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Zhou R, Morita N, Ogai Y, Saito T, Zhang X, Yang W, Yang F. Meta-Analysis of Internet Gaming Disorder Prevalence: Assessing the Impacts of DSM-5 and ICD-11 Diagnostic Criteria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:700. [PMID: 38928946 PMCID: PMC11203952 DOI: 10.3390/ijerph21060700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024]
Abstract
With the inclusion of Internet gaming disorder (IGD) in both the DSM-5 and ICD-11, understanding the prevalence and diagnostic discrepancies is crucial for developing appropriate interventions. This study presents a meta-analysis of the prevalence of IGD based on two diagnostic criteria. We systematically searched the PubMed and Web of Science databases. A total of 22 studies were included in the final analysis. The analysis incorporated studies employing the DSM-5 and ICD-11 criteria and focused on the impact of various factors, including study location, sample characteristics, sample size, and quality score, on the reported prevalence rates using a random-effects model. The pooled prevalence of IGD is 6.7% (95% CI: 5.7-7.7%). The subgroup analysis indicated significant differences in the prevalence rates of IGD (DSM-5 criteria) and GD (ICD-11 criteria) (Q b = 38.46, p < 0.01). There were also significant differences in IGD prevalence rates between different scales (Q b = 54.23, p < 0.001). Our findings indicate that different diagnostic criteria and different assessment scales have a significant impact on the prevalence of IGD. This underscores the importance of adopting standardized methodologies to guide public health interventions. However, given the limited research based on ICD-11 diagnostic criteria, further investigation is necessary to determine the variations in prevalence rates of IGD under different diagnostic standards.
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Affiliation(s)
- Ruoyu Zhou
- Doctoral Program in Human Care Science, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba 305-8577, Japan;
| | - Nobuaki Morita
- Department of Social Psychiatry and Mental Health, School of Medicine and Medical Sciences, University of Tsukuba, Tsukuba 305-8577, Japan; (N.M.); (Y.O.); (T.S.)
| | - Yasukazu Ogai
- Department of Social Psychiatry and Mental Health, School of Medicine and Medical Sciences, University of Tsukuba, Tsukuba 305-8577, Japan; (N.M.); (Y.O.); (T.S.)
| | - Tamaki Saito
- Department of Social Psychiatry and Mental Health, School of Medicine and Medical Sciences, University of Tsukuba, Tsukuba 305-8577, Japan; (N.M.); (Y.O.); (T.S.)
| | - Xinyue Zhang
- Public Health Degree Program, Faculty of Comprehensive Human Sciences, University of Tsukuba, Tsukuba 305-8577, Japan;
| | - Wenjie Yang
- The Mental Health Center, Yunnan University, Kunming 650091, China
| | - Fan Yang
- Graduate School of Letters, Arts and Sciences, Waseda University, Tokyo 162-8644, Japan;
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Rajan RE, Gunasekaran S, Duraisamy V, Mathew BM, Vinolia TM, Gainneos PD. Internet gaming disorder: The prevalence and associated gaming behavior, anxiety, and depression among 8-12-year-old children of private schools in Salem city, India. J Indian Soc Pedod Prev Dent 2024; 42:98-103. [PMID: 38957906 DOI: 10.4103/jisppd.jisppd_27_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/21/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND The escalating concern over Internet gaming disorder (IGD) among children underscores the urgency of comprehending its determinants and links to mental health, particularly for interventions targeting school-aged children. AIM This study aimed to evaluate the prevalence and determinants of IGD and its association with depression, anxiety, and behavior among 8-12-year-old children attending private schools in Salem city. SETTINGS AND DESIGN A cross-sectional study involving 780 children aged 8-12 years from Salem district was conducted. Schools were randomly sampled, and data were collected through a self-administered questionnaire. MATERIALS AND METHODS Data were gathered from children without genetic, systemic, or mental disorders and brain trauma. The questionnaire, adapted from Alhamoud M A et al. (2022), encompassed sections on sociodemographic characteristics, gaming behavior, and scales for assessing IGD, depression, and anxiety. Administration occurred during school hours with a 30-35 min completion time. STATISTICAL ANALYSIS USED Data analysis utilized SPSS v23.0, including descriptive statistics, ANOVA, Chi-square tests for intergroup comparisons, and Pearson's correlation coefficient to determine associations. RESULTS The prevalence of IGD in Salem district was 1.2%, with higher rates of anxiety and depression observed among older children, particularly males. CONCLUSIONS A positive correlation was evident between IGD, anxiety, and depression. Urgent preventive measures have to be warranted to curb the rising trend of IGD, such as limiting screen time and promoting outdoor activities to enhance children's overall health.
