Urban-rural Gap Research Articles

Time tracking and multidimensional influencing factors analysis on female breast cancer mortality: Evidence from urban and rural China between 1994 to 2019.

BackgroundThere are huge differences in female breast cancer mortality between urban and rural China. In order to better prevent breast cancer equally in urban and rural areas, it is critical to trace the root causes of past inequities and predict how future differences will change. Moreover, carcinogenic factors from micro-individual to macro-environment also need to be analyzed in detail. However, there is no systematic research covering these two aspects in the current literature.MethodsBreast cancer mortality data in urban and rural China from 1994 to 2019 are collected, which from China Health Statistical Yearbook. The Age-Period-Cohort model is used to examine the effects of different age groups, periods, and birth cohorts on breast cancer mortality. Nordpred project is used to predict breast cancer mortality from 2020 to 2039.ResultsThe age effect gradually increases and changes from negative to positive at the age of 40–44. The period effect fluctuates very little and shows the largest difference between urban and rural areas in 2019. The birth cohort effect gradually decreases with urban-rural effects alternating between strong and weak. In the predicted results, the urban-rural mortality gap becomes first narrow and then wide and shows a trend of younger death.ConclusionsFrom the perspective of a temporal system, the changing trend of breast cancer mortality is highly consistent with the history of social and economic structural changes in China. From the perspective of the theory of social determinants of health, individuals, families, institutions and governments need to participate in the prevention of breast cancer.

High Urban-Rural Inequities of Abdominal Obesity in Malawi: Insights from the 2009 and 2017 Malawi Noncommunicable Disease Risk Factors Surveys.

Geographical disparities in abdominal obesity (AO) exist in low-income countries due to major demographic and structural changes in urban and rural areas. We aimed to investigate differences in the urban–rural prevalence of AO in the Malawi population between 2009 and 2017. We conducted a secondary analysis of data from the Malawi 2009 and 2017 STEPS surveys. AO (primary outcome) and very high waist circumference (secondary outcome) were defined using WHO criteria. Prevalence estimates of AO and very high waist circumference (WC) were standardized by age and sex using the age and sex structure of the adult population in Malawi provided by the 2018 census. A modified Poisson regression analysis adjusted for sociodemographic covariates was performed to compare the outcomes between the two groups (urban versus rural). In total, 4708 adults in 2009 and 3054 adults in 2017 aged 25–64 were included in the study. In 2009, the age–sex standardized prevalence of AO was higher in urban than rural areas (40.9% vs 22.0%; adjusted prevalence ratio [aPR], 1.51; 95% confidence interval [CI], 1.36–1.67; p < 0.001). There was no significant trend for closing this gap in 2017 (urban 37.0% and rural 21.4%; aPR, 1.48; 95% CI, 1.23–1.77; p < 0.001). This urban–rural gap remained and was slightly wider when considering the ‘very high WC’ threshold in 2009 (17.0% vs. 7.1%; aPR, 1.98; 95%CI, 1.58–2.47; p < 0.001); and in 2017 (21.4% vs. 8.3%; aPR, 2.03; 95%CI, 1.56–2.62; p < 0.001). Significant urban–rural differences exist in the prevalence of AO and very high WC in Malawi, and the gap has not improved over the last eight years. More effective weight management strategies should be promoted to reduce health care disparities in Malawi, particularly in urban areas.

Evaluating the national system for rare diseases in China from the point of drug access: progress and challenges

