Elderly Health Inequality in China and its Determinants: A Geographical Perspective
Abstract
:1. Introduction
2. Methods
2.1. Data
2.1.1. Individual-Level Variables
2.1.2. Provincial-Level Variables
2.2. Ill-Health Score
2.3. Spatial Autocorrelation of Elderly Health
2.4. Health Concentration Curve
2.5. Determinants of Health Inequality
3. Results
3.1. Spatial Pattern of Elderly Health
3.2. Determinants of Elderly Health Inequality in China
3.2.1. Determinants of Inter-Provincial Health Inequality by Multi-Level Regression
3.2.2. Determinants for Health Inequality by Multi-Level Regression at the Individual Level
4. Discussion
4.1. A Significant Geographical Differentiation in Elderly Health in China
4.2. Elderly Health Inequality at the Provincial Level and Its Determinants
4.3. Health Inequality of the Elderly at the Individual Level and Its Determinants
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Level | Type | Code | Variable name | Expected effects on ill-health1 | Calculation method | |
---|---|---|---|---|---|---|
Dependent variable | Y | Ill- health score | Ill-health score [47] (see 2.2) | |||
Level 2: provincial-level | Explanatory variables | Medical resources [30,31] | S1 | Grade-A tertiary hospital Per capita | - | Urban Statistical Yearbook of China |
Education [23] | S2 | Proportion of higher education population to total population | - | The Sixth Population Census Data | ||
Economic | S3 | GDP Per capita | - | Urban Statistical Yearbook of China | ||
Environment [36,41] | S4 | Annual average air pollution index in 2010 | + | Datacenter in Ministry of Environmental Protection of China | ||
S5 | Average daily precipitation | ? | Urban Statistical Yearbook of China, Unit: mm | |||
S6 | Average daily temperature | + | Urban Statistical Yearbook of China, Unit: 0.1 °C | |||
S7 | Average daily sunshine duration | - | Urban Statistical Yearbook of China, Unit: hours/year | |||
Level 1: Individual-level | Control variables | Individual characteristics | X1 | Age | + | |
X2 | Gender | - | Male = 0, female = 1 | |||
X3 | Educational level | - | Uneducated = 1 Elementary school = 2 Junior high school = 3 High school/Technical secondary school/ Vocational high school = 4 College degree = 5 Bachelor degree or above = 6 | |||
X4 | Marital Status | - | Spouse is alive = 1Other = 0 | |||
X5 | Ethnicity | - | Han = 0, Other = 1 | |||
X6 | Exercise frequency | - | 1 = No exercise 2 = Less than once in a week 3 = One to two times 4 = Three to Five Times 5 = Six times and above | |||
Social interaction | X7 | Loneliness | - | Often = 1 Sometimes = 2 Never = 3 | ||
X8 | Social responsibility | - | Maintain community social security/Help mediate Neighborhood Disputes/Maintain Community Environment/Help Neighbors/Care For The Next Generation/ Participate In Cultural And Scientific Promotion Activities = 1 Do not participate = 0 | |||
X9 | Social activity | - | Watching movies / Dancing, Croquet/ Table tennis/ Badminton, Playing mahjong/Playing poker/Playing chess, Fishing/Calligraphy/ Photography/ Collection = 1 Do not participate = 0 | |||
Explanatory variables | Built -environment | X10 | Place of residence | + | Urban = 0, Urban-Rural area = 1, Town = 2, Town-Rural area = 3, Village = 4 | |
X11 | House Type | + | Block = 1, Bungalow = 2, Mud house and other = 3 | |||
X12 | House quality | + | Property rights = 1 Lease and other = 2 | |||
Personal economic situation | X13 | Annual income | - | Ten thousand Yuan (Ln) | ||
X14 | Social insurance | - | No social insurance = 0, else = 1 | |||
X15 | Commercial insurance | - | No commercial insurance = 0, else = 1 |
Variables | N | Min | Max | Average | Std. | |
---|---|---|---|---|---|---|
Y | Ill-health score | 221,518 | 0.14 | 7.61 | 1.5522 | 1.66329 |
S1 | Grade-A tertiary hospital per capita | 31 | 0.01 | 0.04 | 0.011 | 0.006 |
S2 | Proportion of higher education population to total population | 31 | 5.29 | 31.5 | 9.00 | 3.82 |
S3 | GDP per capita | 31 | 2.62 | 10.9 | 5.34 | 2.03 |
S4 | Annual Average air pollution index (AQI) in 2010 | 31 | 37.86 | 108.91 | 69.12 | 9.48 |
S5 | Average daily precipitation | 31 | 100.20 | 1555.36 | 828.26 | 355.89 |
S6 | Average daily temperature | 31 | 15.78 | 247.84 | 144.59 | 44.23 |
S7 | Average daily sunshine duration | 31 | 834.63 | 2493.64 | 1676.14 | 363.49 |
