BackgroundWith the rise of the aging population, it is particularly important for health services to be used fairly and reasonably in the elderly. This study aimed to assess the present inequality and horizontal inequity for health service use among the elderly in China and to identify the main determinants associated with the disparity.MethodsThis cross-sectional study was based on the sample of the survey of the China Health and Retirement Longitudinal Study (CHARLS) for 2015. The elderly was defined as individuals aged 60 and above, with a total of 7836 participants. We used the concentration index (CI) and the horizontal inequity (HI) to measure the inequity of the utilization of health services. The method of concentration index decomposition was utilized to measure the contribution of various influential factors to the overall unfairness.ResultsThe CI for the probability and the frequency of outpatient use were 0.1102 and 0.1015, respectively, and the corresponding values of inpatient use were 0.2777 and 0.2980, respectively. The household consumption expenditure disparity was the greatest inequality factor favoring the better-off. The Urban Employee Basic Medical Insurance made a pro-wealth contribution to inequality in frequency of health services utilization (17.58% for outpatient and 13.40% for inpatient). The contributions of New Rural Cooperative Medical Scheme on reducing unfairness in inpatient use were limited (− 2.23% for probability of inpatient use and − 5.89% for frequency of inpatient use).ConclusionsThere was a strong pro-rich inequality in both the probability and the frequency of use for health services among the elderly in China. The medical insurance was not enough to address this inequity, and different medical insurance schemes had different effects on the unfairness of health service utilization.Electronic supplementary materialThe online version of this article (10.1186/s12939-018-0861-6) contains supplementary material, which is available to authorized users.

Background: Aging and the chronic non-communicable diseases (NCDs) challenge the Chinese government in the process of providing hospitalization services fairly and reasonably. The Chinese government has developed the basic medical insurance system to solve the problem of "expensive medical cost and difficult medical services" for vulnerable groups and alleviate the unfair phenomenon. However, few studies have confirmed its effect through longitudinal comparison. This study aimed to explore the trend in the inequity of inpatient use among middleaged and elderly individuals with NCDs in China. Methods: This longitudinal comparative study was based on CHARLS data in 2011, 2013 and 2015. Concentration index (CI) was used to measure the variation trend of inequity of inpatient services utilization, while the decomposition method of the CI was applied to measure the factors contributing to inequity in inpatient services utilization. The effect of each factor on the change of inequity in inpatient services utilization was divided into the change of the elasticity and the change of inequality using the Oaxaca-type decomposition method. Results: The affluent middle-aged and elderly patients with NCDs used more inpatient services than poor groups. The per capita household consumption expenditure (PCE) and Urban Employee Basic Medical Insurance (UEBMI) contributed to the decline in pro-rich inequality of inpatient use, while the New Rural Cooperative Medical Scheme (NRCMS) contributed to the decline in pro-poor inequality of inpatient use. Conclusions: There was a certain degree of pro-rich unfairness in the probability and frequency of inpatient services utilization for middle-aged and elderly individuals with NCDs in China. The decrease of pro-wealth contribution of PCE and UEBMI offset the decrease of pro-poor contribution of NRCMS, and improved the equity of inpatient services utilization, favoring poor people.

Background With the changes in environmental, medical technique, population structure and national health projects, human mortality rates have undergone great changes all over the world. According to “World Health Statistics 2016: Monitoring Health for the SDGs (Sustainable Development Goals)”, we can draw a globally vision about life expectancy and cause of death; also, significant inequality still persists within and among countries. This study was designed to research into the trend of mortality pattern in China, evaluate the disparities of age-specific and disease-specific mortality rates between male and female, and provides a scientific basis for further prevention strategies and policies design. Methods Data from the Chinese Disease Surveillance Points system were used to calculate crude and age-adjusted death rates, annual percent changes (APC) for men and women during 2004 to 2016. Age-standardized mortality rates (ASMR) were performed through the direct method with the World Health Organization’s World Standard Population. APC, according to log linear model, was adopted to describe the mortality rate trend. The χ 2 test was used to compare differences between age-specific and cause-specific mortality rates of men and women. Data analysis and figures were completed by R software. Results The mortality rates of men and women have decreased significantly ( P < 0.05) during 2004–2016, and the APC were1.98 and 2.45%, respectively. In 2016, the crude mortality rate (CMR) and ASMR in all causes of death were 658.50 and 490.28 per 100,000 per year, respectively. The 5 leading causes of death were malignant neoplasm, cerebrovascular disease, heart disease, COPD, and accidental injury. The mortality rates of men were higher than that of women in all age groups. Conclusions There are severe health gaps and disparities between male and female, and the chronic non-communicable diseases continue to be a serious health threat to Chinese residents. Electronic supplementary material The online version of this article (10.1186/s12889-019-7163-9) contains supplementary material, which is available to authorized users.

BackgroundVarious hypertension predictive models have been developed worldwide; however, there is no existing predictive model for hypertension among Chinese rural populations.MethodsThis is a 6-year population-based prospective cohort in rural areas of China. Data was collected in 2007-2008 (baseline survey) and 2013-2014 (follow-up survey) from 8319 participants ranging in age from 35 to 74 years old. Specified gender hypertension predictive models were established based on multivariate Cox regression, Artificial Neural Network (ANN), Naive Bayes Classifier (NBC), and Classification and Regression Tree (CART) in the training set. External validation was conducted in the testing set. The estimated models were assessed by discrimination and calibration, respectively.ResultsDuring the follow-up period, 432 men and 604 women developed hypertension in the training set. Assessment for established models in men suggested men office-based model (M1) was better than others. C-index of M1 model in the testing set was 0.771 (95% confidence Interval (CI) = 0.750, 0.791), and calibration χ2 = 6.3057 (P = 0.7090). In women, women office-based model (W1) and ANN were better than the other models assessed. The C-indexes for the W1 model and the ANN model in the testing set were 0.765 (95% CI = 0.746, 0.783) and 0.756 (95% CI = 0.737, 0.775) and the calibrations χ2 were 6.7832 (P = 0.1478) and 4.7447 (P = 0.3145), respectively.ConclusionsNot all machine-learning models performed better than the traditional Cox regression models. The W1 and ANN models for women and M1 model for men have better predictive performance which could potentially be recommended for predicting hypertension risk among rural populations.

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