Education-related gender differences in health in rural China

Long-term effects of the left-behind experience on health and its mechanisms: Empirical evidence from China

Previous studies have primarily focused on the contemporaneous, short-term and medium-term effects of the childhood left-behind experience on subsequent health, but ignored its long-term effects and the mediating mechanisms of health outcomes. Using nationally representative data from the 2018 China Labor-force Dynamic Survey, this study uses self-rated health as a measure of health outcomes to examine the long-term effects of the left-behind experience and elucidate the underlying mechanisms that contribute to health inequality from a life-course perspective. The results show: (1) the childhood left-behind experience exerts a long-term negative impact on self-rated health in adulthood, and this impact persists and does not fade over time after ending the left-behind status; (2) the influence of the childhood left-behind experience on self-rated health demonstrates a cumulative disadvantage effect, with longer duration of being left-behind resulting in greater negative impacts; additionally, there's a critical window effect, with earlier left-behind experience leading to more significant negative outcomes; (3) the experience of being left behind during childhood has a negative impact and threshold effect on social trust in adulthood, meaning that the left-behind experience negatively affects social trust, but the duration of being left behind doesn't exacerbate this reduction; and (4) social trust is a key mediating factor between left-behind experiences and health, explaining 8.70% of this effect, and explaining 12.15% and 7.71% of mediation effects for adults with left-behind experience in middle and primary school stages, respectively.

A dose-response association of night sleep duration with hypertension in a Chinese rural population: the Henan Rural Cohort Study

The purpose of the study was to determine if there was a relationship between night sleep duration and hypertension, and to evaluate as to whether blood lipid levels played a role in this relationship. A total of 37,317 participants aged 18-79 years were included in this study. Night sleep duration was classified as <5, 5-, 6-, 7-, 8-, 9-, and ≥10 hours. Logistic regression and restricted cubic spline analysis was carried out to evaluate the association of sleep duration with hypertension. Compared with reference sleep duration (7 hours), in males, the multivariate odds ratios (ORs) (95% confidence interval [95% CI]) of the groups with longest sleep duration (≥10 hours) and shortest sleep duration (<5 hours) for hypertension was 1.52 (1.25-1.84) and 1.07 (0.80-1.44), respectively. Similarly, the longest sleep duration was associated with diagnosed hypertension (1.21, 1.00-1.45) in females. The OR for an indirect effect of sleep duration through low-density lipoprotein cholesterol (LDL-C) on hypertension was 1.085 (95% CI 1.038-1.137). Overall, a 3.5% possibility of hypertension being associated with sleep duration was attributable to LDL-C. In summary, a relationship between sleep duration and hypertension was observed in this rural population. LDL-C appeared to partially mediate the effect of sleep duration on hypertension in males.

Incorporating biomarkers into the study of socio-economic status and health among older adults in China

The social gradient in health - that individuals with lower SES have worse health than those with higher SES- is welldocumented using self-reports of health in more developed countries. Less is known about the relationship between SES and health biomarkers among older adults residing in less developed countries. We use data from the ChineseLongitudinal Healthy Longevity Survey (CLHLS) longevity areas sub-sample to examine the social gradient in healthamong rural young-old and oldest-old adults (N=2,121). Our health indicators include individual biomarkers, metabolic syndrome, and self-reports of health. We found a largely positive relationship between SES and health. SES was more consistently associated with individual biomarkers among the oldest-old than the young-old, providing evidence for cumulative disadvantage. We discuss the implications of our findings for older adults who have lived through different social, economic, and health regimes.

Epidemiology of self-rated health in rural China: a population-based cross-sectional study

Self-rated health (SRH) has been shown to be a good predictor of mortality. Data on SRH and its associated factors in the Chinese general population are limited. This study aims to assess the epidemiology of SRH in rural Anyang, China. SRH (categorized as "healthy", "fair" or "unhealthy") was measured in a population-based study of 2,814 adults (including 697 couples) aged 25 to 69 who were recruited from rural Anyang in 2014. Of 2,814 subjects, 63.1% rated their health as "healthy", whereas 28.1% and 8.8% rated their health as "fair" and "unhealthy". Compared to males, females had a higher likelihood of reporting a better SRH. Health ratings declined with increasing age, unmarried status, lower education levels. Poor SRH was positively correlated with medical history as well as high levels of fasting plasma glucose and total cholesterol, but not with unhealthy lifestyle indicators including smoking, drinking, and obesity. High household income was predictive of better SRH in men but not in women. Among couples, a positive spousal SRH concordance was observed, although the strength of this concordance was low. These findings will be useful for formulation of appropriate strategies for improving risk perception and promoting general health in economically developing regions.

