital role in diminishing HI, fostering inclusive growth in public health. The study underscores the imperative of sustained DHSR endeavours and allocating resources to key older demographics to substantially mitigate HI.
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Affiliation(s)
- Xinzhu Qi
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Tieying Feng
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Renyi Deng
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
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Bazyar M, Kakaei H, Jalilian M, Mirzaei A, Mansournia MA, Pakzad R. Socioeconomic inequality in self-rated health and its determinants: an Oaxaca blinder decomposition in Ilam, West of Iran during 2023. BMC Health Serv Res 2023; 23:1203. [PMID: 37924069 PMCID: PMC10625218 DOI: 10.1186/s12913-023-10242-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023] Open
Abstract
AIM To determine inequality and decompose it's in Self-Rated Health (SRH). METHOD This population-based cross-sectional study was undertaken on the entire population of the city of Ilam, Iran, in 2023. Multi-stage stratified cluster random sampling with proportion-to-size approach was used to select the participants. Oaxaca-Blinder decomposition technique was used to show the amount of inequity in SRH and to decompose of the gap of SRH between the poor and the rich group of participants. RESULTS 1370 persons participated in the study. The 59.38% of participants stated good SRH status and just 8.86% of participants had poor SRH status. The results of the Oaxaca-Blinder decomposition revealed a considerable gap (15.87%) in the poor status of SRH between the rich and the poor. A large proportion (89.66%) of this difference was described by explained portion of the model. The results of decomposition showed that economic status was directly responsible for explaining 27.98% of overall inequality gap between rich and poor people. Moreover, hopelessness to future (32.64%), having an underlying disease (18.34%) and difference in the education level (10.71%) were associated with an increase in inequality disfavoring the poor. CONCLUSION For people suffering from underlying disease, it is suggested to devise policies to improve access to/and remove healthcare utilization barriers. To address hopelessness to future, it is recommended to carry out further studies to reveal factors which affect it in more details. This can help policy makers to formulate more realistic and evidence-informed policies on order to lessen the current socioeconomic inequity in SRH.
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Affiliation(s)
- Mohammad Bazyar
- Department of Health Management and Economics, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Hojatollah Kakaei
- Department of Occupational Health, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohsen Jalilian
- Department of Public Health, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Amin Mirzaei
- Department of Public Health, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Pakzad
- Health and Environment Research Center, Ilam University of Medical Sciences, Ilam, Iran.
- Psychosocial Injuries Research Center, Ilam University of medical Sciences, Ilam, Iran.
- Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Banganjab, Pajouhesh Blvd, Ilam, Iran.
- Student Research Committee, Ilam University Medical Sciences, Ilam, Iran.
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Luo J, Zhao D, Gao T, Sun J, Li P, Wang X, Wang X, Chai S, Li J, Zhou C. Activities of daily living limitations and family doctor contract services among overweight and obese older adults: is there a rural-urban difference? BMC PRIMARY CARE 2023; 24:223. [PMID: 37891472 PMCID: PMC10612158 DOI: 10.1186/s12875-023-02177-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the relationship between activities of daily living (ADL) limitations and family doctor contract services among overweight and obese older adults, as well as to examine whether this association varies by urban-rural residence. METHODS Data for the present study were obtained from the sixth Health Service of Shandong province, China. A total of 4,249 overweight and obese older adults were included in this study. Binary logistic regression models were used to evaluate the relationship between ADL limitations and family doctor contract services, to examine the potential differences between urban and rural areas. RESULTS Of 4,249 overweight and obese older adults, the prevalence of limitations in ADL and family doctor service contracting rate in Shandong province were 12.47% and 66.46%, respectively. The results of the regression analyses revealed that overweight and obese older adults with ADL limitations were more likely to sign up for family doctor services than those without ADL limitations (OR = 1.27, 95%CI: 1.02-1.58, P = 0.033). Only among rural overweight and obese older adults, the relationship between ADL limitations and family doctor contract services was statistically significant (OR = 1.50, 95%CI: 1.13-1.99, P = 0.005). CONCLUSIONS Our study found a significant association between ADL limitations and family doctor contract services among overweight and obese older adults in Shandong, China. This relationship differed by urban-rural residence. To promote the positive development of the family doctor contract service system, the government should increase publicity, provide personalized contracted services, and prioritize the healthcare needs of overweight and obese older adults with ADL limitations, with special attention to rural areas.
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Affiliation(s)
- Jingjing Luo
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, 250012, Jinan, China
- Institute of Health and Elderly Care, Shandong University, 250012, Jinan, China
| | - Dan Zhao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, 250012, Jinan, China
- Institute of Health and Elderly Care, Shandong University, 250012, Jinan, China
| | - Tingting Gao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, 250012, Jinan, China
- Institute of Health and Elderly Care, Shandong University, 250012, Jinan, China
| | - Jingjie Sun
- Shandong Health Commission Medical Management Service Center, 250012, Jinan, China
| | - Peilong Li
- Shandong Health Commission Medical Management Service Center, 250012, Jinan, China
| | - Xuehong Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, 250012, Jinan, China
- Institute of Health and Elderly Care, Shandong University, 250012, Jinan, China
| | - Xueqing Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, 250012, Jinan, China
- Institute of Health and Elderly Care, Shandong University, 250012, Jinan, China
| | - Shujun Chai
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, 250012, Jinan, China
- Institute of Health and Elderly Care, Shandong University, 250012, Jinan, China
| | - Jiayan Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, 250012, Jinan, China
- Institute of Health and Elderly Care, Shandong University, 250012, Jinan, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, 250012, Jinan, China.
- Institute of Health and Elderly Care, Shandong University, 250012, Jinan, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University), 250012, Jinan, China.
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Patel R, Bansod DW. Correlates of poor self-rated health among school-going adolescent girls in urban Varanasi, India. BMC Public Health 2023; 23:1921. [PMID: 37794345 PMCID: PMC10552224 DOI: 10.1186/s12889-023-16822-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/22/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The concept of self-rated health (SRH) has widely been studied among the adults and older population in developed as well as developing countries, including India. Also, studies are available in abundance examining the various concepts of SRH among adolescents. However, in India, studies on the SRH of adolescents remain scarce, especially those aiming to understand the correlates of SRH among school-going adolescent girls in an urban setting. Therefore, this study aims to determine the correlates of poor SRH among school-going adolescent girls in the urban setting of Varanasi, India. METHODS This study is based on the primary data collected in the Varanasi district of Uttar Pradesh, India, from October 2019 to February 2020. Nearly 350 adolescent girls and their mothers were personally interviewed. Self-rated health was the primary outcome variable of this study. The exact wording of the question asked from the adolescent girls was, "In general, how would you say your health is?". RESULTS Almost one-fifth (19.4%) of the adolescent girls reported poor SRH. Adolescent girls from Other Backward Class (OBC) [OR: 0.39; 95% CI: .18-.85] and Others caste [OR: 0.58; 95% CI: .23-0.87] were less likely to report poor SRH than their Scheduled Caste/Scheduled Tribe (SC/ST) counterparts. Girls residing in households where number of daughters were more than sons were more likely to report poor SRH [OR: 7.8; 95% CI: 1.5-39.5] than girls who belonged to the daughters only households. CONCLUSION Composition of children was one of the important factors as outlined in this study. The role of mothers in improving the overall SRH of the girls is critical as they are involved in caring process of their daughters.
