Social determinants of community health services utilization among the users in China: a 4-year cross-sectional study.
BACKGROUND
To identify social factors determining the frequency of community health service (CHS) utilization among CHS users in China.


METHODS
Nationwide cross-sectional surveys were conducted in 2008, 2009, 2010, and 2011. A total of 86,116 CHS visitors selected from 35 cities were interviewed. Descriptive analysis and multinomial logistic regression analysis were employed to analyze characteristics of CHS users, frequency of CHS utilization, and the socio-demographic and socio-economic factors influencing frequency of CHS utilization.


RESULTS
Female and senior CHS clients were more likely to make 3-5 and ≥6 CHS visits (as opposed to 1-2 visits) than male and young clients, respectively. CHS clients with higher education were less frequent users than individuals with primary education or less in 2008 and 2009; in later surveys, CHS clients with higher education were the more frequent users. The association between frequent CHS visits and family income has changed significantly between 2008 and 2011. In 2011, income status did not have a discernible effect on the likelihood of making ≥6 CHS visits, and it only had a slight effect on making 3-5 CHS visits.


CONCLUSIONS
CHS may play an important role in providing primary health care to meet the demands of vulnerable populations in China. Over time, individuals with higher education are increasingly likely to make frequent CHS visits than individuals with primary school education or below. The gap in frequency of CHS utilization among different economic income groups decreased from 2008 to 2011.
Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China.
Yanhong
Y
Gong
Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China.
Xiaoxv
X
Yin
Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China.
Yunxia
Y
Wang
Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China.
Yongbin
Y
Li
Department of Maternal and Child Health Care and Community Health, National Health and Family Planning Commisson of the People's Republic of China, Beijing, P. R. China.
Geng
G
Qin
Department of Maternal and Child Health Care and Community Health, National Health and Family Planning Commisson of the People's Republic of China, Beijing, P. R. China.
Liqun
L
Liu
Department of Maternal and Child Health Care and Community Health, National Health and Family Planning Commisson of the People's Republic of China, Beijing, P. R. China.
Wei
W
Zhou
Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich, United Kingdom.
Fujian
F
Song
Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China.
Xiaoxin
X
Dong
Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China.
Shiyi
S
Cao
Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China.
Chen
C
Yang
Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China.
Huajie
H
Yang
Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China.
Jun
J
Xie
Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China.
Junan
J
Liu
Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China.
Zuxun
Z
Lu
D000328:Adult; D000368:Aged; D002681:China; D003153:Community Health Services / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged