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As urbanization accelerates in China, more and more rural elders are moving to cities to live with their children. However, they face challenges in overcoming cultural, social, and economic disparities and maintaining health in urban life, and health is important human capital that may have a significant impact on the urban adaptation of rural elderly migrants (REMs). Based on the 2018 China Health and Retirement Longitudinal Study (CHARLS), this paper constructs an indicator system to measure the level of urban adaptation of REMs. The health level and urban adaptation of REMs are studied in depth, and how to better help them adapt to urban life in order to provide a healthy living environment and a good lifestyle is explored. The empirical analysis finds the following: (1) good health helps REMs achieve a better level of urban adaptation. (2) REMs with good health status are more likely to go to community clubs for activities and do physical activities and thus improve their urban adaptation level. (3) There are significant differences in the effects of health status on urban adaptation among REMs with different characteristics. REMs with better health status in the central and western regions have significantly higher levels of urban adaptation than those in the eastern regions, and men have higher levels of urban adaptation than women. Therefore, the government should construct classification measures according to the differentiated characteristics of rural elderly migrants' urban adaptation, and guide and support their stratified and orderly adaptation to urban society. [ABSTRACT FROM AUTHOR]

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 plethora of pathways leading to health problems of later life has made the causal assessment of widowhood on the health of older adults difficult. This research aimed to assess the short‐term impact of widowhood on the objective health of older adults and to the moderating role of community‐based care (CBC) in improving the health outcomes of older adults. In this study, the activities of daily living (ADLs) and number of hospitalisations of older adults were measured, and PSM‐DID models were conducted. Widowhood had a significant negative impact on the objective health of older adults. Widowed adults had higher ADL scores (B = 0.569, 95 percent CI: 0.295 to 0.844) and more hospitalisations (B = 2.551, 95 percent CI: 1.189 to 3.914) than nonwidowed adults. Meanwhile, CBC in urban areas can significantly reduce ADL scores (B = −0.154, SE = 0.082) and the number of hospitalisations (B = −1.402, SE = 0.348) in older adults, whereas CBC in rural areas can only significantly reduce ADL scores (B = −0.197, SE = 0.087). Taken together, there is an urgent need to focus on the health of widowed and older adults and to provide CBC in both urban and rural areas equally. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine the joint effects of self and spousal frailty status on functional and mental health in Chinese older adults and determine whether such effects vary by urban versus rural residency. Background: Frailty is a clinical syndrome among old adults and would lead to adverse outcomes. However, studies on the interactive patterns of frailty status between spouses and the joint effects of such patterns on health outcomes are scarce. Design: Data were from the China Health and Retirement Longitudinal Study (CHARLS). A total of 2,581 married seniors who participated both 2011 and 2015 waves of the CHARLS were categorised into four groups: robust self–robust spouse (RR), robust self–frail spouse (RF), frail self–robust spouse (FR) and frail self–frail spouse (FF). Methods: Frailty was measured using the physical frailty phenotype scale. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CESD). Functional health was measured by difficulties in activities of daily living (ADL) and instrumental activities of daily living (IADL). The generalised estimating equation was used to estimate the effects of concordant frailty on mental and functional outcomes, stratified by rural/urban residency. This study followed the STROBE checklist. Results: The FF group reported higher levels of ADL/IADL difficulties and depressive symptoms at follow‐up than the RR group; urban individuals in the RF group reported higher follow‐up depression than the RR group; and rural individuals from the FR or RF groups reported more follow‐up ADL/IADL difficulties than the RR group. Conclusion: Frailty and subsequent health decline are interdependent in older couples, and the rural/urban context is important for understanding this interdependence in the older Chinese population. Relevance to clinical practice: Couples‐based intervention strategies are needed to tackle situations in which one or both spouses are concurrently facing frailty. [ABSTRACT FROM AUTHOR]

