Health service underutilization and its associated factors for chronic diseases patients in poverty-stricken areas in China: a multilevel analysis

Abstract

Background Underutilization of health services among chronic non-communicable disease sufferers, especially for hypertension (HBP) and diabetes mellitus (DM), was considered as a significant contributing factor to substantial cases in terms of both avoidable morbidity and mortality. However, evidence on health services underutilization and its associated factors in poverty-stricken areas remain scarce based on previous literature. This study aims to describe health services underutilization for people diagnosed with chronic diseases in impoverished regions and to identify its associated factors, which are expected to provide practical implications for the implementations of interventions tailored to the specific needs of disadvantaged residents in rural China to achieve effective utilization of health services in a timely manner. Methods Data were collected from a cross-sectional survey conducted through face-to-face interviews among 2413 patients from six counties in rural central China in 2019. The Anderson behavioral model was adopted to explore the associated factors. A two-level logistic model was employed to investigate the association strengths reflected by adjusted odds ratios (AOR) and 95% confidence intervals in forest plots. Results On average, 17.58% of the respondents with HBP and 14.87% with DM had experienced health services underutilization during 1 month before the survey. Multilevel logistic regression indicated that predisposing factors (age), enabling factors (income and a regular source of care), and need factors (self-reported health score) were the common predictors of health service underutilization both for hypertensive and diabetic patients in impoverished areas, among which obtaining a regular source of care was found to be relatively determinant as a protective factor for health services underutilization after controlling for other covariates. Conclusions Our results suggested that the implementation of a series of comprehensive strategies should be addressed throughout policy-making procedures to improve the provision of regular source of care as a significant determinant for reducing health services underutilization, thus ultimately achieving equal utilization of health services in impoverished regions, especially among chronic disease patients. Our findings are expected to provide practical implications for other developing countries confronted with similar challenges resulting from underdeveloped healthcare systems and aging population structures.

Multimorbidity and catastrophic health expenditure: Evidence from the China Health and Retirement Longitudinal Study

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Factors associated with health care utilization and catastrophic health expenditure among cancer patients in China: Evidence from the China health and retirement longitudinal study

“…Health service use reflects individual behaviors related to obtaining health services to meet their health demands. Existing literature has shown that health service use is affected by individual demographic and socioeconomic factors such as age, gender, marital and employment status, education level, insurance, income ( 13 ), and health care system characteristics such as the availability, affordability, and accessibility of drugs and healthcare services ( 14 ). Previous studies have reported that health service use among cancer patients differs by sex, age, residence, employment, education, health insurance, household income, tumor site, and tumor stage ( 15 – 18 ).…”

Machine learning-based warning model for chronic kidney disease in individuals over 40 years old in underprivileged areas, Shanxi Province

“…We think our early warning model is practical and down-to-earth in rural China. As the largest developing country confronted with underdeveloped healthcare systems and aging population ( 41 ), China is struggling to address the issue of health care coverage in rural areas. Despite the tremendous achievements in health care in rural China over the past 30 years, the problem of “difficult and expensive access to health care” still exists in the countryside.…”