BackgroundThere are about 7000 rare diseases worldwide, of which only 5% of the diseases can be treated with medicines, showing that it’s important to improve patient access to orphan drugs. Recently, China has actively worked to set up a national system for rare diseases to improve the diagnosis and treatment capabilities and ensure the accessibility of drugs. However, the benefits of the system have yet not to be measured. This study aimed to provide an overview of orphan drug access based on the Compendium of China’s First List of Rare Diseases and National Network to Collaborate on Diagnosis and Treatment of Rare Diseases, expecting to map a blueprint for orphan drug access in China.MethodsFramework of China’s national system for rare diseases was summarized. We surveyed the availability and affordability of 79 approved orphan drugs based on the Compendium of China’s First List of Rare Diseases in 30 leading provincial institutions from 2017 to 2020. The availability was measured annually at 3 levels (market, hospital and drug), and affordability was reflected by comparing costs of daily defined dose with per capita income of urban and rural residents, with the National Basic Medical Insurance considered.ResultsThe market availability of orphan drugs in China showed an upward trend. As of 2020, the median hospital-level availability was 41.1% (increased by 1.5 times), highly available drugs increased by 16.5%. There were 64/74 orphan drugs that were affordable to rural/urban residents with the National Basic Medical Insurance considered (an increase of 14.1%), and the urban–rural gap of affordability ratio was narrowed (down by 6.0%). Comprehensive analysis showed the proportions of drugs with better availability and affordability in urban and rural areas by 2020 were 39.4% and 32.3%, respectively, which had increased but were still at a low level.ConclusionsChina’s national system for rare diseases has made great progress in orphan drug access, indicating that it’s been functioning under the joint reformation of medical treatment, medical insurance and medicines supply. The list of rare diseases will be updated and collaboration in networks will be enhanced to further improve the system.

Urban identity as a factor in increasing the urbanization efficiency in China

The urban identity of the migrant population in the citizenship process is a key factor in determining whether they are willing to stay in the city. This paper examines the relationship between identity and the willingness of rural migrants to stay using the Data of China Migrants Dynamic Survey. The results show a significant positive correlation between the urban identity of the agricultural transfer population and their willingness to stay, and the urban identity can increases the probability of their stay. A moderating variable, the improvement of personal skill level, however, increases the probability of rural migrants returning to their hometowns. Based on the above findings, we suggest improving the urban identity of rural migrants to promote the two-way flow of labor between urban and rural areas, which will help narrow the urban-rural gap further and promote the equalization of urban-rural identity in China.

Gravity center change of carbon emissions in Chinese residential building sector: Differences between urban and rural area

In China, dynamic spatial–temporal evolution and urban–rural gap in carbon emissions of residential building sector are crucial for understanding the current state, which is faced with great challenges related to emission mitigation. To overcome the challenge, this study employed the gravity center model to explore spatial–temporal evolution of carbon emissions and analyzed the driving factories leading the differences between urban residential buildings and rural residential buildings via decomposition analysis. Meanwhile, Tapio decoupling index is used to predict the future movement of the gravity center. Our results indicated that: (i) the carbon emissions gravity center of both residential building types tends to move south; (ii) the northeast and northwest regions play the largest role in driving the gravity center movement of urban residential buildings and rural residential buildings, respectively; (iii) per capita disposable income is the primary factors affecting the gravity center movement. (iv) the gravity center of both residential building types might tend to move westward in the future. Overall, this study attempts to remedy the current lack of research pertaining to spatial–temporal evolution laws governing carbon emissions in the Chinese residential building sector and provides a reference point for the implementation of targeted urban and rural emission reduction policies.

Research on the Influence of Economic Development Quality on Regional Employment Quality: Evidence from the Provincial Panel Data in China

Economic development plays an important role in regional employment quality. Taking provincial panel data in China during 2010–2019 as a sample, we constructed an employment quality and economic development quality indicator system. The system conducted a comprehensive evaluation model with entropy weight to measure provincial employment and economic development quality indexes. The system also applied fixed-effect panel regression models to research the influence of economic development quality on regional employment quality. The results showed that employment structure affected the regional employment quality index, followed by social security. There were regional differences in the employment quality index, among which the employment quality index in the eastern area was higher, and it was at its lowest in the western region. The sharing economy was a critical factor in economic development quality, which had significant regional heterogeneity. Economic growth had the most significant and positive influence on employment quality, followed by the sharing economy and economic structure. In addition, the consumer price index and the urban–rural gap substantially affected employment quality. However, education expenditure played a significant inhibitory role in employment quality. Economic development quality had the most significant effect on eastern employment quality, followed by the central region, and it had the least effect in the west.

A non-linear decomposition analysis of children's dietary diversity scores: explaining rural-urban inequality.