Background: This population-based cross-sectional study aimed to evaluate the prevalence of oral mucosal lesions (OMLs) in children in a rural area in China as epidemiological data on these conditions from such areas are insufficient. Methods: A total of 3145 children in Xiangyun of Yunnan were enrolled. A socio-economic questionnaire and a field survey of OMLs were administered. We gathered information on factors (sex, age, caregiver, parental education, and last-month household income) that might be associated with OMLs in these children. Results: OMLs in children in Xiangyun of Yunnan had a prevalence of 1.8% (95% CI; 1.3–2.3%). The most prevalent OML was oral ulcer (n = 11; 18.3%), followed by linea alba (n = 10; 16.7%), whereas the least prevalent OMLs were frenal tag (n = 1; 1.7%) and herpes labialis (n = 1; 1.7%). On unadjusted or adjusted regression, school-aged children had about 50% lower risk of OMLs than preschoolers. Conclusions: These findings indicate that the prevalence of OMLs in Xiangyun of Yunnan is lower than previously reported. Additionally, the age might be associated with the occurrence of OMLs in children in Xiangyun of Yunnan, China. [ABSTRACT FROM AUTHOR]

The "paradox of aging" refers to the phenomenon that even though people's physical health and functions may decline when they enter later adulthood, their happiness does not necessarily. Previous studies have shown that older adults' better emotional regulation skills may contribute to the maintenance of their happiness. This study aims to examine the relationship between age, health, and happiness, and the moderating role of emotional stability. We adopted a nationally representative sample (n = 10,968) from the Chinese General Social Survey (CGSS) and performed weight-adjusted regression models with interaction terms. There is generally an S-shaped age-happiness relationship with significant urban-rural differences. Emotional stability buffers the negative association between health and happiness, and this moderating effect was stronger among older than younger adults, especially in rural China. This study calls for special attention paid to the oldest-old population in rural China and older adults' emotional regulation skills. [ABSTRACT FROM AUTHOR]

BACKGROUND: Household air pollution (HAP) from solid fuel use for cooking affects 2.5 billion individuals globally and may contribute substantially to disease burden. However, few prospective studies have assessed the impact of HAP on mortality and cardiorespiratory disease. OBJECTIVES: Our goal was to evaluate associations between HAP and mortality, cardiovascular disease (CVD), and respiratory disease in the prospective urban and rural epidemiology (PURE) study. METHODS: We studied 91,350 adults 35-70 y of age from 467 urban and rural communities in 11 countries (Bangladesh, Brazil, Chile, China, Colombia, India, Pakistan, Philippines, South Africa, Tanzania, and Zimbabwe). After a median follow-up period of 9.1 y, we recorded 6,595 deaths, 5,472 incident cases of CVD (CVD death or nonfatal myocardial infarction, stroke, or heart failure), and 2,436 incident cases of respiratory disease (respiratory death or nonfatal chronic obstructive pulmonary disease, pulmonary tuberculosis, pneumonia, or lung cancer). We used Cox proportional hazards models adjusted for individual, household, and community-level characteristics to compare events for individuals living in households that used solid fuels for cooking to those using electricity or gas. RESULTS: We found that 41.8% of participants lived in households using solid fuels as their primary cooking fuel. Compared with electricity or gas, solid fuel use was associated with fully adjusted hazard ratios of 1.12 (95% CI: 1.04, 1.21) for all-cause mortality, 1.08 (95% CI: 0.99, 1.17) for fatal or nonfatal CVD, 1.14 (95% CI: 1.00, 1.30) for fatal or nonfatal respiratory disease, and 1.12 (95% CI: 1.06, 1.19) for mortality from any cause or the first incidence of a nonfatal cardiorespiratory outcome. Associations persisted in extensive sensitivity analyses, but small differences were observed across study regions and across individual and household characteristics. DISCUSSION: Use of solid fuels for cooking is a risk factor for mortality and cardiorespiratory disease. Continued efforts to replace solid fuels with cleaner alternatives are needed to reduce premature mortality and morbidity in developing countries. [ABSTRACT FROM AUTHOR]