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Affiliation(s)
- Reshma Elizabeth Rajan
- Department of Pediatric and Preventive Dentistry, Vinayaka Mission's Sankarachariyar Dental College, Vinayaka Mission's Research Foundation (Deemed to be University), Salem, Tamil Nadu, India
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Hammad MA, Al-Shahrani HF. Impulsivity and aggression as risk factors for internet gaming disorder among university students. Sci Rep 2024; 14:3712. [PMID: 38355642 PMCID: PMC10867029 DOI: 10.1038/s41598-024-53807-5] [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: 09/12/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024] Open
Abstract
Internet gaming addiction is a global problem, especially among young individuals. Exhibiting characteristics similar to other addictions, Internet Gaming Disorder (IGD) is linked to adverse mental health outcomes. Identified as risk factors for dependence behaviors, the association of impulsivity and aggression with IGD is relatively under-researched in the student population. The present sample of 350 university students (Mage = 21.30 years, SDage = 4.96 years) from Najran university in Saudi Arabia completed an online questionnaire that included the Internet Gaming Disorder Scale-Short-Form (IGDS9-SF), the Buss-Perry Aggression Questionnaire-Short Form, and the Barratt Impulsiveness Scale (BIS-15). Results indicated that impulsivity and aggression were positively associated with IGD severity and both personality traits explained 34.6% of the variance in IGD scores. Further bivariate analyses suggested that individuals spending 7 or more hours on internet gaming were more likely to exhibit high impulsivity and aggression, and had a relatively higher severity of IGD. These results suggest that individuals with these personality traits may be more vulnerable to developing an addiction to internet gaming. These findings need to be confirmed in future more robust studies; however, this exploratory study provides insights for potential programs to prevent IGD among young individuals.
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Affiliation(s)
| | - Hend Faye Al-Shahrani
- Department of Social Work, College of Humanities and Social Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
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J. Gurjar Y, Nikita S, Himalay J, Margi J, Rajveersinh J, Abhishek J, Harsh H, Jaydip J. The Prevalence of Internet Gaming Disorder and its Associated Factors Among College Students in Saurashtra Region, Gujarat, India. ADDICTION & HEALTH 2024; 16:11-16. [PMID: 38651028 PMCID: PMC11032614 DOI: 10.34172/ahj.2024.1451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 04/24/2023] [Indexed: 04/25/2024]
Abstract
Background Internet gaming has become popular in the last few decades; however, very few studies have been conducted on internet gaming in India. This study aimed to investigate internet gaming disorder (IGD), its prevalence, gaming behavior, and effects as well as multiple factors associated with its emergence among college students. Methods This cross-sectional study involved a group of 150 college students. Data were collected using a semi-structured questionnaire containing the Internet Gaming Disorder Scale-Short Form (IGDS9-SF). Statistical analysis was done using Jamovi software. Findings A total of 150 college student gamers were involved with a mean age of 18.69±0.10 years. The mean IGD score was 18.74 with a standard deviation of 0.53, while the median score was 18. The prevalence of IGD was 5.3% among the participants. The IGD prevalence was higher in male students and those whose mothers had a high school diploma or higher. Gamers who spent more than2 hours a day on games had significantly higher IGD scores (P<0.05). A significant association was also found between tingling/numbness in the hand while playing and physical pain with IGD (P<0.05). Conclusion Spending more time playing online games was significantly associated with a higher risk of IGD. One negative consequence of IGD is the development of physical health issues. It is important to raise awareness about the physical health consequences of excessive gaming among students, parents, institutions, and concerned authorities.
