Background: Considerable socioeconomic and health inequalities have been reported in China. However, because of a lack of appropriate data, limited research has been conducted on variations in disability-free life expectancy (DFLE) among older adults. This study aimed to use the most up-to-date disability survey data to explore geographical variations in DFLE at age 60 in China and to identify the socioeconomic and health care factors that partially account for these variations.Methods: This study used 2006 mortality data extrapolated from the 1990 and 2000 Census and disability data from a national disability survey conducted in 2006. Disability was performance based and was diagnosed by trained physicians. DFLE was calculated by region using the Sullivan method. Multiple linear regression models by gender were conducted to explore correlates of DFLE.Results: DFLE at age 60 varied widely by region, from 11.2 to 20.8 years in 2006. Per capita gross domestic product, proportion of urban residents, and access to health care were the primary factors associated with geographical variations in DFLE.Conclusion: The pattern of differences in DFLE by region mirrors the pattern of regional economic development in China. Countermeasures to decrease regional differences in DFLE include accelerating regional economic development and improving health care distribution.

Background: The medical cost reimbursement function of medical insurance can reduce the medical burden of individuals and thus improve their medical service utilization level. This study aimed to explore the impact of different cross-regional reimbursement types of medical insurance (instant reimbursement and manual reimbursement) on the hospitalization costs incurred by the floating population. Methods: The data used in this study was from the 2018 China Migrants Dynamic Survey (CMDS) conducted by the National Health Commission of China. The multiple linear regression model and Propensity Score Matching method (PSM) were used to analyze the impact of instant and manual reimbursement on hospitalization costs. Results: (1) Instant reimbursement and manual reimbursement could significantly reduce the floating population’s out-of-pocket proportion of hospitalization costs by 33.2% and 26.9%, respectively; (2) the average proportion and amounts of out-of-pocket hospital costs of instant reimbursement for the floating population were lower than those of manual reimbursement by 6.35% and 19.6%, respectively, and this impact would gradually increase as the flow distance expanded; (3) there was no significant impact of instant reimbursement on the total hospitalization costs relative to manual reimbursement. Conclusions: Our study suggests that instant reimbursement can effectively reduce the out-of-pocket medical burden of the floating population at the individual level, but it will not have an obvious impact on the total hospitalization costs at the social level.

Introduction: Body mass index (BMI) has a strong correlation with chronic diseases and all-cause mortality. However, few studies have previously reported the longitudinal transition of BMI status and its influential factors, especially among Chinese middle-aged and older adults.Methods: This population-based cohort study involved 6,507 participants derived from the China Health and Retirement Longitudinal Study from 2011 to 2015, including objectively measured BMI recorded in 26,028 person-year of all observations followed up. Multistate Markov model was performed to estimate the BMI state transition intensity and hazard ratios of each potential exposure risk.Results: The mean intensity of the population that shifted from normal to overweight was more than twice than shifted to underweight. Besides, a predicted probability was up to 16.16% that the population with overweight would suffer from obesity and more than half of the population with underweight would return to normal weight over a 6-year interval. The study also implied significant effects of baseline age, gender, marital status, education level, alcohol consumption, smoking, depression symptoms, and activities of daily living impairment on BMI status transition to varying degrees.Conclusions: Findings of this study indicated that the mean transition probability between different BMI statuses varied, specific exposure factors serving as barriers or motivators to future transitions based on current BMI status was clarified for the health promotion strategies.

In the study described herein, we investigated and explored the association between wealth inequality and the risk of mental disability in the Chinese population. We used nationally represented, population-based data from the second China National Sample Survey on Disability, conducted in 2006. A total of 1,724,398 study subjects between the ages of 15 and 64, including 10,095 subjects with mental disability only, were used for the analysis. Wealth status was estimated by a wealth index that was derived from a principal component analysis of 10 household assets and four other variables related to wealth. Logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for mental disability for each category, with the lowest quintile category as the referent. Confounding variables under consideration were age, gender, residence area, marital status, ethnicity, education, current employment status, household size, house type, homeownership and living arrangement. The distribution of various types and severities of mental disability differed significantly by wealth index category in the present population. Wealth index category had a positive association with mild mental disability (p for trend <0.01), but had a negative association with extremely severe mental disability (p for trend <0.01). Moreover, wealth index category had a significant, inverse association with mental disability when all severities of mental disability were taken into consideration. This study’s results suggest that wealth is a significant factor in the distribution of mental disability and it might have different influences on various types and severities of mental disability.

Increasing medical expenditure is viewed as one of the critical challenges in the context of population ageing. Physical activity (PA), as a primary prevention strategy for promoting health, is considered as an effective way to curb the excessive growth in medical expenditure. This study aimed to analyze the association between PA and the household out-of-pocket medical expenditure (HOPME) among Chinese urban adults aged 45 and over, and to explore the mediating role of spousal health behaviour. This study analyzed a nationally longitudinal survey: 2014–2018 China Family Panel Studies (CFPS). Fixed effects regression model was applied to estimate the association between PA and annual HOPME. Sobel model was utilized to test the mediating effect. (1) PA was negatively associated with the annual HOPME among urban resident aged 45 and over in China. Exercising 1–5 times per week and maintaining the duration of each exercise session at 31–60 min were effective in reducing annual HOPME. (2) Spousal PA played a significant mediating role in the relationship between respondent's PA and annual HOPME. (3) The negative association between the respondent's PA and HOPME were found among women and those aged between 45 and 65, so was the mediating effect of spouse's PA. Individual PA not only directly reduces HOPME but also indirectly contributes to this reduction by enhancing the PA levels of their spouses. To capitalize on these benefits, more actions should be taken to increase the availability of PA facilities, enhance the public awareness of PA's benefits, and encourage residents to consistently engage in regular PA.