Association of Access to Healthcare with Self-Assessed Health and Quality of Life among Old Adults with Chronic Disease in China: Urban Versus Rural Populations
Abstract
:1. Introduction
2. Methods
Data
3. Measurements
3.1. Outcome Variables
3.2. Explanatory Variables
3.3. Control Variables
3.4. Statistical Analysis
4. Results
4.1. Characteristics of Respondents
4.2. Associations of Access to Healthcare with Self-Assessed Health and QOL in Urban Respondents
4.3. Associations of Access to Healthcare with Self-Assessed Health and QOL in Rural Respondents
5. Discussion
6. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Ethical Approval
References
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Variables | Description | Urban (n = 3194) | Rural (n = 2602) | p |
---|---|---|---|---|
Outcome variables | ||||
Self-assessed health | Mean ± SD | 89.29 ± 8.96 | 86.79 ± 10.05 | <0.001 |
Quality of life | Mean ± SD | 71.91 ± 11.10 | 69.46 ± 12.21 | <0.001 |
Explanatory variables | ||||
Two-week access | To medications or treatment for chronic conditions over the past 2 weeks (n, %) | 1247 (39.00) | 750 (28.80) | <0.001 |
One-year access | To medications or treatment for chronic conditions over the past 12 months (n, %) | 1751 (54.80) | 1318 (50.70) | 0.002 |
Access in need | Received healthcare services when needed (n, %) | 2970 (93.00) | 2410 (92.60) | 0.592 |
Control variables | ||||
Sex | Male (n, %) | 1356 (42.50) | 1179 (45.30) | 0.029 |
Female (n, %) | 1838 (57.50) | 1423 (54.70) | ||
Age | Years (mean ± SD) | 65.81 ± 9.39 | 63.76 ± 9.00 | <0.001 |
Marital status | Never married (n, %) | 22 (0.70) | 19 (0.70) | 0.029 |
Currently married (n, %) | 2589 (81.10) | 2102 (80.80) | ||
Cohabiting (n, %) | 6 (0.20) | 7 (0.30) | ||
Separated/divorced (n, %) | 62 (1.90) | 25 (1.00) | ||
Widowed (n, %) | 515 (16.10) | 449 (17.30) | ||
Ethnicity | Han (n, %) | 3131 (98.00) | 2577 (99.00) | 0.002 |
Others (n, %) | 63 (2.00) | 25 (1.00) | ||
Education | Years of school (mean ± SD) | 7.42 ± 4.67 | 3.09 ± 3.25 | <0.001 |
Living arrangement | Moved from somewhere else (n, %) | 2271 (71.10) | 779 (29.90) | <0.001 |
Always lived in the same village/town/city (n, %) | 923 (28.90) | 1823 (70.10) | ||
Work | At least two days during the last seven days (n, %) | 2590 (81.10) | 1813 (69.70) | <0.001 |
Less than two days during the last seven days (n, %) | 604 (18.90) | 789 (30.30) | ||
Smoking | No (n, %) | 2626 (82.20) | 1840 (70.70) | <0.001 |
Yes (n, %) | 568 (17.80) | 762 (29.30) | ||
Drinking | No alcohol consumption in the last 30 days (n, %) | 2748 (86.00) | 2028 (77.90) | <0.001 |
Consumed alcohol in the last 30 days (n, %) | 446 (14.00) | 574 (22.10) | ||
Exercise | No (n, %) | 2365 (74.00) | 2382 (91.50) | <0.001 |
Yes (n, %) | 829 (26.00) | 220 (8.50) | ||
Household size | Total number of people living in the household (metric variable) (mean ± SD) | 2.72 ± 1.29 | 2.71 ± 1.35 | 0.914 |
Social support | In the last 12 months, household did not receive any financial or in-kind support (n, %) | 2952 (92.40) | 1977 (76.70) | <0.001 |
