To what extent do disparities in economic development and healthcare availability explain between‐province health inequalities among older people in China?

Abstract

Abstract Background Uneven economic development has led to substantial health inequalities between Chinese provinces. The extent of, and factors underlying, between‐province health inequalities have received little attention. Methods Data from 15,278 respondents in Wave 2 (2013) of the China Health and Retirement Longitudinal Study (CHARLS) were used to investigate inequalities among people aged ≥50 years in five health outcomes between 27 Chinese province‐level administrative units. After characterizing the between‐province differences and the relevance of province effects, proportional change in variance between unadjusted and adjusted models was calculated to determine the percentage of between‐province variance in health outcomes explained by province‐level variables including measures of economic development and healthcare availability. Results Although province effects explained <10% of overall variance in health outcomes, they underpinned large between‐province inequalities among people aged ≥50 years. Gross Regional Product per capita was more important than doctor density in explaining between‐province variance in health outcomes, particularly depression symptoms and instrumental activities of daily living impairment. Conclusion Policy efforts, including more equal distribution of healthcare personnel, may be warranted to reduce between‐province health inequalities.

Keywords

• inequalities
• multilevel modelling
• depression
• wellbeing
• disability
• overweight