Mitigating Health Disparities among the Elderly in China: An Analysis of the Roles of Social Security and Family Support from a Perspective Based on Relative Deprivation
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsBasic reporting
Dear authors, the manuscript is generally well-written and easy to read; a slight spell-check is required. I have just some concerns that the authors need to address.
Abstract
What’s the gap you’re trying to fill with your work?
Results section could benefit from a more specific statistical significance data.
keywords usually should be different from that used in the main title.
Introduction
The literature on the subject is sufficiently well summarised. However, it could be useful to add some information about:
- Although the concept of health disparity is introduced in the text, it is unclear what is meant by "relative health deprivation" in comparison to other, more accepted indicators of health inequality. To help prevent confusion, the relationship between these concepts may be expressed more clearly.
- Without making an obvious connection between the two, the text alternates between macro-level topics (like social security policies) and micro-level analysis (like personal attitudes toward aging). More cogent integration of the relationship between different levels of study is needed, especially when talking about how macro policies affect micro-outcomes.
- There is short discussion of the causative mechanisms. You indicate, for instance, that views toward aging impact health through "physiological, behavioral, and psychological pathways," but it does not go into depth about these pathways. An in-depth explanation of the workings of these processes would strengthen the claim.
- I could be wrong but, please, consider this: Hypothesis 4 ("An individual’s attitude towards aging mediates the relationship between elderly support and relative health deprivation") risks circular reasoning. If elderly support improves attitudes toward aging and these attitudes then reduce health deprivation, the distinction between cause and effect could be blurred, particularly if attitudes are also shaped by health status.
- Although you discuss the contrasts between urban and rural areas, it should go into more detail about how cultural and regional variations within China affect how well social security and family assistance work to reduce health inequalities.
Methods
Methods section are quite clear and well structured.
Validity of the findings
- You suggest that participation in pension insurance initially increases the elderly's sense of relative health deprivation, but this effect becomes non-significant after accounting for temporal dynamics. Doesn't this contradict other findings in the study that indicate pension insurance increases health deprivation, especially in rural areas and among middle-aged elderly? Maybe you need to clarify why the effect of pension insurance varies under different circumstances and why it becomes non-significant after accounting for time, while other studies have shown different results.
- If the sample is not fully representative, the findings may not be applicable to all elderly populations in China. This limitation should be addressed more explicitly, and the study should consider how to improve representativeness or carefully interpret the findings with this limitation in mind.
If the mediating role of attitudes towards aging is not fully understood, the conclusions drawn about their influence might be speculative.
Comments on the Quality of English LanguageMinor editing of English language required.
Author Response
Please see the attachment.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsThe paper tends to answer the following research questions:
11. What is the relationship between family support and social security for the elderly regarding health inequalities?
22. What mechanisms link traditional family support and continually improving social security to health disparities among the elderly?
33. How do family support and social security impact health inequalities differently across genders, ages, and regions?
While the research is valuable, the following suggestions should be considered before the paper is published
1. The definition of health disparities
The paper could include a definition of health disparities similar to the one provided by Shi, Chen Yip (2023).
22. The aims of the paper
The paper could include a clear statement of the study's aims.
43. Dummy variables (categorical variables) should not be averaged.
In table 2, several variables, such as Pension Insurance, are dummy variables and are not appropriate for calculating means (or expressed as means).
54. China Longitudinal Aging Social Survey
Could you please clarify whether the 16337 samples from 2014 were followed up in 2016, or if there were independent 16337 samples in 2014 and 2016?
65. Temporal effect
Please clarify how the temporal effect (e.g., 2 years) was measured in the models. Additionally, provide further details on the policy changes in social pension security between 2014 and 2016, and discuss their potential impact on the temporal effect.
76. More discussion on heterogeneity tests
The results of the heterogeneity tests are interesting. Please further discuss the potential explanations for the differences related to sex, rurality, and age, as well as the corresponding policy implications.
Comments for author File: Comments.pdf
The readability of the article needs significant improvement. For instance, some paragraphs in the 'Introduction' and 'Literature Review and Research Hypotheses' sections are overly long and lack a clear focus. Additionally, the abstract requires substantial enhancement; it is challenging to discern the key messages without spending considerable time reading the methods and data sections to understand the study's measures.
Author Response
Please see the attachment.
Author Response File: 
Author Response.docx
Round 2
Reviewer 1 Report
Comments and Suggestions for Authorsthe authors adressed all my concerns. I have no further suggestions.
