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Background <p>With escalating population aging, the significance of ensuring equitable access to elderly care services is becoming increasingly prominent. This study explored whether inequity exists in home- and community-based service (HCBS) use among older adults in China, assessed the extent of inequity, and analyzed the factors influencing the utilization of HCBSs and the resulting inequities.</p> Methods <p>This study focused on older adults (aged 60 and above) using data from the 2018 wave of the China Health and Retirement Longitudinal Study. Variables from previous studies and the Anderson Behavioral model were classified into need and non-need factors for the analysis. Ultimately, 2823 participants were included. We used the concentration curve, concentration index (CI), and horizontal inequity (HI) to measure inequity in HCBS utilization. Through CI decomposition analysis, we examined the contribution of each factor to the overall inequity.</p> Results <p>In the older adult population, with income levels ranging from low to high, service utilization showed an initial rising trend, and then a decline. Middle-income older adults used HCBSs the most under both actual and need-standardized scenarios, accounting for 24.12% and 25.08% of the total utilization, respectively. Low- and high-income older adults had lower HCBS utilization than middle-income older adults. The CI and HI for inequity in HCBS utilization among older Chinese adults were 0.085 (<i>p</i> &lt; 0.01) and 0.064 (<i>p</i> &lt; 0.01), respectively. A slight inequity in HCBS use among older adults in China was found in favor of higher-income users. The contribution of non-need factors to inequity in HCBS use was 450.93%, of which the contribution from income was 464.69% (some non-need factors contributed negatively to inequity). Differences in income significantly exacerbated the issue of fairness in HCBS usage, with low-income older individuals potentially more susceptible to experience inequities.</p> Conclusions <p>Government-issued policies to promote the utilization of HCBSs by vulnerable older adults have achieved certain results. Middle-income older adults are more likely than those with higher incomes to use HCBSs. However, there is still inequity in service utilization, with low-income older adults showing less service utilization, which requires further government intervention. We propose recommendations for future policy improvements.</p>

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Does income-related inequity exist in the utilization of home and community-based services among older adults in China? A cross-sectional study based on the China health and retirement longitudinal study 2018

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  • 发表日期：

    2025年12月22日

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  • Songjia Zhang,
  • Chishuang Wang,
  • Lizheng Ge,
  • Yuyang Zhu,
  • Haojie Jin,
  • Zhiming Xie,
  • Rujia Zhang,
  • Qingren Yang,
  • Xiaoyi Wang,
  • Xiangyang Zhang,
  • Chun Chen

摘要

Background

With escalating population aging, the significance of ensuring equitable access to elderly care services is becoming increasingly prominent. This study explored whether inequity exists in home- and community-based service (HCBS) use among older adults in China, assessed the extent of inequity, and analyzed the factors influencing the utilization of HCBSs and the resulting inequities.

Methods

This study focused on older adults (aged 60 and above) using data from the 2018 wave of the China Health and Retirement Longitudinal Study. Variables from previous studies and the Anderson Behavioral model were classified into need and non-need factors for the analysis. Ultimately, 2823 participants were included. We used the concentration curve, concentration index (CI), and horizontal inequity (HI) to measure inequity in HCBS utilization. Through CI decomposition analysis, we examined the contribution of each factor to the overall inequity.

Results

In the older adult population, with income levels ranging from low to high, service utilization showed an initial rising trend, and then a decline. Middle-income older adults used HCBSs the most under both actual and need-standardized scenarios, accounting for 24.12% and 25.08% of the total utilization, respectively. Low- and high-income older adults had lower HCBS utilization than middle-income older adults. The CI and HI for inequity in HCBS utilization among older Chinese adults were 0.085 (p < 0.01) and 0.064 (p < 0.01), respectively. A slight inequity in HCBS use among older adults in China was found in favor of higher-income users. The contribution of non-need factors to inequity in HCBS use was 450.93%, of which the contribution from income was 464.69% (some non-need factors contributed negatively to inequity). Differences in income significantly exacerbated the issue of fairness in HCBS usage, with low-income older individuals potentially more susceptible to experience inequities.

Conclusions

Government-issued policies to promote the utilization of HCBSs by vulnerable older adults have achieved certain results. Middle-income older adults are more likely than those with higher incomes to use HCBSs. However, there is still inequity in service utilization, with low-income older adults showing less service utilization, which requires further government intervention. We propose recommendations for future policy improvements.