With the continuous advancement of the aging process in our country, the health problems of the middle-aged and elderly population has increasingly become a social problem which cannot be overlooked.
To comprehensively understand the prevalence trend of health shock in rural middle-aged and elderly people in Ningxia during the 14 years before and after poverty alleviation, identify the dynamic changes of related influencing factors, and provide data support for effective identification and intervention of health shock.
This study selected the health follow-up data of four periods: the early stage of the new medical reform (2009), the promotion period of health poverty alleviation (2015), the poverty alleviation period (2019), and the transition period of rural revitalization and health poverty alleviation (2022). The research subjects were obtained by adopting the method of multi-stage stratified cluster random sampling. Firstly, all the towns and townships in the sample counties (Yanchi, Haiyuan, Pengyang, Xiji) were counted. The administrative villages of each town and township were divided into three levels according to the high, medium and low economic levels. 40% of the natural villages were randomly selected from each level, and 33 rural households were selected from each village by the method of systematic sampling. The middle-aged and elderly people aged 45 and above in the household were taken as the research subjects and a questionnaire survey was conducted. The contents of the questionnaire survey include general demographic characteristics, indicators related to family economic status, health-related indicators, indicators related to the utilization of health services, and indicators related to health poverty alleviation policies. After excluding subjects with missing values for important variables, 6 351, 8 035, 8 566, and 9 337 research subjects were included in the four phases of the survey, respectively. The prevalence trend changes in the incidence of health shocks were analyzed using the χ2 test. The single factors influencing the occurrence of health shocks were explored using the χ2 test or t-test. The fixed binary Logit regression model was used based on Grossman's theory of health needs to identify the effect magnitudes of the related influencing factors.
In 2009, 2015, 2019 and 2022, the incidence of health shock in the rural elderly in Ningxia was 29.74% (1 889/6 351), 27.18% (2 184/8 035), 31.27% (2 679/8 566) and 25.00% (2 334/9 337). The difference was statistically significant (χ2trend=22.520, P<0.001), respectively. The regression results showed that before poverty alleviation, higher per capita annual income and larger family size were the main positive influencing factors of health shocks (P<0.001), while poor self-rated health status, debt due to illness and older age were the main negative influencing factors (P<0.001). After poverty alleviation, higher per capita annual income, larger family size and medical consultations within two weeks were the main positive influencing factors (P<0.001), while poor self-rated health status, debt due to illness and annual hospitalization were the main negative influencing factors (P<0.001). The impact of smoking on health was not significant (P>0.05).
In the 14 years before and after poverty alleviation, the incidence of health shock of the middle-aged and elderly people in rural Ningxia has decreased significantly. The main factors affecting the occurrence of health shock are higher per capita annual income, larger family size, medical consultations within two weeks and debt due to illness. It is necessary to increase the policy support of government funds, improve the level of residents' income, and improve the medical security system to reduce the incidence of health shocks among the middle-aged and elderly people in rural Ningxia.
In the post-poverty alleviation era, in-depth research on the health poverty vulnerability of chronic disease patients can help effectively prevent the recurrence of poverty or new poverty caused by illness at its root.
To understand the Ningxia of health poverty vulnerability among rural residents with chronic diseases and its influencing factors, and to provide theoretical support and practical suggestions for formulating more precise and effective poverty alleviation policies and measures.
From June to July 2022, a multistage stratified cluster random sampling method was used to select participants from four counties (Yanchi, Haiyuan, Xiji, and Pengyang) in Ningxia Hui Autonomous Region. The questionnaire, designed based on literature research and expert consultation, covered demographic characteristics, health status and behaviors, medical security, and family economic conditions. The health poverty vulnerability index for chronic disease patients was calculated using the three-stage feasible generalized least squares (FGLS) method. Binary Logistic regression was employed to explore influencing factors, and Shapley value decomposition was used to quantify the contribution of each factor.
A total of 4 778 chronic disease patients were included. Using a threshold of health poverty vulnerability index > 0.5, 253 were classified into the health poverty vulnerable group and 4 525 into the non-vulnerable group. Logit regression showed that age and seeking care at township health centers or county hospitals were risk factors for health poverty vulnerability (P<0.05). Protective factors included primary or junior high school education, self-rated general or good health, longer disease duration, ≥6 conscious exercise sessions per week, participation in urban-rural integrated basic medical insurance or employee medical insurance, and risk-based health expenditures (P<0.05). Shapley value decomposition indicated that individual characteristics contributed the most (43.51%), followed by health status (21.26%) and disease burden (18.81%).
The health poverty vulnerability of chronic disease patients in Ningxia remains relatively high nationwide. Key factors include age, catastrophic health expenditure, self-rated health, weekly exercise frequency, education level, and disease duration. Governments should increase investments, strengthen health education and promotion campaigns, improve medical service systems and healthcare security mechanisms for chronic disease patients, and foster cross-sector collaboration to establish an early warning platform for health poverty vulnerability.
As China embarks on a new journey towards common prosperity, it is crucial to address the issue of preventing rural residents from falling back into poverty due to illness. This is a significant step towards achieving common prosperity.
This study aims to understand the distribution of health poverty vulnerability among rural out-migrant workers in Ningxia and identify the influencing factors, with the goal of providing policy recommendations for Ningxia to consolidate its poverty alleviation achievements and prevent poverty from returning due to illness.
Using field survey data collected by the research team in Haiyuan County, Yanchi County, Xiji County, and Pengyang County in Ningxia from June to July 2022, the study employed the three-stage feasible generalized least squares (FGLS) method to measure health poverty vulnerability. Logit regression analysis was used to identify the influencing factors. The study also used the marginal effect and Shapley value decomposition method to quantify the contribution of each factor.
The proportion of health poverty vulnerable rural out-migrant workers in Ningxia is 4.5%. The logit model regression analysis results show that housing and kitchen separation, using electricity as living fuel, and participating in a health check in the past year can reduce the risk of health poverty vulnerability. Married status, borrowing money due to illness, and having a low level of education will increase the risk of health poverty vulnerability. The Shapley value decomposition results show that demographic characteristics contribute the most (55.93%), followed by family characteristics (16.46%) and health risk characteristics (15.34%).
The health poverty vulnerability among rural migrant workers in Ningxia is within a controllable range compared with the overall level in the western region. Having separate housing and kitchen areas, using electricity as a domestic fuel, participating in health check - ups within the past year, being in a married status, and borrowing money due to illness are key factors affecting the health poverty vulnerability of migrant workers from Ningxia. It is recommended that relevant departments establish an early warning system for the risk of returning to poverty due to illness, proactively adjust policies, and promote the effective implementation of health poverty prevention efforts.