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Affiliation(s)
- Ratna Patel
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India.
| | - Dhananjay W Bansod
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
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Li Y, Marquez R. Can government subsidies and public mechanisms alleviate the physical and mental health vulnerability of China's urban and rural residents? Int J Equity Health 2023; 22:59. [PMID: 37005599 PMCID: PMC10067002 DOI: 10.1186/s12939-022-01805-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 12/12/2022] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Poverty vulnerability has been defined as the likelihood of a family falling into poverty in the upcoming months. Inequality is a major cause of poverty vulnerability in developing countries. There is evidence that establishing effective government subsidies and public service mechanisms significantly reduces health poverty vulnerability. One of the ways to study poverty vulnerability is by using empirical data such as income elasticity of demand to perform the analysis. Income elasticity refers to the extent to which changes in consumers' income affect changes in demand for commodities or public goods. In this work, we assess health poverty vulnerability in rural and urban China. We provide two levels of evidence on the marginal effects of the design and implementation of government subsidies and public mechanisms in reducing health poverty vulnerability, before and after incorporating the income elasticity of demand for health. METHODS Multidimensional physical and mental health poverty indexes, according to the Oxford Poverty & Human Development Initiative and the Andersen model, were implemented to measure health poverty vulnerability by using the 2018 China Family Panel Survey database (CFPS) as the data source for empirical analysis. The income elasticity of demand for health care was used as the key mediating variable of impact. Our assessment was conducted by a two-level multidimensional logistic regression using STATA16 software. RESULTS The first level regression indicates that the marginal utility of public mechanism (PM) in reducing urban and rural vulnerability as expected poverty on physical and mental health (VEP-PH&MH) was insignificant. On the other hand, government subsidies (GS) policies had a positive suppression effect on VEP-PH&MH to a relatively low degree. The second level regression found that given the diversity of health needs across individual households, i.e., the income elasticity of demand (HE) for health care products, PM and GS policies have a significant effect in reducing VEP-PH&MH in rural and urban areas. Our analysis has verified the significant positive impact of enacting accurate GS and PM policies on effectively reducing VEP-PH&MH in rural as well as urban areas. CONCLUSIONS This study shows that implementing government subsidies and public mechanisms has a positive marginal effect on reducing VEP-PH&MH. Meanwhile, there are individual variations in health demands, urban-rural disparities, and regional disparities in the effects of GS and PM on inhibiting VEP-PH&MH. Therefore, special consideration needs to be given to the differences in the degree of health needs of individual residents among urban and rural areas and regions with varying economic development. Furthermore, considerations of this approach in the current worldwide scenario are analyzed.
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Affiliation(s)
- Yali Li
- School of Business, Jiangxi University of Science and Technology, Nanchang, 330013, China.
| | - Ronald Marquez
- Laboratoire Physico-Chimie des Interfaces Complexes, ESPCI Paris, 10 rue Vauquelin, F-75231, Paris, France
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Nghipandulwa MT, Mukong AK. Estimating Income-Related Health Inequalities Associated with Tobacco and Alcohol Consumption in Namibia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1062. [PMID: 36673818 PMCID: PMC9859020 DOI: 10.3390/ijerph20021062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/31/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
Disparities in resources and access to material opportunities are important determinants of income-related health inequality. This paper hypothesises that the gradient of the inequality in health between the poor and the rich is likely to depend on differences in lifestyle practices including tobacco use and alcohol abuse. Using the 2015/16 Namibia Household Income and Expenditure Survey and the Erreygers corrected concentration index, we estimate the effect of tobacco and alcohol use on income-related health inequalities. A decomposition technique was used to estimate the separate and joint contribution of tobacco and alcohol use to income-related health inequalities. The results indicate that tobacco use widens the income-related health inequality gap while alcohol consumption reduces health disparities. The simultaneous consumption of these goods has a stronger multiplicative effect on income-related health inequality. For instance, the simultaneous consumption of both goods contribute up to 1.03% of the inequality in health while tobacco use alone contributed only 0.6%. While policy options for each of these goods could be essential in reducing inequalities in health, there is a need to advocate additional measures that could simultaneously control the consumption of both goods.
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Shang XT, Wei ZH. Socio-economic inequalities in health among older adults in China. Public Health 2023; 214:146-152. [PMID: 36549024 DOI: 10.1016/j.puhe.2022.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 11/03/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES This study aimed to explore socio-economic inequalities in the health status of older people in China using the most recent data available. STUDY DESIGN This was a cross-sectional study. METHODS Data for this study were obtained from the 2018 China Health and Retirement Longitudinal Study, which included 9831 subjects aged 60 years and older. We assessed differences in the prevalence of self-reported health, functional limitations, and chronic conditions by education level and household income level, and then estimated the Slope of Inequality Index (SII) and the Relative Inequality Index (RII) - indexes of the relative magnitude of socio-economic inequalities in health. RESULTS We found inequalities in all dimensions of health (self-assessed health status, reported chronic conditions, and physical functional limitations) at the household income level. Physical functional limitations, particularly the ability to perform instrumental activities of daily living, produced greater inequality than other domains, with an adjusted SII of 0.495 (95% CI, 0.467-0.524) and an adjusted RII of 2.129 (95% CI, 1.604-2.653). ADL limitations (adjusted SII, 0.524, 95% CI, 0.473-0.575, adjusted RII, 1.527, 95% CI, 1.027-2.027) and self-measured health (adjusted SII, 0.523, 95% CI, 0.258-0.789, adjusted RII, 1.531, 95% CI, 0.551-2.512) were also clearly different. Inequalities were also found across all health domains in terms of educational attainment. Consistent with inequalities in household income, inequalities were greatest for limitations in the ability to perform instrumental activities of daily living (adjusted SII, 0.581, 95% CI, 0.424-0.739, adjusted RII, 3.699, 95% CI, 3.642-3.757). Relative inequalities in limitations in activities of daily living (adjusted SII, 0.676, 95% CI, 0.560-0.792, adjusted RII, 2.587, 95% CI, 2.392-2.784) and self-rated health (poor/very poor) (adjusted SII, 0.647, 95% CI, 0.617-0.677, adjusted RII, 2.406, 95% CI, 2.224-2.587) were also higher. CONCLUSION Our study shows significant socio-economic differences in the areas of self-rated health, functional limitations, and reported chronic diseases, particularly in the area of IADL limitations. These inequalities need to be explicitly addressed and vulnerable subgroups should be targeted to reduce the socio-economic disparities.
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Affiliation(s)
- X T Shang
- School of Social Development, Tianjin University of Technology, 391 Binshui West Road, Xiqing District, Tianjin, 300384, China.
| | - Z H Wei
- School of Social Development, Tianjin University of Technology, 391 Binshui West Road, Xiqing District, Tianjin, 300384, China.
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12
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Liu L, Yang Y, Zhao Y, Zhang T. Ethnic Differences in Social Support for Elderly Individuals in Rural Southern China: A Cross-sectional Survey. Asia Pac J Public Health 2023; 35:21-26. [PMID: 36461168 DOI: 10.1177/10105395221141966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
This study investigated ethnic differences in social support received by the rural elderly population and the effect of ethnic culture, socioeconomic status, and contextual variables on their social support. We determined social support received by 6451 elderly individuals from the rural Guangxi region. Children and spouses represented the most important sources of social support for this population. The Jing and Zhuang, and the Yao and Dong ethnic groups received the maximum and minimum support from the children, respectively. The overall mean social support score was 35.5, and the Jing had the highest and the Maonan had the lowest score. Amid the variation in social support received by different ethnic groups, contextual effects on social support received at the household level are more important than those at the village level among rural elderly individuals. Modern Chinese society should try to narrow the social gap.
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Affiliation(s)
- Lu Liu
- Faculty of Public Health, Dali University, Dali, P.R. China
| | - Yixing Yang
- Faculty of Public Health, Dali University, Dali, P.R. China
| | - Yuan Zhao
- Faculty of Public Health, Dali University, Dali, P.R. China
| | - Tai Zhang
- Faculty of Public Health, Dali University, Dali, P.R. China
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13
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Li C, Tang C. Income-related health inequality among rural residents in western China. Front Public Health 2022; 10:1065808. [PMID: 36589999 PMCID: PMC9797679 DOI: 10.3389/fpubh.2022.1065808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/29/2022] [Indexed: 12/16/2022] Open
Abstract
Objective Health equality has drawn much public attention in both developed and developing countries. China, the largest developing country, has implemented a new round of health system reform to improve health equality since 2009. This study aims to examine the magnitude and sources of income-related health inequality in western rural regions of China. Methods Data were obtained from the Survey of Rural Economic and Social Development in Western China conducted in 2014, in which 14,555 individuals from 5,299 households in 12 provinces were included. Health outcome variables of interest were self-rated health status, prevalence of chronic disease and four-week illness. Concentration index was calculated to assess magnitude of income-related health inequality, and nonlinear decomposition analysis was performed to identify the sources of health inequality. Results The Concentration indexes for poor self-rated health status, prevalence of chronic disease and four-week illness were -0.0898 (P<0.001),-0.0860 (P<0.001) and -0.1284 (P<0.001), respectively. Income and education were two main sources of health inequality, accounting for about 25-50% and 15% contribution to the inequality. Ethnicity made <10% contribution to income-related health inequality, and enrollment in New Rural Cooperative Medical Scheme contributed to <1%. Conclusion This study found slight income-related health inequality among rural residents in western China, implying that although China has made substantial progress in economic development and poverty alleviation, health inequality in western rural region should still be concerned by the government. To achieve health equality further, the Chinese government should not only strengthen its reimbursement mechanism of the current health insurance scheme to improve affordability of primary healthcare for residents in western rural regions, but also implement health poverty alleviation policies targeting socioeconomically vulnerable population and ethnic minorities in future.
