Rural-urban disparities in the unmet need for home visiting services among oldest-old in China: Changes over time and decomposition analysis

PURPOSE: This study aims to assess trends in rural-urban disparities in the prevalence of unmet community-based home visiting services need and their contributing factors from 2005 to 2018 among oldest-old in China. METHODS: The Chinese Longitudinal Healthy Longevity Survey data of oldest-old collected with a targeted random-sampling approach from half of counties/cities from 23 provinces across China was used. Unmet need was measured as the differences between healthcare services expected and available. We used Cochran-Armitage tests to test linear trends in prevalence of unmet need. Average marginal differences were estimated to measure magnitude of rural-urban disparities in prevalence of unmet need. Changes in rural-urban disparities were decomposed using Blinder-Oaxaca Decomposition technique to logit models. All analysis was performed by Stata 15.0. RESULTS: < 0.001). In 2017/2018, urban oldest-old reported greater prevalence of unmet need (average marginal difference, 95% CI: 3.7% [0.4%-7.1%]); affluent oldest-old reported less unmet need than their peers. Oldest-old from Central and Western China reported greater prevalence of unmet need than their Eastern peers. Increases in income (percentages of explained change, overall: 21.3%; rural: 16.9%, urban: 36.9%) mainly contributed to decreased trends in prevalence of unmet need. CONCLUSIONS: Oldest-old with socioeconomic disadvantages or living in Central and Western China reported greater prevalence of unmet need. Policy efforts are warranted to ensure equitable access to home visiting services among those oldest-old.