The influence of individual socioeconomic status on the clinical outcomes in ischemic stroke patients with different neighborhood status in Shanghai, China

Objective: Socioeconomic status (SES) is being recognized as an important factor in both social and medical problems. The aim of present study is to examine the relationship between SES and ischemic stroke and investigate whether SES is a predictor of clinical outcomes among patients with different neighborhood status from Shanghai, China. Methods: A total of 471 first-ever ischemic stroke patients aged 18-80 years were enrolled in this retrospective study. The personal SES of each patient was evaluated using a summed score derived from his or her educational level, household income, occupation, and medical reimbursement rate. Clinical adverse events and all-cause mortality were analyzed to determine whether SES was a prognostic factor, its prognostic impact was then assessed based on different neighborhood status using multivariable Cox proportional hazard models after adjusting for other covariates. Results: The individual SES showed a significant positive correlation with neighborhood status (r = 0.370; P < 0.001). The incidence of clinical adverse events and mortality were significantly higher in low SES patients compared with middle and high SES patients (P = 0.001 and P = 0.037, respectively). After adjusting other risk factors and neighborhood status, Kaplan-Meier analysis showed clinical adverse events and deaths were still higher in the low SES patients (all P < 0.05). Multivariate Cox regression analysis demonstrated that both personal SES and neighborhood status are independent prognostic factors for ischemic stroke (all P < 0.05). Besides, among patients with low and middle neighborhood status, lower individual SES was significantly associated with clinical adverse events and mortality (all P < 0.05). Conclusion: Both individual SES and neighborhood status are significantly associated with the prognosis after ischemic stroke. A lower personal SES as well as poorer neighborhood status may significantly increase risk for adverse clinical outcomes among ischemic stroke patients.

Landless female peasants living in resettlement residential areas in China have poorer quality of life than males: results from a household study in the Yangtze River Delta region

Background

Urbanization has accelerated in China, and a large amount of arable land has been transformed into urban land. Moreover, the number of landless peasants has continually increased. Peasants lose not only their land, but also a series of rights and interests related with land. The problems of landless peasants have been long-standing; however, only a few studies have examined their health or quality of life (QOL). This paper assesses the QOL of landless peasants in the Yangtze River Delta (YRD) region, analyzes gender differences, and explores health inequity.

Methods

Data are derived from household samples in six resettlement residential areas of three cities (Nanjing, Hangzhou, and Yangzhou) in the YRD region (N = 1,500; the effective rate = 82.4%). This study uses the short version of World Health Organization Quality of Life questionnaire (WHOQOL-BREF) scale to measure the QOL of landless peasants, and performs confirmatory factor analysis (CFA) and analyze gender differences in QOL on the basis of CFA.

Results and conclusion

First, we use Analysis of Variance and Non-parametric Tests to test if the differences of mean value of testing generals have statistical significances. Results shows significant differences occur between the impacts of different genders on the four domains of QOL (physical health, psychological health, social relationships, and environment). The internal reliability of the WHOQOL-BREF scale is good (Cronbach’s alpha > 0.8), and the four domains of QOL are connected with each other. Second, scores in each QOL domain are commonly low, whereas the scores of females are much lower, indicating a poorer QOL than that of males. Third, results of the CFA of the QOL domains and their related observed variables indicate a good model fit. Fourth, results imply that the order of importance of the four domains (psychological health (males = 26.74%, females = 27.17%); social relationships (males = 26.23%, females = 25.35%); environment (males = 25.70%, females = 24.40%); and physical health (males = 21.33%, females = 23.08%)) affecting QOL from high to low is the same for landless male and female peasants, whereas the proportion of importance is different between genders. The results highlight the importance of government intervention to improve the QOL of Chinese landless peasants, ultimately reducing health inequity.

