title: Non-use of health care service among empty-nest elderly in Shandong, China: a cross-sectional study.
abstract: BACKGROUND
  Empty-nest elderly refers to those elderly with no children or whose children have already left home. Few studies have focused on healthcare service use among empty-nest seniors, and no studies have identified the prevalence and profiles of non-use of healthcare services among empty-nest elderly. The purpose of this study is to compare the prevalence of non-use of healthcare services between empty-nest and non-empty-nest elderly and identify risk factors for the non-use of healthcare services among empty-nest seniors.
  
  
  METHODS
  Four thousand four hundred sixty nine seniors (60 years and above) were draw from a cross-sectional study conducted in three urban districts and three rural counties of Shandong Province in China. Non-visiting within the past 2 weeks and non-hospitalization in previous year are used to measure non-use of healthcare services. Chi-square test is used to compare the prevalence of non-use between empty-nesters and non-empty-nesters. Multivariate logistic regression analysis is employed to identify the risk factors of non-use among empty-nest seniors.
  
  
  RESULTS
  Of 4469 respondents, 2667 (59.7%) are empty-nesters. Overall, 35.5% of the participants had non-visiting and 34.5% had non-hospitalization. Non-visiting rate among empty-nest elderly (37.7%) is significantly higher than that among non-empty-nest ones (32.7%) (P = 0.008). Non-hospitalization rate among empty-nesters (36.1%) is slightly higher than that among non-empty-nesters (31.6%) (P = 0.166). Financial difficulty is the leading cause for both non-visiting and non-hospitalization of the participants, and it exerts a larger negative effect on access to healthcare for empty-nest elderly than non-empty-nest ones. Both non-visiting and non-hospitalization among empty-nest seniors are independently associated with low-income households, health insurance status and non-communicable chronic diseases. The non-visiting rate is also found to be higher among the empty-nesters with lower education and those from rural areas.
  
  
  CONCLUSIONS
  Our findings indicate that empty-nest seniors have higher non-use rate of healthcare services than non-empty-nest ones. Financial difficulty is the leading cause of non-use of health services. Healthcare policies should be developed or modified to make them more pro-poor and also pro-empty-nested.
authors.affiliation: School of Public Health, Shandong University, Jinan, 250012, China. zhouchengchao@sdu.edu.cn.
authors.forename: Chengchao
authors.initials: C
authors.lastname: Zhou
authors.affiliation: Licheng Centre for Maternal and Child Healthcare, Jinan, 250001, China. lcqxxk@126.com.
authors.forename: Chunmei
authors.initials: C
authors.lastname: Ji
authors.affiliation: Shandong Centre for Disease Control and Prevention, Jinan, 250014, China. sdjn_chj@163.com.
authors.forename: Jie
authors.initials: J
authors.lastname: Chu
authors.affiliation: Freeman Spogli Institute, Stanford University, Stanford, CA, 94305, USA. amedina5@stanford.edu.
authors.forename: Alexis
authors.initials: A
authors.lastname: Medina
authors.affiliation: School of Public Health, Shandong University, Jinan, 250012, China. 785407371@qq.com.
authors.forename: Cuicui
authors.initials: C
authors.lastname: Li
authors.affiliation: School of Public Health, Shandong University, Jinan, 250012, China. 123643416@qq.com.
authors.forename: Shan
authors.initials: S
authors.lastname: Jiang
authors.affiliation: Weifang Medical College, Weifang, 261053, China. wgzheng@sdu.edu.cn.
authors.forename: Wengui
authors.initials: W
authors.lastname: Zheng
authors.affiliation: School of Public Health, Shandong University, Jinan, 250012, China. liujing@sdu.edu.cn.
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.affiliation: Freeman Spogli Institute, Stanford University, Stanford, CA, 94305, USA. rozelle@stanford.edu.
authors.forename: Scott
authors.initials: S
authors.lastname: Rozelle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002681:China; D003430:Cross-Sectional Studies; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D011795:Surveys and Questionnaires