Inequalities of Inpatient Health Services Utilization for the Middle-Aged and Elderly with Multiple Chronic Conditions in China

Abstract

Abstract Background Despite growing evidence of health inequalities, equity of inpatient health service utilization(IHSU) among middle-aged and elderly people with multiple chronic conditions(MCCs) have received little attention. Therefore, this study aims to access the inequities of IHSU among middle-aged and elderly people with MCCs in China, and determine the contributing social factors and their influences by using the national data. Methods This study used two cross-sectional data from the 2013 and 2018 China Health and Retirement Longitudinal Study(CHARLS) The inequities of IHSU were illustrated and quantified by the concentration curve and normalized concentration index. Multivariate logistic regression was conducted to identify the associated factors of IHSU. And decomposition analysis was further applied to decompose the contribution of each determinant to the observed inequalities of IHSU. Results The study indicated that the rate of IHSU among Chinese middle-aged and elderly people with MCCs was 16.6% in 2013 and 17.7% in 2018. The overall concentration index for IHSU was − 0.0301 in 2013 and 0.0354 in 2018, which suggested a higher concentration of IHSU among economically disadvantaged middle-aged and elderly people with MCCs in recent year. The results showed the rate of IHSU was associated with age, sex, household income per capita, self-rated health, smoking, and drinking. Decomposition results further revealed the contributions of the determinants to the inequalities of IHSU. Specifically, age (43.16%), sex (-12.46%), household income per capita (-8.89%), self-rated health (-35.71%), smoking (63.70%), and drinking (59.90%) have varying degrees of contributions to the inequality in IHSU. Conclusion This study sheds light on the pro-rich inequality in IHSU among Chinese middle-aged and elderly people with MCCs. It suggests that policymakers should pay more attention to middle-aged and elderly adults who are male, old, economically disadvantaged, smoking, and drinking. In addition, more targeted interventions should be taken to improve the economic situation of these vulnerable individuals and strengthen their ability to cope with MCCs.