Multilevel analysis of the determinants of smoking and second-hand smoke exposure in a tobacco-cultivating rural area of southwest China

OBJECTIVES

To examine contextual and individual demographical predictors of smoking and exposure to second-hand smoke (SHS) in a tobacco-cultivating rural area of southwest China.

METHODS

A cross-sectional survey of 4070 consenting individuals aged 18 years or more was conducted in 2010. Information on demographical characteristics, tobacco smoking status and SHS exposure were obtained by a standard questionnaire. Multilevel logistic regression was used to model the variation in prevalence of smoking and SHS exposure.

RESULTS

In the study population, the prevalence rates of smoking and exposure to SHS were 63.5% and 74.7% for men, and 0.6% and 71.2% for women, respectively. Men were more likely to use tobacco than women: OR 8.27, 95% CI (4.83 to 10.97). Age was inversely associated with the probability of tobacco use (OR 0.98, 95% CI 0.97 to 0.99), and exposure to SHS (OR 0.97, 95% CI 0.96 to 0.99). Individual educational level was inversely associated with smoking, but showed no association with exposure to SHS. Adults who did not grow tobacco were less likely to consume tobacco (OR 0.75, 95% CI 0.57 to 0.99) and to be exposed to SHS (OR 0.76, 95% CI 0.58 to 0.99). Living in a high-income community was associated with a low rate of current smoking (OR 0.66, 95% CI 0.57 to 0.77) and SHS exposure (OR 0.58, 95% CI 0.52 to 0.65).

CONCLUSIONS

Future interventions to reduce smoking and exposure to SHS in China should focus more on tobacco farmers, less-educated individuals and on poor rural communities.

Lower socioeconomic status is associated with worse outcomes in pulmonary arterial hypertension

RATIONALE

Lower socioeconomic status (SES) confers a heightened risk of common cardiovascular and pulmonary diseases and increased mortality. The association of SES with outcomes in patients with pulmonary arterial hypertension (PAH) is less clear.

OBJECTIVES

To determine the association between SES and outcomes in patients with PAH.

METHODS

We performed a prospective cohort study at a national referral center for patients with PAH in China. Two hundred sixty-two consecutive incident patients aged 18 to 65 years with a diagnosis of idiopathic PAH were recruited between January 2007 and June 2011 and followed up until November 2011. The primary endpoint was all-cause mortality. An SES score for each patient was derived from their educational level, annual household income, occupation, and medical reimbursement rate.

MEASUREMENTS AND MAIN RESULTS

Patients with a lower SES had higher unadjusted mortality rates, with 3-year survival estimates of 50.1, 70.8, and 86.0% in increasing tertiles of SES (P for trend < 0.001). After adjustment for clinical features, hemodynamics, and type of PAH treatment, the hazard ratios for death were 2.98 (95% confidence interval, 1.51-5.89) in the lowest tertile of SES and 1.80 (95% confidence interval, 0.89-3.63) in the middle tertile of SES compared with the upper tertile (P for trend = 0.006).

CONCLUSIONS

A lower SES is strongly associated with a higher risk of death in idiopathic PAH. This association was independent of clinical characteristics, hemodynamics, and treatment. Addressing the health disparities associated with a lower SES may improve the outcomes of patients with PAH.

Incidence and correlates of receiving cigarettes as gifts and selecting preferred brand because it was gifted: findings from the ITC China Survey

Background

Giving cigarettes as gifts is a common practice in China, but there have been few systematic studies of this practice. The present study was designed to estimate the incidence of receiving cigarettes as gifts, correlates of this practice, and its impact on brand selection in a representative sample of urban adult smokers in China.

Methods

Data were analyzed from Wave 2 of the International Tobacco Control (ITC) China Survey, where 4843 adult urban smokers were interviewed in six major Chinese cities between October 2007 and January 2008. The incidence of most recent cigarette acquisition due to gifting and the prevalence of preferred brand selection due to having received it as a gift were estimated. Bivariate and adjusted logistic regression models were estimated to identify factors associated with these two outcomes.

Results

The incidence of receiving cigarettes as a gift at most recent cigarette acquisition was 3.5%. Smokers who received these gifted cigarettes were more likely to be female, older, have higher educational attainment, live in Beijing, and smoke fewer cigarettes per day. The prevalence of choosing one’s preferred brand due to having received it as a gift was 7.0%, and this was more likely among smokers who lived in Beijing and Guangzhou, had lower educational attainment, smoked less frequently, and had smoked their preferred brand for less than one year.

Conclusions

The 3.5% incidence of one’s most recent cigarette acquisition due to gifting is consistent with prevalence estimates based on longer reference periods and translates into the average smoker receiving a gift of cigarettes approximately five times a year. Gifting also appears to have a significant influence on brand preference. Tobacco control interventions in China may need to denormalize the practice of giving cigarettes as gifts in order to decrease the social acceptability of smoking.

Patterns and socioeconomic influences of tobacco exposure in tobacco cultivating rural areas of Yunnan Province, China

Background

This study describes the patterns and socioeconomic influences of tobacco use among adults in tobacco-cultivating regions of rural southwest China.

Methods

A cross-sectional survey was conducted in 8681 adults aged ≥18 years in rural areas of Yunnan Province, China from 2010 to 2011. A standardized questionnaire was administered to obtain data about participants’ demographic characteristics, individual socioeconomic status, ethnicity, self-reported smoking habits, and exposure to secondhand smoke (SHS). The socioeconomic predictors of current smoking, nicotine addiction, and SHS exposure were analyzed using multivariate logistic regression.

Results

The prevalence rates of tobacco use were much higher in men compared with women (current smoking 68.5% vs. 1.3%; and nicotine dependence 85.2% vs. 72.7%). However, the rate of SHS exposure was higher in women compared with men (76.6% vs. 70.5%). Tobacco farmers had higher prevalence rates of current smoking, nicotine dependence, and SHS exposure compared with participants not engaged in tobacco farming (P<0.01). Most tobacco users (84.5%) reported initiating smoking during adolescence. A total of 81.1% of smokers smoked in public places, and 77.6% smoked in workplaces. Individuals belonging to an ethnic minority had a lower probability of SHS exposure and nicotine dependence. Individual educational level was found to be inversely associated with the prevalence of current smoking, exposure to SHS, and nicotine dependence. Higher annual household income was associated with a greater risk of nicotine dependence.

Conclusions

This study suggests that tobacco control efforts in rural southwest China must be tailored to address tobacco-cultivating status and socioeconomic factors.

Short sleep duration is associated with hypertension risk among adults: a systematic review and meta-analysis

A number of studies have reported that sleep duration might have an important role in the development of hypertension. However, the results have been inconsistent. In this study, a meta-analysis was performed to clarify the association between sleep duration and hypertension risk. PubMed, Embase and ISI web of science databases updated on 28 October 2011 were searched for eligible publications. Pooled odds ratio (OR) or relative risk (RR) with 95% confidence intervals (CI) was calculated using a random- or fixed-effect model. Six prospective (N=9959) and seventeen cross-sectional (N=105432) studies were identified for the data analysis on sleep duration. The results indicated that short sleep duration was associated with an increased risk of prevalent hypertension (OR=1.20, 95% CI: 1.09-1.32, P<0.001), especially among subjects younger than 65 years and females. In addition, short sleep duration was also associated with an increased risk of incident hypertension among subjects younger than 65 years (RR=1.33, 95% CI: 1.11-1.61, P=0.002). Overall, there was a significant association between long sleep duration and the risk of prevalent hypertension (OR=1.11, 95% CI: 1.05-1.17, P<0.001). Further subgroup analysis also suggested a significant association between long sleep duration and the risk of prevalent hypertension among subjects younger than 65 years (OR=1.12, 95% CI: 1.06-1.19, P<0.001). The present meta-analysis indicated that short sleep duration was associated with an increased risk of hypertension in the overall polulation and incident hypertension among subjects younger than 65 years. In addition, long sleep duration might be associated with a risk of prevalent hypertension, especially among subjects younger than 65 years.

