Age and sex differences in the association between access to medical care and health outcomes among older Chinese

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Abstract
Whether the association between access to medical care and health outcomes differs by age and gender among older adults in China is unclear. We aimed to investigate the associations between self-reported inadequate access to care and multiple health outcomes among older men and women in mainland China. Based on four latest waves available so far from a national longitudinal study in mainland China in 2005–2014, we used multilevel random-effect logistic models to estimate the contemporaneous relationships between inadequate access to care and disabilities in instrumental activities of daily living (IADL) and cognitive impairment in men and women at ages 65–74, 75–84, 85–94, and 95+, separately. We also used multilevel hazard models to investigate the relationships between reported access to care and mortality in 2005–2014. Nested models were used to adjust for survey design, sociodemographic background, enrollment in health insurance, and health behaviors. Approximately 6.5% of older adults in China reported inadequate access to care in the period of 2005–2014; and the percentages increased with age and were higher among women at older ages (≥75 years). Overall, older adults with self-reported inadequate access to care had greater odds of IADL and ADL disabilities and cognitive impairment than those with adequate access to healthcare. The elevated odds ratios (ORs) in men were higher in middle-old (75–84) and old-old (85–94) age groups compared to other age groups; whereas the elevated ORs in women were higher in young-old (65–74) and middle-old (75–84) age groups. The relationship between access to care and the health outcomes was generally weakest at the oldest-old ages (95+). Inadequate access to care was also linked with higher mortality risk, primarily in adults aged 75–84, and it was somewhat more pronounced in women than in men. Increased odds of physical disability and cognitive impairment and increased risk of mortality are linked with inadequate access to care. The associations were generally stronger in women than in men and varied across age groups. The findings of the present study have important implications for further improving access to health care and improving health outcomes of older adults in China.

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