In the last 12 months, household received some financial or in-kind support (n, %) | 242 (7.60) | 605 (23.30) | ||
Regular income | Regular source of income (n, %) | 3109 (97.30) | 1358 (52.20) | <0.001 |
Regular but seasonal source of income (n, %) | 37 (1.20) | 825 (31.70) | ||
No regular source of income (n, %) | 48 (1.50) | 419 (16.10) | ||
Debt or loans | Household or any members of the household have current debt or outstanding loans (n, %) | 178 (5.60) | 469 (18.0) | <0.001 |
Household or any members of the household have no current debt or outstanding loans (n, %) | 3016 (94.40) | 2133 (82.00) | ||
Household’s financial situation | Very good (n, %) | 59 (1.80) | 18 (0.70) | <0.001 |
Good (n, %) | 599 (18.80) | 227 (8.70) | ||
Moderate (n, %) | 1983 (62.10) | 1588 (61.00) | ||
Bad (n, %) | 478 (15.00) | 681 (26.20) | ||
Very bad (n, %) | 75 (2.30) | 88 (3.40) | ||
Healthcare expenditure | As a percentage (%) of annual household income (mean ± SD) | 0.91 ± 0.29 | 0.45 ± 0.40 | 0.048 |
Variables | Self-Assessed Health | QOL | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
q10 | q50 | q90 | q10 | q50 | q90 | |||||||
Coef. | p | Coef. | p | Coef. | p | Coef. | p | Coef. | p | Coef. | p | |
Two-week access (ref. = No) | ||||||||||||
Yes | 1.37 | 0.019 | 1.82 | 0.005 | 0.08 | 0.760 | −0.39 | 0.522 | 0.41 | 0.457 | 0.75 | 0.089 |
One-year access (ref. = No) | ||||||||||||
Yes | −0.95 | 0.274 | −0.44 | 0.332 | 0.09 | 0.739 | −0.25 | 0.785 | −0.58 | 0.197 | −1.11 | 0.052 |
Access in need (ref. = No) | ||||||||||||
Yes | 4.97 | 0.020 | 1.98 | 0.001 | 0.23 | 0.544 | 5.11 | <0.001 | 5.12 | <0.001 | 1.89 | 0.046 |
Sex (ref. = Male) | ||||||||||||
Female | 0.17 | 0.800 | −0.61 | 0.071 | 0.02 | 0.892 | 1.71 | 0.214 | 0.21 | 0.678 | 0.60 | 0.183 |
Age | −0.36 | <0.001 | −0.24 | <0.001 | −0.11 | <0.001 | −0.03 | 0.470 | 0.01 | 0.821 | −0.01 | 0.914 |
Marital status (ref. = Never married) | ||||||||||||
Currently married | 6.40 | 0.008 | 5.02 | 0.032 | 4.97 | 0.044 | 6.54 | 0.112 | 3.82 | 0.235 | 4.09 | 0.391 |
Cohabiting | 3.37 | 0.557 | 3.84 | 0.169 | 4.36 | 0.189 | −2.96 | 0.728 | −2.79 | 0.686 | −0.83 | 0.888 |
Separated/ divorced | 2.07 | 0.463 | 2.32 | 0.339 | 2.29 | 0.365 | 3.50 | 0.477 | 0.98 | 0.803 | 2.95 | 0.580 |
Widowed | 4.03 | 0.119 | 3.43 | 0.146 | 4.40 | 0.067 | 6.39 | 0.110 | 2.73 | 0.412 | 3.05 | 0.533 |
Ethnicity (ref. = Han) | ||||||||||||
Others | −5.49 | 0.095 | −2.84 | 0.003 | −0.09 | 0.858 | 4.48 | 0.148 | 0.322 | 0.792 | −2.11 | 0.055 |
Education | 0.41 | <0.001 | 0.23 | <0.001 | 0.12 | <0.001 | 0.51 | <0.001 | 0.260 | <0.001 | 0.217 | <0.001 |
Living arrangement (ref. = Moved from elsewhere) | ||||||||||||
The same place | 2.91 | <0.001 | 1.16 | <0.001 | 0.24 | 0.256 | 2.29 | 0.026 | 1.34 | 0.004 | 0.99 | 0.046 |
Work (ref. = Yes) | ||||||||||||
No | −5.66 | 0.002 | −3.00 | <0.001 | −1.97 | 0.010 | −3.51 | 0.049 | −3.14 | 0.019 | −0.53 | 0.643 |
Smoking (ref. = No) | ||||||||||||
Yes | −0.38 | 0.691 | −0.19 | 0.699 | −0.07 | 0.769 | −0.34 | 0.647 | −1.22 | 0.039 | 0.48 | 0.446 |
Drinking (ref. = No) | ||||||||||||