Income-related health inequalities across regions in Korea

Introduction

In addition to economic inequalities, there has been growing concern over socioeconomic inequalities in health across income levels and/or regions. This study measures income-related health inequalities within and between regions and assesses the possibility of convergence of socioeconomic inequalities in health as regional incomes converge.

Methods

We considered a total of 45,233 subjects (≥ 19 years) drawn from the four waves of the Korean National Health and Nutrition Examination Survey (KNHANES). We considered true health as a latent variable following a lognormal distribution. We obtained ill-health scores by matching self-rated health (SRH) to its distribution and used the Gini Coefficient (GC) and an income-related ill-health Concentration Index (CI) to examine inequalities in income and health, respectively.

Results

The GC estimates were 0.3763 and 0.0657 for overall and spatial inequalities, respectively. The overall CI was -0.1309, and the spatial CI was -0.0473. The spatial GC and CI estimates were smaller than their counterparts, indicating substantial inequalities in income (from 0.3199 in Daejeon to 0.4233 Chungnam) and income-related health inequalities (from -0.1596 in Jeju and -0.0844 in Ulsan) within regions.

The results indicate a positive relationship between the GC and the average ill-health and a negative relationship between the CI and the average ill-health. Those regions with a low level of health tended to show an unequal distribution of income and health. In addition, there was a negative relationship between the GC and the CI, that is, the larger the income inequalities, the larger the health inequalities were. The GC was negatively related to the average regional income, indicating that an increase in a region's average income reduced income inequalities in the region. On the other hand, the CI showed a positive relationship, indicating that an increase in a region's average income reduced health inequalities in the region.

Conclusion

The results suggest that reducing health inequalities across regions require a more equitable distribution of income and a higher level of average income and that the higher the region's average income, the smaller its health inequalities are.

Gender-specific association of sleep duration with blood pressure in rural Chinese adults

BACKGROUND

There are limited data about the role of gender on the relationship between sleep duration and blood pressure (BP) from rural populations.

METHODS

We conducted a cross-sectional rural population-based study. This report includes 1033 men and 783 women aged 18-65 years from a cohort of twins enrolled in Anhui, China, between 2005 and 2008. Sleep duration was derived from typical bedtime, wake-up time, and sleep latency as reported on a standard sleep questionnaire. Primary outcomes included measured systolic blood pressure (SBP) and diastolic blood pressure (DBP). High blood pressure (HBP) was defined as SBP ⩾130 mmHg, DBP ⩾85 mmHg, or physician diagnosed hypertension. Linear and logistic regression models were used to assess gender-specific associations between sleep duration and BP or HBP, respectively, with adjustment for known risk factors including adiposity and sleep-related disorder risk from the questionnaires. Generalized estimating equations were used to account for intra-twin pair correlations.

RESULTS

Compared with those sleeping 7 to <9h, women sleeping <7h had a higher risk of HBP (odds ratios [ORs] 3.0, 95% confidence interval [CI], 1.4-6.6); men sleeping ⩾9h had a higher risk of HBP (ORs=1.5, 95%CI: 1.1-2.2).

CONCLUSIONS

Among rural Chinese adults, a gender-specific association of sleep duration with BP exists such that HBP is associated with short sleep duration in women and long sleep duration in men. Longitudinal studies are needed to further examine the temporal relationship and biological mechanisms underlying sleep duration and BP in this population. Our findings underscore the potential importance of appropriate sleep duration for optimal blood pressure.

Social Change and Socioeconomic Disparities in Health over the Life Course in China: A Cohort Analysis

This article examines social stratification in individual health trajectories for multiple cohorts in the context of China's dramatically changing macro-social environment. Using data from the China Health and Nutrition Survey, we find significant socioeconomic status (SES) differences in the mean level of health and that these SES differentials generally diverge over the life course. We also find strong cohort variations in SES disparities in the mean levels of health and health trajectories. The effect of education on health slightly decreases across successive cohorts. By contrast, the income gap in health trajectories diverges for earlier cohorts but converges for most recent cohorts. Both effects are more pronounced in rural areas. Given that these cohort effects are opposite those reported in recent U.S. studies, we discuss China's unique social, economic, and political settings. We highlight the association between SES and health behaviors, China's stage of epidemiologic transition, and the changing power of the state government and its implications for health care.

