title: Inequality in the hepatitis B awareness level in rural residents from 7 provinces in China.
abstract: The hepatitis B (HB) awareness level is an important factor affecting the rates of HB virus vaccination. To better understand income-related inequalities in the HB awareness level, it is imperative to identify the sources of inequalities and assess the contribution rates of these influential factors. This study analyzed the unequal distribution of the HB awareness level and the contributions of various influential factors. We performed a cross-sectional household survey with questionnaire-based, face-to-face interviews in 7 Chinese provinces. Responses from 7271 respondents were used in this analysis. Multinomial logistic regression was used for the analysis of contributing factors, and the concentration index was used as a measure of HB awareness inequalities. The HB awareness level varied across participants with different characteristics. Multinomial logistic regression of the explanatory factors of the HB awareness level showed that several estimated coefficients and relative risk ratios were statistically significant for middle- and high-level awareness, except for sex, occupation, and household income. The concentration index of the HB knowledge score was 0.140, indicating inequality gradients disadvantageous to the poor. The contribution rate of socioeconomic factors was the largest (60.8%), followed by demographic characteristics (29.0%) and geographic factors (4.3%). Demographic, socioeconomic, and geographic factors are associated with the HB awareness inequality. Therefore, to reduce inequality, HB-related health education targeting individuals with low socioeconomic status should be performed. Less-developed provinces, especially with high proportions of poor residents, warrant particular attention. Our findings may be beneficial to improve the HB virus vaccination rate for individuals with low socioeconomic status.
authors.affiliation: a Department of Health Service Management , School of Public Health, Xuzhou Medical University , Xuzhou , Jiangsu , China.
authors.forename: Juan
authors.initials: J
authors.lastname: Zheng
authors.affiliation: b Center for Health Economic Experiments and Public Policy , School of Public Health, Shandong University , Jinan , Shandong , China.
authors.forename: Quan
authors.initials: Q
authors.lastname: Li
authors.affiliation: b Center for Health Economic Experiments and Public Policy , School of Public Health, Shandong University , Jinan , Shandong , China.
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.affiliation: c Peking Union Medical College Hospital , Beijing , China.
authors.forename: Guojie
authors.initials: G
authors.lastname: Zhang
authors.affiliation: d Department of Health Management and Health Economics , University of Oslo , Oslo , Norway.
authors.forename: Knut R
authors.initials: KR
authors.lastname: Wangen
mesh_terms: D000328:Adult; D002681:China; D003430:Cross-Sectional Studies; D004522:Educational Status; D005191:Family Characteristics; D005260:Female; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006509:Hepatitis B / Q000523:psychology; D017325:Hepatitis B Vaccines; D006801:Humans; D007182:Income; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D012424:Rural Population; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000523:psychology
chemical_list: D017325:Hepatitis B Vaccines
keywords: China; Hepatitis B; awareness level; inequality; questionnaire; vaccination