Abstract
Background
As the number of elderly migrants in China continues to grow, it is necessary to pay closer attention to their health and health services. Some studies have confirmed that social capital plays a significant role in the utilization of health services. Therefore, an in-depth exploration of the relationship between social capital and the utilization of essential public health services (EPHS) by elderly migrants will not only contribute to improving their overall health but also facilitate a more balanced development of public health service system in China.
Methods
Based on the cross-sectional data from the 2017 China Migrants Dynamic Survey (CMDS), this study examined the impact of social capital on the utilization of EPHS among elderly migrants. We evaluated social capital at two distinct levels: the individual and the community, and considered two dimensions of social capital: structural social capital (SSC) and cognitive social capital (CSC). The study aimed to delve into the impact of these forms of social capital on the utilization of EPHS among elderly migrants, and whether the migration range moderates this impact by multilevel logistic regression analysis.
Results
A total of 5,728 migrant elderly individuals were selected. The health records establishment rate and health education acceptance rate were approximately 33.0% and 58.6%, respectively. Social capital influenceed the utilization of EPHS among elderly migrants. Specifically, individual-level SSC and CSC have impacts on both the establishment of health records (OR = 1.598, 95%CI 1.366–1.869; OR = 1.705, 95%CI 1.433–2.028) and the acceptance of health education (OR = 1.345, 95%CI 1.154–1.567; OR = 2.297, 95%CI 1.906–2.768) among elderly migrants, while community-level SSC only affected the acceptance of health education (OR = 3.838, 95%CI 1.328–11.097). There were significant differences in individual-level SSC, health records, and health education among different migration range subgroups among elderly migrants. Migration range moderated the effect of social capital on the utilization of EPHS, crossing provinces could weaken the relationship between SSC and health education.
Conclusions
Social capital is associated with a higher utilization rate of EPHS among elderly migrants. It is necessary to encourage them to actively participate in social activities, strengthen public services and infrastructure construction in the area, and improve their sense of belonging and identity.
Similar content being viewed by others
Introduction
With the booming of China’s economy and the development of urbanization, migrant population has increased significantly. The proportion of elderly migrants is continually on the rise in the context of an ageing population and family migration [1]. As of 2015, there were over 13 million elderly migrants, accounting for 5.3% of the total million migrants, with an increase of 8 million and an annual growth rate of 6.6% during the past 15 years [2]. According to the " China Migrant Population Development Report 2018”, the trend of increasing elderly migrants has persisted since 2015 [3]. The dual challenges of “migration” and “ageing” are particularly evident among elderly migrants. Age-associated decline in health and the deterioration of bodily functions, with a corresponding increase in demand for health services [ National Health Commission of the People’s Republic of China. 2022. “China Migrant Dynamic Survey (CMDS).”. https://www.chinaldrk.org.cn/wjw/#/user/apply. Luo Y, Guo C, Wang Y, Zheng X. Trends and challenges for population health and migration—China,2015–2050. China CDC Wkly. 2020;2:520–4. National Bureau of Statistics. United Nations Population Fund, United Nations Children’s Fund. Domestic migrants in China: Trends, Challenges and Recommendations. 2019. https://china.unfpa.org/en/report/20190816. Accessed 21 June 2023. National Health Commission of the People’s Republic of China. Report on China’s migrant Population Development 2018. China Population Publishing House, Bei**g, China; 2018. ** S, Song Y, Li X, Li M, Lu Z, Yang Y, et al. Local-migrant gaps in healthcare utilization between older migrants and local residents in China. J Am Geriatr Soc. 2020;68:1560–7. Zhao J, Kong F, Li S. Association between social integration and medical returns among the migrant elderly following children to **an City China. BMC Public Health. 2021;21:1822. Guo J, Dai Y, Fu LL, Yang HL, Liu LL. Structural equation model of the influencing factors of the medical behavior of floating elderly population. Chin J Health Policy. 2019;12(2):35–40. Li Q, Zhou X, Ma S, Jiang M, Li L. The effect of migration on social capital and depression among older adults in China. Soc Psychiatry Psychiatr Epidemiol. 2017;52(12):1513–22. Opinions of the Central Committee of the Communist Party. Of China and the State Council on deepening the reform of the Medical and Health System. China’s Labor Secur.2009(05):48–53. The Central People’s Government of the People’s Republic of China. Newly Included in the Essential Public Health Service Work Specification. (2019 Edition). https://www.gov.cn/fuwu/2019-09/06/content_5427746.htm. Accessed 20 Feb 2024. Wang PG. Research Report on the Equalization of Essential Public Health Services of China’s migration. 