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Affiliation(s)
- Chaofan 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
| | - Chengxiang Tang
- Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia,*Correspondence: Chengxiang Tang
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14
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Pérez RA, Tejada CAO, Triaca LM, Bertoldi AD, dos Santos AMA. Socioeconomic inequality in health in older adults in Brazil. DIALOGUES IN HEALTH 2022; 1:100009. [PMID: 38515904 PMCID: PMC10953994 DOI: 10.1016/j.dialog.2022.100009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 03/23/2024]
Abstract
Objective This study analyzed socioeconomic inequality in self-rated health for older adults (aged fifty or over) in Brazil. Methods Data from the 2015-2016 Brazilian Longitudinal Study of Aging (ELSI-Brazil). Socioeconomic inequality in self-rated health was measured using the concentration index, which was decomposed to analyze the contribution of different factors. Results This study revealed that 11.5% of the older adults interviewed reported their health as poor and very poor. For the complete sample, the estimated concentration index, -0.2434, indicated that there is a concentration of poor and very poor self-rated health among older and poorer adults. Income, education and having a private health insurance plan are the factors that contributed most to the observed inequality. Discussion The decomposition showed that there are avoidable inequalities in relation to socioeconomic status for older adults in Brazil. These factors can guide the formulation of social and health policies aimed at reducing health inequalities.
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Affiliation(s)
- Raquel Alves Pérez
- Posgraduate Program in Economics, Federal University of Pelotas (Universidade Federal de Pelotas - UFPel), Rio Grande do Sul, Brazil
| | - Cesar Augusto Oviedo Tejada
- Posgraduate Program in Economics, Federal University of Pelotas (Universidade Federal de Pelotas - UFPel), Rio Grande do Sul, Brazil
| | - Lívia Madeira Triaca
- Posgraduate Program in Economics, Federal University of Pelotas (Universidade Federal de Pelotas - UFPel), Rio Grande do Sul, Brazil
- Department of Economics, Federal University of Rio Grande Foundation (Fundação Universidade Federal do Rio Grande – FURG), Rio Grande, Brazil
| | - Andréa Dâmaso Bertoldi
- Postgraduate Program in Epidemiology, Federal University of Pelotas (Universidade Federal de Pelotas - UFPel), Rio Grande do Sul, Brazil
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15
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Haque MA, Choudhury N, Ahmed SMT, Farzana FD, Ali M, Naz F, Khan A, Wahid BZ, Siddiqua TJ, Akter R, Rahman SS, Faruque ASG, Ahmed T. Food security status of Suchana-participating households in north-eastern rural Bangladesh. Front Public Health 2022; 10:950676. [PMID: 36176515 PMCID: PMC9513544 DOI: 10.3389/fpubh.2022.950676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/22/2022] [Indexed: 01/21/2023] Open
Abstract
Despite achieving remarkable progress, food insecurity remains a major public health challenge in Bangladesh, and severe food insecurity status has not been reduced in susceptible areas and vulnerable regions in Bangladesh. Wetlands that are susceptible to flooding can be found in Bangladesh's north-eastern Sylhet division. Suchana, a large-scale nutrition programme, implemented nutrition-specific and sensitive interventions in poor and very poor households in Sylhet and Moulvibazar districts in the north-eastern region of Bangladesh. The aim of this article is to assess the association between the Suchana intervention and household food security status among poor and very poor households in north-eastern rural Bangladesh using the Suchana baseline and endline survey databases. The baseline survey was conducted between November 2016 and February 2017, while the endline survey was undertaken 3 years later, during the same months. The outcome variable in this analysis was household food security status, which was measured using the Food and Nutrition Technical Assistance's Guideline. Descriptive statistics were used to summarize the data; after controlling for the union as a cluster and relevant covariates, a multiple multinomial logistic regression model was used to estimate the independent effect of the Suchana intervention as an exposure. Overall, 14.0% of households were food secure at the baseline survey (intervention: 14.1%, control: 14.0%) and 22.0% were food secure (intervention: 26.6%, control: 20.2%) at the endline survey. For households in the intervention area in comparison to the control area, the odds of being moderately food insecure [aOR: 1.36 (1.05, 1.76), p < 0.05], mildly food insecure [aOR: 1.83 (1.33, 2.51), p < 0.001], or food secure [aOR: 2.21 (1.47, 3.33), p < 0.001] compared to being severely food insecure was significantly higher. Thus, we infer that the 3 years of Suchana intervention marginally increased household food security status among the socio-economically disadvantaged population in north-eastern rural Bangladesh. If concerns regarding gender equity, women's education, and income-generating activities are addressed, the population could experience even greater benefits in food security. In order to overcome these challenges, all stakeholders including programme implementers and policymakers should work together to implement the appropriate measures.
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Affiliation(s)
- Md Ahshanul Haque
- Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh,*Correspondence: Md Ahshanul Haque
| | - Nuzhat Choudhury
- Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh
| | | | | | - Mohammad Ali
- Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh
| | - Farina Naz
- Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh
| | - Ashfaque Khan
- Child Poverty Sector, Save the Children Bangladesh, Dhaka, Bangladesh
| | | | | | - Rumana Akter
- Child Poverty Sector, Save the Children Bangladesh, Dhaka, Bangladesh
| | | | - A. S. G. Faruque
- Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh
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16
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Zhao D, Zhou Z, Shen C, Zhai X, Zhao Y, Cao D, Deng Q, Liu G, Lim JFY. The Effect of Health Check-Ups on Health Among the Elderly in China: Evidence From 2011–2018 Longitudinal Data. Int J Public Health 2022; 67:1604597. [PMID: 35990189 PMCID: PMC9389946 DOI: 10.3389/ijph.2022.1604597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 07/13/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives: To assess the effect of health check-ups on health among the elderly Chinese. Methods: The first dataset was panel data extracted from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Health Longevity Survey (CLHLS). The second dataset was cross-sectional data come from CLHLS 2018 linked with the lagged term of health check-ups in CLHLS 2011. Health check-ups were measured by a binary variable annual health check-up (AHC). Health was assessed by a binary variable self-rated health (SRH). A coarsened exact matching method and individual fixed-effects models, as well as logistic regressions were employed. Results: AHC attendance among the elderly increased from 2011 to 2018, with higher utilization of AHC also detected in the rural group. AHC had positive effects on SRH among rural respondents (short-term effect: OR = 1.567, p < 0.05; long-term effect: OR = 3.385, p < 0.001). Conclusion: This study highlights a higher utilization of AHC in rural area, and the effectiveness of AHC in SRH improvement among rural participants. It indicates enhanced access to public healthcare services in rural area and underlying implications of health check-ups for reducing urban–rural health inequalities.
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Affiliation(s)
- Dantong Zhao
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Zhongliang Zhou,
| | - Chi Shen
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Xiaohui Zhai
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China
| | - Yaxin Zhao
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China
| | - Dan Cao
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Qiwei Deng
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China
| | - Guanping Liu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Jeremy Fung Yen Lim
- Saw Swee Hock School of Public Health, Leadership Institute for Global Health Transformation, National University of Singapore, Singapore, Singapore
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Socioeconomic status and self-rated health in Iran: findings from a general population study. Cost Eff Resour Alloc 2022; 20:30. [PMID: 35768798 PMCID: PMC9241314 DOI: 10.1186/s12962-022-00364-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background There are large gaps in health and well-being among different groups of the society. Socioeconomic factors play a significant role in determining the health status of the society. The present study was conducted to examine socioeconomic inequality in health status among the adult population of Khorramabad city, the capital of Lorestan province, wester part of Iran. Methods A cross-sectional study was conducted on 1348 participants selected through multistage sampling. A valid and reliable questionnaire was used for data collection. The wealth index as an indicator of the socioeconomic status (SES) was used to categorize the subjects in terms of the SES. The concentration index and concentration curve was used to measure socioeconomic inequity in poor self-rated health (SRH) of population. Finally, after determine the status of inequity in poor SRH, a decomposition analysis approach was used to identify the most important determinants of this inequity. Results The prevalence of poor SRH was 18.91% in all subjects, 38.52% in the lowest SES group, and 11.15% in the highest SES group. The value of the concentration index for poor SRH was − 0.3243 (95% CI − 0.3996 to − 0.2490), indicating that poor SRH was more concentrated among the poor. The results of decomposition analysis showed that SES (41.2%), higher body mass index (28.6%) and lack of physical activity (26.9%) were the most important factors associated with the concentration of poor SRH in the poor groups. Conclusion Identification of socioeconomic factors affecting on health status is the first step for proper policymaking. Policymakers and health system managers at the national and subnational levels can use the results of this study as well as other similar domestic studies to design and implement proper interventions to promote equity and improve the health status of population.
