The effect of housing tenure on health status of migrant populations in China: are health service utilization and social integration mediating factors?

Prediction and unsupervised clustering of fertility intention among migrant workers based on machine learning: a cross-sectional survey from Henan, China

BACKGROUND

Although China has implemented multiple policies to encourage childbirth, the results have been underwhelming. Migrant workers account for a considerable proportion of China's population, most of whom are of childbearing age. However, few articles focus on their fertility intentions.

METHOD

From August 3 to August 29, 2023, we conducted a cross-sectional survey in Henan Province, China, which included 18,806 participants. Machine learning was used to construct a predictive model for the fertility intention of migrant workers, and unsupervised clustering was used to explore subgroup classification.

RESULT

Out of 18,806 participants, only 1057 had fertility intention. We constructed a predictive model for fertility intention based on XGBoost, with an AUC of 0.83. Age, number of children, and marital status are the most important characteristics that affect the fertility intention of migrant workers. Subsequently, unsupervised clustering was conducted on participants without fertility intentions, and it was found that they could be divided into three categories of population. The first group of people is the youngest and mostly unmarried without pregnancy, the second group has the lowest monthly income and self-perceived economic level, and the third group is the oldest and has the highest proportion of women. Regardless of the group, economic and age factors are the main reasons for participants not having a family plan in the near future.

CONCLUSION

The fertility intention of the migrant workers is at an extremely low level. Improving childcare-related benefits and family support services to reduce the economic and time costs of childcare is an effective measure to reverse fertility intentions.

Association of social support with depression and anxiety among the migrant population of Henan, China: Based on a large cross-sectional study

Amid China's rapid urbanization, the growing migrant population has increasingly drawn attention due to the rising prevalence of mental health concerns. Based on a large cross-sectional study, we explored the relationship between social factors and depression and anxiety among the migrant population and also quantified the correlations of different dimensions of social support and the varying levels of depression and anxiety. Results showed that the prevalence of depression and anxiety are 47.0% and 34.9%, respectively, among the 19,498 migrant populations. Females and individuals with chronic conditions were found to be more vulnerable to experiencing symptoms of anxiety and depression within the migrant population. Participants who received higher levels of social support were less likely to experience symptoms of depression and anxiety. Additionally, various dimensions of social support (including subjective, objective, and utilization) exhibited significant negative associations with different levels of depression and anxiety within the migrant population. Social support plays a crucial role in alleviating depression and anxiety among the migrant population, particularly in mitigating moderate and severe symptoms, which provides an important reference for improving the mental well-being of the migrant population.

Social integration as a mediator of the association between housing tenure and health inequalities among China's migrants: A housing discrimination perspective

Due to the housing affordability crisis and institutional discrimination embedded in China's housing system, which refers to the unequal rights between homeowners and renters, migrant renters face greater social exclusion and health inequalities compared to migrant homeowners. Although housing tenure is considered an important determinant of health, along with other socioeconomic factors, the pathways underlying the association between housing tenure and health remain overlooked. Using data from the 2017 China Migrants Dynamic Survey of 62,268 participants, this study examined the mediating effects of social integration between housing tenure and self-rated health, and whether housing affordability moderated the mediating effects. Simple mediation models showed that social integration partly mediated the association between housing tenure and self-rated health. Moderated mediation models revealed that housing affordability moderated the association between housing tenure and social integration, and did not moderate the association between social integration and self-rated health. Compared with migrants living in affordable housing, the mediating effect of social integration was significantly smaller among migrants living in unaffordable housing. The results add knowledge to previous literature by uncovering the underlying mechanisms between housing tenure and health and linking housing studies to social inequalities in health. Our study suggested that diminishing housing discrimination and improving housing affordability could not only be beneficial for migrants' health but also be helpful to narrowing the health inequalities among migrants.

How Housing Stress Affect Health Care Costs: A Panel Data Study

As housing prices in China continue to escalate and the limitations of the "personal unlimited liability system" for housing loans become more evident, the financial stress on families has significantly increased. This stress not only impacts the physical and mental health of family members but also results in rising health care costs. This paper presents empirical research examining how housing stress influences changes in household health care costs through a panel data analysis. The study is based on the China Family Panel Study (CFPS) database and employs a panel two-way fixed effect model alongside a mediating effect model to examine the impact of housing stress, family income, and health status on health care costs. The findings reveal a significant positive correlation between housing stress and health care costs; specifically, for every 1% point increase in housing stress, health care costs rise by 0.141. Robustness tests and propensity score matching (PSM) further validate these findings, even after addressing endogeneity issues. Mediation effect analysis indicates that for every 1% point increase in housing stress, household disposable income decreases by 1.749, and health status declines by 0.468, thereby increasing household health care costs. Heterogeneity analysis demonstrates that housing stress has a more pronounced impact on health care costs among western, eastern, urban, and rental households. The government should implement various measures, such as promoting a "personal limited liability system" mortgage policy, reducing housing prices, and ensuring equal rights to rent and purchase, to alleviate housing stress, enhance family income, and improve residents' health status. These actions would contribute to the promotion of both the housing market and medical care, supporting the sustainable development of the health care sector and ultimately improving long-term social welfare.