Sufficient and nourishing foods during the early years of a child’s life are essential for optimal growth and healthy life. The existing disparities among rural-urban populations also affect the dietary pattern as well. Therefore, this study aims to identify the factors that contribute towards the rural-urban disparity in children’s dietary diversity (CDD) and quantify their importance for the reduction of rural-urban disparities in achieving a minimum dietary diversity level. Using Pakistan Demographic and Health Survey (PDHS) data, version 2017-18, a non-linear decomposition analysis was performed. Eighty-one (81%) of the gap in CDD between rural-urban areas is attributed to the differences in the observed factors (endowments) and of these most of the difference is explained by three factors i.e. number of antenatal care visits (45%), maternal education (18%) and type of toilet facility (15%). There is a need to explore maternal education-related interventions to decrease the rural-urban gap regarding CDD as maternal education may affect CDD through different dimensions. Moreover, such programs should be initiated that may be helpful to enhance women’s role in society, such as skilled education, well-paid job opportunities and better health facilities.

Effectiveness of Smoking Prevention Programs on the Knowledge, Attitudes, and Anti-Smoking Exposure Self-Efficacy among Non-Smoking Rural Seventh-Grade Students in Taiwan.

The disproportionate smoking prevalence among adolescents in rural Taiwan may be attributed to insufficient anti-smoking education. Increasing access to such education may help reduce initiation and promote smoking cessation in adolescents, particularly in rural areas. However, effects of these programs require verification. This study determined the effectiveness of a school-based prevention program in enhancing knowledge, attitudes, and anti-smoking exposure self-efficacy among seventh-grade non-smoking students. A quasi-experimental design with convenience sampling was employed, where participants included seventh graders from two junior high schools who completed a questionnaire 1–2 weeks before and after the intervention. Furthermore, the intervention group received four smoking and secondhand smoke (SHS) prevention classes, whereas the control group engaged in scheduled school activities. Knowledge on smoking (B = 4.38, p < 0.001) and SHS (B = 2.35, p < 0.001) were significantly greater in the intervention group. Moreover, the groups differed significantly in avoiding SHS exposure (B = 3.03, p = 0.031). Intervention modifications may be necessary to enhance the program’s effect on smoking exposure-related attitudes and self-efficacy. Additionally, cultural and other aspects (or “urban-rural gap”) might influence these results. Future randomized controlled trials should compare urban to rural adolescents, use longitudinal designs, and assess smoking initiation or cessation.

The Construction of Civil Scientific Literacy in China from the Perspective of Science Education.

On 25 June 2021, the State Council issued the new Outline of the National Action Scheme for Scientific Literacy for All Chinese Citizens (2020–2035) (Outline of Scientific Literacy). In order to provide reference for its implementation, this study analyzes the achievements and obstacles in the implementation of the old Outline of Scientific Literacy (2006–2010-2020) based on the results of all previous surveys on civic scientific literacy (CSL) in China and from the perspective of science education. The results showed a continued steady growth in CSL, from 1.6 in 2005 to 10.56% in 2020. Specifically, male, urban, and younger adults were more likely to qualify as possessing CSL. Moreover, education level was found to be positively related to CSL. The study also found that in China, the effectiveness of formal science education has been hampered by the long-term division of the arts and sciences, examination-oriented education, the urban–rural gap, and the aging population. In terms of informal education, 37.2% of Chinese citizens visited science museums in 2020, and the Internet plays an increasing important role. Nowadays, Chinese science popularization lacks interaction, with limited opportunities for public engagement. There are deficiencies in both the country’s formal and informal science education, meaning that there is still much room for improvement in the promotion of CSL in China.

Decomposing the rural–urban gap in the prevalence of undiagnosed, untreated and under-treated hypertension among older adults in India

