Large urban–rural disparity in the severity of two-week illness: updated results based on the first health service survey of Hunan Province, China

International Journal for Equity in Health, Feb 2016

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.

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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)


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Danping Tian, Li Sun, Lingling Zhang, Lin Zhang, Wei Zhang, Li Li, Xin Deng, Peishan Ning, Xunjie Cheng, Jing Deng, Guoqing Hu. Large urban–rural disparity in the severity of two-week illness: updated results based on the first health service survey of Hunan Province, China, International Journal for Equity in Health, 2016, pp. 37, 15, DOI: 10.1186/s12939-016-0330-z