Structural Determinants of Child Health in Rural China: The Challenge of Creating Health Equity

Wealth gradients in healthy aging: evidence from the 2011 and 2013 waves of the China Health and Retirement Longitudinal Study

BACKGROUND

It is crucial to understand how individuals accumulate wealth over their lifespan and explain the relation with the changes in health by age cohort. This study examines wealth-to-health causality as an explanation for the health-wealth gradient.

METHODS

Using the 2011 and 2013 waves of individuals aged 45 and above from the China Health and Retirement Longitudinal Study, this study tests for causality by employing various econometric models and statistical strategies, conducting longitudinal and cross-sectional data analyses. The validity of the causal mechanisms is assessed by comparing the fitting results from different models.

RESULTS

The fixed effects model reveals that a 1% increase in wealth results in a statistically significant decrease in the constructed health index by approximately 0.00032 units, at a 1% significance level. Similarly, in the instrumental variables model, the coefficient for wealth is -0.229 and is also significant at the 1% level. The results for other control variables, such as demographic, socioeconomic status, geographical, and childhood health status, remain stable and align with expectations across different models.

CONCLUSION

This study demonstrates a causal relationship between wealth and health, with permanent income as a key determinant. It highlights the need for poverty alleviation policies that promote long-term wealth accumulation, strengthen social welfare, and consider the indirect health effects of economic and environmental reforms.

Urban-Suburban Differences in Public Perspectives on Digitalizing Pediatric Research: Cross-Sectional Survey Study

BACKGROUND

Recruiting and retaining participants in pediatric research has always been challenging, particularly in healthy populations and remote areas, leading to selection bias and increased health disparities. In the digital age, medical research has been transformed by digital tools, offering new opportunities to enhance engagement in clinical research. However, public perspectives on digitalizing pediatric research and potential differences between urban and suburban areas remain unclear.

OBJECTIVE

This study aimed to investigate public perspectives on digitalizing pediatric research and compare differences between urban and suburban areas to help diversify participants and address health disparities.

METHODS

A cross-sectional web-based survey targeting caregivers of kindergarten children (aged 2-7 years) in Chongqing was conducted between June and December 2023. A total of 4231 valid questionnaires were analyzed, with 25.1% (n=1064) of the children residing in urban areas and 74.9% (n=3167) in suburban areas. Descriptive statistics and intergroup comparisons were used for data analysis.

RESULTS

Approximately 59.8% (n=2531) of the caregivers had first impressions of pediatric research, with 36.9% (n=1561) being positive and 22.9% (n=970) being negative. A total of 38.3% (n=1621) of caregivers recognized the growing popularity of digital tools, and 36.7% (n=1552) supported their use in pediatric research, but only 25.2% (n=1068) favored online-only research methods. The main concerns regarding the use of software in pediatric research were privacy issues (n=3273, 77.4%) and potential addiction (n=2457, 58.1%). Public accounts of research institutions (n=3400, 80.4%) were the most favored for online recruitment. Telephones (1916/3076, 62.3%) and social media apps (1801/3076, 58.6%) were the most popular for regular contact. Intergroup comparisons revealed that suburban caregivers had more positive first impressions of pediatric research (38.6% vs 32%; P<.001; adjusted odds ratio [aOR] 1.27, 95% CI 1.09-1.47) and faced fewer participation barriers: "worry about being an experimental subject" (70.9% vs 76.6%; P<.001; aOR 0.79, 95% CI 0.67-0.93), "pose a risk to children's health" (58.6% vs 67.8%; P<.001; aOR 0.71, 95% CI 0.61-0.83), "do not have enough background information" (55.2% vs 61.6%; P<.001; aOR 0.78, 95% CI 0.67-0.89), and "worry about recommending other products" (48.2% vs 55%; P<.001; aOR 0.78, 95% CI 0.67-0.89). They also showed greater support for online-only research methods (26% vs 22.9%; P=.045; aOR 1.19, 95% CI 1.01-1.41) and greater openness to unofficial online recruitment sources (social media friends: 24.7% vs 18.9%; P<.001; aOR 1.33, 95% CI 1.11-1.59; moments on social media: 15.5% vs 11.1%; P<.001; aOR 1.35, 95% CI 1.09-1.67).

CONCLUSIONS

In the digital age, enhancing recruitment and retention in pediatric research can be achieved by integrating both official and unofficial social media strategies, implementing a hybrid online-offline follow-up approach, and addressing privacy concerns.

