Urban-rural differences in the association between access to healthcare and health outcomes among older adults in China

BMC Geriatrics

Research Article

Matthew E. Dupre¹  Xufan Zhang²  Wei Zhou²  Yuan Zhao³  Li Qiu⁴  Danan Gu⁵ 

[1] Duke Clinical Research Institute & Department of Sociology, Duke University, Durham, NC, USA;Ginling College & International Center for Aging and Health, Nanjing Normal University, Nanjing, China;Ginling College, School of Geography Science & International Center for Aging and Health and Nanjing Normal University, Nanjing, China;Independent Researcher, New York, NY, USA;United Nations Population Division, Two UN Plaza, DC2-1910, New York, NY, USA;

关键词: Healthcare;    Medical care;    Access to healthcare;    Disability;    Mortality;    Older adults;    Oldest-old;    Rural;    Rrban;    China;    CLHLS;   

DOI  :  10.1186/s12877-017-0538-9

 received in 2017-03-09, accepted in 2017-07-06,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundStudies have shown that inadequate access to healthcare is associated with lower levels of health and well-being in older adults. Studies have also shown significant urban-rural differences in access to healthcare in developing countries such as China. However, there is limited evidence of whether the association between access to healthcare and health outcomes differs by urban-rural residence at older ages in China.MethodsFour waves of data (2005, 2008/2009, 2011/2012, and 2014) from the largest national longitudinal survey of adults aged 65 and older in mainland China (n = 26,604) were used for analysis. The association between inadequate access to healthcare (y/n) and multiple health outcomes were examined—including instrumental activities of daily living (IADL) disability, ADL disability, cognitive impairment, and all-cause mortality. A series of multivariate models were used to obtain robust estimates and to account for various covariates associated with access to healthcare and/or health outcomes. All models were stratified by urban-rural residence.ResultsInadequate access to healthcare was significantly higher among older adults in rural areas than in urban areas (9.1% vs. 5.4%; p < 0.01). Results from multivariate models showed that inadequate access to healthcare was associated with significantly higher odds of IADL disability in older adults living in urban areas (odds ratio [OR] = 1.58–1.79) and rural areas (OR = 1.95–2.30) relative to their counterparts with adequate access to healthcare. In terms of ADL disability, we found significant increases in the odds of disability among rural older adults (OR = 1.89–3.05) but not among urban older adults. Inadequate access to healthcare was also associated with substantially higher odds of cognitive impairment in older adults from rural areas (OR = 2.37–3.19) compared with those in rural areas with adequate access to healthcare; however, no significant differences in cognitive impairment were found among older adults in urban areas. Finally, we found that inadequate access to healthcare increased overall mortality risks in older adults by 33–37% in urban areas and 28–29% in rural areas. However, the increased risk of mortality in urban areas was not significant after taking into account health behaviors and baseline health status.ConclusionsInadequate access to healthcare was significantly associated with higher rates of disability, cognitive impairment, and all-cause mortality among older adults in China. The associations between access to healthcare and health outcomes were generally stronger among older adults in rural areas than in urban areas. Our findings underscore the importance of providing adequate access to healthcare for older adults—particularly for those living in rural areas in developing countries such as China.

【 授权许可】

CC BY   
© The Author(s). 2017