Inequality in the treatment of diabetes and hypertension across residency status in China

ABSTRACT

Objectives: This paper studies the institutional inequality that exists in the prevalence of diabetes and hypertension, as well as their diagnosis and medication management, between urban and rural residency status (hukou) holders in China.

Methods: Exploiting the Chinese Health and Nutrition Survey, we primarily demonstrate that while a lower proportion of rural residency holders suffer from diabetes and hypertension, a larger proportion have never been diagnosed with these conditions and do not take medicine to control them. We explore the determinants of these disparities by the non-linear decomposition method.

Results: Decomposition results illustrate that a large part of disparities in the prevalence of diabetes and hypertension can be explained by the differences in demographic structure and occupational socio-economic status. Regarding the ruralurban disparity in the under diagnosis and under-medication rates, the differences in demographic structure, household affluence, occupational socio-economic status and consumption patterns make the greatest contributions.

Conclusions: This evidence suggests that improving the institutional economic inequality and enhancing the occupational mobility of rural residency holders are of paramount importance to mitigate any inequality in health and healthcare utilisation.

KEYWORDS:

• Health inequality
• non-linear decomposition
• diabetes
• hypertension
• China

JEL CODE:

• I14
• I15

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1 Formally known as non-insulin-dependent diabetes.

2 Major channels for rural-urban hukou conversion are employment by state-owned enterprises, enrolment in higher education institutions, and land acquisition by the government etc. (Chan and Zhang, 1999). Despite living and working in urban areas, migrant workers from the countryside are not entitled to public services.

3 A sample weight to make the samples nationally representative is not available to the CHNS.

4 Plasma and serum samples were then frozen and stored at −86°C for later laboratory analysis. All samples were analysed in a national central lab in Beijing (medical laboratory accreditation certificate ISO15189:2007) with strict quality controls. Survey protocols, instruments and the process for obtaining informed consent for this study were approved by the institutional review committees of the University of North Carolina at Chapel Hill, the National Institute of Nutrition and Food Safety, the Chinese Center for Disease Control and Prevention, and the China-Japan Friendship Hospital which is affiliated with the Ministry of Health (China-Japan Friendship Hospital 2009).

5 To avoid omitting migrant workers and children enrolled at boarding schools, special efforts were made to schedule visits in the early morning or at weekends when these participants would be at home.

6 This is equivalent to 7.7 $mmol/l$ and 47.5 $mmol/mol$.

7 Blood pressure was measured on the right arm using mercury sphygmomanometers with appropriate cuff sizes. Measures were collected in triplicate after a 10-minute seated rest.

8 Horizontal inequality in healthcare differs from (general) inequality in that horizontal inequality is the inequality after controlling for healthcare needs.

9 Age squared is used to better capture the non-linear relationship between treatment and age.

10 The living standards index is the first principal component of the following binary variables: use of in-house tap water as drinking water; use of in-yard tap water as drinking water; use of a flush toilet; use of an in-house toilet; no excreta in the house; use of electric lighting; and use of coal/electricity for cooking.

11 This is the first principal component of the number and type of health facilities in or nearby ($\le 12km$) a community and the number of pharmacies in the community (Jones-Smith and Popkin, 2010).

12 Loader, logger, miner, stone cutter, farmer, dancer, steelworker, athlete, etc.

13 Student, driver, electrician, metalworker, etc.

14 Salesperson, laboratory technician, teacher, office worker, watch repairer, etc.

15 Out of an initial 8855 samples, 2267 are dropped because of missing data on HbA1c and/or blood pressure.