Descriptive statistics
Descriptive analyses for the participants in 2013 were presented in Table 1. Of the 13,551 participants, 51.62% (number (N) = 6,995) were female, 89.92% (N = 12,172) have spouse, 79.63% (N = 10,790) have agricultural Hukou, and 44.59% (N = 6,042) have smoking history. In addition, about 62.73% (N = 8,500) of participants were living in rural areas, the distribution of the sample was 38.64% (N = 5,236) from east region, 25.43% (N = 3,446) from central region, and 35.93% (N = 4,869) from west region. The mean age was 59.30 (SD = 9.14), and the average years of education was 5.39.
Table 1
Health-care service utilization and socio-demographic characteristics of the sample.
Variable | Total Frequency (%) | Urban (%) | Rural (%) | P-value |
Inpatient care in 2013 | | | | 0.006 |
Not have | 11867(87.57) | 4372(86.56) | 7495(88.18) | |
Have | 1684(12.43) | 679(13.44) | 1005(11.82) | |
Outpatient care in 2013 | | | | 0.703 |
Not have | 10533(77.73) | 3935(77.91) | 6598(77.62) | |
Have | 3018(22.27) | 1116(22.09) | 1902(22.38) | |
Inpatient care in 2015 | | | | 0.011 |
Not have | 11637(85.88) | 4288(84.89) | 7349(86.46) | |
Have | 1914(14.12) | 763(15.11) | 1151(13.54) | |
Outpatient care in 2015 | | | | 0.226 |
Not have | 10754(79.36) | 4036(79.90) | 6718(79.04) | |
Have | 2797(20.64) | 1015(20.10) | 1782(20.96) | |
Gender | | | | 0.028 |
Male | 6556(48.38) | 2382(47.16) | 4174(49.11) | |
Female | 6995(51.62) | 2669(52.84) | 4326(50.89) | |
Marry status | | | | 0.518 |
Not have spouse | 1379(10.18) | 503(9.96) | 876(10.31) | |
Have spouse | 12172(89.92) | 4548(90.04) | 7624(89.69) | |
Hukou status | | | | < 0.001 |
Non-agricultural hukou | 2761(20.37) | 2374(85.98) | 387(14.02) | |
Agricultural hukou | 10790(79.63) | 2677(24.81) | 8113(75.19) | |
Smoking history | | | | < 0.001 |
Not have | 7509(55.41) | 2888(57.18) | 4621(54.36) | |
Have | 6042(44.59) | 2163(42.82) | 3879(45.64) | |
Medical insurance | | | | 0.507 |
Not have | 441(3.25) | 171(3.39) | 270(5.35) | |
Have | 13110(96.75) | 4880(96.61) | 8230(94.65) | |
Self-report health | | | | < 0.001 |
Good | 3182(23.48) | 1296(25.66) | 1886(22.19) | |
Fair | 7196(53.10) | 2835(56.13) | 4361(51.31) | |
Poor | 3173(23.42) | 920(18.21) | 2253(26.50) | |
Chronic Disease | | | | 0.730 |
Not have | 3813(28.14) | 1430(28.31) | 2383(28.04) | |
Have | 9738(71.86) | 3621(71.69) | 6117(71.96) | |
Current living place | | | | |
Rural | 8500(62.73) | -- | -- | |
Urban | 5051(37.27) | -- | -- | |
Region | | | | < 0.001 |
East | 5236(38.64) | 2166(42.88) | 3070(36.12) | |
Central | 3446(25.43) | 1262(24.99) | 2184(25.69) | |
West | 4869(35.93) | 1623(32,13) | 3246(38.19) | |
Depression | | | | < 0.001 |
Not have | 10354(76.41) | 4120(81.57) | 6234(73.34) | |
Have | 3197(23.59) | 931(18.43) | 2266(26.66) | |
Variable | Mean(Std.) | | | |
Age | 59.30(9.14) | 59.44(9.22) | 59.21(9.09) | 0.147 |
Education years | 5.39(4.15) | 6.75(4.25) | 4.59(3.88) | < 0.001 |
Income | 4.29(1.04) | 4.63(1.01) | 4.10(1.01) | < 0.001 |
N | 13551 | 8500 | 5051 | |
Note: a.Std. was Standard deviation; |
b. “1.000” was the results of keeping 3 decimal places. c. Income was logarithm. |
In terms of self-report health status, 23.48% of participants reported that their health status was good, while the rates for fair and poor status were 53.10% and 23.42%, respectively. About 27.88% of the respondents were found to have depressive symptoms using 10 as the threshold. In addition, most participants (71.86%) indicated that they have chronic diseases. Overall, compared to Chinese urban population, rural people were more likely to receive outpatient care, and more likely to have depressive symptoms (22.38% & 26.66%).
