Analysis Of Socioeconomic Status-related Health Equity In Different Regions

Objective:To understand the healthy distribution and the health equity among different socioeconomic status groups from asurvey of east, central and western areas in China, and quantify the contributions of determinants to theself-assessed health(SAH) inequality, providing the evidence-based and policy recommendations for narrowing health inequalities and achieving health equity. Methods:Data were taken from household surveyconducted the comprehensive reform of primary health in 2014, asked two-week illness, chronic illness and self-assessed health, including eastern Shaoxing, Zhejiang, Zhenjiang,Jiangsu, Central Wuhu,Anhui, Xiangtan,Hunan, westernXining,Qinghai, Chifeng,Inner Mongolia in 12 districts of 6 provinces.Indirect standardization and concentration index(CI) was calculated as a measure of income-related, education-related, occupation-related health inequalities and inequitiesamong different socioeconomic status groups, in urban and rural areas, east, central and western areas.Contributions of each determinant to income-related self-assessed health inequalities were evaluated using a decomposition method. Results:1.The two-week prevalence rate of urban residents, the uneducated and tertiary or higher education groups were 47.1% and 11.5%, unemployed and excellentoccupation groups were 39.3% and 28.5%. Rural residents and the eastern, central and western residents have a similar trend that the two-week prevalence rate is relatively higher withing low education levels and vulnerable occupations.2.Prevalence of chronic diseases in central residents, the poorest and the richest were 27.4% and 24.8%, the uneducated and tertiary or higher education groups were 43.2% and 9.8%, unemployed and excellent occupation groups were 37.0% and 33.9%.3.The rate of self-assessed health good, the poorest and the richest were 69.2% and 79.8%, the uneducated and tertiary or higher education groups were 49.1% and 90.9%, unemployed and excellent occupation groups were 58.9% and 70.6%.4.The two-week illness standardized concentration index absolute value is less than 0.01, except when based on occupation,the city and central area was-0.0135 and-0.0179.5.Eastern, central, western residents’ standardized concentration index of chronic diseases, while income-based, respectively was 0.0268,0.0161,0.0486; while education-based, respectively was-0.0753,-0.0226,-0.0543; while occupation-based, respectively was-0.0328,-0.0127,-0.0491. The absolute standardized concentration index of chronic diseases of central is less than that of east and west.6.Standardized concentration index income-related, education-related, occupation-related of self-assessed health good, city respectively was 0.0227, 0.0254, 0.0180, corresponding smaller than the rural 0.0325,0.0385,0.0334.7.Decomposition of income-related self-assessed health inequalities revealed that contribution rate of age-sex group(15.1%), income status(43.1%), educational status(14.7%), type of occupation(0.6%), rural/urban areas(3.8%), region of residence(23.6%). Conclusions:1.Whether urban, rural, or eastern, central and western, the existence of health inequalities reflected that the higher socioeconomic status population, the better health, relatively.2.Equity of the two-week illness was relatively good.Chronic diseases was inequity in the pro-rich, pro-low edcation, pro-vulnerable occupations, equity of central is better than that of east and west. Self-assessed health good was inequity in the pro-rich, pro-high edcation, pro- excellent occupations, equity of urban is better than that of rural.3.The findings indicate that income and region factors played a most important role on widening the self-assessed health inequalities. Improving income distribution, narrowing the gap of development between regions, promoting education fairness and accelerating the integration of urban and rural areas are effective to reduce health inequalities.