Yes | 2.23 | 0.012 | 1.54 | <0.001 | 0.34 | 0.269 | 3.31 | <0.001 | 1.04 | 0..064 | 1.12 | 0.124 |
Exercise (ref. = No) | ||||||||||||
Yes | 3.46 | <0.001 | 1.67 | <0.001 | 0.58 | 0.020 | 2.47 | 0.001 | 1.62 | <0.001 | 0.39 | 0.307 |
Household size | −0.13 | 0.516 | −0.37 | 0.010 | −0.25 | 0.012 | −0.16 | 0.460 | −0.54 | 0.001 | −0.10 | 0.402 |
Social support (ref = No) | ||||||||||||
Yes | −1.51 | 0.424 | −0.93 | 0.150 | 0.16 | 0.638 | −1.75 | 0.235 | −1.82 | 0.066 | −0.31 | 0.751 |
Regular income (ref. = Regular) | ||||||||||||
Regular but seasonal | −0.75 | 0.860 | 0.33 | 0.836 | −0.99 | 0.355 | 5.51 | 0.044 | 2.87 | 0.177 | 2.89 | 0.045 |
No | −4.00 | 0.364 | −0.50 | 0.803 | −2.83 | <0.001 | −2.39 | 0.459 | −5.73 | 0.159 | −0.52 | 0.892 |
Debt or loans (ref. = Yes) | ||||||||||||
No | 3.00 | 0.086 | 0.83 | 0.349 | 1.05 | 0.138 | 1.64 | 0.412 | 0.24 | 0.726 | 0.09 | 0.935 |
Financial situation (ref. = Very good) | ||||||||||||
Good | −1.18 | 0.741 | −2.10 | 0.003 | 0.69 | 0.402 | −9.29 | <0.001 | −3.14 | <0.001 | −10.91 | <0.001 |
Moderate | −2.76 | 0.411 | −2.38 | 0.001 | 0.14 | 0.865 | −13.85 | <0.001 | −6.05 | <0.001 | −12.87 | <0.001 |
Bad | −5.80 | 0.093 | −4.49 | <0.001 | −0.98 | 0.262 | −23.26 | <0.001 | −14.67 | <0.001 | −15.51 | <0.001 |
Very bad | −8.10 | 0.060 | −7.55 | <0.001 | −3.25 | 0.025 | −26.72 | <0.001 | −17.06 | <0.001 | −14.86 | <0.001 |
Healthcare expenditure | −0.02 | 0.988 | −0.01 | 0.964 | −0.01 | 0.958 | −0.01 | 0.788 | −0.01 | 0.988 | −0.01 | 0.787 |
Pseudo R2 | 0.15 | 0.13 | 0.07 | 0.17 | 0.12 | 0.05 |
Variables | Self-Assessed Health | QOL | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
q10 | q50 | q90 | q10 | q50 | q90 | |||||||
Coef. | p | Coef. | p | Coef. | p | Coef. | p | Coef. | p | Coef. | p | |
Two-week access (ref. = No) | ||||||||||||
Yes | −1.63 | 0.087 | 0.67 | 0.157 | 0.10 | 0.796 | −1.26 | 0.206 | 0.20 | 0.806 | 2.10 | 0.042 |
One-year access (ref. = No) | ||||||||||||
Yes | 1.74 | 0.097 | −0.08 | 0.878 | −0.19 | 0.635 | 1.44 | 0.032 | 0.05 | 0.927 | −1.45 | 0.360 |
Access in need (ref. = No) | ||||||||||||
Yes | 3.83 | 0.006 | 3.43 | <0.001 | 1.73 | 0.004 | 1.27 | 0.493 | 1.23 | 0.379 | 0.87 | 0.555 |
Sex (ref. = Male) | ||||||||||||
Female | −0.61 | 0.645 | −0.57 | 0.344 | −1.05 | 0.041 | −1.25 | 0.188 | 1.15 | 0.186 | 0.88 | 0.392 |
Age | −0.52 | <0.001 | −0.26 | <0.001 | −0.13 | <0.001 | −0.21 | <0.001 | −0.13 | 0.002 | −0.04 | 0.355 |
Marital status (ref. = Never married) | ||||||||||||
Currently married | 18.45 | 0.013 | 8.59 | 0.016 | −3.00 | 0.543 | 3.61 | 0.564 | 6.38 | 0.023 | −0.65 | 0.909 |
Cohabiting | 5.36 | 0.695 | 12.40 | 0.002 | −3.14 | 0.489 | 4.15 | 0.710 | 13.92 | 0.026 | 12.49 | 0.133 |
Separated/divorced | 22.98 | 0.007 | 7.96 | 0.032 | −2.28 | 0.665 | 3.84 | 0.574 | 4.47 | 0.277 | −3.42 | 0.563 |
Widowed | 18.03 | 0.020 | 8.24 | 0.025 | −3.25 | 0.513 | 3.71 | 0.562 | 5.71 | 0.058 | −1.32 | 0.821 |
Ethnicity (ref. = Han) | ||||||||||||
Others | 1.73 | 0.678 | 1.00 | 0.351 | 1.74 | 0.400 | 1.50 | 0.698 | 2.43 | 0.436 | −0.54 | 0.891 |
