Primary care and all-cause mortality in urban China: a mixed-level analysis

Abstract

Background: There is still a lack of evidence focusing on primary care supply in developing countries where the educational achievement of primary care practitioners is relatively low.

Objectives: By using a nationally representative longitudinal and prospective cohort study, this study examined whether primary care supply, measured by the availability and the number of community health centres (CHCs), was associated with 4-year mortality risk among community-dwelling participants aged 45 and above in urban China.

Methods: Using the 2011 and 2015 waves of the China Health and Retirement Longitudinal Survey (CHARLS), we conducted a longitudinal mixed-level logistic analysis to study the impact of the availability and the number of CHC on 4-year follow-up mortality risk, after adjusting community- and individual-level covariates.

Results: Individuals living in communities with CHC were 31% less likely to die during the 4-year follow-up (P < 0.05) conditional on community-level characteristics, including the basic facilities availability, population size and physical area, and individuals' socio-demographic and health characteristics and health behaviours. Also, an increased number of community-level CHC was shown to decrease residents' 4-year mortality risk significantly (odds ratio = 0.82, P < 0.05). Furthermore, the association was more pronounced among adults aged 65 and above.

Conclusion: This study provides additional evidence of the health-promoting effect of primary care supply among urban residents in China. Improving primary care coverage in China should be necessary to improve health care access, thus promoting population health.

Keywords: Aging population; community health centre; longitudinal mixed-level analysis; mortality risk; primary care supply; urban China.