Air pollution and refraining from visiting health facilities: a cross-sectional study of domestic migrants in China

• Published in: BMC public health Vol. 22; no. 1; pp. 1 - 2007
• Main Authors: Liu, Zhixin, Liu, Chaojie, Cui, Yu, Liu, Junping, Zhang, Huanyu, Feng, Yajie, Wang, Nan, Jiao, Mingli, Kang, Zheng, Xu, Xiaoxue, Zhao, Juan, Wang, Chen, Zou, Dandan, Liang, Libo, Wu, Qunhong, Hao, Yanhua
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 02.11.2022; BioMed Central; BMC
• Subjects: Air pollution; Air pollution measurements; Air quality; Airborne particulates; Behavior; China; Cross-sectional studies; Diabetes mellitus; Domestic migrants; Environmental aspects; Environmental factors; Environmental indicators; Health aspects; Health behavior; Health care; Health care facilities; Health facilities; Health insurance; Hypertension; Immigrants; Mental health; Migrants; Migration; Migration, Internal; Municipalities; Outdoor air quality; Particulate emissions; Particulate matter; Pollution indicators; Pollution surveys; Refrain from visiting health facilities; Regression analysis; Regression models; Respiratory diseases; Socioeconomic factors; Statistical analysis; Surveys; Time series; China
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-022-14401-4

Abstract Background Local environmental factors are associated with health and healthcare-seeking behaviors. However, there is a paucity in the literature documenting the link between air pollution and healthcare-seeking behaviors. This study aimed to address the gap in the literature through a cross-sectional study of domestic migrants in China. Methods Data were extracted from the 2017 China Migrants Dynamic Survey ( n  = 10,051) and linked to the official air pollution indicators measured by particulate matter (PM 2.5 and PM 10 ) and air quality index (AQI) in the residential municipalities ( n  = 310) of the study participants over the survey period. Probit regression models were established to determine the association between air pollution and refraining from visiting health facilities after adjustment for variations in the predisposing, enabling and needs factors. Thermal inversion intensity was adopted as an instrumental variable to overcome potential endogeneity. Results One unit (µg/m 3 ) increase in monthly average PM 2.5 was associated with 1.8% increase in the probability of refraining from visiting health facilities. The direction and significance of the link remained unchanged when PM 2.5 was replaced by AQI or PM 10 . Higher probability of refraining from visiting health facilities was also associated with overwork (β = 0.066, p  = 0.041) and good self-related health (β = 0.171, p  = 0.006); whereas, lower probability of refraining from visiting health facilities was associated with short-distance (inter-county) migration (β=-0.085, p  = 0.048), exposure to health education (β=-0.142, p  < 0.001), a high sense of local belonging (β=-0.082, p  = 0.018), and having hypertension/diabetes (β=-0.169, p  = 0.005). Conclusion Air pollution is a significant predictor of refraining from visiting health facilities in domestic migrants in China.