Search

Background: Most existing research on rural–urban health inequalities focuses on disparities in service access and health outcomes based on region. This paper examines rural–urban disparities in maternal healthcare utilization and delivery modes based on household registration (hukou) status to understand the role of state institutions in producing healthcare disparities in China. Methods: Utilizing administrative data from the Public Maternal Health Insurance scheme, we analyzed 54,733 live births in City A (2015–2019) and 25,849 live births in City B (2018–2019) in Guangdong Province in China. We constructed regression models using hukou status (rural versus urban) as the explanatory variable. Results: While there is no statistically significant difference in rural and urban mothers' probability of obtaining the minimum recommended number of prenatal care checkups in City A (OR = 0.990 [0.950, 1.032]), mothers with rural hukou status have a lower probability of obtaining the minimum recommended number of visits in City B than their counterparts with urban hukou (OR = 0.781 [0.740, 0.825]). The probability of delivering in tertiary hospital is lower among mothers with rural hukou than among those with urban hukou in both cities (City A: OR = 0.734 [0.701, 0.769]; City B: OR = 0.336 [0.319, 0.354]). Mothers with rural hukou are more likely to have a Cesarean section than those with urban hukou in both cities (City A: OR = 1.065 [1.027, 1.104]; City B: OR = 1.127 [1.069, 1.189]). Compared with mothers with urban hukou, mothers with rural hukou incurred 4 % (95 % CI [-0.046, -0.033]) and 9.4 % (95 % CI [-0.120, -0.068]) less in total medical costs for those who delivered via Cesarean section and 7.8 % (95 % CI [-0.085, -0.071]) and 19.9 % (95 % CI [-0.221, -0.177]) less for those who delivered via natural delivery in City A and City B, respectively. Conclusions: Rural hukou status is associated with younger age, no difference or lower probability of having a minimum number of prenatal checkups, higher likelihood of delivering in nontertiary hospitals, increased Cesarean delivery rates, and lower medical cost for delivery in these two Chinese cities. Evaluating how hukou status influences maternal healthcare in Chinese cities is important for devising targeted public policies to promote more equitable maternal health services. [ABSTRACT FROM AUTHOR]

Objectives: This paper studies the institutional inequality that exists in the prevalence of diabetes and hypertension, as well as their diagnosis and medication management, between urban and rural residency status (hukou) holders in China. Methods: Exploiting the Chinese Health and Nutrition Survey, we primarily demonstrate that while a lower proportion of rural residency holders suffer from diabetes and hypertension, a larger proportion have never been diagnosed with these conditions and do not take medicine to control them. We explore the determinants of these disparities by the non-linear decomposition method. Results: Decomposition results illustrate that a large part of disparities in the prevalence of diabetes and hypertension can be explained by the differences in demographic structure and occupational socio-economic status. Regarding the ruralurban disparity in the under diagnosis and under-medication rates, the differences in demographic structure, household affluence, occupational socio-economic status and consumption patterns make the greatest contributions. Conclusions: This evidence suggests that improving the institutional economic inequality and enhancing the occupational mobility of rural residency holders are of paramount importance to mitigate any inequality in health and healthcare utilisation. [ABSTRACT FROM AUTHOR]

The gender gap in labor force participation (LFP) in China has grown over the last 30 years, despite substantial advances in women's education and economic development. Previous research has identified gender discrimination and work-family conflicts as two key explanations for the gap, both of which have risen since the start of China's economic reform in 1978. Using multiple waves of the national census and household panel data from China, this research shows that one overlooked mechanism widening the LFP gender gap lies in the institutional constraints that require women to retire earlier than men. This research also demonstrates how the impact of women's early retirement on the LFP gender gap has been exacerbated by two societal-level changes: (1) population aging, which increased the share of women who reached the retirement age; and (2) economic development, which increased the number of women entering nonfarming occupations and, hence, the gender-based retirement system. These findings suggest that without significant revisions to China's retirement system, the LFP gender gap will continue to expand as the population ages and economic development proceeds. [ABSTRACT FROM AUTHOR]