BackgroundAlthough awareness and treatment rates of hypertension have significantly improved in recent years, the prevalence of undiagnosed and untreated hypertension remains a major public health concern for Indian policymakers. While the urban–rural variation in the prevalence, diagnosis, control, and treatment of hypertension is reasonably well-documented, the explanation behind such variation remains poorly understood given the dearth of studies conducted on exploring the determinants of the rural–urban gap in the prevalence of undiagnosed, untreated, and uncontrolled hypertension in India. In view of this research gap, our paper aims to decompose the inter-group differences between rural and urban areas in undiagnosed, untreated, and undertreated hypertension among older adults in India into the major contributing factors.MethodsNationally representative data collected in the Longitudinal Ageing Study of India, Wave-1 (2017–18), was utilized for this study. Maximum-likelihood binary logistic-regression models were employed to capture the crude and adjusted associations between the place of residence and prevalence of undiagnosed, untreated, and undertreated hypertension. Fairlie’s decomposition technique was used to decompose the inter-group differences between rural and urban residents in the prevalence of undiagnosed, untreated, and undertreated hypertension among the older population in India, into the major contributing factors, in order to explore the pathways through which these differences manifest.ResultsThe overall prevalence rates of undiagnosed, untreated, and undertreated hypertension among older adults were 42.3%, 6%, and 18.7%, respectively. However, the prevalence of undiagnosed and untreated hypertension was higher in rural areas, by 12.4 and 1.7 percentage-points, respectively, while undertreated hypertension was more prevalent in the urban areas (by 7.2 percentage-points). The decomposition analysis explained roughly 41% and 34% of the urban advantage over rural areas in the case of undiagnosed and untreated hypertension, while it explained 51% of the urban disadvantage in respect of undertreated hypertension. The rural–urban differentials in education and comorbidities accounted for the majority of the explained rural disadvantage in the prevalence of undiagnosed hypertension, explaining 13.51% and 13.27% of the gap, respectively. The regional factor was found to be the major driver behind urban advantage in the prevalence of untreated hypertension, contributing 37.47% to the overall gap. In the case of undertreated hypertension, education, comorbidities, and tobacco consumption were the major contributors to the urban–rural inequality, which accounted for 12.3%, 10.6%, and 9.8% of the gap, respectively.ConclusionSocio-economic and lifestyle factors seemed to contribute significantly to the urban–rural gap in undiagnosed, untreated and undertreated hypertension in India among older adults. There is an urgent need of creating awareness programmes for the early identification of hypertensive cases and regular treatment, particularly in under-serviced rural India. Interventions should be made targeting specific population groups to tackle inequality in healthcare utilization.

Social health insurance consolidation and urban-rural inequality in utilization and financial risk protection in China

Universal health care is a long-term policy goal for health care reform in China. In 2016, China consolidated its urban and rural resident social health insurance programs into one program with a goal to reduce disparities between rural and urban populations. Using a nationally-representative sample of 14,967 individuals from the China Family Panel Studies surveys (2012–2018), we investigate whether the consolidation reduced gaps in total and out-of-pocket medical expenditure, and reimbursement between rural and urban residents. Our identification approach relies on an augmented difference-in-differences analysis whereby we compare the two programs that were consolidated to a different program that was not consolidated, before and after the consolidation. We find no evidence that the urban-rural gaps in these measures have narrowed as a result of the consolidation, at least in the near term. This surprising result may be partly explained by urban-rural inequality in access to care and provincial fiscal spending on health care. While these findings need to be confirmed with additional data and research, we call for continued efforts on addressing supply-side challenges, particularly in under-served areas.

Correlates of access to sanitation facilities and benefits received from the Swachh Bharat Mission in India: analysis of cross-sectional data from the 2018 National Sample Survey

ObjectiveEquitable and affordable access to improved sanitation facilities is linked to health and is among the priority areas of development programmes in a country like India. This study assesses the...

Differences in Health-Related Quality of Life and Its Associated Factors Among Older Adults in Urban and Rural Areas.

PurposeUrban-rural health disparity is one of the most prominent challenges in China today. The goal of this study is to find differences in health-related quality of life (HRQoL) and its associated factors among older people in urban and rural areas.MethodsA multi-stage stratified sampling method was conducted in Shanxi Province, with a total of 3250 older adults participated in this cross-sectional survey. HRQoL was assessed using the Chinese version of the EQ-5D-5L. Tobit regression models were employed to identify associated factors for HRQoL.ResultsThe mean EQ-5D utility score of the total sample was 0.87± 0.23, with a statistically significant difference observed between urban (0.89 ± 0.22) and rural areas (0.86 ± 0.23). Obesity (Coe=−0.10, p=0.021) and nutrition awareness (Coe=−0.14, p=0.009) were two unique associated factors to rural older adults’ HRQoL. While, age (Urban: Coe=0.13, p=0.001; Rural: Coe=−0.019, p<0.001), socioeconomic status (Urban: Coe=0.13, p<0.001; Rural: Coe=0.14, p<0.001), number of chronic non-communicable diseases (Urban: Coe=−0.20, p<0.001; Rural: Coe=−0.15, p<0.001), sleep quality (Urban: Coe=−0.22, p<0.001; Rural: Coe=0.15, p<0.001) and daytime sleepiness (Urban: Coe=−0.13, p<0.001; Rural: Coe=−0.13, p<0.001) were found to be associated with HRQoL regardless of the residential area.ConclusionThis study suggested that rural older adults are facing HRQoL disadvantages compared to those in urban area. Accordingly, more attention should be devoted to rural older adults’ HRQoL, particularly to the unique factors like body weight and nutrition awareness. Targeted policies and interventions should be implemented to improve HRQoL and bridge the urban-rural HRQoL gap.

