Self-rated health differences among different workers in China with an agricultural hukou: the chain mediation effect of income satisfaction and medical service quality

Workers with agricultural hukou (WAH) in China, due to the prevalence of their group and their vulnerability in terms of health, have long been the focal point of research. This study utilizes data from the 2016, 2018, and 2020 China Family Panel Studies (CFPS) to analyze the self-rated health status and influencing factors of different subgroups of WAH, including subsistence farmers, agricultural laborers, and non-agricultural workers. This study employed the two-way fixed-effects model, treatment effects model, double machine learning (DML), and structural equation modeling (SEM). The results show that, within the WAH population, subsistence farmers have the lowest self-rated health levels. In contrast, no statistically significant health differences were found between agricultural laborers and non-agricultural workers. Drawing upon public service accessibility theory, this study further confirms the chain mediation effect of income satisfaction and medical service quality on these health disparities. The findings provide important insights for the government to formulate more targeted and practical health promotion policies.