Socioeconomic Inequality in Health Outcomes Among the Elderly: Evidence from a Cross-Sectional Study in China

Abstract

Background and Aim

Health is viewed as a form of human capital and a necessary basis for people to realize capabilities. Moreover, socioeconomic inequality in health outcome widens income inequality and exacerbates social inequality. The aim of this study is to measure socioeconomic inequality in health outcomes among the elderly in China.

Methods

The data used in this study were sourced from China Health and Retirement Longitudinal Study in 2015, including 5643 participants aged 60 and above. Concentration curve and concentration index were applied to measure the extent of socioeconomic inequality in health outcomes among older adults. Furthermore, the decomposition method of concentration index proposed by Wagstaff was employed to quantify each determinant’s contribution to the measured socioeconomic inequality in health outcomes.

Results

The concentration index of Activity of Daily Living Scale and Center of Epidemiological Survey-Depression Scale score were −0.0064 and −0.0158, respectively, indicating pro-rich inequality in physical and mental health among the elderly. The decomposition analysis revealed that household income (41.15%), aged 70–79 (17.37%), being male (8.38%), and living in urban area (5.78%) were key factors to explain the pro-rich inequality in physical health. Furthermore, the results also suggested that household income (68.41%), being male (17.55%), having junior high school education (10.67%), and living in urban area (6.49%) were key factors to explain the pro-rich inequality in mental health.

Conclusion

This study revealed that there are pro-rich inequalities in physical and mental health among the elderly in China, and the degree of pro-rich inequality in mental health is higher than that in physical health. Moreover, the results also suggested that household income is the biggest contributor to socioeconomic inequality in physical and mental health. Furthermore, this study found that educational attainment makes a substantial contribution to socioeconomic inequality in health outcomes, while the contribution of health insurance to health inequality is limited.

Keywords:

• socioeconomic inequality
• health outcomes
• elderly
• decomposition of concentration index
• China

Acknowledgment

This study was funded by National Social Science Foundation of China (15BJL003), Shanghai Philosophy and Social Science Planning Project (2014BJL002), Research Foundation of Shanghai Municipal Development and Reform Commission of 2018, Scientific Research Foundation of Outstanding Young Teachers of Shanghai Jiao Tong University and SMC of 2016, and Urban Governance Foundation in Humanities and Social Sciences in Shanghai Jiao Tong University (16JCCS16).

Abbreviations

CHARLS, China Health and Retirement Longitudinal Study; ADL, Activity of Daily Living; CES-D, Center of Epidemiological Survey-Depression Scale.

Author Contributions

SL designed the study. JS analyzed the data and drafted the manuscript. RZ analyzed the data. All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflict on interest in this work.