The changes in socioeconomic inequalities and inequities in health services utilization among patients with hypertension in Pearl River Delta of China, 2015 and 2019

Background Assessing inequities in health services utilization contributes to build effective strategies for health equity promotion. This study aimed to evaluate the socioeconomic inequalities and inequities in health services utilization among hypertensive patients and explore the changes between 2015 and 2019 in Pearl River Delta of China. Methods The cross-sectional surveys were conducted using the questionnaire. Eight hundred thirty and one thousand one hundred sixty-six hypertensive patients in 2015 and 2019 were interviewed, respectively. The concentration index (CI) and the horizontal inequity index (HI) were used to access the socioeconomic inequalities and horizontal inequities in outpatient and inpatient health services use. The contribution of influential factors to the overall inequalities was estimated via the concentration index decomposition. Oaxaca-type decomposition technique was utilized to measure the changes in socioeconomic inequalities between the observation periods. Results In 2015 and 2019, the CIs for outpatient and inpatient utilization decreased from 0.1498 to 0.1198, 0.1982 to 0.1648, respectively, and the HIs for outpatient and inpatient utilization decreased from 0.1478 to 0.1078, 0.1956 to 0.1390, respectively. Economic status contributed the maximum ratio of the socioeconomic inequalities in the use of outpatient service (81.05% in 2015, 112.89% in 2019) and inpatient service (82.46% in 2015, 114.68% in 2019) in these 2 years. Oaxaca decomposition revealed that educational level (78.30% in outpatient, 53.79% in inpatient) and time to the nearest health facilities (66.78% in outpatient, 31.06% in inpatient) made the main positive contributions to decline the inequalities. While the main factor pushing the equalities toward deterioration was economic status (− 46.11% in outpatient, −76.56% in inpatient). Conclusion There were certain declines in the socioeconomic inequalities and inequities in health services utilization by hypertensive patients in Pearl River Delta of China over time. The widening economic gap was the largest contribution to the observed inequalities. Interventions to protect the vulnerable group deserve further concern from policy makers.

Decomposing Differences in Health Service Utilization between Older Rurul-to-Urban Migrant Workers and Older Rural Residents：What is Driving the Differences?

Background: In recent years, the widening gap of health service utilization between different groups in mainland China has become an important issue that cannot be avoided. Yet the related study on the health services utilization for older rural-to-urban migrant workers and comparative study on older rural-to-urban migrants in China is still in its infancy. Our study explored the health service utilization of the older rural-to-urban migrant workers based on a sinicization of the latest Andersen model, by comparison with the older rural dwellers. Further, our study revealed the facets and causes by decomposing the differences in the health service utilization into determinants.Methods: The data of China Labor-Force Dynamic Survey in 2016, the data of Urban Statistical Yearbook in 2016, and Statistical Bulletin were used. Our study applied the lasted Andersen Model according to China's currency situation. Before we studied the health service utilization, we used Coarsened Exact Matching to control the confounding factors to enhance the comparability of the two groups. The matched data were used to analyze the influencing factors. Fairlie decomposition method was used to analyze the differences and the sources of health service utilization between older rural-to-urban migrant workers and their rural counterparts.Results: After matching, the probability of two weeks outpatient of older rural-to-urban migrant workers (5.59%) was significantly lower than older rural dwellers (7.57%). The probability of inpatient of older rural migrant workers (5.59%) was significantly lower than older rural dwellers (9.07%). 17.98% of the total difference of two weeks outpatient utilization was due to the observed influence factors. 71.88% of the total difference of inpatient utilization was due to the observed influence factors. Income quantiles (49.57%), self-assessed health (80.91%), and sex ratio in the community (-102.29%) were significant in the differences of inpatient utilization.Conclusions: The findings have important implications for the difference in the health services utilization between older rural-to-urban migrant workers and older rural residents in China, urging the government to take full account of the heterogeneity. The results provide references for the healthcare policy reform in the process of active ageing in China.

Predicting 5- and 10-Year Mortality Risk in Older Adults with Diabetes Mellitus

<b>OBJECTIVE: </b>Several diabetes clinical practice guidelines suggest that treatment goals may be modified in older adults based on comorbidities, complications and life expectancy. The long-term benefits of treatment intensification may not outweigh short-term risks for patients with limited life expectancy. Due to the uncertainty of determining life expectancy for individual patients, we sought to develop and validate prognostic indices for mortality in older adults with diabetes. <p><b>RESEARCH DESIGN AND METHODS: </b>We used a prevalence sample of Veterans with diabetes who were aged ≥65 years on January 1, 2006 (n=275,190). Administrative data were queried for potential predictors that included patient demographics, comorbidities and procedure codes, lab values and anthropomorphic measurements, medication history, and previous health services utilization. Logistic least absolute shrinkage and selection operator (LASSO) regressions were employed to identify variables independently associated with mortality. The resulting odds ratios were then weighted to create prognostic indices of mortality over 5 and 10 years. </p> <p><b>RESULTS: </b>Thirty-three predictors of mortality were identified: four demographic variables, prescriptions for insulin or sulfonylureas, five biomarkers, previous outpatient and inpatient utilization, and twenty comorbidities/procedures. The prognostic indices showed good discrimination, with c-statistics of 0.74 and 0.76 for 5 and 10-year mortality, respectively. The indices also demonstrated excellent agreement between observed outcome and predictions, with calibration slopes of 1.01 for both 5 and 10-year mortality.</p> <p><b>CONCLUSIONS: </b>Prognostic indices obtained from administrative data can predict 5- and 10-year mortality in older adults with diabetes. Such a tool may enable clinicians and patients to develop individualized treatment goals that balance risks and benefits of treatment intensification. </p>