Research On Income-related Health Inequality And Influencing Factors Among Rural Old Adults In Three Counties Of Shandong Province

BackgroundHealth is one of an important dimensions to measure the degree of social development, With the rapid development of living standard, more emphasis has been put on the pursuit of justice; therefore, health equity becomes an important goal of social development.In recent years, our social and economic development level has improved gradually. At the same time, the health inequality degree of the residents also increased with the income gap gradually expanding. Rural older adults in China are facing threats from chronic disease, malignant tumor, mental health, life care and pension and a series of problems, the health inequality among rural older adults has caused wide attention. Under the social background of rapid development of the aging, studying health inequalities among rural older adults to formulate suitable health promotion policies, and confront the challenge of an aging society, has important practical implications.ObjectivesUsing the baseline and follow-up survey data to analyze the income-related health inequality of the rural older adults, and calculate the health inequality degree and the contribution percentages of all influencing factors by using decomposition method, providing suggestions and countermeasures to improve health inequality of the rural older adults.MethodsThe data of this study were from the baseline and follow-up surveys conducted in Junan, Liangshan, and Pingyin (the healthresearch bases of Shandong university) in Shandong province in 2009 and 2013. Objects of investigation were older adults of 60-75 years; the baseline survey included 1412 people, and the follow-up survey included 1348 people. Investigation contents included the basic information, self-reported health status, personal social capital status, health related quality of life(HRQOL), etc. Analysis method mainly included descriptive analysis, single factor analysis and generalized linear regression, calculating the concentration index of income-related health inequality and the contribution of the various influence factors in 2009 and 2013 through the decomposition method, and comparing the difference of health inequality between 2009 and 2013.The data processing were conducted bySPSS19.0 and stata13.0 software.Main results(1) The health inequality status of the rural older adults:in the baseline and follow-up surveys, with the improvement of annual family income per capita self-reported health score had an obvious increasing trend. Income -related health concentration index were 0.022 and 0.029 respectively, so the inequality of self-reported health status existed to a larger extent among the poor rural older adults, and the inequality degree increased slightly in follow-up survey.(2) The influence factors of health inequality of the rural older adults:from the overall, gender, income, whether suffering from chronic diseases had statistically significant influences on the health inequalities of the rural older adults in both of the baseline and follow-up surveys. In the follow-up survey, we added the individual social capital variables, and found that individual social capital had statistical significance on the inequality of the rural older adults in terms of physical and mental health.(3) The influencing factors decomposition results of self-reported health inequality of the rural older adults:in the baseline and follow-up surveys, the contribution percents of income to the health inequality was the largest, accounting for more than 50%; the second was whether suffering from chronic diseases, accounting for more than 10%. With the pushing of the new rural cooperative medical system and new health reform, the contribution percents of income, occupation, medical insurance to income-related health inequality decreased obviously.(4) The inequality of HRQOL among rural older adults:in the follow-up survey, we used physical and mental HRQOL scores of the rural older adults as health indicators, and added the individual social capital to the influencing factors decomposition. We found that the physical and mental HRQOL had positive associations with income and social capital, and the inequality was in favor of the rich. The largest contribution percent to the health inequality was income (50%), followed by individual social capital(10%). The total social capital and daily life resources, personal skill resources and problem solving resources had positive influences on HRQOL of the rural older adults, and daily life resources was the greatest contribution factor for the inequalities of physical and mental.Conclusions and SuggestionsThis study found that the higher income of the rural older adults was associated with higher self-reported health scores; the income-related health concentration index were positive, existing to a lagest extent among the poor. Income, whether suffering from chronic diseases, social capital were the main influence factors of income-related health inequality. Therefore, improving income level, increasing social capital, strengthening the prevention and treatment of chronic diseases are the main measures to improve the equality of the health related quality of life of the rural older adults. Therefore, we put forward the following suggestions:(1) The government should pay more attention to health inequalities of the rural older adults. To strengthen studies on the health inequalities of the local rural older adults and coping strategies, and apply the results to policy making; (2)Take effective measures to increase the income of the rural older adults, improve their income and living conditions, and narrow the income gap between the rich and the poor actively; (3) Strengthen the health education and health promotion of the rural older adults toimprove their physical and mental health; (4) The government should actively organize all kinds of social activities for the rural older adults, strengthen the construction of activity sites and supporting facilities for older adults, improve their social contacts and emotional communications to increase their social capital, and finally achieve the goal of improving health equity.