Spatial risk for gender-specific adult mortality in an area of southern China

Background: Although economic reforms have brought significant benefits, including improved health care to many Chinese people, accessibility to improved care has not been distributed evenly throughout Chinese society. Also, the effects of the uneven distribution of improved healthcare are not clearly understood. Evidence suggests that mortality is an indicator for evaluating accessibility to improved health care services. We constructed spatially smoothed risk maps for gender-specific adult mortality in an area of southern China comprising both urban and rural areas and identified ecological factors of gender-specific mortality across societies. Results: The study analyzed the data of the Hechi Prefecture in southern in China. An average of 124,204 people lived in the area during the study period (2002-2004). Individual level data for 2002-2004 were grouped using identical rectangular cells (regular lattice) of 0.25 km². Poisson regression was fitted to the group level data to identify gender-specific ecological factors of adult (ages 15-<45 years) mortality. Adult male mortality was more than two-fold higher than adult female mortality. Adults were likely to die of injury, poisoning, or trauma. Significantly more deaths were observed in poor areas than in areas with higher incomes. Specifically, higher spatial risk for adult male mortality was clustered in two rural study areas, which did not overlap with neighborhoods with higher risk for adult female mortality. One high-risk neighborhood for adult female mortality was in a poor urban area. Conclusion: We found a disparity in mortality rates between rural and urban areas in the study area in southern China, especially for adult men. There were also differences in mortality rates between poorer and wealthy populations in both rural and urban areas, which may in part reflect differences in health care quality. Spatial influences upon adult male versus adult female mortality difference underscore the need for more research on gender-related influences on adult mortality in China.