Income-Related Health Inequalities in Korea

Data from the 2001 Korean National Health and Nutrition Examination Survey and the ill health concentration index (CI) were used to examine income-related health inequalities among Koreans. Participants (>19 years old) were requested to provide information regarding monthly household income, expenditures, subjective living conditions, and health status. Ill health was determined both subjectively through self-rated health (SRH) scores and objectively through the number of diseases (ND). At the individual level, the CIs for SRH and ND were -0.147 and -0.093, respectively; age—gender adjusted CIs were -0.065 and -0.071, respectively. These values remained unchanged when estimating CI for grouped data. These results indicate that ill health was more pronounced among lower income groups in Korea. However, avoidable health inequality in Korea was smaller than in the United Kingdom and the United States, larger than in Sweden, Eastern Germany, Finland, and Western Germany, and roughly equal to the Netherlands, Spain, and Switzerland.

Changing health status and health expectancies among older adults in China: gender differences from 1992 to 2002

Numerous studies document improvements in health status and health expectancies among older adults over time. However, most evidence is from developed nations and gender differences in health trends are often inconsistent. It remains unknown whether changes in health in developing countries resemble Western trends or whether patterns of health improvement are unique to the country's epidemiologic transition and gender norms. Using two nationally representative samples of non-institutionalized adults in China aged 65 years and older, this study investigates gender differences in the improvements in disability, chronic disease prevalence, and self-rated health from 1992 to 2002. Results from multivariate logistic regression models show that all three indicators of health improved over the 10-year period, with the largest improvement in self-rated health. With the exception of disability, the health of women improved more than men. Using Sullivan's decomposition methods, we also show that active life expectancy, disease-free life expectancy, and healthy life expectancy increased over this decade and were patterned differently according to gender. Overall, the findings demonstrate that China experienced broad health improvements during its early stages of the epidemiologic transition and that these changes were not uniform by gender. We discuss the public health implications of the findings in the context of China's rapidly aging population.

Differences between women's and men's socioeconomic inequalities in health: longitudinal analysis of the Canadian population, 1994-2003

BACKGROUND

Socioeconomic inequalities in health are ubiquitous in developed countries; however, whether these inequalities differ between women and men over time is less clear.

OBJECTIVE

To estimate the potentially different health effects of changes in socioeconomic position (SEP) on changes in health for working-age women and men over a 10-year period. Three main questions were addressed: (1) are there health differences between women and men over time, (2) do changes in SEP lead to health inequalities and (3) do changes in SEP impact health differently for women and men?

METHODS

Generalised estimating equations models were used to analyse cycles 1-5 of the Canadian National Population Health Survey for four measures of health, number of chronic conditions, self-rated health, functional health and mental distress, and three measures of SEP, income, education and employment status.

RESULTS

Health inequalities by sex/gender and by changes in SEP were present for all four outcomes in age-adjusted models; however, after controlling for time-dependent social structure, behaviour, and psychosocial factors the relationships persisted only for chronic conditions and psychological distress. There was no evidence that these effects differed, over time, between women and men.

CONCLUSIONS

Men and women in this nationally representative sample of Canadians do not differentially embody changes in SEP, although both sex/gender and changes in SEP independently impact health.

Association of education and the occurrence of low birthweight in rural southern China during the early and late 1990s

OBJECTIVES

We examined whether education-related inequalities were associated with the occurrence of low birthweight in 6 counties in southern China in the early and late 1990s.

METHODS

The study population consisted of 111,181 women (65,669 in the early 1990s and 45,482 in the late 1990s) in a population-based Perinatal Health Care Surveillance System. We used the chi(2) test, logistic regression, and concentration index for our analyses.

