Health inequalities among middle-aged and elderly people in China: analyses of cross-sectional surveys from the China Health and Retirement Longitudinal Study 2011–2016

Objectives: China has a history of striving to achieve health equity, including efforts to prevent and control infectious diseases. However, to date, there is no comprehensive assessment of inequalities in chronic diseases in China. Methods: Data for this study were obtained from the China Health and Retirement Longitudinal Study (CHARLS) conducted from 2011 to 2016. A total of 50,244 Chinese adults aged 45 years and older were included (16,128 in 2011, 16,646 in 2013, and 17,470 in 2015). Principal component analysis was used to construct the socioeconomic status indicator. We calculated concentration indices and corresponding CIs for 14 chronic diseases and comorbidities. We then estimated the Kendall rank correlation coefficient for inequalities and GDP per capita among provinces. Results: For 10 of the 14 chronic diseases, prevalence rates were higher for the poorest tertiles than for the richest tertiles. The concentration indices of dyslipidaemia, diabetes or high blood sugar, and cancer or malignant tumour were, respectively, 0.1256 (95% confidence interval, 0.1052–0.151), 0.098 (0.0704–0.1244), and 0.1305 (0.0528–0.215) in 2015–2016, which indicated pro-rich inequality. Health inequality for chronic lung diseases and eight other diseases grew markedly from 2011 to 2016. Overall, health inequality was lower for urban residents (−0.035 in 2011–2012, −0.036 in 2013–2014, and −0.05 in 2015–2016) than rural residents (−0.053, −0.064, and −0.08, respectively), and inequality was twice as high among women (−0.051, −0.05, and −0.072, respectively) than among men (−0.023, −0.02, and −0.032, respectively). Provinces that were ranked higher for GDP per capita were also ranked higher in the degree to which disease prevalence was higher in people with lower income (Kendall’s τ=−0.2328, p=0.015; Kendall’s τ=−0.3545, p=0.0077; Kendall’s τ=−0.2646, p=0.0079, respectively). Conclusions: Pro-poor health inequalities for many diseases in China are large and widening. Policies associated with health equity, including free public health services and community health programmes, are needed to achieve the Sustainable Development Goals.