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Affiliation(s)
- Yamini J. Gurjar
- Department of Community medicine, Shantbaa medical College & general Hospital, Amreli, India
| | - Savani Nikita
- Department of Community medicine, Swaminarayan Institue of medical Sciences and Research, kalol, Gandhinagar, India
| | - Joshi Himalay
- Shantbaa medical College & general Hospital, Amreli, India
| | - Jani Margi
- Shantbaa medical College & general Hospital, Amreli, India
| | | | - Jani Abhishek
- Shantbaa medical College & general Hospital, Amreli, India
| | - Hirpara Harsh
- Shantbaa medical College & general Hospital, Amreli, India
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Alrahili N, Alreefi M, Alkhonain IM, Aldakhilallah M, Alothaim J, Alzahrani A, Alshargi A, Baabbad N. The Prevalence of Video Game Addiction and Its Relation to Anxiety, Depression, and Attention Deficit Hyperactivity Disorder (ADHD) in Children and Adolescents in Saudi Arabia: A Cross-Sectional Study. Cureus 2023; 15:e42957. [PMID: 37667729 PMCID: PMC10475310 DOI: 10.7759/cureus.42957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/06/2023] Open
Abstract
Background and objective Video games have become a popular source of entertainment among children and adolescents, not only targeting the young generation but also increasingly popular among older demographics as well. This study aimed to assess the association between video game addiction and depression, anxiety, and attention deficit hyperactivity disorder (ADHD) among children and adolescents in Saudi Arabia. Materials and methods This was a cross-sectional study involving Saudi adolescents aged 12-16 years. A self-administered online survey was distributed on social media (Twitter, WhatsApp, and Snapchat). The survey addressed sociodemographic characteristics (i.e., age, gender, area of residence city, etc.). Arabic versions of the Patient Health Questionnaire-9 (PHQ-9), the seven-item Generalized Anxiety Disorder Scale (PHQ-GAD7), the ADHD Rating Scale-IV (ADHD-RS), and the seven-item Game Addiction Scale (GAS-7) questionnaires were distributed as well, including Arabic terms for depression, anxiety, and ADHD. Results A total of 393 surveys were completed (males: 58.3% vs. females: 41.7%). Of note, 63.1% of the respondents reported playing video games every day with an average of more than five hours of gaming time per day (25.2%). The prevalence of video game addiction was 62.1%. Independent risk factors of video game addiction included being young in age, playing video games every day, playing more than three hours per day, and playing multiplayer games. Furthermore, our findings suggest that a higher video game addiction score is correlated with higher scores in inattention, anxiety, and depression. Conclusion This study found a high prevalence of video game addiction among Saudi children and adolescents. Excessive video game playing negatively influences mental health and leads to issues including anxiety, depression, and ADHD. Also, younger males with an increased rate of regular playtime were more likely to exhibit video game addiction in comparison to the rest of the population. Further research is required to more comprehensively assess the prevalence rate of video game addiction and its effect on the mental health of the younger generation within the region.
