Trend in income-related inequalities in inpatient care utilization among Chinese middle-aged and older adults with multiple chronic conditions, 2011–2020

The high prevalence of multiple chronic conditions (MCCs) has become a significant concern in many countries. Equality entails the absence of unnecessary or rectifiable disparities among different groups. Since the inequalities in using inpatient care among patients with MCCs and associated driving factors of the inequalities remain largely unknown, this study aims to examine the trend of using inpatient care and identify its factors among middle-aged and older adults with MCCs in China. We utilized five waves of data from the China Health and Retirement Longitudinal Study (CHARLS), collected in 2011, 2013, 2015, 2018, and 2020, to examine the trend of using inpatient care, employing the concentration curve and standard concentration index to quantify the inequalities in inpatient care utilization, and decomposition analysis to decompose the contribution of potential determinants to the changes in the inequalities between two adjacent years. Totally, the standard concentration index (0.1235 in 2011, 0.0721 in 2013, 0.0780 in 2015, 0.0447 in 2018, 0.0357 in 2020) showed a declined trend, except for an increase between 2013 and 2015. Decomposition analysis indicated that medical expenditure (-90.74%) exacerbated the inequality of inpatient care utilization in Variation 1 (2011–2013). Smoking (512.50%) exacerbated the inequality of inpatient care utilization in Variation 2 (2013–2015). Commercial insurance (273.91%) alleviated the inequality of inpatient care utilization, but New Rural Cooperative Medical Insurance (NRCMI) (-117.39%) exacerbated it in Variation 3 (2015–2018). Commercial insurance (-522.73%) exacerbated the inequality of inpatient care utilization, while NRCMI (263.64%) declined it in Variation 4 (2018–2020). Inequality in income-related disparity in inpatient care utilization has declined for Chinese middle-aged and older adults with MCCs, showing pro-poverty change trend. Despite the impressive reductions in inequality, it is important to maintain and improve equal access to inpatient care. Future interventions and policies could target improving the economic situation of socially and economically vulnerable individuals and strengthening their ability to cope with MCCs.