Explaining urban-rural health disparities in China

BACKGROUND: Given strict residency controls and geographic imbalances in health care resources, China may experience serious urban-rural health disparities. OBJECTIVES: To investigate urban-rural disparities in the patterns of health status and health care utilization in China and to examine the evolution of these disparities from 1997 to 2006. SUBJECTS: This study uses data from the China Health and Nutrition Survey 1997-2006 with a sample of 27,897 rural and 13,898 urban respondents aged 18 or older. MEASURES: We use self-reported health status, activity limitations due to illness, and diagnosis of serious diseases to measure health status, and physician visits for illness to measure health care utilization. RESULTS: Self-reported health status of urban residents is consistently worse than their rural counterparts (OR = 0.76; P < 0.01) based on multivariate logistic regression analysis. Urban residents are significantly more likely to have activity limitations due to illness (OR = 1.13; P < 0.01) and to have been diagnosed with a serious disease (OR = 1.69; P < 0.01). Urban residents are less likely to visit physicians for illness than are rural residents, a difference that has increased substantially since 1997. CONCLUSIONS: Urban residents appear to fare worse than rural residents in terms of overall health status and health care utilization in China. Identifying the causes of these urban-rural health disparities and developing appropriate policy responses are critical directions for researchers and policymakers.