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Affiliation(s)
- Nader Alrahili
- Psychiatry, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | | | - Issa M Alkhonain
- Family Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Malak Aldakhilallah
- Psychiatry, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Jamal Alothaim
- Psychiatry, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | | | | | - Nuran Baabbad
- Psychiatry, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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Bumozah HS, Al-Quwaidhi AJ, Al-Ghadeeb R. Prevalence and Risk Factors of Internet Gaming Disorder Among Female Secondary School Students in Al-Ahsa, Kingdom of Saudi Arabia. Cureus 2023; 15:e40375. [PMID: 37456410 PMCID: PMC10343149 DOI: 10.7759/cureus.40375] [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] [Accepted: 06/11/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES This study measured the prevalence and potential risk factors of Internet gaming disorder (IGD) among female secondary school students in Al-Ahsa, Kingdom of Saudi Arabia. METHODS This cross-sectional study was conducted between January and February 2023. A total of 400 female secondary school students in Al-Ahsa were recruited through multistage stratified cluster sampling. Data were collected by distributing a self-administered questionnaire among students. A chi-squared test was performed to compare categorical variables. The associations between IGD, depression, and anxiety scores were determined using the Pearson correlation coefficient. RESULTS Among the total sample, 282 were classified as "gamers" and included in our analysis. The prevalence of IGD was found to be 19%. We also found a statistically significant and moderately positive correlation between IGD and anxiety and depression scores. Spending more than four hours daily playing video games, starting to play video games at less than seven years of age, having depression, having anxiety, and playing an online game were found to be potential risk factors for IGD. CONCLUSION IGD among female adolescent students in Al-Ahsa is a public health concern that requires attention from the concerned parties. Health education projects on IGD, its risk factors, and its consequences should be designed for adolescents and their families.
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Affiliation(s)
- Hanin S Bumozah
- Preventive Medicine, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa, SAU
| | | | - Rahmah Al-Ghadeeb
- Preventive Medicine, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa, SAU
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Alghamdi MH, Alghamdi MM. Prevalence of Internet Gaming Disorder Among Intermediate and High School Students in Albaha, Saudi Arabia: A Cross-Sectional Study. Cureus 2023; 15:e37115. [PMID: 37153233 PMCID: PMC10159006 DOI: 10.7759/cureus.37115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 05/09/2023] Open
Abstract
Background and Objectives Excessive video game use, particularly among young people, is a growing problem that poses potential serious mental health risks in many parts of the world. However, there is a lack of research on the prevalence of internet gaming disorder (IGD) in Saudi Arabia, particularly in Albaha region. The objective of this study was to determine the prevalence of IGD among a sample of intermediate and high school students in Albaha and to identify potential factors associated with the development of the disorder. Methods In this cross-sectional study, we collected data between August and November 2022 using a self-administered online Arabic questionnaire, which included a validated translation of the IGD-20 test, which is a tool based on the DSM-5 criteria for diagnosing IGD. We used a multistage sampling technique, with two administrative areas as clusters, to randomly select eight intermediate and high schools with an equal distribution of male and female students. We analyzed the data using descriptive statistics and chi-square analysis. Results A total of 391 participants were included in the study, with an age range of 12 to 18 years. Males accounted for 51.4% (n=201) of the sample, and females accounted for 48.6% (n=190). The prevalence of IGD was found to be 3.5% (n=14), with males accounting for 64% (n=9) of affected participants. The study found that prolonged gaming duration (three or more hours per day), using mobile phones for gaming, and engaging in online gaming were significant factors associated with the diagnosis of IGD (p<0.001, p<0.001, and p=0.004, respectively). Conclusion This study provides preliminary evidence on the prevalence of IGD among intermediate and high school students in Albaha, Saudi Arabia. The results suggest a lower incidence of IGD compared to studies conducted in other regions of the country. A larger study with in-person interviews is needed to confirm the findings and extend the generalizability of the results. Furthermore, the study highlights the need for further research to explore the risk factors associated with IGD and to develop interventions to address this emerging mental health issue among Saudi Arabian youth.
