All-cause mortality rate in China: do residents in economically developed regions have better health?

Abstract

BACKGROUND: Urban-rural disparities have been extensively investigated, while most investigators overlooked urban-suburban-rural variations in population health. Although regional disparities in East-West China have been largely discussed, limited attention has been directed to the interaction between regional differences and urban-suburban-rural disparities. This study aims to analyze urban-suburban-rural variations in all-cause mortality rates across four geographic regions in China. METHODS: Data came from China's National Census Survey and public statistical yearbooks in 2000 and 2010. Urban districts, county-level cities, and counties were respectively defined as urban, suburban, and rural areas. We obtained 2322 areas, including 2148 areas with two observations and 174 areas with only one observation. Data visualization was performed to depict geographic variations and changes in all-cause mortality rates. Five hierarchical linear regression analyses with generalized estimating equations (GEE) were employed to analyze variations in all-cause mortality rates over time. Demographic and socioeconomic attributes were introduced as covariates. RESULTS: Despite an overall decline in all-cause mortality rate, rural residents generally achieved worse health than urban and suburban counterparts. In contrast, urban-suburban disparities could be fully explained by demographic and socioeconomic differences. In addition, Northeastern and Central residents achieved better health than Eastern and Western residents. Last, there existed urban/suburban-rural disparities in all regions, except Northeastern, where urban/suburban-rural disparities were eliminated after controlling for socioeconomic and demographic attributes. CONCLUSION: Even though suburban and rural areas were often merged, there exist urban/suburban-rural disparities in population health. Furthermore, urban/suburban-rural disparities vary across regions.

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