Education | 0.21 | 0.061 | 0.13 | 0.037 | 0.07 | 0.114 | 0.16 | 0.123 | 0.29 | 0.007 | 0.39 | 0.006 |
Living arrangement (ref. = Moved from elsewhere) | ||||||||||||
The same place | 1.50 | 0.056 | 0.94 | 0.101 | 0.16 | 0.609 | −0.57 | 0.440 | −0.06 | 0.937 | 0.377 | 0.643 |
Work (ref. = Yes) | ||||||||||||
No | −5.17 | 0.004 | −3.57 | <0.001 | −0.75 | 0.096 | −3.51 | 0.034 | −5.25 | <0.001 | −0.92 | 0.431 |
Smoking (ref. = No) | ||||||||||||
Yes | 0.44 | 0.755 | 0.53 | 0.411 | −0.63 | 0.245 | −1.83 | 0.056 | 0.21 | 0.819 | −0.26 | 0.779 |
Drinking (ref = No) | ||||||||||||
Yes | 3.48 | <0.001 | 1.28 | 0.008 | 0.22 | 0.615 | 3.14 | 0.001 | 2.48 | 0.001 | 1.45 | 0.097 |
Exercise (ref. = No) | ||||||||||||
Yes | 3.95 | 0.003 | 0.85 | 0.285 | 0.67 | 0.319 | 4.41 | 0.002 | 3.34 | <0.001 | 1.61 | 0.244 |
Household size | 0.59 | 0.134 | 0.61 | <0.001 | 0.32 | 0.011 | 0.19 | 0.413 | 0.42 | 0.067 | 0.64 | 0.019 |
Social support (ref. = No) | ||||||||||||
Yes | −1.53 | 0.134 | −2.54 | <0.001 | −1.36 | 0.004 | 0.60 | 0.544 | 0.64 | 0.347 | −0.37 | 0.665 |
Regular income (ref. = Regular) | ||||||||||||
Regular but seasonal | −0.54 | 0.660 | −0.40 | 0.376 | −0.48 | 0.205 | −2.49 | 0.001 | −1.21 | 0.084 | −2.15 | 0.005 |
No | −4.19 | 0.041 | −2.41 | <0.001 | −1.09 | 0.010 | −4.70 | <0.001 | −2.41 | 0.018 | −2.69 | 0.012 |
Debt or loans (ref. = Yes) | ||||||||||||
No | 5.30 | <0.001 | 1.82 | <0.001 | 0.73 | 0.167 | 3.56 | 0.001 | 2.90 | 0.015 | 1.83 | 0.048 |
Financial situation (ref. = Very good) | ||||||||||||
Good | 0.60 | 0.901 | −0.98 | 0.469 | −0.60 | 0.691 | −4.91 | 0.488 | 0.65 | 0.855 | −9.26 | 0.170 |
Moderate | −2.01 | 0.698 | −3.28 | 0.008 | −1.65 | 0.242 | −9.99 | 0.147 | −4.00 | 0.255 | −14.37 | 0.028 |
Bad | −4.70 | 0.375 | −4.75 | <0.001 | −3.10 | 0.028 | −13.97 | 0.044 | −10.06 | 0.005 | −16.62 | 0.010 |
Very bad | −9.90 | 0.059 | −9.52 | <0.001 | −3.33 | 0.019 | −21.66 | 0.004 | −15.86 | <0.001 | −21.70 | 0.002 |
Healthcare expenditure | 0.05 | 0.832 | −0.03 | 0.408 | −0.04 | 0.151 | −0.02 | 0.813 | −0.08 | 0.285 | −0.17 | <0.001 |
Pseudo R2 | 0.19 | 0.12 | 0.07 | 0.13 | 0.10 | 0.06 |
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Zhang, T.; Liu, C.; Ni, Z. Association of Access to Healthcare with Self-Assessed Health and Quality of Life among Old Adults with Chronic Disease in China: Urban Versus Rural Populations. Int. J. Environ. Res. Public Health 2019, 16, 2592. https://doi.org/10.3390/ijerph16142592
Zhang T, Liu C, Ni Z. Association of Access to Healthcare with Self-Assessed Health and Quality of Life among Old Adults with Chronic Disease in China: Urban Versus Rural Populations. International Journal of Environmental Research and Public Health. 2019; 16(14):2592. https://doi.org/10.3390/ijerph16142592
Chicago/Turabian StyleZhang, Tao, Chaojie Liu, and Ziling Ni. 2019. "Association of Access to Healthcare with Self-Assessed Health and Quality of Life among Old Adults with Chronic Disease in China: Urban Versus Rural Populations" International Journal of Environmental Research and Public Health 16, no. 14: 2592. https://doi.org/10.3390/ijerph16142592