Health Inequality Among the Elderly in Rural China and Influencing Factors: Evidence from the Chinese Longitudinal Healthy Longevity Survey
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data
2.2. Methods
2.2.1. Health Measures
2.2.2. Measurement of Health Inequality
2.2.3. Decomposition Methods of Factors Influencing Health Inequality
2.3. Variables
2.3.1. Interpreted Variables
2.3.2. Explanatory Variables
3. Results
3.1. Health Characteristics of the Elderly in Rural China
3.2. Health Inequality Among the Elderly in Rural China
3.3. Decomposition of the Factors Affecting Health Inequality Among the Rural Elderly in China
3.3.1. Demographic Characteristics and Health Inequality Among the Rural Elderly
3.3.2. Socioeconomic Status (SES) and Health Inequality Among the Rural Elderly
3.3.3. Health Care Access and Health Inequality Among the Rural Elderly
3.3.4. Quality of Later Life and Health Inequality Among the Rural Elderly
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Year | Sample of Survey Year | Continuous Survey Sample | Survey Year Rural Sample | Rural Sample for Continuous Survey |
---|---|---|---|---|
2002 | 16,064 | — | 8670 | — |
2005 | 15,638 | 8175 (2002–2005) | 8658 | 4337 |
2008 | 16,954 | 4191 (2002–2008) | 10,293 | 1897 |
2011 | 9765 | 2513 (2002–2011) | 5145 | 737 |
2014 | 7192 | 1681 (2002–2014) | 3980 | 332 |
Content | Weight | Questionnaire No. | |
---|---|---|---|
Mobility Scale (MOB) | |||
4 | Did not drive a car, health related; did not ride in a car as usual for age (younger than 15 yr), health related, and/or did not use public transportation, health related; or had or would have used more help than usual for age to use public transportation, health related. | −0.062 | E4, E14 |
Physical Activity Scale (PAC) | |||
3 | In wheelchair, moved or controlled movement of wheelchair without help from someone else; or had trouble or did not try to lift, stoop, bend over, or use stairs or inclines, health related; and/or limped, used a cane, crutches, or walker, health related; and/or had any other physical limitation in walking, or did not try to walk as far or as fast as others the same age are able, health related. | −0.060 | G9, G11, E11–E13 |
Social Activity Scale (SAC) | |||
4 | Limited in other (e.g., recreational) role activity, health related. | −0.061 | E6–E8 |
3 | Limited in major (primary) role activity, health related. | −0.061 | E2–E3 |
2 | Performed no major role activity, health related, but did perform self-care activities. | −0.061 | E3 |
1 | Performed no major role activity, health related, and did not perform, or had more help than usual in performance of one or more self-care activities, health related. | −0.106 | E1–E3, E6, E9–E10 |
Symptom/Problem Complexes (CPX) | |||
5 | Trouble learning, remembering, or thinking clearly. | −0.340 | C54–C55, G15O1 |
6 | Any combination of one or more hands, feet, arms, or legs either missing, deformed (crooked), paralyzed (unable to move), or broken—includes wearing artificial limbs or braces. | −0.333 | C55 |
8 | Pain, burning, bleeding, itching, or other difficulty with rectum, bowel movements, or urination (passing water). | −0.292 | E5, G15B1, G15S1 |
12 | Spells of feeling upset, being depressed, or of crying. | −0.257 | B23–B24, B26 |
18 | Pain in ear, tooth, jaw, throat, lips, tongue; several missing or crooked permanent teeth—includes wearing bridges or false teeth; stuffy, runny nose; or any trouble hearing-includes wearing a hearing aid. | −0.170 | C55, G22, H1 |
Variables | Description | Mean ± SD or n (%) |
---|---|---|
Health Status | QWB Score | 0.6276 ± 0.1500 |
Demographic characteristics | ||
Gender | Male | 7923 (40.96) |
Female | 11,418 (59.04) | |
Age groups | Age group1 (65–74) | 2149 (11.11) |
Age group2 (75–84) | 3255 (16.83) | |
Age group3 (85–94) | 6980 (36.09) | |
Age group4 (95+) a | 6957 (35.97) | |
Marital status | Married | 4728 (24.45) |
Divorced, separated, widowed, or single | 14,613 (75.55) | |
Socioeconomic status (SES) | ||
Income inequality | Gini coefficient of province | 0.3677 ± 0.0749 |
Education | Years of education | 1.3810 ± 2.6982 |
Region | Eastern China a | 8001 (41.37) |
Central China | 6313 (32.64) | |
Western China | 5027 (25.99) | |
Health care access | ||
Timely medical treatment | Yes | 17,037 (88.09) |
No | 2304 (11.91) | |
Medical facilities | Number of medical institution beds per 1000 people | 1.0190 ± 0.4847 |
