Abstract
BackgroundPartial- or full-lockdowns, among other interventions during the COVID-19 pandemic, may disproportionally affect people (their behaviors and health outcomes) with lower socioeconomic status (SES). This study examines income-related health inequalities and their main contributors in China during the pandemic.MethodsThe 2020 China COVID-19 Survey is an anonymous 74-item survey administered via social media in China. A national sample of 10,545 adults in all 31 provinces, municipalities, and autonomous regions in mainland China provided comprehensive data on sociodemographic characteristics, awareness and attitudes towards COVID-19, lifestyle factors, and health outcomes during the lockdown. Of them, 8448 subjects provided data for this analysis. Concentration Index (CI) and Corrected CI (CCI) were used to measure income-related inequalities in mental health and self-reported health (SRH), respectively. Wagstaff-type decomposition analysis was used to identify contributors to health inequalities.ResultsMost participants reported their health status as “very good” (39.0%) or “excellent” (42.3%). CCI of SRH and mental health were − 0.09 (p < 0.01) and 0.04 (p < 0.01), respectively, indicating pro-poor inequality in ill SRH and pro-rich inequality in ill mental health. Income was the leading contributor to inequalities in SRH and mental health, accounting for 62.7% (p < 0.01) and 39.0% (p < 0.05) of income-related inequalities, respectively. The COVID-19 related variables, including self-reported family-member COVID-19 infection, job loss, experiences of food and medication shortage, engagement in physical activity, and five different-level pandemic regions of residence, explained substantial inequalities in ill SRH and ill mental health, accounting for 29.7% (p < 0.01) and 20.6% (p < 0.01), respectively. Self-reported family member COVID-19 infection, experiencing food and medication shortage, and engagement in physical activity explain 9.4% (p < 0.01), 2.6% (the summed contributions of experiencing food shortage (0.9%) and medication shortage (1.7%), p < 0.01), and 17.6% (p < 0.01) inequality in SRH, respectively (8.9% (p < 0.01), 24.1% (p < 0.01), and 15.1% (p < 0.01) for mental health).ConclusionsPer capita household income last year, experiences of food and medication shortage, self-reported family member COVID-19 infection, and physical activity are important contributors to health inequalities, especially mental health in China during the COVID-19 pandemic. Intervention programs should be implemented to support vulnerable groups.
Highlights
Disease pandemic is one of the leading health threats worldwide [1]
Since January 2020, China has implemented various containment measures, including community quarantine, self-isolation, and social distancing; while differences exist in the practices across regions in China due to their specific situation related to the number of cases reported, social and economic development levels, etc
SRH self-reported health, CI Concentration Index, Corrected CI (CCI) corrected CI *** p < 0.01 a Since we use the continuous re-scaled latent SRH and mental health score, we directly report their mean values
Summary
Disease pandemic is one of the leading health threats worldwide [1]. As of March 8, 2021, confirmed cases of the novel coronavirus disease (COVID-19) exceeded 116 million, with approximately 2.6 million deaths across 216 countries and regions [2]. Since January 2020, China has implemented various containment measures, including community quarantine, self-isolation, and social distancing; while differences exist in the practices across regions in China due to their specific situation related to the number of cases reported, social and economic development levels, etc. These measures, together with the economic impacts of the partial shutdown of the economy, have accentuated the mental health problems of the affected population [8]. This study examines income-related health inequalities and their main contributors in China during the pandemic
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