Descriptive analyses for the participants in 2013 are presented in Table 1. Of the 13,551 participants, 51.62% were female, 89.92% were married, 79.63% were registered as agricultural hukou, and 44.59% (N = 6,042) had a history of smoking. In addition, about 62.73% of participants were living in rural areas. Regional distribution of the sample was 38.64% east, 25.43% central, and 35.93% west. The mean age was 59.30 years (SD = 9.14), and the average years of education was 5.39.
In terms of self-report health status, 23.48% of participants reported that their health status was good, while the rates for fair and poor status were 53.10% and 23.42%, respectively. About 27.88% of the respondents were found to have depressive symptoms using 10 as the cut-off point. In addition, most participants (71.86%) indicated that they had chronic disease. Overall, compared to the Chinese urban population, rural respondents were more likely to receive outpatient care and were more likely to have depressive symptoms (22.38% and 26.66%, respectively).
In terms of health care utilization, in 2013, the proportion of respondents who received inpatient care and outpatient care were 12.43% and 22.27%, while in 2015 the rate of inpatient care and outpatient care were 14.12% and 20.64%, respectively.
Bivariate correlation analyses
Table 2 shows the results of comparison of depressive symptoms and socio-demographic characteristics by inpatient and outpatient care utilization in 2013. The following characteristics were associated with greater likelihood of inpatient care: unmarried, non-agricultural hukou, presence of medical insurance, poor self-report health status, presence of chronic disease, urban residence, west region, and depressive symptoms. Similarly, the following characteristics were associated with greater likelihood of outpatient care: unmarried, presence of medical insurance, poor self-report health status, presence of chronic disease, west region, oldere age, higher education, and depressive symptoms.
Binary logistic regression analyses
Logistic analyses were used to assess the relationship between depressive symptoms and health services utilization among Chinese middle-aged and older adults in 2013. For participants’ health services utilization in 2013 (Table 3), after adjusting for sociodemographic and other covariates, depressive symptoms were significantly associated with inpatient care and outpatient care. Compared to rural residents, urban elderly adults were more likely to seek inpatient care.
Within the rural sample, depressive symptoms were significantly associated with inpatient care (OR 1.276, 95% CI 1.096–1.486) and outpatient care (OR 1.400, 95% CI 1.241–1.578). In the urban sample, depressive symptoms were significantly associated with inpatient care (OR 1.496, 95% CI 1.219–1.835) and outpatient care (OR 1.287, 95% CI 1.082–1.531).
The relationship between depressive symptoms and participants’ health services utilization was further verified by full models. Table 4 shows the longitudinal relationship between depressive symptoms in 2013 and health care utilization in 2015. In the whole sample, depressive symptoms were significantly associated with inpatient care (OR 1.209, 95% CI 1.075–1.360) and outpatient care (OR 1.394, 95% CI 1.261–1.542). Adopting a conservative p value of 0.01, this relationship persists across other sub-models except Model 5. The relationship between depressive symptoms and participants’ inpatient care utilization was weak in the rural sample (OR 1.219, 95% CI 1.055–1.408) and in the urban sample (OR 1.190, 95% CI 0.972–1.458).