An Analysis of Rural-Urban Learning Performance Inequality in Malawi Primary Education

The promotion of regional equity has become an important topic in Sub-Saharan Africa (SSA). In Malawi, this issue is particularly important because of facing wide regional inequalities concerning income and living standards. In the field of education, the rural-urban learning performance inequality has been a persistent issue to be addressed, but there has not been enough evidence suggesting what causes were behind rural-urban student performance inequality in Malawi. This study examines how family, teacher, school, and community factors are associated with reading scores in Malawi from two perspectives, vertical inequality and horizontal inequality. This research analyses Southern and Eastern Africa Consortium for Monitoring Educational Quality (SACMEQ) data collected in 2013 through ordinary least squares (OLS) regression and quantile regression. The results indicate that there is an obvious rural-urban gap significantly in each factor and a variation in the effect among different performance levels. One of the important findings is that the education level of school heads above senior secondary education and management training for school heads have a significant and positive relationship with student reading scores in the rural area. Thus, deploying more qualified school heads and carrying out school head training in rural might improve student outcomes. Furthermore, community involvement is positively associated with learning outcomes in urban and it may be a determinant of student achievement in Malawi. Further study about this topic should be needed to set a more sophisticated theoretical framework, use more recent data, and a time-series analysis with data long after the implementation would provide a clearer picture of the policy’s effects.

China's carbon inequality of households: Perspectives of the aging society and urban-rural gaps

To take the carbon reduction responsibility into consumption activities and reveal the discrepancy of carbon footprint (CF) among different types of households, this study investigates CF and inequality of household consumption in 25 provinces in China by calculating combing eight categories covering both direct and indirect household carbon emissions. Importantly, the aging society and urban-rural gaps are considered. The findings indicate that per capita CF varies appreciably among the different household groups, and the aged tend to generate less emission. However, the CF of a young person may not decrease as he/she ages owing to completely diverse expenditure preferences from current older people. We revealed that people living in urban regions have larger CF than those in rural regions, and the urban–rural gap promotes inequality in household CF. Furthermore, there is a correlation between the aging of population and urban-rural gaps. The young people migrate from villages to cities, leaving the elderly and children at villages. Therefore, the aging of population in rural regions is worse than that in cities, which raises the carbon inequality among households.

Educational Interventions to Promote Cervical Cancer Screening among Rural Populations: A Systematic Review.

The urban–rural gap in cervical cancer screening uptake is a significant public health consideration. Educational interventions are commonly adopted to promote cervical cancer screening among females in rural areas; however, the characteristics and effectiveness of these educational interventions remain unclear. In this review, we aimed to identify the characteristics of educational interventions used in rural populations and to evaluate the effects of these interventions on cervical cancer screening-related outcomes. Seven English databases were searched in January 2022. Randomized controlled trials (RCTs) and quasi-experimental studies were included. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Randomized Controlled Trials and the JBI Critical Appraisal Checklist for Quasi-Experimental Studies were used for quality appraisal. RevMan 5.4 software was used for the meta-analysis. A narrative synthesis was conducted in instances where a meta-analysis was inappropriate. Three RCTs and seven quasi-experimental studies conducted in six countries were included. A social cognitive theory-based framework, the community setting, group sessions, healthcare professional-led approaches, and culture-tailored materials were implemented in the educational interventions for cervical cancer screening. The educational content mainly included basic information on cervical cancer screening, psychological issues, barriers and strategies to overcome them, and locally available resources. Educational interventions increased the knowledge and uptake of cervical cancer screening in the rural population. However, the studies only evaluated the short-term effects of these educational interventions, with the cervical screening behavior only being assessed in one instance for each participant. Educational interventions promote cervical cancer screening among females in rural areas. Theory-driven, community-involved, group-based, and healthcare professional-led approaches should be prioritized in the application of educational interventions in rural populations. Both the short- and long-term, influences of educational interventions on the cervical cancer screening behavior of females in rural areas need to be recognized.