RESULTS

From the early to late 1990s, the mean maternal education level increased significantly, and the percentage of low-birthweight births declined among all groups, for both male and female births, and at all levels of the mother's education. Relative to those with less than 9 years of formal education, there was a decreasing risk of low birthweight among those with 9 to 11 years of formal education (range in adjusted odds ratio=0.69-0.82) and with 12 or more years of formal education (range in adjusted odds ratio=0.51-0.74). Between the early and late 1990s, the concentration index changed from -0.0778 to -0.0656 for male births and from -0.0717 to -0.0813 for female births.

CONCLUSIONS

Education-related inequalities associated with low birthweight persisted from the early to the late 1990s in surveyed areas.

Rural and Urban Disparity in Health Services Utilization in China

OBJECTIVES

To describe patterns in physician and hospital utilization among rural and urban populations in China and to determine factors associated with any differences.

METHODS

In 2003, the Third National Health Services Survey in China was conducted to collect information about health services utilization from randomly selected residents. Of the 193,689 respondents to the survey (response rate, 77.8%), 6429 urban and 16,044 rural respondents who were age 18 or older and reported an illness within the last 2 weeks before the survey were analyzed. Generalized estimating equations with a log link were used to assess the relationship between rural/urban residence and physician visit/hospitalization to adjust for respondents clustered at the household level.

RESULTS

About half of respondents did not see a physician when they were ill. Rural respondents used physicians more than urban respondents (52.0% vs. 43.0%, P < 0.001) and used hospitals less (7.6% vs. 11.1%, P < 0.001). Factor associated with increased physician utilization included residing in rural areas among majority Chinese (ie, Han) [rate ratio (RR), 1.21; 95% confidence interval (95% CI), 1.16-1.26], residing <3 km away from the medical center (RR, 1.16; 95% CI, 1.12-1.21), or being uninsured (RR, 1.38; 95% CI, 1.30-1.46). Rural minority Chinese visited physicians significantly less than urban minority Chinese (RR, 0.90; 95% CI, 0.83-0.98). Hospital utilization was significantly lower among rural males (RR, 0.84; 95% CI, 0.72-0.98), rural seniors (age, > or =65; RR, 0.64; 95% CI, 0.53-0.77), rural respondents with low education (RR, 0.70; 95% CI, 0.57-0.86 for illiterate), or rural insured respondents (RR, 0.86; 95% CI, 0.69-0.99) than hospitalization among urban counterparts.

CONCLUSIONS

Three national approaches should be considered in reforming the healthcare system in China: universal insurance coverage, higher amounts of insurance coverage, and increasing the population's level of education. In addition, access issues in remote areas and by rural minority Chinese population should be addressed.

Gender power and marital relationship as predictors of sexual dysfunction and sexual satisfaction among young married couples in rural China: a population-based study

OBJECTIVES

To investigate associations between gender relationships and sexual dysfunction (SD) of younger married couples living in rural China.

METHODS

An anonymous cross-sectional population-based survey study was conducted in a rural area in Hunan, China. A random sample of 298 couples were recruited. Self-reported SD, sexual satisfaction, and variables related to gender power and marital relationship were measured.

RESULTS

Of the respondents, 28.2% and 45.6% of the husbands and wives were having at least one of the studied SDs, respectively. The results of the multivariate analyses showed that husbands not reporting a quality marital relationship (odds ratio [OR] 4.27, 95% confidence interval [CI] 2.13 to 8.57), who mistrusted their wives (OR 9.14, 95% CI 4.22 to 19.78), who claimed themselves as the decision-maker regarding condom use (OR 2.41, 95% CI 1.20 to 4.85), and whose wife scored lower in the relationship control subscale of the sexual relationship power scale (OR 2.83, 95% CI 1.15 to 6.95) were more likely than other husbands to have at least one SD. Wives who were not trusted by their husbands (OR 2.94, 95% CI 1.39 to 6.25), whose husbands were more powerful than they were in general decision-making (OR 1.98, 95% CI 1.14 to 3.43), and who scored lower in the relationship control subscale (OR 3.77, 95% CI 1.65 to 8.62) were more likely than other wives to have at least one SD.

CONCLUSIONS

Gender relationships, including the quality of the marital relationship, mutual trust, decision-making, and relationship control, were significantly associated with SD. Gender inequality has been observed and needs to be taken into account in promoting sexual health among married couples living in rural China.