J Epidemiol Community Health 60:1065-1069 doi:10.1136/jech.2005.043539
  • Research report

Provincial income inequality and self-reported health status in China during 1991–7

  1. X Pei1,
  2. E Rodriguez2
  1. 1Department of Policy Analysis and Management, Cornell University, Ithaca, New York, USA
  2. 2Stanford University, Center for Education in Family Community Medicine Stanford, USA
  1. Correspondence to:
 X Pei
 Department of Policy Analysis and Management, 140 MVR Hall, Cornell University, Ithaca, NY 14853, USA; xp25{at}
  • Accepted 26 April 2006


Background: The relationship between income inequality and health has been widely explored. Today there is some evidence suggesting that good health is inversely related to income inequality. After the economic reforms initiated in the early 1980s, China experienced one of the fastest-growing income inequalities in the world. The state of China in the 1990s is focussed on and possible effects of provincial income inequality on individual health status are explored.

Methods: A multilevel regression model is used to analyse the data collected in 1991, 1993 and 1997 from nine provinces included in the China Health and Nutrition Survey. The effects of provincial Gini coefficients on self-rated health in each year are evaluated by two logistic regressions estimating the odds ratios of reporting poor or fair health. The patterns of this effect are compared among the survey years and also among different demographic groups.

Results: The analyses show an independent effect of income inequality on self-reported health after adjusting for individual and household variables. Furthermore, the effect of income distribution is not attenuated when household income and provincial gross domestic product per capita are included in the model. The results show that there is an increased risk of about 10–15% on average for fair or poor health for people living in provinces with greater income inequalities compared with provinces with modest income inequalities.

Conclusions: In China, societal income inequality appears to be an important determinant of population health during 1991–7.


  • i As we are looking at the effect of a provincial-level variable (Gini coefficient), it is more appropriate to control for province-level variability. A multilevel model can account for different factors and different sources of variability at both individual and provincial levels.

  • ii 1993 GDP per capita is from Lee J. Changes in the sources of China’s regional inequality. China Econ Rev 2000;11:232–45. 1997 GDP per capita is from While we mention this additional analysis, we chose not to report on a more detailed analysis because the accuracy of GDP data available is still under scrutiny.

  • iii The results are not reported here due to the space limitation. It can be requested from the author.

  • X Pei conceived the idea for the study and conducted the statistical analysis. Both authors were involved in the study design, interpretation of the analysis and the preparation of the manuscript.

  • Competing interests: None.