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18
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You J, Zhang J, Li Z. Consumption-Related Health Education Inequality in COVID-19: A Cross-Sectional Study in China. Front Public Health 2022; 10:810488. [PMID: 35548092 PMCID: PMC9082410 DOI: 10.3389/fpubh.2022.810488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 03/03/2022] [Indexed: 01/10/2023] Open
Abstract
Background The COVID-19 pandemic influences various aspects of society, especially for people with low socioeconomic status. Health education has been proven to be a critical strategy in preventing a pandemic. However, socioeconomic characteristics may limit health education among low socioeconomic status groups. This study explores consumption-related health education inequality and the factors that contribute to this, which are variable across China during COVID-19. Methods The 2020 China COVID-19 Survey is a cross-sectional study in China, based on an anonymous online survey from 7,715 samples in 85 cities. It employed machine-learning methods to assess household consumption and other contributing variates associated with health education during the pandemic. Concentration Index (CI) and Horizontal Index (HI) were used to measure consumption-related inequalities in health education, respectively. Moreover, Wagstaff decomposition analysis was employed to identify other contributing variables to health education inequality. Results The result indicates that participants with more education, better income, and positive consumption preferences undertake higher health education during COVID-19. The CI and HI of consumption-health education inequality are 0.0321 (P < 0.001) and 0.0416 (p < 0.001), respectively, which indicates that health education is concentrated in wealthy groups. We adapted Lasso regression to solve issues and omit variables. In terms of other socioeconomic characteristics, Annual Income was also a major contributor to health education inequalities, accounting for 27.1% (P < 0.001). The empirical results also suggests that education, health status, identification residence, and medical health insurance contribute to health education inequality. Conclusions The difference in Household consumption, annual income, rural and urban disparity, and private healthcare insurance are critical drivers of health education inequality. The government should pay more attention to promoting health education, and healthcare subside policy among vulnerable people. Significantly to improve awareness of undertaking health education with lower education, rural residential, to enhance confidence in economic recovery and life after COVID-19.
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Affiliation(s)
- Jialu You
- Shanghai University of Finance and Economics, Shanghai, China
| | - Jinhua Zhang
- Shanghai University of Finance and Economics, Shanghai, China
| | - Ze Li
- Yunlin University of Science and Technology, Douliu, China.,Hubei University of Technology, Wuhan, China
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19
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Li Z, Hu M. Spatio-Temporal Disparity and Driving Forces of the Supply Level of Healthcare Service in the Yangtze River Delta. Front Public Health 2022; 10:863571. [PMID: 35530733 PMCID: PMC9068963 DOI: 10.3389/fpubh.2022.863571] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/10/2022] [Indexed: 11/13/2022] Open
Abstract
The equalization of healthcare supply is not only related to the people's need for a better life, but can also provide a strong guarantee for the high-quality and sustainable development of the Yangtze River Delta integration. By using exploratory spatial analysis techniques, this study analyzed the spatio-temporal evolution characteristics and heterogeneous influence effects of the supply level of healthcare service in the Yangtze River Delta from 2007 to 2019. It was found that the supply level of healthcare service in the Yangtze River Delta had improved significantly. The differences in the supply level of healthcare service between cities had tended to narrow without polarization, and the supply level of healthcare service generally showed a high spatial pattern in the south delta and low spatial pattern in the north delta. The higher the supply level of healthcare service was, the weaker the interannual variability was. The supply level of healthcare service in the Yangtze River Delta region presented obvious spatial association and differentiated tendency of local high and low spatial clusters. The relative length and curvature of the supply level of healthcare service in the Yangtze River Delta generally presented a spatial pattern with low values in the northeast and high values in the southwest. Population density and urban-rural income gap generally exhibited negative spatio-temporal impact on the supply level of healthcare service across most cities. On the other hand, urbanization level and per capita disposable income generally had positive spatio-temporal impact on the supply level of healthcare service across most cities. Per capita gross domestic product (GDP) showed an increasingly positive spatio-temporal impact on the supply level of healthcare service across most cities. While per capita fiscal expenditure exhibited significantly negative impact on the supply level of healthcare service across most cities in space.
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Affiliation(s)
- Zaijun Li
- Research Institute of Central Jiangsu Development, Yangzhou University, Yangzhou, China
| | - Meijuan Hu
- College of Tourism and Culinary Science, Yangzhou University, Yangzhou, China
- *Correspondence: Meijuan Hu
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20
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Chen X, Su D, Chen X, Chen Y. Effect of informal care on health care utilisation for the elderly in urban and rural China: evidence from China health and retirement longitudinal study (CHARLS). BMC Health Serv Res 2022; 22:271. [PMID: 35232442 PMCID: PMC8887010 DOI: 10.1186/s12913-022-07675-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 02/23/2022] [Indexed: 02/03/2023] Open
Abstract
Background Receiving informal care from family members is the mainstream way of care for the elderly in China because of the influence of the culture of filial piety. However, the relationship between informal care and health care use in urban and rural areas needs to be further explored. This study aimed to understand the association between informal care and health care utilisation for the elderly and explore how this effect may differ between urban and rural China. Method A total of 5704 residents aged 65 years and above were selected from wave 3 (2015) and wave 4 (2018) of the China Health and Retirement Longitudinal Study, which is a nationally representative survey. A negative binomial regression model for the panel data was used to explore the relationship between informal care and health care utilisation. A fixed-effect binary choice model for panel data was used for the sensitivity test. Result The elderly who received informal care had increased in outpatient and inpatient visits compared with those who did not receive informal care. The inpatient visits of the elderly who received 15–29 days of informal care was higher than the elderly who did not receive informal care (incidence rate ratio [IRR] = 2.082, P < 0.05). Moreover, the elderly who received informal care for more than 30 days had 39.6% more inpatient visits (IRR = 1.396, P < 0.01) and 37.4% more outpatient visits than the elderly who did not receive informal care (IRR = 1.374, P < 0.05). For urban respondents, receiving informal care can facilitate outpatient use of the elderly, but for rural respondents, receiving informal care can predict an increase in outpatient and inpatient visits. Conclusion Informal care was associated with higher use of health services. The association between informal care and health care utilisation varies between rural and urban residents. These findings indicate the role of informal care and remind that relevant departments should pay attention to the differences in medical service utilisation levels amongst different elderly groups.
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Affiliation(s)
- Xinlan Chen
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Research Centre for Rural Health Service, Wuhan, 430030, China
| | - Dai Su
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Research Centre for Rural Health Service, Wuhan, 430030, China.,Department of Health Management and Policy, School of Public Health, Capital Medical University, Beijing, China
| | - Xinlin Chen
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Research Centre for Rural Health Service, Wuhan, 430030, China
| | - Yingchun Chen
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. .,Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Research Centre for Rural Health Service, Wuhan, 430030, China.
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21
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Yuan H, Chen S, Pan G, Zheng L. Social Pension Scheme and Health Inequality: Evidence From China's New Rural Social Pension Scheme. Front Public Health 2022; 9:837431. [PMID: 35198537 PMCID: PMC8858825 DOI: 10.3389/fpubh.2021.837431] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/30/2021] [Indexed: 01/05/2023] Open
Abstract
Health equality is an essential component of social justice, and the social policies should be as conducive to promoting health equality as possible. Based on the data from China, this article uses the regression discontinuity design method and the technique of decomposition of concentration index to examine whether the social pension schemes can significantly reduce health inequality among the residents, and tries to compute the contribution rate of pension benefit in alleviating the health inequality. Our results show that the pension benefit can improve the health level of the rural subscribers, especially for the low-income population. Implement of New Rural Pension Scheme contributes to reducing the health inequality among the rural elderly with contribution rate of 39.32%. Our results contain important policy implications.
