Urban–Rural Disparities Of Dietary,Nutrition And Health In China

Objective: On the basis of investigation of dietary characteristic, nutrient intake, health status and health service utilization among urban and rural residents, to reveal the urban–rural disparities and provide reference for the construction of Health China.Method: The study extraction data on dietary, disease and health service from the China Health and Nutrition Survey. Difference in dietary knowledge, dietary preferences between urban and rural residents was compared. By transforming of the dietary survey material, we calculated the intake of energy nutrients, minerals and vitamins. Exploratory factor analysis was used to explore the dietary patterns of respondents. The prevalence of several non-communicable chronic diseases and the rate of health service utilization were calculated and compared. And to underscore the income-related health inequality and urban–rural health disparities, the concentration curve and concentration index were used to analysis the rate of health service utilization.Result:(1)There was a lack of understanding of professional nutrition knowledge among Chines, and the rural residents were worse in this aspect. For example, the awareness of Dietary Guidelines for Chinese in urban and rural areas were 24.4% and 17.9%(?2=53.230, P<0.001). Only 22% of the interviewee are following the AMDR of fat and carbohydrate, which defined the suitable proportion of energy derived from fat and carbohydrate. An enormous gap of protein intake was showed in the survey, with only 50.5% urban residents and 38.2% rural residents achieve the RNI of protein(?2=124.775, P<0.001). Deficiency of minerals, such as calcium, zinc and iron, were also revealed. People whose calcium intake less than the EAR only accounted for 93%. And we found urban-rural disparities in the intake of these nutrients. Similar insufficient status were detected in the intake of Vitamin A, E, B1, B2, etc., that is, less than 60% residents could reach the suitable level defined by RNIs.(2) Common patterns and special patterns were obtained in the dietary patterns analysis. Chinese traditional diet, characterized by pairing of staple food(flour and rice) and garnish(vegetables and pork), was the primary patterns in all residents. When it comes to the western-style bakeries and other dietary patterns, people in urban and rural had various features.(3) The prevalence rate of overweight and obesity reached 39.62% and 10.60% in China, and there were significant difference in obesity rate between urban and rural areas(u=2.918,P<0.002). The prevalence of hypertension was 24.13% and 25.83% in urban and rural areas, respectively. After age-standardization, the difference of the prevalence was statistically significant(u=3.173, P<0.001). The prevalence of stroke, myocardial infarction, asthma, fractures and tumor were also high in this survey. The urban residents had lower four-week prevalence rate and hospitalization rate, but higher attendance rate, outpatient rate and utilization rate of health services. The concentration curves of outpatient and hospitalization services in the four waves were located below the diagonal, and corresponding concentration indexes were positive. We found the number of concentration indexes of hospitalization services were relatively large. When it comes to preventive health care services, the concentration curves and concentration indexes were volatile.Conclusion: Urban–rural disparities of dietary, nutrition and health existed in China.Dietary knowledge and nutrition intake among urban and rural residents were both insufficient. People living in rural areas lag far behind in these aspects. Common features and minor differences co-existed in dietary patterns of urban and rural residents. Health disparity was revealed both from the prevalence of non-communicable chronic diseases and the rate of health service utilization. To achieve the goal of healthy China program, there is an urgent need for health workers to provide dietary instruction and strengthen health education to the public. And the health care system should pay special attention on public health services and medical security capability in rural areas.