摘要
Background:Uneven economic development has led to substantial health inequalities between Chinese provinces.The extent of,and factors underlying,between-province health inequalities have received little attention.Methods:Data from 15,278 respondents in Wave 2(2013)of the China Health and Retirement Longitudinal Study(CHARLS)were used to investigate inequalities among people aged≥50 years in five health outcomes between 27 Chinese province-level administrative units.After characterizing the betweenprovince differences and the relevance of province effects,proportional change in variance between unadjusted and adjusted models was calculated to determine the percentage of between-province variance in health outcomes explained by province-level variables including measures of economic development and healthcare availability.Results:Although province effects explained<10%of overall variance in health outcomes,they underpinned large between-province inequalities among people aged≥50 years.Gross Regional Product per capita was more important than doctor density in explaining between-province variance in health outcomes,particularly depression symptoms and instrumental activities of daily living impairment.Conclusion:Policy efforts,including more equal distribution of healthcare personnel,may be warranted to reduce between-province health inequalities.
基金
supported by the Behavioral and Social Research division of the National Institute on Aging(grant numbers 1-R21-AG031372-01,1-R01-AG037031-01,and 3-R01AG037031-03S1)
the Natural Science Foundation of China(grant numbers 70910107022,71130002 and 71273237)
the World Bank(contract numbers 7145915 and 7159234)
the China Medical Board
Peking University.
