Urban-rural disparities in the association between home and community-based services utilization and levels of disabilities among Chinese older adults with disabilities

Abstract

Abstract Background: China has the highest number of older adults with disabilities worldwide. Home and community-based services (HCBSs) are optimal ways to deal with disability problems. Studies have shown urban-rural disparities in the supply and demand of HCBSs in China and that disability levels are significantly associated with HCBSs utilization. However, what’s inconspicuous is whether there are urban-rural disparities in HCBSs utilization and whether HCBSs utilization and levels of disabilities are associated. This study is designed to analyze urban-rural disparities both in HCBSs utilization and in the relationship between HCBSs utilization and levels of disabilities among Chinese older adults with disabilities. Methods: In applying the Andersen behavioral model, bivariate analysis and multivariate regression models were employed using data from 843 older adults with disabilities from the 2018 China Longitudinal Aging Social Survey. Results: Urban older adults with disabilities used HCBSs over twice as often as their rural counterparts. Furthermore, older adults with moderate disabilities living in urban areas used HCBSs more than twice as often as older adults with mild disabilities, while older adults with severe disabilities residing in urban areas used HCBSs approximately three times more often than older adults with mild disabilities. However, regarding rural older adults with disabilities, the levels of disabilities were unrelated to HCBSs utilization. Conclusion: Disability levels among Chinese older adults with disabilities were significantly correlated with HCBSs utilization throughout the country and in urban areas, but not in rural areas. The underlying reason for these disparities is the low utilization of HCBSs in rural areas among older adults with disabilities. The government should combine the supply-side and demand-side perspectives to fundamentally address urban-rural disparities in using HCBSs among Chinese older adults with disabilities.