In terms of health care utilization, in 2013, the proportion of participants who received inpatient care and outpatient care were 12.43% and 22.27%, while the rate of inpatient care and outpatient care were 14.12%, 20.64% in 2015, respectively.
Bivariate Correlation Analyses
Table 2 shows the results of comparison of depressive symptoms and socio-demographic characteristics by inpatient and outpatient care utilization in 2013. Participants without spouse, having non-agricultural hukou, having medical insurance, poor self-report health status, having chronic diseases, living in urban areas currently, from west region, with depressive symptoms were more likely to receive inpatient care. Similarly, participants without spouse, having medical insurance, poor self-report health status, having chronic diseases, from west region, with old age, high education and depressive symptoms were more likely to receive outpatient care.
Table 2
Comparison of depress symptoms and socio-demographic characteristics by inpatient and outpatient care utilization in 2013 (N = 13551).
Variable | Inpatient | Outpatient |
Not have | have | P-value | Not have | have | P-value |
Gender | | | 0.236 | | | < 0.000 |
Male | 6103(87.25) | 892(12.75) | | 5237(74.87) | 1758(25.13) | |
Female | 5764(87.92) | 792(12.08) | | 5296(80.78) | 1260(19.22) | |
Marry status | | | 0.011 | | | 0.001 |
Not have spouse | 1178(85.42) | 201(14.58) | | 1022(74.11) | 357(25.89) | |
Have spouse | 10689(87.82) | 1483(12.18) | | 9511(78.14) | 2661(21.86) | |
Hukou status | | | 0.004 | | | 0.445 |
Non-agricultural hukou | 2373(85.95) | 388(14.05) | | 2161(78.27) | 600(21.73) | |
Agricultural hukou | 9494(87.99) | 1296(12.01) | | 8372(77.59) | 2418(22.41) | |
Smoking history | | | 0.377 | | | < 0.000 |
Not have | 6559(87.35) | 950(12.65) | | 5673(75.55) | 1836(24.45) | |
Have | 5308(87.85) | 734(12.15) | | 4860(80.44) | 1182(19.56) | |
Medical insurance | | | < 0.000 | | | 0.045 |
Not have | 410(92.97) | 31(7.03) | | 360(81.63) | 81(18.37) | |
Have | 11457(87.39) | 1653(12.61) | | 10173(77.60) | 2937(22.40) | |
Self-report health | | | < 0.000 | | | < 0.000 |
Good | 2992(94.03) | 190 (5.97) | | 2849(89.53) | 333(10.47) | |
Fair | 6485(90.12) | 711(9.88) | | 5720(79.49) | 1476(20.51) | |
Poor | 2390(75.32) | 783(24.68) | | 1964(61.90) | 1209(38.10) | |
Chronic | | | < 0.000 | | | < 0.000 |
Not have | 3605(95.54) | 208(5.46) | | 3374(88.49) | 439(11.51) | |
Have | 8262(84.84) | 1476(15.16) | | 7159(73.52) | 2579(26.48) | |
Current living place | | | 0.006 | | | 0.703 |
Rural | 7495(88.18) | 1005(11.82) | | 6598(77.62) | 1902(22.38) | |
Urban | 4372(86.56) | 679(13.44) | | 3935(77.91) | 1116(22.09) | |
Region | | | < 0.000 | | | < 0.000 |
East | 4729(90.32) | 507(9.68) | | 4250(81.17) | 986(18.83) | |
Central | 2983(86.56) | 463(13.44) | | 2624(76.15) | 822(23.85) | |
West | 4155(85.34) | 714(14.66) | | 3659(75.15) | 1210(24.85) | |
Depress | | | < 0.000 | | | < 0.000 |
Not have | 9277(89.60) | 978(10.40) | | 8380(80.93) | 1974(19.07) | |
