Observational studyBMJ open2026
Determinants of care modality and chronic disease needs among older adults with chronic disease and disability in rural China: a cross-sectional study in Qinghe County, Hebei Province.
Observational study in BMJ open, 2026. 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
objectivesThis study aimed to evaluate the factors associated with care modality among older adults with chronic disease and disability in rural China. We hypothesised that marital status, family structure, duration of disability and the number of chronic diseases would be significantly associated with care modality.
designThis was a cross-sectional observational study using survey data to identify demographic and health-related factors associated with care modality.
settingThe study was conducted in a rural mid-sized county in China and focused on older adults with chronic disease and disability.
participantsA total of 608 older adults aged ≥60 years with chronic disease and disability residing in Qinghe County, Hebei Province, China, completed the survey. Eligible participants had at least one chronic disease and partial or complete loss of self-care ability. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was care modality (home-based care vs institutional care). Secondary outcomes included specific chronic disease care needs.
resultsOf the participants, 18.59% received institutional care. Divorced, widowed or unmarried participants had higher odds of institutional care use (OR=3.113, 95% CI 2.01 to 4.82, p<0.0001), as did those with one child (OR=5.55, 95% CI 1.647 to 18.696, p=0.0057). Participants with a disability lasting 3 or more years had significantly lower odds of institutional care use (OR=0.353, 95% CI 0.186 to 0.667, p=0.0014). Individuals with three chronic diseases (OR=0.486, 95% CI 0.242 to 0.977, p=0.0429) or four or more (OR=0.412, 95% CI 0.183 to 0.928, p=0.0324) also had lower odds of institutional care use. The highest-priority chronic disease care needs were regular physical examinations, rehabilitation guidance, medication guidance, chronic disease management guidance and nutritional guidance. Participants receiving institutional care reported higher needs for digitally supported services such as online referral, medical record information sharing and remote data transmission.
conclusionsMarital status, number of children, duration of disability and number of chronic diseases were significantly associated with care modality in this population. These findings highlight the need to improve institutional care quality and availability and to better address the chronic disease management needs of this population. Future research should focus on longitudinal studies to explore the evolving care needs of this growing demographic.
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