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

Abstract

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.

Adequate access to healthcare and added life expectancy among older adults in China

“…Access to healthcare is a fundamental social determinant of health that has been targeted by the World Health Organization to improve the availability and timeliness of quality healthcare [1]. Numerous studies have shown that timely and/or adequate access to healthcare promotes better health and well-being [2,3] and that inadequate access to care has been associated with greater psychological distress [4], lower levels of physical health [5], higher rates of rehospitalization [6], and overall higher risks of morbidity and mortality [3,7]. Moreover, a large body of literature has demonstrated the correlates and consequences of access to healthcare in a variety of settings and populations [7,8].…”

“…Moreover, a large body of literature has demonstrated the correlates and consequences of access to healthcare in a variety of settings and populations [7,8]. At older ages, adequate access to healthcare is especially critical to maintaining health and preventing the onset (or exacerbation) of diseases through routine preventive care and treatments [5,9]. Older adults who lack access to healthcare are consequently less likely to receive early diagnoses, timely treatments, and other resources for healthcare that ultimately put them at higher risks of death [10].…”

“…Although the dual-system of healthcare is slowly eroding, the system still plays an important role and consists of several components [16,17]. In urban areas, the system implemented a free public medical care scheme since the 1950s that provided free healthcare services to its employees in the public sector and/or their family members [5]. In the 1990s, the urban medical scheme was reformed and subsequently split into two systems around 2010-the Urban Employer-sponsored Medical Scheme (UEMS) and the Urban Resident Medical Scheme (URMS, for urban residents without UEMS) [18][19][20]-although some oldest-old adults were still covered by free public medical care.…”

Accessing rural health services: Results from a qualitative narrative gerontological study

“…Research indicates living in an environment providing access to reliable and appropriate health services is important to older adult’s feelings of security and sense of belonging . Previous studies have demonstrated that older people living in rural areas have poorer health outcomes, are more likely to experience poverty and are less likely to access health services when compared to older adults living in urban areas . In addition, findings from The Rural healthy People 2020 American study identified that having access to necessary health services was the most important rural health priority …”

“…5 Previous studies have demonstrated that older people living in rural areas have poorer health outcomes, are more likely to experience poverty and are less likely to access health services when compared to older adults living in urban areas. 6 In addition, findings from The Rural healthy People 2020 American study identified that having access to necessary health services was the most important rural health priority. 7 Neoliberal government-driven ideologies have seen a reduction in acute and hospital services in rural environments.…”