Abstract
Rural-urban disparity in China attracts special international attention in view of the imbalance of economic development between rural and urban areas. However, few studies used patient level data to explore the disparity of health outcomes between rural and urban patients. This study aims to evaluate the trend of health outcomes between rural and urban patients hospitalized with acute myocardial infarction (AMI) in China. Using an electronic medical records (EMRs) database in Shanxi, China, we identified 87,219 AMI patients hospitalized between 2013 and 2017. We used multivariable binary logistic regressions and two-part models to estimate the association between region of origin (rural/urban) and two outcomes, in-hospital mortality and out-of-pocket (OOP) expenses. Rural patients were associated with lower in-hospital mortality and the adjusted Odds Ratios (ORs) were 0.173, 0.34, 0.605, 0.522, 0.556 (p-values < 0.001) from 2013 to 2017, respectively. For the OOP expenses, rural patients were experiencing increasing risk of having OOP expenses, with the ORs of 0.159, 0.573, 1.278, 1.281, 1.65. The coefficients for the log-linear models in the five years were 0.075 (p = 0.352), 0.61, 0.565, 0.439, 0.46 (p-values < 0.001). Policy makers in China should notice and narrow the gap of health outcomes between rural and urban patients.
Highlights
Health inequality between rural and urban areas has been a widely studied topic in the field of public health all over the world [1,2,3,4,5,6,7,8]
According to the statistics by the World Bank, the percent of people living in the rural areas has been constantly declining between 1960 and 2017, but it still remained at 45.3% in 2017 [9]
The percent of urban patients who had no OOP expenses had been increasing while a reversed trend could be observed among rural patients
Summary
Health inequality between rural and urban areas has been a widely studied topic in the field of public health all over the world [1,2,3,4,5,6,7,8]. According to the statistics by the World Bank, the percent of people living in the rural areas has been constantly declining between 1960 and 2017, but it still remained at 45.3% in 2017 [9]. Compared to their urban counterparts, rural residents generally have limited financial incomes and access to healthcare resources, but lower levels of environmental pollution and stress. Eliminating the gap in health outcomes between rural and urban residents is a central target for health departments in China [13]. The government has been widely criticized for being limited in reducing the imbalance of healthcare resources between
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