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Affiliation(s)
- Hui Yuan
- Department of Insurance, School of Finance, Zhongnan University of Economics and Law, Wuhan, China
| | - Shuoqi Chen
- Department of Insurance, School of Finance, Zhongnan University of Economics and Law, Wuhan, China
- *Correspondence: Shuoqi Chen
| | - Guochen Pan
- Department of Insurance and Actuarial Science, Economics and Management School, Wuhan University, Wuhan, China
| | - Lingyun Zheng
- Department of Insurance and Actuarial Science, Economics and Management School, Wuhan University, Wuhan, China
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22
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Asif AM, Akbar M. Decomposing socio-economic inequality in vaccination coverage among Pakistani children: A population-based cross-sectional study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:602-611. [PMID: 32959465 DOI: 10.1111/hsc.13163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/16/2020] [Accepted: 08/17/2020] [Indexed: 06/11/2023]
Abstract
There is scarce knowledge about factors contributing to underlying inequalities in vaccination coverage among Pakistani children. Therefore, the main objective of this study is to measure and decompose socioeconomic inequalities in childhood vaccination coverage. Pakistan Demographic and Health Survey, version 2017-18, data were used for analysis. Bivariate association was checked through Chi-square test and concentration curve (CC) and concentration index (CI) were used to assess the existence and nature of inequality. Finally, decomposition analysis was performed to measure the contribution of different factors to the observed inequality. Our findings suggested that vaccination coverage is more concentrated among children of educated mothers (CI = 0.296) and decomposition results suggest that a substantial proportion of the inequality is explained by maternal education, wealth status, paternal education and improved sanitation (34%, 19%, 14% and 21% respectively). Also, differences are observed between regions regarding vaccination coverage. There is need of female-targeted interventions to increase maternal role in the society through better education and decision-making autonomy. Also, the policies to improve the household's wealth status should be considered.
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Affiliation(s)
- Atta M Asif
- Department of Mathematics and Statistics, Faculty of Basic and Applied Science, International Islamic University, Islamabad, Pakistan
| | - Muhammad Akbar
- Department of Mathematics and Statistics, Faculty of Basic and Applied Science, International Islamic University, Islamabad, Pakistan
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Guan M. Associations of fruit & vegetable intake and physical activity with poor self-rated health among Chinese older adults. BMC Geriatr 2022; 22:10. [PMID: 34979973 PMCID: PMC8722069 DOI: 10.1186/s12877-021-02709-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the existing literature highlights the central roles of sociodemographic factors, fruit & vegetable (F&V) intake, and physical activities for maintaining good health, less is known about the associations in the Chinese context. This study attempted to explore the associations of servings of F&V intake and levels of physical activities with poor self-rated health (SRH) among Chinese older adults. METHODS Data were drawn from the Study on Global Ageing and Adult Health-China (SAGE-China) issued by the World Health Organization and included 7560 respondents aged ≥60 years in China. After screening out the potential confounding factors, multiple logistic regression models were adopted to explore the associations of sociodemographic factors, servings of F&V intake, and levels of physical activities with poor SRH. RESULTS Among the sample, nearly a quarter reported poor health status. There were significant gender differences in the case of servings of F&V intake and levels of physical activities. Logistic regressions indicated that higher fruit intake was associated with lower likelihood of vigorous level of physical activity as compared to zero intake. Likewise, higher vegetable intake (≥10 servings) was associated with a higher likelihood of vigorous & moderate level of physical activity when compared to lower intake (≤ 4 servings). Higher fruit intake was associated with a lower likelihood of poor SRH. Similarly, vegetable intake (5 servings: AOR = 0.69, 95%CI: 0.58-0.83; 6-9 servings: AOR = 0.72, 95%CI: 0.59-0.87) was significantly associated with poor SRH. Additionally, vigorous level of physical activity (AOR = 0.79, 95%CI: 0.65-0.97) and vigorous fitness/leisure (AOR = 0.57, 95%CI: 0.39-0.84) were significantly associated with poor SRH. CONCLUSION This study suggested that older adults with high fruit intake had lower probability of performing vigorous & moderate level of physical activity, while those with high vegetable intake had higher probability of performing vigorous & moderate level of physical activity. Likewise, the older adults with high F&V intake and higher probability of performing vigorous level of physical activity, walk/bike activity, and vigorous/moderate fitness/leisure had less likelihood to face the risk for poor SRH outcomes. The appropriate servings of F&V intake and levels of physical activity should be highlighted.
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Affiliation(s)
- Ming Guan
- Family Issues Center, Xuchang University, Road Bayi 88, Xuchang, Henan, China. .,International Issues Center, Xuchang University, Road Bayi 88, Xuchang, Henan, China. .,School of Business, Xuchang University, Road Bayi 88, Xuchang, Henan, China.
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Decomposition of inequalities in out-of-pocket health expenditure burden in Saudi Arabia. Soc Sci Med 2021; 286:114322. [PMID: 34454127 DOI: 10.1016/j.socscimed.2021.114322] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/23/2022]
Abstract
Out-of-pocket (OOP) health expenditure remains a serious welfare problem worldwide. The aim of this study was to investigate and decompose factors that are associated with inequalities in relative OOP health expenditure, estimated as the percentage of income spent on healthcare, in Saudi Arabia. Data from 10,785 respondents were obtained from a national cross-sectional survey conducted in Saudi Arabia as a part of the 2018 Family Health Survey. Inequalities in relative OOP health expenditure were measured using concentration indices and concentration curves. Moreover, the Wagstaff approach was used to decompose the concentration index of relative OOP health expenditure to assess the contribution of each of its determinants. The results revealed that relative OOP health expenditure in Saudi Arabia are concentrated among the poor (concentration index = -0.151, p < 0.01), resulting in a greater burden for the poor. Decomposition of the factors that contribute to this inequality revealed heterogeneity. Specifically, factors that increase the burden amongst the poor included aged above 60 years, and low levels of education, whereas factors that increase the burden amongst the rich included male gender, below the age of 60 years, secondary and higher education, having health insurance coverage, and suffering from chronic illnesses. Importantly, these results demonstrate that poor people might be exposed to hazardous health spending. Therefore, efforts to curbing OOP health expenditure should be framed by taking into account the specific factors that drive the burden towards the poor, such as older age and lack of education, so as to safeguard the overall welfare of the poor.
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Alaba OA, Hongoro C, Thulare A, Lukwa AT. Leaving No Child Behind: Decomposing Socioeconomic Inequalities in Child Health for India and South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7114. [PMID: 34281051 PMCID: PMC8296912 DOI: 10.3390/ijerph18137114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/01/2021] [Accepted: 06/26/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The United Nations' 2030 Agenda for Sustainable Development argues for the combating of health inequalities within and among countries, advocating for "leaving no one behind". However, child mortality in developing countries is still high and mainly driven by lack of immunization, food insecurity and nutritional deficiency. The confounding problem is the existence of socioeconomic inequalities among the richest and poorest. Thus, comparing South Africa's and India's Demographic and Health Surveys (DHS) of 2015/16, this study examines socioeconomic inequalities in under-five children's health and its associated factors using three child health indications: full immunization coverage, food insecurity and malnutrition. METHODS Erreygers Normalized concentration indices were computed to show how immunization coverage, food insecurity and malnutrition in children varied across socioeconomic groups (household wealth). Concentration curves were plotted to show the cumulative share of immunization coverage, food insecurity and malnutrition against the cumulative share of children ranked from poorest to richest. Subsequent decomposition analysis identified vital factors underpinning the observed socioeconomic inequalities. RESULTS The results confirm a strong socioeconomic gradient in food security and malnutrition in India and South Africa. However, while full childhood immunization in South Africa was pro-poor (-0.0236), in India, it was pro-rich (0.1640). Decomposed results reported socioeconomic status, residence, mother's education, and mother's age as primary drivers of health inequalities in full immunization, food security and nutrition among children in both countries. CONCLUSIONS The main drivers of the socioeconomic inequalities in both countries across the child health outcomes (full immunization, food insecurity and malnutrition) are socioeconomic status, residence, mother's education, and mother's age. In conclusion, if socioeconomic inequalities in children's health especially food insecurity and malnutrition in South Africa; food insecurity, malnutrition and immunization in India are not addressed then definitely "some under-five children will be left behind".