Impact of urbanisation on the gaps of hypertension prevalence, awareness and treatment among older age in China: a cross-sectional study

ObjectivesTo examine the impact of urbanisation on the prevalence, awareness and treatment of hypertension among elderly in China.DesignThis cross-sectional study used data from the most recent nationally representative Chinese Longitudinal...

Socio-economic, demographic, and environmental determinants of under-five mortality in Indonesia: insights from a national survey

Despite great improvements in childhood mortality in the past several decades, many Indonesian children did not surpass their fifth birthday. This paper investigates the social and environmental determinants of under-five (U-5) mortality in Indonesia. By utilising the most recent Indonesia Demographic and Health Survey (IDHS) in 2017, we fitted survival regression models to the data. We observed that maternal smoking (aHR = 2.15, 95% CI = 1.15–4.03), maternal age (aHR = 2.48, 95% CI = 1.43–4.30), and maternal employment status (aHR = 1.68, 95% CI = 1.34–2.11) correspond to shorter lives of U-5 children. Conversely, we found that higher maternal education (aHR = 0.50, 95% CI = 0.29–0.87) corresponds to better child survival. Improved household sanitation also negatively associated with child mortality, albeit statistically insignificant at 5% (aHR = 0.78, 95% CI = 0.60–1.01). These associations hold after we take into account proximate and biological correlates. These findings corroborate extant literature that living environment (not only socio-economic and demographic factors) plays a prominent role in determining child survival. Hence, increasing access to and reducing the rural-urban gap related to improved sanitation facilities and curtailing smoking prevalence are paramount in further curbing child mortality.

Economic inequalities and rural-urban disparities in clean cooking fuel use in Ghana

Expanding access to clean cooking fuels is an important driver of sustainable development goal (SDG) 7, which is to ensure universal access to affordable and clean energy. Ghana is among 20 countries that account for more than 80% of the global deficit in access to clean cooking fuel, despite efforts to improve uptake of clean cooking fuel over the years. Using the last three rounds of the Ghana Living Standards Survey, this study examines the trend and extent of economic inequalities, as well as the factors that account for the rural-urban disparity in the use of clean cooking fuels. We first used concentration curves and concentration indices to analyse the magnitude and trend of economic inequality. We then decomposed the rural-urban gap in the use of clean cooking fuels by applying a non-linear decomposition technique. Our results reveal that, in general, economic inequality persists across the three survey rounds. The level of inequality was higher in urban areas but relative change over time was higher in the rural sample. Also, rural-urban differences in economic status, education of the household head and ownership of television were the biggest contributors to the rural-urban gap in clean cooking fuel use. Our findings reveal the need for a more targeted approach in the design and implementation of policies to encourage the use of clean cooking fuels. Tailored strategies to reach the poor and vulnerable in rural and urban areas while scaling up access will be a step in the right direction.

Convergence characteristics and distribution patterns of residential electricity consumption in China: An urban-rural gap perspective

This paper mainly investigates the distribution patterns and convergence characteristics of per capita residential electricity consumption (PCREC) in urban and rural areas in China at the provincial level from 2000 to 2017. First, the results show significant positive spatial autocorrelation of PCREC in rural areas. In contrast, it presents insignificant spatial autocorrelation in urban areas. In addition, the distribution pattern of rural PCREC has changed dramatically, while the distribution pattern of urban areas changes more slowly than in rural areas. Second, the sigma convergence trends show that the discrete distribution level of PCREC in rural areas is higher than that in urban areas, and its sigma and absolute beta convergence rates are faster than that of urban areas. Further, the conditional variables for beta convergence indicate that population size, population density, and per capita GDP should be considered for the convergence mechanism of PCREC. In sum, our results reveal the reduction of the inequality of PCREC in China during the study period, especially in rural areas. In addition, convergence modeling indicates that PCREC converges to different equilibrium levels in urban and rural areas, which indicates the need for an urban-rural-tailored set of energy policies in China.