Ex post moral hazard, the additional healthcare utilization induced by health insurance, can be decomposed into an efficient portion generated by the income effect and an inefficient portion caused by the substitution effect, which has been discussed theoretically, but few studies have provided evidence of the efficient moral hazard. In 2016, the Chinese government launched the consolidation of urban and rural resident health insurance at the national level. After the consolidation, insurance benefits for nearly 800 million rural residents got improved. This paper uses a nationally-representative sample of 30,972 individuals from the China Health and Retirement Longitudinal Study (2011–2018) and adopts a 2-step empirical approach with the difference-in-differences method and the fuzzy regression discontinuity design to estimate the efficient moral hazard in the consolidation among rural residents. We find that the price shock contained in the consolidation increases inpatient care utilization, and the corresponding price elasticity is between −0.68 and −0.62. Further analysis shows that the efficient moral hazard resulting in welfare gains accounts for 43.33%–66.36% of the additional healthcare utilization. These findings highlight the necessity of evaluating the efficient moral hazard when analyzing the cost-benefit of health insurance reform. • We provide rare evidence of the efficient moral hazard effect in health insurance. • We focus on low-income groups from developing countries. • We use a 2-step empirical approach to estimate the efficient moral hazard effect. • The efficient moral hazard generated by income effect accounts for 43.33%–66.36%. [ABSTRACT FROM AUTHOR]

Background: Youth with disabilities have the same right to sexual and reproductive health (SRH) as their peers without disabilities. However, their needs and rights are often ignored. Little is known about the knowledge, needs and access barriers related to SRH information among youth with different types of disabilities in China. Methods: A cross-sectional survey was carried out among 473 unmarried youth aged 15–24 with visual, hearing, physical disabilities in both urban and rural areas in China. Results: Out of a maximum possible score of 100, respondent's median score ranged from 30 to 50 for knowledge related to sexual physiology, STIs/HIV/AIDS and contraception. For these three categories of knowledge, respondents with hearing and physical disabilities or from rural areas scored lower than their counterparts with visual disabilities or from urban areas. The multivariate analyses showed that the residential area and education level were strong correlates of knowledge among respondents with visual and hearing disabilities. Other significant correlates were age for respondents with visual impairment and physical impairment, and single child status in the family and father's education level for respondents with hearing impairment. Sources of and barriers and preferences in accessing SRH information differed by type of disabilities, residential areas and gender. In general, school teachers were the primary and most preferred sources of SRH knowledge, followed by the Internet, peers/friends and parents. Unaware of where to get accurate information and feeling embarrassed to seek information were the two most frequently mentioned barriers in accessing SRH information. Conclusion: Respondents had poor knowledge of SRH and limited access to SRH information, especially those from rural areas. Efforts should be made to promote school and family-based sexuality education tailored for youth with different types of disabilities. Plain language summary: Youth with disabilities have the same sexual and reproductive health (SRH) needs as their peers without disabilities and the equal right to attain the highest standard of SRH. However, their SRH needs and rights are often overlooked or neglected. Studies on SRH among unmarried youth with disabilities are very limited in China. This study used data collected from 473 unmarried youths with different types of disabilities from both urban and rural areas in China, to understand their SRH knowledge and its associated factors, as well as barriers and preferences in accessing sexuality-related information. This study demonstrated that unmarried youth with disabilities lacked knowledge of SRH, especially those with hearing or physical disabilities and those from rural areas. In general, residential area and education level were significant correlates of knowledge among respondents. Sources of and barriers and preferences in accessing SRH information varied across types of disabilities, residential areas and gender. In general, school teachers were the primary and most preferred sources of knowledge, followed by the Internet, peers and parents. Unaware of the available sources of accurate information and feeling embarrassed to seek information were the most frequently mentioned barriers in accessing SRH information. The findings of the study highlight the need to reduce the barriers to sexuality education for unmarried youth with different types of disabilities. Efforts should be made to promote school and family-based sexuality education tailored for youth with different types of disabilities and empower them to seek information proactively. [ABSTRACT FROM AUTHOR]

Despite the growing literature on loneliness, little attention has been paid to the impact of broader changes in social structure and environment on individuals' experience of loneliness. Drawing on data from the 2018 Urbanization and Quality of Life Survey (N = 3,229) conducted in 40 localities undergoing rural–urban transition in China, this study investigates how measures of urbanisation (including population density, duration of urban status, neighbourhood transition and housing type) are associated with residents' loneliness. We revised measures of the six‐item De Jong Gierveld Loneliness Scale, differentiated between emotional and social loneliness, estimated multi‐level mixed‐effects regressions and controlled for a number of individual‐level covariates. The results show that emotional loneliness and social loneliness have different patterns of association with multi‐level covariates: urbanisation at county, township and neighbourhood levels is significantly associated with emotional loneliness, whereas residence in temporary housing is a clear risk factor for social loneliness. The analyses further demonstrate that the revised measures of loneliness address concerns about the original scale, offer a clearer sense of the degrees of loneliness and are strongly associated with multi‐level covariates and psychological distress. In addition to showing how urbanisation leads to greater individual loneliness, our research also illustrates how to model locational parameters in analyses of individual well‐being. [ABSTRACT FROM AUTHOR]