Have | 3072(81.01) | 706(18.99) | | 2153(67.34) | 1044(32.66) | |
Variable | Mean(Std) | Mean(Std) | P-value | Mean(Std) | Mean(Std) | P-value |
Age | 59.00(9.07) | 61.40(9.39) | < 0.000 | 59.14(9.09) | 59.84(9.29) | < 0.000 |
Education years | 5.44(4.16) | 5.10(4.10) | 0.002 | 5.48(4.15) | 5.11(4.17) | < 0.000 |
Income | 4.29(1.04) | 4.31(1.02) | 0.400 | 4.28(1.04) | 4.35(1.04) | < 0.001 |
Note: Std was Standard deviation |
Binary Logistic Regression Analyses
Logistic analyses were used to assess the relationship between depressive symptoms and health services utilization among Chinese middle aged and older adults in 2013. For participants’ health services utilization in 2013 (Table 3), after adjusting for sociodemographic and other covariates, depressive symptoms were significantly associated with inpatient care (OR 1.349, 95% CI 1.194–1.524) and outpatient care (OR 1.366, 95% CI 1.238–1.508). Compared to rural residents, urban elderly adults were more likely to seek inpatient care (OR 1.244, 95%CI 1.094–1.414).
Table 3
Logistic regression analysis for the relationship between depress symptoms and health care utilization among Chinese middle aged and older adults in 2013.
Variable | Model1 Inpatient care in 2013 (Full model) OR [95%CI] | Model2 Outpatient care in 2013 (Full model) OR [95%CI] | Model3 Inpatient care in 2013 (Rural) OR [95%CI] | Model4 Outpatient care in 2013 (Rural) OR [95%CI] | Model5 Inpatient care in 2013 (Urban) OR [95%CI] | Model6 Outpatient care in 2013 (Urban) OR [95%CI] |
Depression (Not have) | | | | | | |
Have | 1.349***[1.194,1.524] | 1.366***[1.238,1.508] | 1.276**[1.096,1.486] | 1.400***[1.241,1.578] | 1.496***[1.219,1.835] | 1.287** [1.082,1.531] |
Age | 1.024***[1.018,1.031] | 1.005+[1.000,1.010] | 1.018***[1.009,1.026] | 1.007*[1.000,1.013] | 1.035***[1.024,1.045] | 1.002[0.993,1.010] |
Education years | 1.005[0.989,1.021] | 1.007 [0.994,1.019] | 1.012[0.991,1.034] | 1.008[0.992,1.025] | 0.999[0.976,1.024] | 1.005[0.985,1.025] |
Gender(Female) | | | | | | |
Male | 1.107[0.941,1.304] | 0.877* [0.769,1.000] | 0.971[0.781,1.207] | 0.846+[0.713,1.004] | 1.301*[1.013,1.669] | 0.934[0.759,1.149] |
Marry status (Not have spouse ) | | | | | | |
Have spouse | 1.077[0.906,1.281] | 0.929[0.807,1.069] | 0.970[0.780,1.206] | 0.965[0.809,1.152] | 1.241[0.929,1.660] | 0.867[0.687,1.093] |
Hukou status (Non-agricultural hukou) | | | | | | |
Agricultural hukou | 0.873+[0.745, 1.023] | 1.023[0.898,1.166] | 0.820[0.599,1.124] | 1.085[0.828,1.424] | 0.853 [0.703,1.035] | 1.009[0.862,1.181] |
Smoking history (Not have ) | | | | | | |
Have | 0.929[0.794,1.087] | 0.873* [0.769,0.991] | 0.990[0.805,1.217] | 0.890[0.755,1.048] | 0.853[0.669,1.087] | 0.845 [0.689,1.036] |
Medical insurance (Not have) | | | | | | |
Have | 1.819**[1.245,2.657] | 1.196[0.927,1.544] | 1.522+[0.958,2.418] | 1.174[0.847,1.626] | 2.430** [1.252,4.714] | 1.214[0.805,1.833] |
Self-report health (Good) | | | | | | |