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Affiliation(s)
- Olufunke A. Alaba
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa;
| | - Charles Hongoro
- Developmental, Capable and Ethical State, Human Sciences Research Council, Pretoria 0001, South Africa;
- School of Health Systems and Public Health (SHSPH), Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Aquina Thulare
- National Department of Health, Pretoria 0001, South Africa;
| | - Akim Tafadzwa Lukwa
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa;
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Nie P, Ding L, Chen Z, Liu S, Zhang Q, Shi Z, Wang L, Xue H, Liu GG, Wang Y. Income-related health inequality among Chinese adults during the COVID-19 pandemic: evidence based on an online survey. Int J Equity Health 2021; 20:106. [PMID: 33902603 PMCID: PMC8072088 DOI: 10.1186/s12939-021-01448-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/13/2021] [Indexed: 01/10/2023] Open
Abstract
Background Partial- or full-lockdowns, among other interventions during the COVID-19 pandemic, may disproportionally affect people (their behaviors and health outcomes) with lower socioeconomic status (SES). This study examines income-related health inequalities and their main contributors in China during the pandemic. Methods The 2020 China COVID-19 Survey is an anonymous 74-item survey administered via social media in China. A national sample of 10,545 adults in all 31 provinces, municipalities, and autonomous regions in mainland China provided comprehensive data on sociodemographic characteristics, awareness and attitudes towards COVID-19, lifestyle factors, and health outcomes during the lockdown. Of them, 8448 subjects provided data for this analysis. Concentration Index (CI) and Corrected CI (CCI) were used to measure income-related inequalities in mental health and self-reported health (SRH), respectively. Wagstaff-type decomposition analysis was used to identify contributors to health inequalities. Results Most participants reported their health status as “very good” (39.0%) or “excellent” (42.3%). CCI of SRH and mental health were − 0.09 (p < 0.01) and 0.04 (p < 0.01), respectively, indicating pro-poor inequality in ill SRH and pro-rich inequality in ill mental health. Income was the leading contributor to inequalities in SRH and mental health, accounting for 62.7% (p < 0.01) and 39.0% (p < 0.05) of income-related inequalities, respectively. The COVID-19 related variables, including self-reported family-member COVID-19 infection, job loss, experiences of food and medication shortage, engagement in physical activity, and five different-level pandemic regions of residence, explained substantial inequalities in ill SRH and ill mental health, accounting for 29.7% (p < 0.01) and 20.6% (p < 0.01), respectively. Self-reported family member COVID-19 infection, experiencing food and medication shortage, and engagement in physical activity explain 9.4% (p < 0.01), 2.6% (the summed contributions of experiencing food shortage (0.9%) and medication shortage (1.7%), p < 0.01), and 17.6% (p < 0.01) inequality in SRH, respectively (8.9% (p < 0.01), 24.1% (p < 0.01), and 15.1% (p < 0.01) for mental health). Conclusions Per capita household income last year, experiences of food and medication shortage, self-reported family member COVID-19 infection, and physical activity are important contributors to health inequalities, especially mental health in China during the COVID-19 pandemic. Intervention programs should be implemented to support vulnerable groups. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01448-9.
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Affiliation(s)
- Peng Nie
- School of Economics and Finance, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.,Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, China
| | - Lanlin Ding
- School of Economics and Finance, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA.,School of Economics, Faculty of Humanities and Social Sciences, University of Nottingham Ningbo China, Ningbo, China
| | - Shiyong Liu
- Center for Governance Studies, Beijing Normal University at Zhuhai, Zhuhai, 519087, China
| | - Qi Zhang
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA, USA
| | - Zumin Shi
- Human Nutrition Department, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Lu Wang
- School of Economics and Finance, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Hong Xue
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, 22030, USA
| | - Gordon G Liu
- Peking University National School of Development, Beijing, 100871, China
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, China.
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Mu A, Deng Z, Wu X, Zhou L. Does digital technology reduce health disparity? Investigating difference of depression stemming from socioeconomic status among Chinese older adults. BMC Geriatr 2021; 21:264. [PMID: 33882865 PMCID: PMC8059190 DOI: 10.1186/s12877-021-02175-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/22/2021] [Indexed: 11/24/2022] Open
Abstract
Background Prior studies on health disparity have shown that socioeconomic status is critical to inequality of health outcomes such as depression. However, two questions await further investigation: whether disparity in depression correlated with socioeconomic status will become larger when depression becomes severer, and whether digital technology will reduce the disparity in depression correlated with socioeconomic status. Our study aims to answer the above two questions. Methods By using the dataset from China Health and Retirement Longitudinal Study 2015, we use quantile regression models to examine the association between socioeconomic status and depression across different quantiles, and test the moderating effect of digital technology. Results Our study obtains four key findings. First, the negative effects of socioeconomic status on depression present an increasing trend at high quantiles. Second, Internet usage exacerbates the disparity in depression associated with education level on average, but reduces this disparity associated with education level at high quantiles. Third, Internet usage reduces the disparity in depression associated with income on average and at high quantiles. Fourth, mobile phone ownership has almost no moderating effect on the relationship between socioeconomic status and depression. Conclusions Our findings suggest the potential use of digital technology in reducing disparity in depression correlated with socioeconomic status among middle-aged and aged individuals in developing countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02175-0.
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Affiliation(s)
- Aruhan Mu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Zhaohua Deng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Xiang Wu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Liqin Zhou
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China.
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Zhao D, Zhou Z, Shen C, Nawaz R, Li D, Ren Y, Zhao Y, Cao D, Zhai X. Rural and urban differences in patient experience in China: a coarsened exact matching study from the perspective of residents. BMC Health Serv Res 2021; 21:330. [PMID: 33849544 PMCID: PMC8042990 DOI: 10.1186/s12913-021-06328-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/29/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patient experience is a key measure widely used to evaluate quality of healthcare, yet there is little discussion about it in China using national survey data. This study aimed to explore rural and urban differences in patient experience in China. METHODS Data regarding this study were drawn from Chinese General Social Survey (CGSS) 2015, with a sample size of 9604. Patient experience was measured by the evaluation on healthcare services. Coarsened exact matching (CEM) method was used to balance covariates between the rural and urban respondents. Three thousand three hundred seventy-two participants finally comprised the matched cohort, including 1592 rural residents and 1780 urban residents. Rural and urban differences in patient experience were tested by ordinary least-squares regression and ordered logistic regression. RESULTS The mean (SD) score of patient experience for rural and urban residents was 72.35(17.32) and 69.45(17.00), respectively. Urban residents reported worse patient experience than rural counterparts (Crude analysis: Coef. = - 2.897, 95%CI: - 4.434, - 1.361; OR = 0.706, 95%CI: 0.595, 0.838; Multivariate analysis: Coef. = - 3.040, 95%CI: - 4.473, - 1.607; OR = 0.675, 95%CI: 0.569, 0.801). Older (Coef. = 2.029, 95%CI: 0.338, 3.719) and healthier (Coef. = 2.287, 95%CI: 0.729, 3.845; OR = 1.217, 95%CI: 1.008, 1.469) rural residents living in western area (Coef. = 2.098, 95%CI: 0.464, 3.732; OR = 1.276, 95%CI: 1.044, 1.560) with higher social status (Coef. = 1.158, 95%CI: 0.756, 1.561; OR = 1.145, 95%CI: 1.090, 1.204), evaluation on adequacy (Coef. = 7.018, 95%CI: 5.045, 8.992; OR = 2.163, 95%CI: 1.719, 2.721), distribution (Coef. = 4.464, 95%CI: 2.471, 6.456; OR = 1.658, 95%CI: 1.312, 2.096) and accessibility (Coef. = 2.995, 95%CI: 0.963, 5.026; OR = 1.525, 95%CI: 1.217, 1.911) of healthcare resources had better patient experience. In addition, urban peers with lower education (OR = 0.763, 95%CI: 0.625, 0.931) and higher family economic status (Coef. = 2.990, 95%CI: 0.959, 5.021; OR = 1.371, 95%CI: 1.090,1.723) reported better patient experience. CONCLUSIONS Differences in patient experience for rural and urban residents were observed in this study. It is necessary to not only encourage residents to form a habit of seeking healthcare services in local primary healthcare institutions first and then go to large hospitals in urban areas when necessary, but also endeavor to reduce the disparity of healthcare resources between rural and urban areas by improving quality and capacity of rural healthcare institutions and primary healthcare system of China.