Purpose: To identify the profile of a pediatric low-vision population and investigate the differences between low-vision services in urban and rural areas. Methods: A retrospective study was conducted of the records of 286 consecutive children presenting at the Low Vision Clinic of the Eye and ENT Hospital of Fudan University from January 2009 to December 2018. The data retrieved included age, sex, education, family history, rural vs. urban residence, cause of visual impairment, and low-vision aids dispensed. Results: Of the 286 children (65.0% boys and 35.0% girls), over half (178, 62.2%) were from urban areas. The age range of the patients was 3–15 years (mean 9.54 ± 4.11). The four major causes of visual impairment were congenital cataract (70, 24.5%), optic atrophy (37, 12.9%), congenital glaucoma (34, 11.9%), and macular dystrophy (31, 10.8%). Low-vision aids were prescribed for 203 children (71.0%), with binocular telescopes (69, 25.0%) and stand magnifiers (66, 23.9%) being the most common. The urban children enjoyed higher rates of low-vision services than the rural children, with more low-vision aids (192, 94.6%) prescribed for the former. Conclusions: Congenital and hereditary diseases constituted the major causes of low vision in the study population. In contrast to their urban counterparts, the rural children experienced inadequate low-vision rehabilitation. Our findings suggest that policymakers need to better address gender inequalities and urban–rural disparities in low-vision services and that the coverage of low-vision services, especially in rural areas, should be enhanced in China. [ABSTRACT FROM AUTHOR]

Using a sample of Chinese adults over the age of 50 from wave 1 of the WHO Study on Global Ageing and Adult Health (n = 13,367), we investigated the relationship between living arrangements and subjective well-being (SWB) in regard to life satisfaction, happiness, and control. We also looked at the moderating role of resources, proxied by income and hukou status. Multivariate regression results indicate that living only with a spouse was significantly associated with better SWB. Multigenerational living arrangements may not always promote SWB, particularly when resources are constrained. Yet, results also underscore the importance of daughters and daughters-in-law in promoting SWB among older adults. Older adults in rural areas had better SWB, including greater life satisfaction if living with grandchildren only, compared to their urban peers living with a spouse only. Findings suggest that context matters in the association between living arrangements and older adults' SWB. [ABSTRACT FROM AUTHOR]

Chronic disease multimorbidity has become a major challenge for health systems. While a lot of research has evaluated the direct economic burden of multimorbidity on health care utilization and cost, little attention has been given to the impacts on work productivity and functional limitations, as indirect indicators of disease burden. This study aims to examine the prevalence of multimorbidity among Chinese adults and its impact on functional disability and work productivity. It also investigates urban-rural differences in these relationships. This study utilized the data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015, including 11,176 participants aged 45 years and older. Multivariable logistic regression models were used to estimate the effect of multimorbidity on functional disability (i.e. ADL: activities of daily life; IADL: instrumental activities of daily life), and work productivity loss due to health problems. Negative binomial regression models were used to assess the association of multimorbidity with sickness absences from agricultural work and employed non-agricultural work. 68.8% of total participants in CHARLS had multimorbidity in China in 2015. Rural residents with multimorbidity reported higher proportions of physical functions and days of sick leave than urban residents. Multimorbidity was positively associated with ADL limitation (odds ratio 1.924, 95% CI 1.656–2.236), IADL limitation (1.522, 1.326–1.748), limited work due to health problems (1.868, 1.601–2.178) and days of sick leave (for agricultural work, incidence rate ratio 1.676, 95% CI 1.390–2.020; for employed non-agricultural work, 2.418, 1.245–4.696). For the rural group, the impact of multimorbidity on functional limitations and work productivity loss (except for early retirement), was less than the urban group. Multimorbidity poses significant challenges for functional health and work productivity These have significant negative economic consequences for individuals, the Chinese health system and the society. [ABSTRACT FROM AUTHOR]