Many communities provide older people with various opportunities to participate in the society. The 2010 Chinese census reveals that the majority of the older adults in China are still healthy, but research shows that older adults have relatively low levels of community participation. This study aims to determine the factors that affect the community participation of older adults in China using data collected from the 2011 China Health and Retirement Longitudinal Study ( CHARLS). The CHARLS survey used a multistage sampling strategy to select respondents from 450 resident or village communities in China. A total of 17,000 persons from 10,000 families participated in the survey. The sample for this study includes 4283 individuals aged 60 years and above who have been invited to answer the survey based on their participation in entertainment and volunteer activities within the past month; 1009 were from urban areas and 3247 were from rural areas. Using logistic regression, this study identifies several variables that can predict the community participation of older adults. These variables included educational background, residence status, self-rated living standard and health status, number of available community facilities, expected social support, family care responsibility and involvement/non-involvement in old-age insurance schemes. In addition, an urban-rural difference was observed in the participation of these adults in entertainment activities, and the differences between older adults residing in urban and rural areas were insignificant in terms of their participation in volunteer work. These findings imply that the Chinese government should consider these predictors and the urban-rural differences when making policies regarding the community participation of older adults. [ABSTRACT FROM AUTHOR]

Background: Inequality in maternal and child health seriously hinders the overall improvement of health, which is a concern in both the United Nations Sustainable Development Goals (SDGs) and Healthy China 2030. However, research on the equality of maternal and child health is scarce. This study longitudinally assessed the equality trends in China's maternal and child health outcomes from 2000 to 2013 based on place of residence and gender to improve the fairness of domestic maternal and child health. Methods: Data on China's maternal and child health monitoring reports were collected from 2000 to 2013. Horizontal and vertical monitoring were performed on the following maternal and child health outcome indicators: incidence of birth defects (IBD), maternal mortality rate (MMR), under 5 mortality rate (U5MR) and neonatal mortality rate (NMR). The newly developed HD*Calc software by the World Health Organization (WHO) was employed as a tool for the health inequality assessment. The between group variance (BGV) and the Theil index (T) were used to measure disparity between different population groups, and the Slope index was used to analyse the BGV and T trends. Results: The disparity in the MMR, U5MR and NMR for the different places of residence (urban and rural) improved over time. The BGV (Slope BGV = -32.24) and T (Slope T = -7.87) of MMR declined the fastest. The gender differences in the U5MR (Slope BGV = -0.06, Slope T = -0.21) and the NMR (Slope BGV = -0.01, Slope T = 0.23) were relatively stable, but the IBD disparity still showed an upward trend in both the place of residence and gender strata. A decline in urban-rural differences in the cause of maternal death was found for obstetric bleeding (Slope BGV = -14.61, Slope T = -20.84). Improvements were seen in the urban-rural disparity in premature birth and being underweight (PBU) in children under 5 years of age. Although diarrhoea and pneumonia decreased in the U5MR, no obvious gender-based trend in the causes of death was observed. Conclusion: We found improvement in the disparity of maternal and child health outcomes in China. However, the improvements still do not meet the requirements proposed by the Healthy China 2030 strategy, particularly regarding the rise in the IBD levels and the decline in equality. This study suggests starting with maternal and child health services and focusing on the disparity in the causes of death in both the place of residence and gender strata. Placing an emphasis on health services may encourage the recovery of the premarital check and measures such as prenatal and postnatal examinations to improve equality. [ABSTRACT FROM AUTHOR]

Background: To examine urban-rural differences in the severity of non-fatal disease and injury using the latest household interview survey data of Hunan Province, China. Methods: Two-week illness data were from the first provincial health household interview survey of Hunan in 2013. The proportion of patients being bedridden, the average days of being bedridden and the average off-work days were calculated to measure the severity of two-week illness. Rao-Scott-adjusted chi-square test was performed to examine the significance of two-week illness severity differences from demographic variables. Multiple logistic regression and linear regression were used to control for sex, age and household income. Results: The two-week illness prevalence was 22.8 % in Hunan province. Despite similar two-week ill prevalence rates between urban areas and rural areas (23.0 % vs. 22.8 %), rural residents had higher proportions of being bedridden and of being off work than urban residents after controlling for sex, age and household income, with adjusted odds ratios of 3.4 and 6.9, respectively. Similarly, the average days of being bedridden and of being off work in rural residents were 0.45 days and 1.61 days longer than in urban residents after controlling for demographic variables, respectively. Conclusion: The recent data shows that two-week illness in rural residents is more serious than urban residents in Hunan Province, China in spite of very similar two-week prevalence rates. The neglected urban-rural disparities in the severity of two-week illness deserve the attention of health policy-makers and researchers. [ABSTRACT FROM AUTHOR]

