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Income-related health inequality among Chinese adults during the COVID-19 pandemic: evidence based on an online survey.
Nie, Peng; Ding, Lanlin; Chen, Zhuo; Liu, Shiyong; Zhang, Qi; Shi, Zumin; Wang, Lu; Xue, Hong; Liu, Gordon G; Wang, Youfa.
  • Nie P; School of Economics and Finance, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
  • Ding L; Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, China.
  • Chen Z; School of Economics and Finance, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
  • Liu S; Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA.
  • Zhang Q; School of Economics, Faculty of Humanities and Social Sciences, University of Nottingham Ningbo China, Ningbo, China.
  • Shi Z; Center for Governance Studies, Beijing Normal University at Zhuhai, Zhuhai, 519087, China.
  • Wang L; School of Community and Environmental Health, Old Dominion University, Norfolk, VA, USA.
  • Xue H; Human Nutrition Department, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
  • Liu GG; School of Economics and Finance, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
  • Wang Y; Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, 22030, USA.
Int J Equity Health ; 20(1): 106, 2021 04 26.
Article in English | MEDLINE | ID: covidwho-1204078
ABSTRACT

BACKGROUND:

Partial- or full-lockdowns, among other interventions during the COVID-19 pandemic, may disproportionally affect people (their behaviors and health outcomes) with lower socioeconomic status (SES). This study examines income-related health inequalities and their main contributors in China during the pandemic.

METHODS:

The 2020 China COVID-19 Survey is an anonymous 74-item survey administered via social media in China. A national sample of 10,545 adults in all 31 provinces, municipalities, and autonomous regions in mainland China provided comprehensive data on sociodemographic characteristics, awareness and attitudes towards COVID-19, lifestyle factors, and health outcomes during the lockdown. Of them, 8448 subjects provided data for this analysis. Concentration Index (CI) and Corrected CI (CCI) were used to measure income-related inequalities in mental health and self-reported health (SRH), respectively. Wagstaff-type decomposition analysis was used to identify contributors to health inequalities.

RESULTS:

Most participants reported their health status as "very good" (39.0%) or "excellent" (42.3%). CCI of SRH and mental health were - 0.09 (p < 0.01) and 0.04 (p < 0.01), respectively, indicating pro-poor inequality in ill SRH and pro-rich inequality in ill mental health. Income was the leading contributor to inequalities in SRH and mental health, accounting for 62.7% (p < 0.01) and 39.0% (p < 0.05) of income-related inequalities, respectively. The COVID-19 related variables, including self-reported family-member COVID-19 infection, job loss, experiences of food and medication shortage, engagement in physical activity, and five different-level pandemic regions of residence, explained substantial inequalities in ill SRH and ill mental health, accounting for 29.7% (p < 0.01) and 20.6% (p < 0.01), respectively. Self-reported family member COVID-19 infection, experiencing food and medication shortage, and engagement in physical activity explain 9.4% (p < 0.01), 2.6% (the summed contributions of experiencing food shortage (0.9%) and medication shortage (1.7%), p < 0.01), and 17.6% (p < 0.01) inequality in SRH, respectively (8.9% (p < 0.01), 24.1% (p < 0.01), and 15.1% (p < 0.01) for mental health).

CONCLUSIONS:

Per capita household income last year, experiences of food and medication shortage, self-reported family member COVID-19 infection, and physical activity are important contributors to health inequalities, especially mental health in China during the COVID-19 pandemic. Intervention programs should be implemented to support vulnerable groups.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Health Status Disparities / COVID-19 / Income Type of study: Experimental Studies / Observational study / Qualitative research / Randomized controlled trials Limits: Adult / Female / Humans / Male Country/Region as subject: Asia Language: English Journal: Int J Equity Health Year: 2021 Document Type: Article Affiliation country: S12939-021-01448-9

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Health Status Disparities / COVID-19 / Income Type of study: Experimental Studies / Observational study / Qualitative research / Randomized controlled trials Limits: Adult / Female / Humans / Male Country/Region as subject: Asia Language: English Journal: Int J Equity Health Year: 2021 Document Type: Article Affiliation country: S12939-021-01448-9