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Affiliation(s)
- Dantong Zhao
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China.
| | - Chi Shen
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
- Department of Health Policy and Management, Yale University, New Haven, CT, 06520, USA
| | - Rashed Nawaz
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Dan Li
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Yangling Ren
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Yaxin Zhao
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Dan Cao
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Xiaohui Zhai
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
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Zhou X, Liao S, Qi L, Wang R. Physical activity and its association with cognitive function in middle- and older-aged Chinese: Evidence from China Health and Retirement Longitudinal Study, 2015. Eur J Sport Sci 2021; 22:937-947. [PMID: 33641627 DOI: 10.1080/17461391.2021.1897164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Despite the known benefits of physical activity (PA) on cognitive function, the specific dimensions of PA that are associated with cognitive function require further research in China. We aimed to explore the patterns of PA and elucidate the association between cognitive function and different levels of PA in middle aged and elderly Chinese individuals. METHODS A total of 8,023 participants aged ≥45 years were selected from the China Health and Retirement Longitudinal Study. The PA intensity was categorized as: vigorous (VPA), moderate (MPA), and light (LPA). The associations of frequency and duration of PA at different intensities with cognitive function were examined using the multivariable linear model, including all respondents and urban-rural subgroups. RESULTS Compared with those who had no VPA, those who spent 6-7 days/week (β = -0.59, 95% CI: -1.10, -0.09) or more than 240 min/each time on VPA had poorer cognitive function among rural respondents, whereas cognitive function was only associated with the duration in urban respondents. Compared with those who had no MPA, the rural respondents who spent 1-5 days/week (β = 0.66, 95% CI: 0.12, 1.20) or 6-7days/week, or spent < 2 hours each time had better cognitive function. For LPA, frequency and duration were both positively associated with cognitive function, and were observed in both rural and urban sub-groups. CONCLUSIONS The association between cognitive function and PA depended largely on the intensity and area. Cultural context and geographical differences should be considered when designing intervention policies.Highlights The prevalence of PA increased as the intensity decreased and was higher in rural respondents than in urban respondents.Cognitive function was related to the intensity, frequency, and duration of PA. However, the magnitude and direction of the association depended mainly on the intensity and geographical area.VPA was negatively correlated with cognitive function, and the association was significant only in rural respondents. However, MPA and LPA were positively correlated with cognitive function, while the association between LPA and cognitive function was significant in both rural and urban respondents.
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Affiliation(s)
- Xiuxiu Zhou
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Shiming Liao
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Ling Qi
- School of Health Science and Nursing, Wuhan Polytechnic University, Wuhan, People's Republic of China
| | - Ruoxi Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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Ge H, Yang Z, Li X, Liu D, Li Y, Pan Y, Luo D, Wu X. The prevalence and associated factors of metabolic syndrome in Chinese aging population. Sci Rep 2020; 10:20034. [PMID: 33208868 PMCID: PMC7675973 DOI: 10.1038/s41598-020-77184-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 11/05/2020] [Indexed: 12/14/2022] Open
Abstract
Metabolic syndrome (MetS) is hitting high notes in the aging society in China. However, the prevalence and associated factors in Chinese aging population lack clarity to some extent. In the present study, we projected to inquire into the prevalence of MetS and its associated factors by analyzing datasets downloaded from the China Health and Retirement Longitudinal Study (CHARLS). Data comprising age, gender, socioeconomic status, lifestyle and health behaviors as well as blood biomarkers were subjected to descriptive statistics followed by univariate logistic regression and multivariate logistic regression. The overall prevalence of MetS was 33.38% (95% CI 32.42–34.34%). With age augments, prevalence increased during 40–70 years, while declined in participants aged 70 years above. Females had 2.94 times of risks (95% CI 2.55–3.39, P < 0.001). Marital status and alcohol consumption contributed nothing to the suffering of MetS. Participants with GDP per capita > 10,000 RMB and a non-agricultural hukou sustained higher risks than other participants (P < 0.05). Participants under education of middle school suffered 1.16 times of risks than other level of education (95% CI 1.01–1.34, P < 0.05). Smokers, participants with high low-density lipoprotein (LDL) or hyperuricemia or high glycosylated hemoglobin HbA1c sustained increased risks (P < 0.05). In Chinese aging population, with the augment of age, the prevalence ascended in men, while descended in women and was interfered by socioeconomic status, lifestyle and health behaviors as well as blood biomarkers, but not marital status and alcohol consumption.
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Affiliation(s)
- Huisheng Ge
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Zihui Yang
- Tsinghua Changgeng Hospital, Tsinghua University, Beijing, 102218, China
| | - Xiaoyu Li
- Laboratory of Innovation, Basic Medical Experimental Teaching Center, Chongqing Medical University, Chongqing, 400016, China
| | - Dandan Liu
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Yan Li
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Yue Pan
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Dan Luo
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
| | - Xixi Wu
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
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Liao S, Zhou Y, Liu Y, Wang R. Variety, frequency, and type of Internet use and its association with risk of depression in middle- and older-aged Chinese: A cross-sectional study. J Affect Disord 2020; 273:280-290. [PMID: 32421614 DOI: 10.1016/j.jad.2020.04.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/06/2020] [Accepted: 04/20/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Internet use is beneficial to mental health has been acknowledged, but its specific patterns await further investigation in China's context of urban-rural disparity. Therefore, we aimed to understand the patterns of Internet use and measure their associations with risk of depression in China from three dimensions: variety, frequency and type. METHODS We selected 18,492 urban and rural Chinses respondents aged 45 years and older from China Health and Retirement Longitudinal Study (CHARLS) 2015 dataset. Risk of depression was measured by 10-item Centre for Epidemiologic Studies (CES-D 10). Internet use was measured from three dimensions: variety, frequency and type, whereas its relationship with risk of depression was examined by multivariate logistic regression model. RESULTS In the whole sample, 67.2% of respondents had no risk of depression, and approximately 7% used Internet, which was inversely associated with risk of depression (AOR=0.617, 95% CI=0.444, 0.858). Rural respondents had higher risk of depression (37.1% VS 26.2%) and lower prevalence of Internet use (2.6% VS 13%). Among rural respondents, using Internet occasionally (AOR=0.338; 95% CI=0.130, 0.881), using one type of device (AOR=0.293; 95% CI=0.113, 0.760), especially mobile phone (AOR=0.427; 95% CI=0.187, 0.978) were associated with lower odds of depression. No significant associations were observed in urban respondents. LIMITATIONS The causal relationship between variables awaits further investigation with a longitudinal design. CONCLUSION Internet use was negatively associated with risks of depression, especially in rural but not in urban participants. Rural-urban disparities should be considered when designing strategies to encourage moderate Internet use.
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Affiliation(s)
- Shiming Liao
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China.
| | - Yongjie Zhou
- Affiliated Mental Health Center of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430012, China; Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, Hubei, 430074, China.
| | - Yifeng Liu
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, People's Republic of China.
| | - Ruoxi Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China; Research center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, Hubei, 430030, China.
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Asif AM, Akbar M. Inequalities in child health care in Pakistan: measurement and decomposition analysis of maternal educational impact. Public Health 2020; 183:94-101. [PMID: 32470697 DOI: 10.1016/j.puhe.2020.03.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/19/2020] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of the study was to measure the impact of maternal education on inequalities in child health care and to explore the contribution of different factors to the observed inequality. STUDY DESIGN The study is based on secondary data from the Pakistan Demographic and Health Survey 2017-18. METHODS Concentration curves and indices were used to identify and quantify the inequality in child health care. Moreover, contributions of different factors to the observed inequality were investigated using decomposition analysis. RESULTS The concentration indices for health care provided were 0.078 (P < 0.001) when a child was experiencing diarrhoea and 0.088 (P < 0.001) for fever/cough. The results of this study indicate that healthcare practices are more common among children of educated mothers. The main contributors resulting in the observed inequalities in child health care were improved sanitation (about 6% for diarrhoea and 15% for fever/cough treatment), rural residence (about 4% and 23% for diarrhoea and fever/cough treatment, respectively), wealth status (49% and 28% for diarrhoea and fever/cough treatment, respectively) and maternal education (26% for diarrhoea and 28% for fever/cough treatment). CONCLUSION The findings suggested that child health care is more frequently provided among educated mothers; therefore, steps should be taken to improve maternal education. Moreover, policies should seek to increase/improve the roles of women in society, as well as job opportunities to overcome the financial barriers of healthcare provision.
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Affiliation(s)
- A M Asif
- Department of Mathematics and Statistics, Faculty of Basic and Applied Sciences, International Islamic University, Islamabad, Pakistan.
| | - M Akbar
- Department of Mathematics and Statistics, Faculty of Basic and Applied Sciences, International Islamic University, Islamabad, Pakistan.