Medical expenses | Total medical expenses last year (yuan) | 1,343.0770 ± 4,827.2570 |
Main medical payment channel | Medical insurance | 3294 (17.03) |
Other | 16,047 (82.97) | |
Quality of later life | ||
Living arrangements | Living in nursing homes | 346 (1.79) |
Not living in nursing homes | 18,995 (98.21) | |
Pension | Yes | 996 (5.15) |
No | 18,345 (94.85) | |
Physical exercise | Yes | 3513 (18.16) |
No | 15,828 (81.84) |
2002 | 2005 | 2008 | 2011 | 2014 | |
---|---|---|---|---|---|
65–74 years old | 0.7730 | 0.7772 | 0.7832 | 0.7810 | 0.7770 |
75–84 years old | 0.7128 | 0.7157 | 0.7197 | 0.7233 | 0.7276 |
85–94 years old | 0.6357 | 0.6478 | 0.6396 | 0.6433 | 0.6600 |
Above 95 years old | 0.5639 | 0.5747 | 0.5627 | 0.5725 | 0.5868 |
2002 | 2005 | 2008 | 2011 | 2014 | ||||||
---|---|---|---|---|---|---|---|---|---|---|
WI | EI | WI | EI | WI | EI | WI | EI | WI | EI | |
65–74 years old | 0.0870 | 0.0826 | 0.0595 | 0.0567 | 0.1060 | 0.1030 | 0.0734 | 0.0716 | 0.0379 | 0.0360 |
75–84 years old | 0.0557 | 0.0534 | 0.0818 | 0.0790 | 0.0474 | 0.0455 | 0.0063 | 0.0061 | 0.0784 | 0.0763 |
85–94 years old | 0.0517 | 0.0516 | 0.0322 | 0.0322 | 0.0352 | 0.0351 | 0.0031 | 0.0031 | 0.0035 | 0.0035 |
Above 95 years old | 0.0379 | 0.0377 | 0.0575 | 0.0574 | 0.0124 | 0.0123 | 0.0232 | 0.0231 | 0.0279 | 0.0276 |
Dimensions | Variables | Shapley Decomposition | RIF-I-OLS Decomposition | ||
---|---|---|---|---|---|
Health (QWB) | Contribution (rate, %) | RifWI | RifEI | ||
Demographic characteristics | Male | 0.0083 | 0.0054 (6.40%) | −0.0058 | −0.0064 |
(0.4263) | (−0.8537) | (−1.0205) | |||
Age group1 (65–74) | 0.0293 | 0.0664 *** | 0.0545 *** | ||
(0.8888) | (4.9352) | (4.3412) | |||
Age group2 (75–84) | −0.1525 *** | 0.0263 *** | 0.0198 ** | ||
(-5.6868) | (2.6841) | (2.1718) | |||
Age group3 (85–94) | −0.0962 *** | 0.0084 | 0.0057 | ||
(−4.6733) | (1.2847) | (0.9398) | |||
Married | −0.0264 | 0.0176 ** | 0.0156 * | ||
(−1.1330) | (2.0328) | (1.9386) | |||
Socioeconomic status (SES) | Gini coefficient | −1.2790 *** | 0.0130 (15.39%) | 0.5882 *** | 0.5440 *** |
(−4.0629) | (5.1053) | (5.0656) | |||
Years of education | 0.0130 *** | 0.0041 *** | 0.0037 *** | ||
(3.5411) | (2.8928) | (2.8011) | |||
Central China | −0.1482 *** | 0.0091 | 0.0084 | ||
(−7.0585) | (1.2016) | (1.1894) | |||
Western China | −0.1238 *** | −0.0338 *** | −0.0323 *** | ||
(−4.6590) | (−3.4009) | (−3.4806) | |||
Health care access | Timely medical treatment | 0.4802 *** | 0.0442 (52.41%) | −0.0286 *** | −0.0284 *** |
(16.6442) | (-3.1046) | (−3.2866) | |||
Medical facilities | 0.0679 *** | −0.0131 * | −0.0116 * | ||
(3.0847) | (−1.7954) | (−1.7222) | |||
Medical expenses | −4.3496 *** | −0.5795 *** | −0.5206 *** | ||
(−9.0786) | (−5.6915) | (−5.5188) | |||
Insurance payment | 0.0438 * | 0.0167 * | 0.0153 * | ||
(1.9154) | (1.7990) | (1.7748) | |||
Quality of later life | Living in nursing homes | −0.0826 | 0.0218 (25.80%) | −0.1111 *** | −0.1031 *** |
(−1.0760) | (−3.4715) | (−3.4544) | |||
Pension | 0.0745 * | 0.0612 *** | 0.0575 *** | ||
(1.9425) | (3.8966) | (3.9514) | |||
Physical exercise | 0.3221 *** | 0.0257 *** | 0.0216 *** | ||
(15.4757) | (3.1152) | (2.8047) | |||
Constant | 3.5439 *** | — | −0.1451 *** | −0.1295 *** | |
(26.8070) | — | (−3.0643) | (−2.9365) | ||
Time fixed effect | Controlled | — | Controlled | Controlled | |
Total Contribution | — | — | 0.0844 (100%) | — | — |
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Pan, C.; Fan, Q.; Yang, J.; Deng, D. Health Inequality Among the Elderly in Rural China and Influencing Factors: Evidence from the Chinese Longitudinal Healthy Longevity Survey. Int. J. Environ. Res. Public Health 2019, 16, 4018. https://doi.org/10.3390/ijerph16204018
Pan C, Fan Q, Yang J, Deng D. Health Inequality Among the Elderly in Rural China and Influencing Factors: Evidence from the Chinese Longitudinal Healthy Longevity Survey. International Journal of Environmental Research and Public Health. 2019; 16(20):4018. https://doi.org/10.3390/ijerph16204018
Chicago/Turabian StylePan, Changjian, Qiuyan Fan, Jing Yang, and Dasong Deng. 2019. "Health Inequality Among the Elderly in Rural China and Influencing Factors: Evidence from the Chinese Longitudinal Healthy Longevity Survey" International Journal of Environmental Research and Public Health 16, no. 20: 4018. https://doi.org/10.3390/ijerph16204018