Analysis on equity of health service utilization and influencing factors in patients with hypertension in China: a longitudinal study

BACKGROUND

Hypertension has become a major public health and social problem endangering the health of Chinese residents, and has brought a large economic burden of diseases to families and even the whole society. Promoting the equity of health service utilization for patients with hypertension is of great significance for reducing the occurrence of cardiovascular and cerebrovascular diseases and reducing the economic burden of patients with hypertension. This study aims to analyze the equity and change of outpatient and inpatient service utilization in patients with hypertension, and to explore its influencing factors.

METHODS

Using the data of Household Health Interview Survey from 34 key points of contact for comprehensive healthcare reform in 17 provinces in 2014 and 2016, the equity and change of outpatient and inpatient service utilization of patients with hypertension were analyzed by concentration index, and the contribution degree of each influencing factor to utilization inequality was analyzed by decomposition of concentration index.

RESULTS

In 2014 and 2016, the standardized concentration index of two-week visits of hypertension patients was 0.0217 and 0.0141, respectively, indicating that the utilization of outpatient services was basically equitable. The standardized concentration index of times of hospitalization was 0.1593 and 0.1364, and the standardized concentration index of hospital length of stay was 0.1517 and 0.1369, respectively. The rich groups utilized more hospitalization services. Compared with 2014, the concentration index of outpatient and inpatient service utilization of patients with hypertension decreased in 2016, indicating that the inequity of outpatient and inpatient service utilization has further improved. The level of family income was the primary factor affecting the inequality of hospitalization utilization.

CONCLUSIONS

The utilization of outpatient services in patients with hypertension was basically equitable; however, wealthier groups had greater utilization of inpatient services. Overall, the degree of inequity has been reduced. Family economic status was the main factor affecting inequality in utilization of medical services. To achieve common prosperity was the most fundamental measure to improve the inequitable utilization of hospitalization services. At this stage, we should improve the medical assistance system and increase the assistance to vulnerable groups, such as the low-income groups.

Associations of parental divorce with student mental health and academic outcomes: A quantitative study in rural China

BACKGROUND

This paper examines the prevalence, correlates, and developmental consequences of divorce among junior high school students in rural China. Specifically, we investigate the connections between parental divorce and student mental health and academic performance, while also examining whether a student's living arrangement after divorce influences these outcomes.

METHODS

Data were collected from 17,955 students across 122 rural junior high schools in China on their mental health, characteristics, and academic performance. Mental health was measured using the self-reported Strengths and Difficulties Questionnaire.

RESULTS

About 8.35 % of the students had divorced parents, with increased risk observed for students who were only children, had migrant mothers, or had higher educated mothers (ORs = 4.35, 29.94, and 1.78, respectively; Bonferroni-adjusted p < 0.05). Students with divorced parents exhibited a higher likelihood of internalizing (0.032), externalizing (0.052) abnormality (Bonferroni-adjusted p < 0.001) and scored 0.203 SD lower on the math test (Bonferroni-adjusted p < 0.001). Living arrangements post-divorce, either with a mother or a father, equally negatively impacted student mental health and academic performance, with a mitigating effect observed when grandparental childcare was provided.

LIMITATIONS

Our study faced limitations in assessing the influence of grandparental childcare on coping with parental divorce due to challenges in gauging the extent of such support for students residing with a parent after divorce. This study did not empirically find differences by ethnicity; further in-depth case study is needed to better illuminate the findings.

CONCLUSIONS

Parental divorce among young students in rural China is associated with adverse developmental outcomes. These findings underscore the importance of implementing targeted programs in rural China to mitigate these risks and provide support for young students with divorced parents.

Social determinants of respiratory health from birth: still of concern in the 21st century?