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Sun J, Lyu S, Zhao R. Socioeconomic Inequality in Health Outcomes Among the Elderly: Evidence from a Cross-Sectional Study in China. Risk Manag Healthc Policy 2020; 13:397-407. [PMID: 32523387 PMCID: PMC7234974 DOI: 10.2147/rmhp.s248019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/24/2020] [Indexed: 01/19/2023] Open
Abstract
Background and Aim Health is viewed as a form of human capital and a necessary basis for people to realize capabilities. Moreover, socioeconomic inequality in health outcome widens income inequality and exacerbates social inequality. The aim of this study is to measure socioeconomic inequality in health outcomes among the elderly in China. Methods The data used in this study were sourced from China Health and Retirement Longitudinal Study in 2015, including 5643 participants aged 60 and above. Concentration curve and concentration index were applied to measure the extent of socioeconomic inequality in health outcomes among older adults. Furthermore, the decomposition method of concentration index proposed by Wagstaff was employed to quantify each determinant's contribution to the measured socioeconomic inequality in health outcomes. Results The concentration index of Activity of Daily Living Scale and Center of Epidemiological Survey-Depression Scale score were -0.0064 and -0.0158, respectively, indicating pro-rich inequality in physical and mental health among the elderly. The decomposition analysis revealed that household income (41.15%), aged 70-79 (17.37%), being male (8.38%), and living in urban area (5.78%) were key factors to explain the pro-rich inequality in physical health. Furthermore, the results also suggested that household income (68.41%), being male (17.55%), having junior high school education (10.67%), and living in urban area (6.49%) were key factors to explain the pro-rich inequality in mental health. Conclusion This study revealed that there are pro-rich inequalities in physical and mental health among the elderly in China, and the degree of pro-rich inequality in mental health is higher than that in physical health. Moreover, the results also suggested that household income is the biggest contributor to socioeconomic inequality in physical and mental health. Furthermore, this study found that educational attainment makes a substantial contribution to socioeconomic inequality in health outcomes, while the contribution of health insurance to health inequality is limited.
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Affiliation(s)
- Jian Sun
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai 200030, People's Republic of China
| | - Shoujun Lyu
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai 200030, People's Republic of China.,China Institute for Urban Governance, Shanghai Jiao Tong University, Shanghai 200030, People's Republic of China
| | - Rui Zhao
- Affiliated Hospital of Hebei University, Hebei 071000, People's Republic of China
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JieAnNaMu, Xu X, You H, Gu H, Gu J, Li X, Cui N, Kou Y. Inequalities in health-related quality of life and the contribution from socioeconomic status: evidence from Tibet, China. BMC Public Health 2020; 20:630. [PMID: 32375713 PMCID: PMC7203898 DOI: 10.1186/s12889-020-08790-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 04/27/2020] [Indexed: 12/29/2022] Open
Abstract
Background This study aimed to understand the association between socioeconomic status (SES) and Health Related Quality of Life (HRQoL) and the contribution of SES to health inequality among Tibetans of agricultural and pastoral areas (APA) in Tibet, China. Methods The data were from Health Survey of Tibetans in APA conducted in 2014. A total of 816 respondents were enrolled for the analysis Multiple linear regression was employed to examine the relationship between SES and HRQoL. Concentration index (CI) was used to measure the degree of health inequality and a Wagstaff-type CI decomposition method was applied to measure the contribution of SES to inequality. Results SES had significant association with HRQoL among the Tibetans in APA. The high SES group was more likely to have a higher Eq-5d index (0.77 vs. 0.67, P < 0.001) and VAS (72.94 vs. 62.41, P < 0.001) than the low SES group. The Concentration index of the Eq-5d index and VAS for total sample was 0.022 and 0.026 respectively, indicating a slight pro-rich inequality among this population. The decomposition analyses showed the SES is the main contributor to health inequality and contributed 45.50 and 41.39% to inequality for the Eq-5d index and VAS, respectively. Conclusion The results showed SES is positively associated with HRQoL among Tibetans in APA. There was a slight pro-rich inequality in the health of the participants and most health inequality was attributable to SES. This study is helpful in gaining an insight into the HRQoL, health inequality and the relationship between SES and health inequality among Tibetans of APA in China.
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Affiliation(s)
- JieAnNaMu
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, China
| | - Xinpeng Xu
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, China
| | - Hua You
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China.
| | - Hai Gu
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, China.
| | - Jinghong Gu
- Nanjing Foreign Language School, Nanjing, China
| | - Xiaolu Li
- Department of Otolaryngology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Nan Cui
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, China
| | - Yun Kou
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, China
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Wang R, Chen Z, Zhou Y, Shen L, Zhang Z, Wu X. Melancholy or mahjong? Diversity, frequency, type, and rural-urban divide of social participation and depression in middle- and old-aged Chinese: A fixed-effects analysis. Soc Sci Med 2019; 238:112518. [PMID: 31473574 DOI: 10.1016/j.socscimed.2019.112518] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/17/2019] [Accepted: 08/22/2019] [Indexed: 12/20/2022]
Abstract
The potential benefit of social participation (SP) to one's mental health has been widely acknowledged. Nevertheless, the specific type and amount of SP that is associated with improved depressive symptoms in middle- and old-aged Chinese awaits further investigation. This study aimed to understand the patterns of depression and SP by comparing urban vs rural China, and according to which, measure the associations between changes in SP and that in depressive symptoms. A total of 10,988 community residents aged 45 years and above were selected from wave 1 (2011), wave 2 (2013), and wave 4 (2015) of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey. The fixed-effects analysis was used to explore the association between the changes in diversity, frequency, and type of SP and the changes in depressive symptoms. The results indicated that rural respondents suffered from a significantly higher risk of depression and took less SP than their urban counterparts. Transitioning from no SP to 1 or more types of SP or to a once a week or higher frequency was associated with a decline in depressive symptoms. For urban respondents, playing mah-jong or cards and joining sports or social clubs predicted a decline in depressive symptoms. For rural residents, interacting with friends regularly was associated with fewer depressive symptoms. In conclusion, more diverse and higher frequency of SP was associated with better mental health, while the social significance of SP varied across different types of SP and between rural and urban areas.
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Affiliation(s)
- Ruoxi Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China.
| | - Zhuo Chen
- College of Public Health, University of Georgia, Athens, GA 30606, USA; School of Economics, University of Nottingham Ningbo China, Ningbo, 315100, China.
| | - Yongjie Zhou
- Affiliated Mental Health Center of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430012, China; Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, Hubei, 430074, China.
| | - Lining Shen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China; Hubei Provincial Research Center for Health Technology Assessment, Wuhan, Hubei, 430030, China.
| | - Zhiguo Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China; Hubei Provincial Research Center for Health Technology Assessment, Wuhan, Hubei, 430030, China.
| | - Xiang Wu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China.
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Song H, Zuo X, Cui C, Meng K. The willingness of patients to make the first visit to primary care institutions and its influencing factors in Beijing medical alliances: a comparative study of Beijing's medical resource-rich and scarce regions. BMC Health Serv Res 2019; 19:361. [PMID: 31174523 PMCID: PMC6556011 DOI: 10.1186/s12913-019-4184-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 05/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To improve the efficiency of the use of medical resources, China has implemented medical alliances (MAs) to implement a hierarchical diagnosis and treatment system. The willingness to undertake a first visit to primary care institutions (PCIs) is an important indicator of the effect of this system. Beijing has also built MAs since 2013, but to date, there have been few studies on the first visit to PCIs in Beijing. The purpose of this study is to analyze patients' willingness to make their first visit to PCIs and its influencing factors to provide references for the realization of a hierarchical diagnosis and treatment system. METHODS Two relatively different districts with large differences in resources in Beijing, D and F, were selected, and a self-reported questionnaire and convenience sampling method were applied. A cross-sectional survey was administered to 1221 patients of MAs. The chi-square test and binary logistic regression were used to analyze the influencing factors of patients' willingness to undertake a first visit to a PCI. RESULTS Fewer patients in District D received medical alliance services (44.42%) than those in District F (59.25%), but patients in District D had a higher degree of satisfaction with the services they received (72.04%) than those in District F (28.96%). Patients in District D had a higher willingness to undertake a first visit (64.00%) than those in District F (58.18%). Patients of an older age, low medical expenses, participation in urban employees' basic medical insurance, a high understanding of MAs and high satisfaction with medical services were indicators of being more willing to choose primary care institutions for their first visit. CONCLUSIONS The different medical resources and MA constructions in the two districts have resulted in a difference between the two districts in terms of the willingness of individuals to make their first visit to PCIs. Strengthening the service capabilities of PCIs remains a priority. The government should propose solutions to solve the problems encountered in practice and actively promote the realization of MAs and hierarchical diagnosis and treatment.
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Affiliation(s)
- Haiyan Song
- Department of Social Medicine and Health Management, School of Public Health, Capital Medical University, Beijing, 100069, China
| | - Xu Zuo
- Department of Social Medicine and Health Management, School of Public Health, Capital Medical University, Beijing, 100069, China
| | - Chengsen Cui
- Department of Social Medicine and Health Management, School of Public Health, Capital Medical University, Beijing, 100069, China
| | - Kai Meng
- Department of Social Medicine and Health Management, School of Public Health, Capital Medical University, Beijing, 100069, China.
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