2022. Lin Y, Chu C, Chen Q, **ao J, Wan C. Factors influencing utilization of primary health care by elderly internal migrants in China: the role of social contacts. BMC Public Health. 2020;20(1):1054. Cui QQ, Liu XW, Hou XL, Ren J, Guo H, Kong Y, Li JC, Zhang JH. Influencing factors for medical visits of elderly migrant patients for common diseases and health record establishment. Chin J Med Manage Sci. 2021;11(06):1–6. The state council the people’s republic of China. The notice of completing the work of the national basic public health service project. (2017). http://www.nhc.gov.cn/jws/s3577/201709/fb16b2e306bd469ab84e0c42173bc52d.shtml. Published 2017. Accessed June 7, 2023. Hua F. Preventive medicine. Bei**g: People’s Medical Publishing House; 2008. Kang SY, Kim I, Kim W. Differential patterns of Healthcare Service Use among Chinese and Korean immigrant elders. J Immigr Minor Health. 2016;18(6):1455–61. Li L, Yang J, Zhai S, Li D. Determinants of Differences in Health Service Utilization between older Rural-to-urban migrant workers and older rural residents: evidence from a Decomposition Approach. Int J Environ Res Public Health. 2022;19(10):6245. Liang J, Shi Y, Osman M, Shrestha B, Wang P. The Association between Social Integration and Utilization of Essential Public Health Services among Internal Migrants in China: a Multilevel Logistic Analysis. Int J Environ Res Public Health. 2020;17(18):6524. Li D, Yang J, Liu H, Ma Y, Jiang J. Comparing income-related inequality on health service utilization between older rural-to-urban migrant workers and older rural residents in China: a cross-sectional study. BMJ Open. 2023;13(2):e060581. Zhan X, Zhou Y, Xu XL, **a YQ, Zhu TL. Social networks embedded in public health services: review and reflection. J Nan**g Med Univ. 2022;22(1):11–4. Bourdieu P. The forms of capital[M]the sociology of economic life. Routledge, 2018: 78–92. Putnam RD. Bowling alone: America’s declining social capital. 2015: 188–196. Moore S, Kawachi I. Twenty years of social capital and health research: a glossary. J Epidemiol Community Health. 2017;71(5):513–7. Uphoff N, Wijayaratna CM. Demonstrated benefits from social capital: the productivity of farmer organizations in gal oya, Sri Lanka. World Dev. 2000;28(11):1875–90. Nyqvist F, Pape B, Pellfolk T, et al. Structural and cognitive aspects of social capital and all-cause mortality: a meta-analysis of cohort studies. Soc Indic Res. 2014;116(2):545–66. Islam MK, Merlo J, Kawachi I, Lindström M, Gerdtham UG. Social capital and health: does egalitarianism matter? A literature review. Int J Equity Health. 2006;5(1):1–28. Szreter S, Woolcock M. Health by association? Social capital, social theory, and the political economy of public health. Int J Epidemiol. 2004;33(4):650–67. Zhou ZL, Mao ZF. Measurement of social capital and its application in health care: a review. Chin J Public Health. 2016;32(09):1287–92. Hou Z, Lin S, Zhang D. Social capital, neighborhood characteristics and utilization of local public health services among domestic migrants in China: a cross-sectional study. BMJ Open. 2017;7(8):e014224. Yang Z, Jiang CH. Impact of social capital, sex and education on the utilization of public health services: a cross sectional study based on the China migrant dynamic survey. BMC Public Health. 2021;21(1):751. Tang S, Long C, Wang R, Liu Q, Feng D, Feng Z. Improving the utilization of essential public health services by Chinese elderly migrants: strategies and policy implication. J Glob Health. 2020;10(1):010807. Ali SH, Yi SS, Wyatt LC, Misra S, Kwon SC, Trinh-Shevrin C, Islam NS. Neighborhood social cohesion and disease prevention in Asian immigrant populations. Prev Med. 2020;141:106298. Qiao S, Li Z, Zhang J, Sun X, Garrett C, Li X. Social Capital, Urbanization Level, and COVID-19 vaccination uptake in the United States: A National Level Analysis. Vaccines (Basel). 2022;10(4):625. Story WT. Social capital and the utilization of maternal and child health services in India: a multilevel analysis. Health Place. 2014;28:73–84. Poortinga W. Social capital: an individual or collective resource for health? Soc Sci Med. 2006;62(2):292–302. Wu D, Wang YH, Ge X, Rao T, Gao YX, Li Y. Utilization Status of Basic Public Health Services and its influencing factors among Old migrants in China. Med Soc. 2023;36(3):43–4855. Hou HL, Li CH, Identity. Region and city size: Inequality of Basic Public Health Services for the Elderly Floating Population. Popul Dev. 2019;25(2):31–8. Li Y, Qi Y. The impact of regional cultural differences on the social integration of elderly migrants. Acad Exch. 2021;8:132–42. Chen ZG. Wandering and loneliness: a study on the social interaction of the migrant elderly population. Social Sci Rev. 2021;36(3):93–103. Hu YP, Liu Y, Wang CK. Research on the influencing factors of the elder immigrants’ Social Integration. Popul Econ. 2018(6):77–88. Murayama H, Fujiwara Y, Kawachi I. Social capital and health: a review of prospective multilevel studies. J Epidemiol. 