Elderly individuals' trust in general practitioners (GPs) is conducive to enhancing their health outcomes and promote healthy ageing. However, this trust has been declining in recent decades. Social capital is associated with patients' trust in healthcare providers in several countries, which make it a potential path for improving the trust of the elderly people in GPs in China, but it is not yet validated. The objective of this study was to explore how social capital influences elderly individuals' trust in GPs in China. The data were collected through a survey conducted with 2,754 people aged 60 and over in China, 2018. Multilevel regression models were employed to analyse the impact of social capital on the trust of the elderly people in GP in China. The results revealed that individual social capital (ISC) and community social capital (CSC) had significant positive correlations with the trust of the elderly people in GPs in China. In addition, CSC has more impact than ISC on the trust of the elderly people in GP. Additionally, older people, women and patients whose highest level of education was junior high school and who had participated in the New Cooperative Medical Scheme tended to have higher trust in GPs. In conclusion, more social capital, especially CSC, contributed more trust of the elderly people in GPs in China. [ABSTRACT FROM AUTHOR]

Economic growth has brought improvements in many areas of child health, but its effects on anaemia among school‐aged children remain unknown. However, this is important because iron deficiency anaemia is common and is the main cause of disability‐adjusted life years for school‐aged children. In this study, we included 429,222 Chinese children aged 7–17 years from five consecutive national cross‐sectional surveys during 1995–2014. Using altitude‐adjusted haemoglobin concentration measured from capillary blood samples, we defined anaemia status according to World Health Organization's recommendation. We used logistic regressions weighted by provincial population to examine the association between provincial gross domestic product (GDP) per capita and anaemia, adjusting for sex, age, urban–rural location, regional socio‐economic status (SES), fixed effect of province, and clustering of schools. We used generalised additive mixed models to evaluate a potentially non‐linear relationship. For each 100% growth in GDP per capita, there was a 40% (odds ratio [OR] = 0.60; 95% confidence interval [CI; 0.56, 0.65]) reduction in anaemia. However, the association was weaker for girls and in cities with a lower SES. The association was weaker across 2005–2014 (OR = 0.75, 95% CI [0.62, 0.90]) compared with 1995–2005 (OR = 0.52; 95% CI [0.44, 0.61]), reflecting a weaker association when GDP per capita reaches around $2,000. The results were similar for moderate‐to‐severe anaemia. We concluded that economic growth has been associated with reductions in anaemia among school‐aged children in China but with fewer benefits for girls and those in poorer settings. Further economic development in China is unlikely to bring similar reductions in anaemia, suggesting that additional population level and targeted interventions will be needed. [ABSTRACT FROM AUTHOR]

Objectives: To assess the association between rural and urban residential mobility and cognitive function among middle-aged and older adults in China. Method: We used data from the World Health Organization Study on global AGEing and adult health that included adults age 50+ from China (N = 12,410). We used multivariate linear regressions to examine how residential mobility and age at migration were associated with cognitive function. Results: Urban and urban-to-urban residents had the highest level of cognitive function, whereas rural and rural-to-rural residents had the poorest cognitive function. Persons who migrated to/within rural areas before age 20 had poorer cognitive function than those who migrated during later adulthood. Socioeconomic factors played a major role in accounting for the disparities in cognition; however, the association remained significant after inclusion of all covariates. Discussion: Residential mobility and age at migration have significant implications for cognitive function among middle-aged and older adults in China. [ABSTRACT FROM AUTHOR]

The aim of our study was to systematically review studies which had compared self-concept in left-behind children with the general population of children in China. Relevant studies about self-concept of left-behind children in China published from 2004 to 2014 were sought by searching online databases including Chinese Biological Medicine Database ( CBM), Chinese National Knowledge Infrastructure ( CNKI), Wanfang Database, Vip Database, Pub Med Database, Google Scholar and Web of Science. The methodological quality of the articles was assessed by using Newcastle- Ottawa Scale ( NOS). Poled effect size and associated 95% confidence interval ( CI) were calculated using the random effects model. Cochrane's Q was used to test for heterogeneity and I2 index was used to determine the degree of heterogeneity. Nineteen studies involving 7758 left-behind children met the inclusion criteria and 15 studies were included in a meta-analysis. The results indicated that left-behind group had a lower score of self-concept and more psychological problems than the control group. The factors associated with self-concept in left-behind children were gender, age, grade and the relationships with parents, guardians and teachers. Left-behind children had lower self-concept and more mental health problems compared with the general population of children. The development of self-concept may be an important channel for promoting mental health of left-behind children. [ABSTRACT FROM AUTHOR]