Urban-rural differences in the association between access to healthcare and health outcomes among older adults in China.
Abstract
BACKGROUND: Studies 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. METHODS: Four 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. RESULTS:
Inadequate 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. CONCLUSIONS: Inadequate 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.
Type
Journal articleSubject
Access to healthcareCLHLS
China
Disability
Healthcare
Medical care
Mortality
Older adults
Oldest-old
Rrban
Rural
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https://hdl.handle.net/10161/15327Published Version (Please cite this version)
10.1186/s12877-017-0538-9Publication Info
Zhang, Xufan; Dupre, Matthew E; Qiu, Li; Zhou, Wei; Zhao, Yuan; & Gu, Danan (2017). Urban-rural differences in the association between access to healthcare and health
outcomes among older adults in China. BMC Geriatr, 17(1). pp. 151. 10.1186/s12877-017-0538-9. Retrieved from https://hdl.handle.net/10161/15327.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Matthew E. Dupre
Associate Professor in Population Health Sciences
Dr. Dupre is an Associate Professor in the Department of Population Health Sciences
and the Department of Sociology. He is also a Senior Fellow at the Center for Aging
and Human Development and member of the Cardiovascular Outcomes Group at the Duke
Clinical Research Institute. Dr. Dupre is a medical sociologist who specializes in
research on aging and the life course, health disparities, and cardiovascular disease
(CVD) outcomes in older adults. As an interdisciplinary researcher, he has foc

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