Fair | 1.422***[1.199,1.686] | 1.824***[1.600,2.078] | 1.182[0.946,1.477] | 1.829***[1.538,2.175] | 1.807***[1.385,2.358] | 1.828***[1.498,2.231] |
Poor | 3.639***[3.033,4.366] | 3.627***[3.136,4.195] | 2.989***[2.371,3.769] | 3.595***[2.981,4.336] | 4.848***[3.615,6.502] | 3.720***[2.943,4.702] |
Chronic (Not have) | | | | | | |
Have | 1.955***[1.668,2.291] | 1.897***[1.690,2.130] | 2.150***[1.743,2.653] | 1.909***[1.647,2.213] | 1.703***[1.335,2.172] | 1.889***[1.568,2.276] |
Current living place (Rural) | | | | | | |
Urban | 1.244***[1.094,1.414] | 1.044[0.941,1.157] | | | | |
Region (East) | | | | | | |
Central | 1.323***[1.152,1.520] | 1.224***[1.098,1.365] | 1.322** [1.102,1.587] | 1.442***[1.253,1.658] | 1.330** [1.072,1.649] | 0.952[0.799,1.134] |
West | 1.416***[1.247,1.607] | 1.230***[1.113,1.359] | 1.393***[1.181,1.643] | 1.341***[1.180,1.526] | 1.466***[1.200,1.791] | 1.096[0.933,1.288] |
Income | 1.074* [1.016,1.135] | 1.133***[1.084,1.184] | 1.102**[1.027,1.182] | 1.121***[1.061,1.185] | 1.029[0.941,1.126] | 1.148***[1.065,1.238] |
Constant | 0.003***[0.002,0.006] | 0.029***[0.017,0.050] | 0.006***[0.002,0.016] | 0.023***[0.011,0.048] | 0.001***[0.000,0.005] | 0.041***[0.017,0.095] |
R2 | 0.080 | 0.070 | 0.074 | 0.077 | 0.094 | 0.061 |
N | 13551 | 13551 | 8500 | 8500 | 5051 | 5051 |
Note: a. OR: Odds Ratio; |
b. Parentheses was reference group and 95% confidence interval of odds ratio; |
c. “1.000/0.000” was the results of keeping 3 decimal places. |
d. *** p < 0.001, ** p < 0.01, * p < 0.05, + p < 0.1 |
In the rural sample, depressive symptoms were significantly associated with inpatient care (OR 1.276, 95% CI 1.096–1.486) and outpatient care (OR 1.400, 95% CI 1.241–1.578). In the urban sample, depressive symptoms were significantly associated with inpatient care (OR 1.496, 95% CI 1.219–1.835) and outpatient care (OR 1.287, 95% CI 1.082–1.531).
Table 4 shows the longitudinal relationship between depressive symptoms in 2013 and health care utilization in 2015.
Table 4
Logistic regression analysis for the relationship between depress symptoms and health care utilization among Chinese older adults in 2015.
Variable | Model1 Inpatient care in 2015 (Full model) OR [95%CI] | Model2 Outpatient care in 2015 (Full model) OR [95%CI] | Model3 Inpatient care in 2015 (Rural) OR [95%CI] | Model4 Outpatient care in 2015 (Rural) OR [95%CI] | Model5 Inpatient care in 2015 (Urban) OR [95%CI] | Model6 Outpatient care in 2015 (Urban) OR [95%CI] |
Depression (Not have) | | | | | | |
Have | 1.209**[1.075,1.360] | 1.394***[1.261,1.542] | 1.219**[1.055,1.408] | 1.399***[1.238,1.581] | 1.190+ [0.972,1.458] | 1.369***[1.146,1.636] |
Age | 1.032***[1.026,1.038] | 1.004[0.999,1.009] | 1.027***[1.019,1.035] | 1.005[0.998,1.012] | 1.040***[1.030,1.050] | 1.001[0.993,1.010] |
Education years | 1.0004[0.9857,1.0152] | 1.016* [1.003,1.028] | 0.999[0.979,1.019] | 1.010[0.994,1.026] | 1.003[0.981,1.026] | 1.028**[1.007,1.049] |
Gender(Female) | | | | | | |