Respiratory symptoms are ubiquitous in children and, even though they may be the harbinger of poor long-term outcomes, are often trivialised. Adverse exposures pre-conception, antenatally and in early childhood have lifetime impacts on respiratory health. For the most part, lung function tracks from the pre-school years at least into late middle age, and airflow obstruction is associated not merely with poor respiratory outcomes but also early all-cause morbidity and mortality. Much would be preventable if social determinants of adverse outcomes were to be addressed. This review presents the perspectives of paediatricians from many different contexts, both high and low income, including Europe, the Americas, Australasia, India, Africa and China. It should be noted that there are islands of poverty within even the highest income settings and, conversely, opulent areas in even the most deprived countries. The heaviest burden of any adverse effects falls on those of the lowest socioeconomic status. Themes include passive exposure to tobacco smoke and indoor and outdoor pollution, across the entire developmental course, and lack of access even to simple affordable medications, let alone the new biologicals. Commonly, disease outcomes are worse in resource-poor areas. Both within and between countries there are avoidable gross disparities in outcomes. Climate change is also bearing down hardest on the poorest children. This review highlights the need for vigorous advocacy for children to improve lifelong health. It also highlights that there are ongoing culturally sensitive interventions to address social determinants of disease which are already benefiting children.

Community Mindfulness and Mentorship Preventive Intervention in Migrant Chinese Children: A Randomized Controlled Trial

Objective

To test the feasibility and effectiveness of a mindfulness-based intervention in rural-to-urban migrant Chinese children using trained community volunteers.

Method

Migrant students ages 9 to 16 from 5 schools in Shanghai (N = 653) were randomly assigned to a mindfulness only group (n = 167), a mindfulness plus life skills group (n = 118), or a waitlist control group (n = 368). The first 2 groups received an 8-week mindfulness intervention delivered 1 hour weekly by trained community volunteers. The mindfulness plus life skills group received 8 additional hours of skills-based mentorship. Measurements on mindfulness, resilience, and anxiety and depression symptoms were collected before and after intervention. Multivariable regression analyses compared the intervention vs control groups.

Results

Before intervention, there were no significant demographic or outcome measure differences between groups except that students in the intervention groups were slightly older. Students had relatively low levels of mindfulness and prosociality difficulties and similar degrees of depression and anxiety symptoms compared with prior studies. After intervention, no statistically significant differences were found in mean scores for mindfulness, resilience, anxiety, or depression in the intervention vs control groups.

Conclusion

A volunteer-led mindfulness intervention did not significantly benefit migrant Chinese children after 8 weeks. More implementation research is needed for low-cost, scalable, and contextually effective mental health prevention programs.

Clinical trial registration information

Planting Seeds for Resilience-a Pilot Mindfulness and Mentorship Program in Migrant Chinese Children; http://www.chictr.org.cn; ChiCTR2100012027.

Diversity & Inclusion Statement

We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure sex and gender balance in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Trends, influencing factors and prediction analysis of under-five and maternal mortality rates in China from 1991 to 2020

Introduction

Under-five mortality rate (U5MR) and maternal mortality rate (MMR) are important indicators for evaluating the quality of perinatal health and child health services in a country or region, and are research priorities for promoting maternal and infant safety and maternal and child health. This paper aimed to analysis and predict the trends of U5MR and MMR in China, to explore the impact of social health services and economic factors on U5MR and MMR, and to provide a basis for relevant departments to formulate relevant policies and measures.

Methods

The JoinPoint regression model was established to conduct time trend analysis and describe the trend of neonatal mortality rate (NMR), infant mortality rate (IMR), U5MR and MMR in China from 1991 to 2020. The linear mixed effect model was used to assess the fixed effects of maternal health care services and socioeconomic factors on U5MR and MMR were explored, with year as a random effect to minimize the effect of collinearity. Auto regressive integrated moving average models (ARIMA) were built to predict U5MR and MMR from 2021 to 2025.

Results

The NMR, IMR, U5MR and MMR from 1991 to 2020 in China among national, urban and rural areas showed continuous downward trends. The NMR, IMR, U5MR and MMR were significantly negatively correlated with gross domestic product (GDP), the proportion of the total health expenditure (THE) to GDP, system management rate, prenatal care rate, post-natal visit rate and hospital delivery rate. The predicted values of national U5MR from 2021 to 2025 were 7.3 ‰, 7.2 ‰, 7.1 ‰, 7.1 ‰ and 7.2 ‰ and the predicted values of national MMR were 13.8/100000, 12.1/100000, 10.6/100000, 9.6/100000 and 8.3/100000.

Conclusion

China has made great achievements in reducing the U5MR and MMR. It is necessary for achieving the goals of Healthy China 2030 by promoting the equalization of basic public health services and further optimizing the allocation of government health resources. China's experience in reducing U5MR and MMR can be used as a reference for developing countries to realize the SDGs.