Valid N | 31 | |||||
X1 | Age | 222,179 | 60 | 109 | 69.731 | 7.84458 |
X2 | Gender | 222,179 | 0 | 1 | 0.4777 | 0.4995 |
X3 | Educational level | 221,445 | 1 | 6 | 2.1401 | 1.0509 |
X4 | Marital Status | 218,772 | 1 | 2 | 1.2791 | 0.44856 |
X5 | Ethnicity | 222,179 | 1 | 5 | 3.8798 | 1.75637 |
X6 | Exercise frequency | 220,903 | 1 | 5 | 2.5233 | 1.66817 |
X7 | Loneliness | 219,094 | 1 | 3 | 2.571 | 0.60939 |
X8 | Social responsibility | 215,366 | 0 | 1 | 0.46 | 0.498 |
X9 | Social activity | 215,706 | 0 | 1 | 0.92 | 0.27 |
X10 | Place of residence | 222179 | 1 | 5 | 3.5357 | 1.66677 |
X11 | House Type | 222179 | 1 | 2 | 1.0505 | 0.21896 |
X12 | House quality | 220777 | 1 | 3 | 1.6342 | 0.71889 |
X13 | Annual income | 218760 | −5.3 | 12.21 | 0.8541 | 1.20279 |
X14 | Social insurance | 215395 | 0 | 1 | 0.0092 | 0.09541 |
X15 | Commercial insurance | 218067 | 0 | 1 | 0.038 | 0.19126 |
Valid N | 210488 |
Variables name | Model 1 | Model 2 | Model 3 | Model 4 | Model 5 | Model 6 | Model 7 | Model 8 | |
---|---|---|---|---|---|---|---|---|---|
Intercept | 1.829 *** | 1.788 *** | 1.996 *** | ||||||
S1 | Grade-A tertiary hospital per capita | −0.027 ** | |||||||
S2 | Proportion of higher education population to total population | −17.391 ** | |||||||
S3 | GDP per capita | −0.803 *** | -- | ||||||
S4 | Annual average AQI | -- | -- | ||||||
S3× S4 | GDP per capita× Annual average AQI | -- | |||||||
S5 | Average daily precipitation | -- | |||||||
S6 | Average daily temperature | -- | |||||||
S7 | Average daily sunshine duration | -- |
Variables name | Model 1 | Model 2 | Model 3 | Model 4 | Model 5 | ||
---|---|---|---|---|---|---|---|
Intercept | 0.173 | 3.000 *** | 2.738 *** | 2.683 *** | 2.972 *** | ||
Determinants for health inequality at the provincial level | S1 | Grade-A tertiary hospital per capita | −0.911 * | −0.411 * | −0.330 * | −1.118 * | −0.551 * |
S2 | Proportion of higher education population to total population | −0.131 * | −0.013 * | −0.013 * | −0.017 *** | −0.014 * | |
S3 | GDP per capita | −0.411 *** | −0.050 *** | −0.049 *** | −0.060 *** | −0.052 *** | |
Individual characteristics at the individual level(Control variable) | X1 | Age | 0.030 *** | 0.023 *** | 0.030 *** | 0.023 *** | 0.023 *** |
X2 | Gender | −0.166 *** | −0.174 *** | −0.182 *** | −0.182 *** | −0.173 *** | |
X3 | Educational level | −0.071 *** | −0.029 *** | −0.057 *** | −0.020 *** | −0.030 *** | |
X4 | Marital status | −0.013 * | −0.302 *** | −0.013 | −0.303 *** | −0.303 *** | |
X5 | Ethnicity | 0.050 *** | 0.037 *** | 0.014 ** | 0.009 * | 0.033 *** | |
X6 | Exercise frequency | −0.156 *** | −0.109 *** | −0.107 *** | −0.105 *** | −0.109 *** | |
Social interaction at the individual level (Control variable) | X7 | Loneliness | −0.542 *** | −0.525 *** | −0.532 *** | −0.523 *** | |
X8 | Social responsibility | −0.211 *** | −0.206 *** | −0.214 *** | −0.201 *** | ||
X9 | Social activity | −0.730 *** | −0.776 *** | −0.729 *** | −0.773 *** | ||
Living Environment at the individual level | X10 | Place of residence | 0.022 *** | 0.047 *** | |||
X11 | House type | 0.086 *** | 0.098 *** | ||||
X12 | House quality | 0.060 *** | 0.062 *** | ||||
X10×S3 | Place of residence×GDP per capita | −0.004 *** | |||||
Economy at the individual level | X13 | Annual income | −0.027 *** | ||||
X14 | Social insurance | −0.207 *** | |||||
X15 | Commercial insurance | −0.088 *** | |||||
AIC | 823615.9 | 767524.1 | 760488.6 | 762080.3 | 739731 |
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Fan, C.; Ouyang, W.; Tian, L.; Song, Y.; Miao, W. Elderly Health Inequality in China and its Determinants: A Geographical Perspective. Int. J. Environ. Res. Public Health 2019, 16, 2953. https://doi.org/10.3390/ijerph16162953
Fan C, Ouyang W, Tian L, Song Y, Miao W. Elderly Health Inequality in China and its Determinants: A Geographical Perspective. International Journal of Environmental Research and Public Health. 2019; 16(16):2953. https://doi.org/10.3390/ijerph16162953
Chicago/Turabian StyleFan, Chenjing, Wei Ouyang, Li Tian, Yan Song, and Wensheng Miao. 2019. "Elderly Health Inequality in China and its Determinants: A Geographical Perspective" International Journal of Environmental Research and Public Health 16, no. 16: 2953. https://doi.org/10.3390/ijerph16162953