Dataset Information

Exploring the association between urbanisation and self-rated health of older adults in China: evidence from a national population sample survey.

ABSTRACT:

Objectives

This study investigated the association between urbanisation and self-rated health of older adults in China, particularly how different dimensions, rate and level of urbanisation are related to older people's health. Additionally, it examined the moderating effect of education on the association between each of the four dimensions of urbanisation and older people's health.

Design

The study uses a cross-sectional survey design.

Participants

This study analysed 236?030 individuals (aged 60-79 years) nested within 267 prefecture-level cities from 2005 China's 1% population sample survey.

Outcome measures

Self-rated health was the outcome variable. Four groups of predictors assessed prefectures' level and rate of urbanisation: land-use conversion, economic growth, population concentration and health services. Multilevel logistic regression was used to examine the association between self-rated health and the level and rate of urbanisation, after adjusting for individual-level covariates. Multiplicative interactions explored variations by education.

Results

The odd of reporting fair or poor health was negatively associated with the level and rate of population concentration (OR 0.93,95%CI 0.87 to 0.99 and 0.74,95%CI 0.59 to 0.93, respectively) and positively associated with the level of health services (OR 1.12, 95%?CI 1.06 to 1.19). Land-use conversion, economic growth and health service improvements (the forms of rate of urbanisation) were not significantly associated with self-rated health. Education had a moderating effect on the association between urbanisation and self-rated health.

Conclusions

Older people living in more densely populated areas and areas undergoing rapid population concentration were less likely to report fair or poor health. This result supports healthy migration and 'salmon bias' hypotheses. No urban health penalty was observed for the older adults in China; therefore, the following pathways linking urbanisation to health are unclear: lifestyle changes, environmental pollution and cultivated land reduction.

SUBMITTER: Liu Y

PROVIDER: S-EPMC6597632 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Publications

Exploring the association between urbanisation and self-rated health of older adults in China: evidence from a national population sample survey.

Liu Ye Y Huang Baishi B Wang Ruoyu R Feng Zhixin Z Liu Yuqi Y Li Zhigang Z

BMJ open 20190624 6

<h4>Objectives</h4>This study investigated the association between urbanisation and self-rated health of older adults in China, particularly how different dimensions, rate and level of urbanisation are related to older people's health. Additionally, it examined the moderating effect of education on the association between each of the four dimensions of urbanisation and older people's health.<h4>Design</h4>The study uses a cross-sectional survey design.<h4>Participants</h4>This study analysed 236 ...[more]

PMID: 31239306

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Project description:IntroductionThe self-rated health (SRH) is a widely adopted indicator of overall health. The sponge hypothesis suggests that predictive power of SRH is stronger among women compared to men. To gain a better understanding of how gender influences SRH, this study examined whether and what determinants of gender disparity exist current self-rated health (SRHcurrent) and change in SRH (SRHchange) among older adults in Indian setting.Materials and methodsWe used cross-sectional data from the 75th National Sample Survey Organizations (NSSO), collected from July 2017 to June 2018. The analytical sample constitutes 42,759 older individuals aged 60 years or older with 21,902 older men and 20,857 older women (eliminating two non-binary individuals). Outcome measures include two variables of poor/worse SRH status (SRHcurrent and SRHchange). We have calculated absolute gaps in the prevalence of poor SRHcurrent and worse SRHchange by background characteristics. We carried out binary logistic regression models to examine the predictors of poor SRHcurrent and worse SRHchange among older adults.ResultsThe overall absolute gender gap in poor SRHcurrent was 3.27% and it was 0.58% in worse SRHchange. Older women had significantly higher odds of poor SRHcurrent [AOR = 1.09; CI = 0.99, 1.19] and worse SRHchange [AOR = 1.09; CI = 1.02, 1.16] compared to older men. Older adults belonging to middle-aged, oldest-old, economically dependent, not working, physically immobile, suffering from chronic diseases, belonging to Muslim religion, and Eastern region have found to have higher odds of poor SRHcurrent and worse SRHchange. Educational attainments showed lower odds of have poor SRHcurrent and worse SRHchange compared to those with no education. Respondents belonging to richest income quintile and those who were not covered by any health insurance, belonging to Schedule caste, OBC, Western and Southern regions are found to have lower odds of poor SRHcurrent and worse SRHchange. Compared to those in the urban residence, respondents from rural residence [AOR = 1.09; CI = 1.02, 1.16] had higher odds of worse SRHchange.ConclusionsSupporting the sponge hypothesis, a clear gender gap was observed in poor current SRH and worse change in SRH among older adults in India with a female disadvantage. We further found lower socioeconomic and health conditions and lack of resources as determinants of poor current SRH and its worse change, which is crucial to address the challenge of the older people's health and their perception of well-being.

Project description:BackgroundHealth outcomes in India are characterized by pervasive inequities due to deeply entrenched socio-economic gradients amongst the population. Therefore, it is imperative to investigate these systematic disparities in health, however, evidence of inequities does not commensurate with its policy objectives in India. Thus, our paper aims to examine the magnitude of and trends in horizontal inequities in self-reported morbidity and untreated morbidity in India over the period of 2004 to 2017-18.MethodsThe study used cross-sectional data from nationwide healthcare surveys conducted in 2004, 2014 and 2017-18 encompassing sample size of 3,85,055; 3,35,499 and 5,57,887 individuals respectively. Erreygers concentration indices were employed to discern the magnitude and trend in horizontal inequities in self-reported morbidity and untreated morbidity. Need standardized concentration indices were further used to unravel the inter-regional and intra-regional income related inequities in outcomes of interest. Additionally, regression based decomposition approach was applied to ascertain the contributions of both legitimate and illegitimate factors in the measured inequalities.ResultsEstimates were indicative of profound inequities in self-reported morbidity as inequity indices were positive and significant for all study years, connoting better-off reporting more morbidity, given their needs. These inequities however, declined marginally from 2004(HI: 0.049, p< 0.01) to 2017-18(HI: 0.045, P< 0.01). Untreated morbidity exhibited pro-poor inequities with negative concentration indices. Albeit, significant reduction in horizontal inequity was found from 2004(HI= - 0.103, p< 0.01) to 2017-18(HI = - 0.048, p< 0.01) in treatment seeking over the years. The largest contribution of inequality for both outcomes stemmed from illegitimate variables in all the study years. Our findings also elucidated inter-state heterogeneities in inequities with high-income states like Andhra Pradesh, Kerala and West Bengal evincing inequities greater than all India estimates and Northeastern states divulged equity in reporting morbidity. Inequities in untreated morbidity converged for most states except in Punjab, Chhattisgarh and Himachal Pradesh where widening of inequities were observed from 2004 to 2017-18.ConclusionsPro-rich and pro-poor inequities in reported and untreated morbidities respectively persisted from 2004 to 2017-18 despite reforms in Indian healthcare. Magnitude of these inequities declined marginally over the years. Health policy in India should strive for targeted interventions closing inequity gap.

Dataset Information

Exploring the association between urbanisation and self-rated health of older adults in China: evidence from a national population sample survey.

Objectives

Design

Participants

Outcome measures

Results

Conclusions

Publications

Exploring the association between urbanisation and self-rated health of older adults in China: evidence from a national population sample survey.

Similar Datasets

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