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PLoS One. 2014 May 22;9(5):e98095. doi: 10.1371/journal.pone.0098095. eCollection 2014.

Social determinants of community health services utilization among the users in China: a 4-year cross-sectional study.

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Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China.
Department of Maternal and Child Health Care and Community Health, National Health and Family Planning Commisson of the People's Republic of China, Beijing, P. R. China.
Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich, United Kingdom.



To identify social factors determining the frequency of community health service (CHS) utilization among CHS users in China.


Nationwide cross-sectional surveys were conducted in 2008, 2009, 2010, and 2011. A total of 86,116 CHS visitors selected from 35 cities were interviewed. Descriptive analysis and multinomial logistic regression analysis were employed to analyze characteristics of CHS users, frequency of CHS utilization, and the socio-demographic and socio-economic factors influencing frequency of CHS utilization.


Female and senior CHS clients were more likely to make 3-5 and ≥6 CHS visits (as opposed to 1-2 visits) than male and young clients, respectively. CHS clients with higher education were less frequent users than individuals with primary education or less in 2008 and 2009; in later surveys, CHS clients with higher education were the more frequent users. The association between frequent CHS visits and family income has changed significantly between 2008 and 2011. In 2011, income status did not have a discernible effect on the likelihood of making ≥6 CHS visits, and it only had a slight effect on making 3-5 CHS visits.


CHS may play an important role in providing primary health care to meet the demands of vulnerable populations in China. Over time, individuals with higher education are increasingly likely to make frequent CHS visits than individuals with primary school education or below. The gap in frequency of CHS utilization among different economic income groups decreased from 2008 to 2011.

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