Depression among Chinese older adults: A perspective from Hukou and health inequities

Jul 29, 2017Journal of affective disorders

Depression in Older Chinese Adults Linked to Household Registration and Health Inequality

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Abstract

Depressive symptoms were significantly higher among villagers and temporary migrants compared to urban local citizens, with a beta of 1.40 for villagers.

Villagers exhibited a higher level of depressive symptoms compared to urban local citizens, with a beta of 1.40.
Temporary rural-to-urban migrants showed increased depressive symptoms with a beta of 0.97 compared to urban local citizens.
Permanent rural-to-urban migrants had a beta of 0.52 for depressive symptoms when compared to urban local citizens.
Individuals who experienced changes in their Hukou status before age 16 were associated with higher depressive symptoms, indicated by a beta of 1.39.
The study's cross-sectional design limits the ability to establish causal relationships between Hukou status and depression.

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BACKGROUND: Previous studies have suggested that socioeconomic status is linked to health status. However, most of these studies have been conducted in developed countries, whose social settings are different from those in China. Hukou (household registration) status, one of China's main socioeconomic indicators, has received limited attention in the literature.

OBJECTIVES: The objective of this study was to examine the relationship between different Hukou statuses, and depression, among older adults in China.

METHODS: The data were obtained from the China Health and Retirement Longitudinal Study (CHARLS). In total, 7409 Chinese older adults aged 60 and over were included in the survey. The Center for Epidemiologic Studies Depression Scale (CESD-10) was used to assess depressive symptoms. The various Hukou statuses were coded into four categories: villager, temporary rural-to-urban migrant, permanent rural-to-urban migrant and urban local citizen.

RESULTS: The results indicated that the level of depressive symptoms was significantly higher among villagers (beta [ß] 1.40, 95%CI 0.83-1.96), temporary migrants (beta [ß] 0.97 95%CI 0.38-1.56) and permanent migrants (beta [ß] 0.52 95%CI 0.04-1.00) than among urban local citizens. In addition, people who had experienced changes in their Hukou status before age 16 were more likely to have depressive symptoms (beta [ß] 1.39, 95% CI 0.20-2.58).

LIMITATIONS: Being cross-sectional, this study is insufficient for determining causal relationships between Hukou status and depression.

CONCLUSIONS: Our findings suggest that deeper reform of the Hukou system, and greater efforts to eliminate the health disparities associated with that system, are needed in China.

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Depression among Chinese older adults: A perspective from Hukou and health inequities

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