Male | 1.083[0.930,1.261] | 0.883+[0.774,1.008] | 1.134[0.927,1.388] | 0.837*[0.705,0.993] | 1.003[0.793,1.268] | 0.964[0.780,1.191] |
Marry status (Not have spouse ) | | | | | | |
Have spouse | 0.934[0.798,1.092] | 0.995[0.862,1.149] | 0.788*[0.649,0.956] | 1.002[0.837,1.199] | 1.250 [0.954,1.636] | 0.955[0.749,1.217] |
Hukou status (Non-agricultural hukou) | | | | | | |
Agricultural hukou | 0.823*[0.709,0.955] | 0.979[0.858,1.117] | 0.842[0.626,1.133] | 0.762*[0.594,0.979] | 0.819*[0.684,0.982] | 1.091[0.929,1.281] |
Smoking history (Not have ) | | | | | | |
Have | 0.909[0.786,1.053] | 0.909[0.800,1.033] | 0.845+[0.698,1.023] | 0.894[0.759,1.052] | 1.013[0.807,1.272] | 0.926[0.753,1.139] |
Medical insurance (Not have) | | | | | | |
Have | 1.260[0.924,1.718] | 1.157[0.896,1.493] | 1.219[0.819,1.812] | 1.072[0.781,1.472] | 1.295[0.788,2.130] | 1.327[0.861,2.045] |
Self-report health (Good) | | | | | | |
Fair | 1.384***[1.193,1.606] | 1.389***[1.230,1.568] | 1.458***[1.189,1.788] | 1.264**[1.082,1.476] | 1.303*[1.047,1.622] | 1.605***[1.320,1.952] |
Poor | 2.343***[1.986,2.765] | 1.905***[1.655,2.192] | 2.416***[1.940,3.008] | 1.633***[1.370,1.946] | 2.267***[1.751,2.937] | 2.472***[1.951,3.133] |
Chronic (Not have) | | | | | | |
Have | 1.982***[1.718,2.287] | 1.725***[1.542,1.931] | 2.115***[1.751,2.555] | 1.828***[1.584,2.110] | 1.807***[1.450,2.251] | 1.579***[1.315,1.897] |
Current living place (Rural) | | | | | | |
Urban | 1.128+[0.999,1.274] | 0.945[0.851,1.049] | | | | |
Region (East) | | | | | | |
Central | 1.101[0.967,1.254] | 1.148*[1.029,1.280] | 1.090[0.919,1.293] | 1.216**[1.057,1.399] | 1.125[0.920,1.376] | 1.060 [0.890,1.264] |
West | 1.264***[1.125,1.421] | 1.148** [1.039,1.269] | 1.241**[1.066,1.444] | 1.259***[1.108,1.430] | 1.296**[1.077,1.560] | 0.979[0.829,1.156] |
Income | 1.038[0.986,1.091] | 1.070**[1.024,1.119] | 1.044[0.979,1.113] | 1.063*[1.006,1.123] | 1.024[0.942,1.112] | 1.078+[1.000,1.163] |
Constant | 0.006***[0.003,0.012] | 0.056***[0.032,0.095] | 0.009***[0.004,0.022] | 0.075***[0.037,0.152] | 0.004***[0.001,0.010] | 0.045***[0.019,0.107] |
R2 | 0.056 | 0.033 | 0.057 | 0.035 | 0.055 | 0.034 |
N | 13551 | 13551 | 8500 | 8500 | 5051 | 5051 |
Note: a. OR: Odds Ratio; |
b. Parentheses was reference group and 95% confidence interval of odds ratio; |
c. “1.000” was the results of keeping 3 decimal places. |
d. *** p < 0.001, ** p < 0.01, * p < 0.05, + p < 0.1 |
The relationship between depressive symptoms and participants’ health services utilization was further verified by full models (Table 4). In the whole sample, depressive symptoms were significantly associated with inpatient care (OR 1.209, 95% CI 1.075–1.360) and outpatient care (OR 1.394, 95% CI 1.261–1.542). Adopting a conservative p value of .01, such relationship persists across other sub-models except Model 5. The relationship between depressive symptoms and participants’ inpatient care utilization was weak in rural sample (OR 1.219, 95% CI 1.055–1.408) and urban sample (OR 1.190, 95% CI 0.972–1.458).