Large urban–rural disparity in the severity of two-week illness: updated results based on the first health service survey of Hunan Province, China
Tian et al. International Journal for Equity in Health
Large urban-rural disparity in the severity of two-week illness: updated results based on the first health service survey of Hunan Province, China
Danping Tian 0 4
Li Sun 0 3
Lingling Zhang 2
Lin Zhang 1
Wei Zhang 1
Li Li 1
Xin Deng 1
Peishan Ning 1
Xunjie Cheng 1
Jing Deng 1
Guoqing Hu 1
0 Equal contributors
1 Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University , 110 Xiangya Road, Changsha 410078 , China
2 Department of Public Health Sciences, Clemson University , Clemson, SC , USA
3 The First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
4 Department of Medical Records and Health Statistics, Hunan Children's Hospital , Changsha , China
Background: To examine urban-rural differences in the severity of non-fatal disease and injury using the latest household interview survey data of Hunan Province, China. Methods: Two-week illness data were from the first provincial health household interview survey of Hunan in 2013. The proportion of patients being bedridden, the average days of being bedridden and the average off-work days were calculated to measure the severity of two-week illness. Rao-Scott-adjusted chi-square test was performed to examine the significance of two-week illness severity differences from demographic variables. Multiple logistic regression and linear regression were used to control for sex, age and household income. Results: The two-week illness prevalence was 22.8 % in Hunan province. Despite similar two-week ill prevalence rates between urban areas and rural areas (23.0 % vs. 22.8 %), rural residents had higher proportions of being bedridden and of being off work than urban residents after controlling for sex, age and household income, with adjusted odds ratios of 3.4 and 6.9, respectively. Similarly, the average days of being bedridden and of being off work in rural residents were 0.45 days and 1.61 days longer than in urban residents after controlling for demographic variables, respectively. Conclusion: The recent data shows that two-week illness in rural residents is more serious than urban residents in Hunan Province, China in spite of very similar two-week prevalence rates. The neglected urban-rural disparities in the severity of two-week illness deserve the attention of health policy-makers and researchers.
Two-week illness; Prevalence; Urban areas; Rural areas; Severity
Background
Urban–rural health disparities are a global health concern
[
1
]. Even in the United States, large differences were
reported in average days of being bedridden and of being off
work that were caused by two-week illness between
metropolitan statistical areas [
2
]. Unfortunately, very
limited urban–rural disparity data are available regarding
urban–rural gaps in the severity of non-fatal diseases and
injuries for China, the largest low- and middle-income
country in the world, despite that the urban–rural disparity
has been documented for injury mortality [
3
], morbidity
[
4
] and hypertension prevalence [
5
].
Currently, two-week illness causes a huge number of
days of being bedridden and of being off work in China.
The first four national health service surveys of China that
were conducted in 1993, 1998, 2003 and 2008 have
revealed higher severity in two-week illness in rural
residents than in urban residents [
6, 7
]. Extensive efforts
and resources have been made to reduce the urban–rural
health differences in China during the past decade. Since
the implementation of new health reforms in 2009, the
central government of China has established the basic
medical insurance system nationwide and has initiated the
basic public health program at the community level that
covers both urban and rural residents [8]. To our
knowledge, the recent urban–rural health disparity has not
reported since the implementation of these projects in
China. Using data from the first health service survey of
Hunan Province, China that was completed in 2013, we
reported updated urban–rural disparity in the prevalence
and severity of two-week illness related to China.
Methods
Data source
Data came from the first health service interview survey
of Hunan Province, China in 2013. This survey adopted
multi-stage random sampling to include 24 282
inhabitants of 8400 households from 7 urban areas and 7 rural
areas. During August 2013, data were collected through
face-to-face household interviews by trained personnel.
This survey focused on health care need and utilization
of respondents.
The survey was organized by the Provincial Health and
Family Planning Commission of Hunan (former Health
Bureau of Hunan). A group of experts inspected the field
implementation of household interviews at all 14 sample
counties (1–2 days per county) to identify the problems in
face-to-face interviews and provide solutions.
During the survey, the interviewers explained the
purpose and confidentiality of the (...truncated)