Determinants of health poverty vulnerability of rural households in Jiangxi Province, China: an analysis based on risk theory.

backgroundAlthough China has made significant progress on poverty alleviation over the past decade, health-related poverty remains an urgent issue in the rural areas of less developed regions, such as central and western China. On the basis of risk theory, this study investigated the determinants of health poverty vulnerability of rural households lifted out of poverty in central China.

methodsFirst-hand survey data collected from a convenience sample of 255 previously impoverished households in rural areas of Jiangxi Province in central China in 2024 were used in this study. In this study, an expected poverty vulnerability approach was used to measure health poverty vulnerability, and a three-stage feasible generalized least squares method was adopted to construct the health poverty vulnerability index. A Tobit regression model regression model was used to analyze the influencing factors of health poverty vulnerability.

resultsAmong the 255 out-of-poverty households surveyed, 21.18% were found to be vulnerable to health poverty. Our findings indicated that catastrophic health expenditures and labor loss were positively associated with increased vulnerability at the individual and household levels. In contrast, effective chronic disease management appeared to be correlated with reduced health vulnerability, possibly reflecting the supportive role of established social security mechanisms. Regarding health risk response capacity, asset accumulation and social capital may serve as important buffers, though their protective associations were context-dependent. Notably, enrollment in basic health insurance was linked to higher health-related poverty vulnerability, suggesting limited effectiveness in mitigating vulnerability among low-income groups. From a risk resilience perspective, higher educational attainment and a greater proportion of working-age family members were associated with lower vulnerability, though underlying mechanisms warranted further investigation.

conclusionsRural households in Jiangxi Province, China has remained susceptible to returning to poverty due to health shocks. These results underscore the need for more human capital investments to enhance the capacity of rural households to withstand health shocks, and a resilient health security system that accurately identifies vulnerability pathways and integrates strengthened social protection, asset-building initiatives.