2012;22(3):179–87. Lu Q, Chang A, Yu G, Yang Y, Schulz PJ. Social capital and health information seeking in China. BMC Public Health. 2022;22(1):1525. Peng P DS. The elderly migrate population in the context of family-based mobility urban integration studies. J Shenzhen Univ. 2020;37(6):105–14. Wang Y, Zhu H, Aziz N, Liu Y. Does Social Capital Improve the Effectiveness of Public Service? An insight from rural-to-Urban migrants in China. Soc Indic Res. 2023;165(2):431–52. Peng YI, Lin TF. Social capital and preventive care use among the elderly under Taiwan’s National Health Insurance. Arch Gerontol Geriatr. Mar-Apr. 2018;75:28–36. Bataineh H, Devlin RA, Barham V. Social capital and having a regular family doctor: evidence from longitudinal data. Soc Sci Med. 2019;220:421–9. Xu XL, Zhou LL, Gu JH. Consideration and enlightenment from social capital embedded in family doctors’ contract service. Chin Health Service Manage. 2020;37(09):656–8. Derose KP, Varda DM. Social capital and health care access: a systematic review. Med Care Res Rev. 2009;66(3):272–306. Zhang W, Huang Y, Lu M, Lin G, Wo T, ** X. I know some people: the Association of Social Capital with Primary Health Care utilization of residents in China. Front Public Health. 2021;9:689765. Perry M, Williams RL, Wallerstein N, Waitzkin H. Social capital and health care experiences among low-income individuals. Am J Public Health. 2008;98(2):330–6. Zhang YN. Effect of social capital and financial medical expenditure on residents’ health: from the perspective of resource access. Shandong university.2022. Mizuochi M. Social capital and refraining from medical care among elderly people in Japan. BMC Health Serv Res. 2016;16:331. Lei XS. The impact of social capital on participation in basic medical insurance-an empirical analysis based on 2015 CGSS data. J Huazhong Agricultural Univ.2019(5):146–55. Yip W, Subramanian SV, Mitchell AD, Lee DT, Wang J, Kawachi I. Does social capital enhance health and well-being? Evidence from rural China. Soc Sci Med. 2007;64(1):35–49. Hendryx MS, Ahern MM, Lovrich NP, McCurdy AH. Access to health care and community social capital. Health Serv Res. 2002;37(1):87–103. Nianwei W, Chen Q, Bo G, **aohui R, Li X. Studying on the residents’ medical seeking behavior from the perspective of social capital. Chin Health Service Manage. 2020;37(10):731–4. Zhang GY, Wu SL. Mobility, insurance and medical treatment: an empirical study based on the Elderly Floating Population: a discussion on the path and goal of Medical Insurance Integration. Social Sci Guangdong. 2022(06):199–211. He YH, Cai Y, Deng YF, Yang Y. The establishment of health records of China’s floating population and its influencing factors. Chin Health Resour. 2021;24(4):462–6. The author greatly appreciates the data shared by the National Health Commission of the People’s Republic of China, and the support and advice from the reviewers and the editors. This work was supported by Capital Medical University (PYZ22036), the corresponding author received funding support from the Bei**g Municipal Health Commission's High-level Public Health Technical Talent Development Program (Grant No. 326). SS, JD contributed to the study design, review, and revision of the manuscript; QL conceived and designed the study, collected and analyzed the data, and contributed to the original draft. XLC collected and analyzed the data. LLZ, QHH contributed to the original draft. All authors read and approved the final manuscript. The study was approved by the institutional review board of the Capital Medical University in 2023. And the data used in our research is secondary data, which from CMDS survey already obtained the ethical approval. All methods were carried out by relevant guidelines and regulations. Not Applicable. The corresponding author states that there is no conflict of interest. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Below is the link to the electronic supplementary material. Supplementary Table 2: Explanation of the total variance of social capital and factor contribution rate. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Luo, Q., Chen, X., Zhao, L. et al. Association between social capital and utilization of essential public health services among elderly migrants: a multilevel logistic study based on the 2017 China migrant dynamic survey (CMDS).
BMC Public Health 24, 1252 (2024). https://doi.org/10.1186/s12889-024-18726-0 Received: Accepted: Published: DOI: https://doi.org/10.1186/s12889-024-18726-0Data availability
References
Acknowledgements
Funding
Author information
Authors and Affiliations
Contributions
Corresponding authors
Ethics declarations
Ethics approval and consent to participate
Consent for publication
Competing interests
Additional information
Publisher’s Note
Electronic Supplementary Material
Supplementary Table 1: Factor analysis suitability test.
Rights and permissions
About this article
Cite this article
Keywords