Background: The inequities in healthcare services between regions, urban and rural, age groups and diverse income groups have been growing rapidly in China. Equal access to basic medical and healthcare services has been recognized as "a basic right of the people" by Chinese government. Spatial accessibility to healthcare facilities has received huge attention in Chinese case studies but been less studied particularly at a county level due to limited availability of high-resolution spatial data. This study is focused on measuring spatial accessibility to healthcare facilities in Deqing County. The spatial inequity between the urban (town) and rural is assessed and three scenarios are designed and built to examine which scenario is instrumental for better reducing the spatial inequity. Methods: This study utilizes highway network data, Digital Elevation Model (DEM), location of hospitals and clinics, 2010 census data at the finest level -- village committee, residential building footprint and building height. Areal weighting method is used to disaggregate population data from village committee level to residential building cell level. Least cost path analysis is applied to calculate the travel time from each building cell to its closest healthcare facility. Then an integral accessibility will be calculated through weighting the travel time to the closest facility between three levels. The spatial inequity in healthcare accessibility between the town and rural areas is examined based on the coverages of areas and populations. The same method is used to compare three scenarios aimed at reducing such spatial inequity -- relocation of hospitals, updates of weighting values, and the combination of both. Results: 50.03 % of residents can reach a county hospital within 15 min by driving, 95.77 % and 100 % within 30 and 60 min respectively. 55.14 % of residents can reach a town hospital within 5 min, 98.04 % and 100 % within 15 and 30 min respectively. 57.86 % of residential building areas can reach a village clinic within 5 min, 92.65 % and 99.22 % within 10 and 15 min. After weighting the travel time between the three-level facilities, 30.87 % of residents can reach a facility within 5 min, 80.46 %% and 99.88 % within 15 and 30 min respectively. Conclusions: The healthcare accessibility pattern of Deqing County has exhibited spatial inequity between the town and rural areas, with the best accessibility in the capital of the county and poorest in the West of the county. There is a high negative correlation between population ageing and healthcare accessibility. Allocation of more advanced medical and healthcare equipment and highly skillful doctors and nurses to village clinics will be an efficient means of reducing the spatial inequity and further consolidating the national medical security system. GIS (Geographical Information Systems) methods have proven successful method of providing quantitative evidence for policy analysis although the data sets and methods could be further improved. [ABSTRACT FROM AUTHOR]

Background: China poverty reduction policy (PRP) addresses two important elements: the targeted poverty reduction (TPA) project since 2015 in line with social assistance policy as national policy; and reducing inequality in health services utilization by making provision of medical financial assistance (MFA). Therefore, this study aims to assess the effects of the PRP in health services utilization (both inpatient and outpatient services) among the central and western rural poor of China. Methods: The study conducted household survey and applied propensity score matching (PSM) method to assess the effects of the PRP on health services utilization among the rural poor of Central and Western China. A sensitivity test was also performed on the PSM results to test their robustness. Results: Key findings showed 17.6% of respondents were the beneficial of PRP. The average treatment effects on the treated (ATT) of the PRP on the inpatient visits within one year was found significantly positive (P = 0.026). Conclusion: There has been relationship between PRP with medical financial assistance and reduction of inequality in health services utilization by the poorer, in particular to accessing the inpatient services from the county or township hospitals of China. Policy makers should pay attention for making provision of improving responsiveness of supply, when subsidizing on the demand side. [ABSTRACT FROM AUTHOR]