Measurement and decomposition of income-related inequality in self-rated health among the elderly in China

Hai Gu,Xinpeng Xu,Xiyan Liu,Yun Kou,Nichao Yang,Hua You,Xiaolu Li,Jinghong Gu,Jing Liu

doi:10.1186/s12939-019-0909-2

Abstract

BackgroundPopulation ageing in China has brought increasing attention to the health inequalities of the elderly. The purpose of this paper is to measure income-related health inequality among the elderly in China and decompose its causes.MethodsThe data are from the China Health and Retirement Longitudinal Study (CHARLS) survey in 2013, which contains 6176 individuals aged 60 years and above. A multiple linear regression model was used to analyze the influencing factors of self-rated health (SRH) among the elder people. Furthermore, the corrected concentration index were used to measure income-related health inequality. Wagstaff-type decomposition analysis was employed to explore the cause of inequality. The measurement and decomposition of health inequality was also performed separately in the male and female subgroups.ResultsMost elderly declared their health status as “fair” (51.33%) or “poor” (21.88%). Income, gender, residence, region, health insurance and other factors had significant association with SRH (P < 0.05). The corrected concentration index (CCI) was 0.06, indicating pro-rich inequality in health among the elderly. Decomposition analyses revealed that the main contributors to health inequality included income, residence, region, health insurance, and employment. For female elderly, most of the inequality was due to residence (50.78%) and income (49.51%); for male elderly, most of the inequality was due to insurance (38.65%) and income (22.26%); for the total sample, employment had a negative contribution to health inequality (− 25.83%).ConclusionThe findings confirm a high proportion of elderly with poor SRH, and health inequality in the Chinese. Some socioeconomic strategies should be conducted to reduce this health inequality among the elderly, such as reducing income disparities, consolidating health insurance schemes, and narrowing urban-rural and regional gaps. Older females with low incomes in rural areas are a vulnerable subgroup and warrant targeted policy attention.

Highlights

Population ageing in China has brought increasing attention to the health inequalities of the elderly
This study revealed that some social factors, including income, residence, region, medical insurance, influenced the health of the elderly, and played critical roles in contributing to health inequality
This study showed that residence has a distinct contribution to health inequality, and the rural elderly have lower levels of health than the urban elderly do

Summary

Introduction

Population ageing in China has brought increasing attention to the health inequalities of the elderly. The purpose of this paper is to measure income-related health inequality among the elderly in China and decompose its causes. By the end of 2014, the number of elders (aged 60 years and above) had reached 212 million, accounting for 15.5% of the population [1]. It is estimated that by 2050, this will exceed 30% [2]. This increasing population of Chinese elderly faces emerging health challenges. Chronic diseases and disabilities have become more common. An earlier study shows that 33% of Chinese aged 60 years and older had chronic pain. Disability is widespread, with 38% of participants reporting difficulties in daily living [3]

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