ArticleGlobal health research and policy2025
Socioeconomic disparities in the trends of inpatient utilization for middle-aged and older adults in China: the perspective of international comparison from four cohorts.
Article in Global health research and policy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDuring the past decade, China has witnessed a rapid increase in healthcare utilization. However, whether this surge in healthcare use is reasonable remains an urgent question to be answered, particularly for informing scientific policy design and adjustment in future health systems reform. We aimed to analyze the differences in healthcare utilization trends among Chinese adults aged 50 and above in comparison with other countries and regions, and to investigate the association between socioeconomic status (SES) and healthcare utilization in China.
methodsParticipants aged 50 and over were drawn from the ageing surveys conducted in China, the United States, South Korea, and Europe. SES was measured using education level, total household income, and employment status. Random-effects negative binomial regression models were employed to examine the association between SES and healthcare utilization.
resultsFrom 2011 to 2020, the outpatient utilization rates in China showed no clear long-term upward or downward trend. The inpatient utilization rates in the United States (tau-b = - 0.02, P < 0.001) and South Korea (tau-b = - 0.05, P < 0.001) declined gradually, whereas inpatient utilization rates in China continuously grew (tau-b = 0.08, P < 0.001). In China, inpatient utilization rates across different SES groups generally showed an upward trend (P < 0.01). Elementary and lower education was positively associated with inpatient utilization rates compared to middle school and higher education (IRR = 1.11, 95% CI: 1.04-1.18, P = 0.003). Similar patterns were observed for low household income (IRR = 1.08, 95% CI: 1.02-1.14, P = 0.007), non-employment (IRR = 1.39, 95% CI: 1.32-1.47, P < 0.001) and retirement (IRR = 1.38, 95% CI: 1.26-1.52, P < 0.001). These associations remained significant even among individuals covered by the Urban and Rural Resident Basic Medical Insurance (URRBMI). Participants with lower SES were more likely to report having two or more chronic diseases and poor self-rated health (P < 0.001).
conclusionsInpatient utilization rates among middle-aged and older adults in China have experienced excessive growth over the past decade. Low SES was associated with high inpatient utilization, likely attributable to the poorer health status of low-SES groups. This association persisted in people covered by URRBMI. Policy reforms should prioritize the development of primary care, targeted health management, and equitable adjustments to health insurance. These measures are essential for curbing unnecessary hospitalizations and advancing healthcare equity in China.
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