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Affiliation(s)
- Majed H Alghamdi
- Preventive Medicine, Ministry of Health, Jeddah, SAU
- General Directorate of Health Affairs, Ministry of Health, Albaha, SAU
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Karakose T, Yıldırım B, Tülübaş T, Kardas A. A comprehensive review on emerging trends in the dynamic evolution of digital addiction and depression. Front Psychol 2023; 14:1126815. [PMID: 36844332 PMCID: PMC9944096 DOI: 10.3389/fpsyg.2023.1126815] [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: 12/18/2022] [Accepted: 01/19/2023] [Indexed: 02/11/2023] Open
Abstract
Introduction Using digital addiction as an umbrella term to cover any type of addictions to digital technologies such as the internet, smartphones, social media, or video games, the current study aimed to reveal the intellectual structure and evolution of research addressing digital addiction-depression relationship. Methods The study combined bibliometric and science mapping analysis methods for this purpose. Data for the study was gathered from Web of Science Core Collection after a comprehensive process of data search/extraction, and 241 articles were included in the final data set. A period-based, comparative science mapping analysis was performed using the SciMAT software. Results The analysis of data over three periods, Period 1 (1983-2016), Period 2 (2017-2019), and Period 3 (2020-2022) showed that internet addiction was the most significant theme across all three periods, which was followed by social media addiction. Depression, which emerged as a significant theme during Period 1, was later covered under anxiety disorder theme. Research interest was mostly on factors related to both addiction and depression such as cognitive distortion, insomnia, loneliness, self-esteem, social support, alexithymia, as well as cybervictimization or academic performance. Discussion The results suggested that much research is warranted on the digital addiction-depression relationship in different age cohorts, especially children and elderly. Similarly, the current analysis showed that this line of research particularly focused on internet, gaming and social media addiction, and evidence with regard to other types of digital addiction or related compulsive behaviors was almost absent. In addition, research was mostly inclined to understanding cause-effect relationships, which is significant, but preventive strategies seemed to be barely addressed. Likewise, the smartphone addiction-depression relationship arguably garnered less research interest, so future research would contribute to the field in this respect.
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Affiliation(s)
- Turgut Karakose
- Department of Education, Kutahya Dumlupınar University, Kutahya, Türkiye,*Correspondence: Turgut Karakose, ✉
| | - Bilal Yıldırım
- Department of Education, Istanbul Sabahattin Zaim University, Istanbul, Türkiye
| | - Tijen Tülübaş
- Department of Education, Kutahya Dumlupınar University, Kutahya, Türkiye
| | - Abdurrahman Kardas
- District Director of National Education, Ministry of National Education, Siirt, Türkiye
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Alsunni AA, Latif R. Internet gaming disorder and its correlates among university students, Saudi Arabia. J Family Community Med 2022; 29:217-222. [PMID: 36389029 PMCID: PMC9664466 DOI: 10.4103/jfcm.jfcm_129_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/01/2022] [Accepted: 07/26/2022] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Over-indulgence in online/offline video games could result in the development of internet gaming disorder (IGD). Knowledge of the prevalence and correlates of IGD may help to understand its etiology. The aim of the present study was to estimate IGD and its psychological/game-related correlates in Saudi university students. MATERIALS AND METHODS For this cross-sectional study, 843 students registered in a university in Saudi Arabia filled an online survey comprising diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), hospital anxiety and depression scale, Rosenberg self-esteem scale, social phobia inventory scale, satisfaction with life scale, and subjective happiness (SH) scale. For data analysis, an independent sample t-test, Pearson correlation coefficient/Chi-square test, and multiple linear regression followed by hierarchical regressions were used. RESULTS The frequency of IGD was 21.5%. Total game time/day, years of playing games, and social phobia were significantly higher in subjects with IGD (P = 0.001, <0.001, and <0.001, respectively), whereas SH was significantly lower (P < 0.001). Tendency to IGD had a significant positive correlation with social phobia, total game time/day, and years of playing games and a negative correlation with SH. Total game time/day, years of playing games, and social phobia were significant positive predictors of tendency to IGD, whereas SH was a negative predictor. The rest of all variables were insignificant predictors. CONCLUSION The frequency of IGD in Saudi university students identified by DSM-5 criteria was relatively high (21.5%). The prediction of the severity of IGD could be based on social phobia, total game time/day, number of years of playing games, and SH.
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Affiliation(s)
- Ahmed A. Alsunni
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rabia Latif
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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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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