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BMC Public Health
Published in: BMC Public Health 1/2022

Open Access 01-12-2022 | Research

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

Authors: Zhixin Liu, Chaojie Liu, Yu Cui, Junping Liu, Huanyu Zhang, Yajie Feng, Nan Wang, Mingli Jiao, Zheng Kang, Xiaoxue Xu, Juan Zhao, Chen Wang, Dandan Zou, Libo Liang, Qunhong Wu, Yanhua Hao

Published in: BMC Public Health | Issue 1/2022

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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 (PM2.5 and PM10) 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/m3) increase in monthly average PM2.5 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 PM2.5 was replaced by AQI or PM10. 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.
Appendix
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Literature
1.
O’Donnell CA, Burns N, Mair FS, Dowrick C, Clissmann C, van den Muijsenbergh M, et al. Reducing the health care burden for marginalised migrants: The potential role for primary care in Europe. Health Policy. 2016;120:495–508.PubMedCrossRef
2.
Shen H, Tao S, Chen Y, Ciais P, Güneralp B, Ru M, et al. Urbanization-induced population migration has reduced ambient PM 2.5 concentrations in China. Sci Adv. 2017;3:e1700300.PubMedPubMedCentralCrossRef
3.
Biswas D, Kristiansen M, Krasnik A, Norredam M. Access to healthcare and alternative health-seeking strategies among undocumented migrants in Denmark. BMC Public Health. 2011;11:560.PubMedPubMedCentralCrossRef
4.
Li X, Yang H, Wang H, Liu X. Effect of Health Education on Healthcare-Seeking Behavior of Migrant Workers in China. IJERPH. 2020;17:2344.PubMedCentralCrossRef
5.
Habib RR, Mikati D, Hojeij S, El Asmar K, Chaaya M, Zurayk R. Associations between poor living conditions and multi-morbidity among Syrian migrant agricultural workers in Lebanon. Eur J Public Health. 2016;26:1039–44.PubMedPubMedCentralCrossRef
6.
Berens E-M, Vogt D, Messer M, Hurrelmann K, Schaeffer D. Health literacy among different age groups in Germany: results of a cross-sectional survey. BMC Public Health. 2016;16:1151.PubMedPubMedCentralCrossRef
7.
Huffman SA, Veen J, Hennink MM, McFarland DA. Exploitation, vulnerability to tuberculosis and access to treatment among Uzbek labor migrants in Kazakhstan. Soc Sci Med. 2012;74:864–72.PubMedCrossRef
8.
Wong DFK, Leung G. The Functions of Social Support in the Mental Health of Male and Female Migrant Workers in China. Health Soc Work. 2008;33:275–85.PubMedCrossRef
9.
Lazarus RS, Launier R. Stress-Related Transactions between Person and Environment. In: Pervin LA, Lewis M, editors. Perspectives in Interactional Psychology. Boston: Springer US; 1978. pp. 287–327.CrossRef
10.
Zhang S, Routledge MN. The contribution of PM2.5 to cardiovascular disease in China. Environ Sci Pollut Res. 2020;27:37502–13.CrossRef
11.
Xing Y-F, Xu Y-H, Shi M-H, Lian Y-X. The impact of PM2.5 on the human respiratory system. J Thorac Dis. 2016;8:E69–74.PubMedPubMedCentral
12.
Maciejczyk P, Chen L-C, Thurston G. The Role of Fossil Fuel Combustion Metals in PM2. 5 Air Pollution Health Associations. Atmosphere. 2021;12:1086.CrossRef
13.
Beelen R, Raaschou-Nielsen O, Stafoggia M, Andersen ZJ, Weinmayr G, Hoffmann B, et al. Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project. The Lancet. 2014;383:785–95.CrossRef
14.
Bo Y, Guo C, Lin C, Chang L, Chan T-C, Huang B, et al. Dynamic Changes in Long-Term Exposure to Ambient Particulate Matter and Incidence of Hypertension in Adults: A Natural Experiment. Hypertension. 2019;74:669–77.PubMedCrossRef
15.
Fasola S, Maio S, Baldacci S, La Grutta S, Ferrante G, Forastiere F, et al. Effects of Particulate Matter on the Incidence of Respiratory Diseases in the Pisan Longitudinal Study. IJERPH. 2020;17:2540.PubMedCentralCrossRef
16.
Tilt B. Perceptions of Risk from Industrial Pollution in China: a Comparison of Occupational Groups. Hum Organ. 2006;65:115–27.CrossRef
17.
Laumbach RJ. Outdoor air pollutants and patient health. Am Family Phys. 2010;81:175.
18.
Power MC, Kioumourtzoglou M-A, Hart JE, Okereke OI, Laden F, Weisskopf MG. The relation between past exposure to fine particulate air pollution and prevalent anxiety: observational cohort study. BMJ. 2015;350:h1111.PubMedPubMedCentralCrossRef
19.
Chen J-C, Schwartz J. Neurobehavioral effects of ambient air pollution on cognitive performance in US adults. Neurotoxicology. 2009;30:231–9.PubMedCrossRef
20.
Power MC, Weisskopf MG, Alexeeff SE, Coull BA, Spiro A III, Schwartz J. Traffic-related air pollution and cognitive function in a cohort of older men. Environ Health Perspect. 2011;119:682–7.PubMedCrossRef
21.
Szyszkowicz M, Thomson EM, Colman I, Rowe BH. Ambient air pollution exposure and emergency department visits for substance abuse. PLoS ONE. 2018;13:e0199826.PubMedPubMedCentralCrossRef
22.
Chew SH, Huang W, Li X. Does haze cloud decision making? A natural laboratory experiment. J Econ Behav Organ. 2021;182:132–61.CrossRef
23.
Yu M, Wu Y, Gordon SP, Cheng J, Chen P, Wang Y, et al. Objectively measured association between air pollution and physical activity, sedentary behavior in college students in Beijing. Environ Res. 2021;194:110492.PubMedCrossRef
24.
Neidell M. Information, avoidance behavior, and health the effect of ozone on asthma hospitalizations. J Hum Resour. 2009;44:450–78.
25.
Chang F-R, Trivedi K. P. Economics of self-medication: theory and evidence. Health Econ. 2003;12:721–39.PubMedCrossRef
26.
Liang Y, Guo M. Utilization of Health Services and Health-Related Quality of Life Research of Rural-to-Urban Migrants in China: A Cross-Sectional Analysis. Soc Indic Res. 2015;120:277–95.CrossRef
27.
Chowdhury N, Naeem I, Ferdous M, Chowdhury M, Goopy S, Rumana N, et al. Unmet Healthcare Needs Among Migrant Populations in Canada: Exploring the Research Landscape Through a Systematic Integrative Review. J Immigr Minor Health. 2021;23:353–72.PubMedCrossRef
28.
Awad A, Al-Saffar N. Evaluation of drug use practices at primary healthcare centers of Kuwait. Eur J Clin Pharmacol. 2010;66:1247–55.PubMedCrossRef
29.
Fu Y, Lin W, Yang Y, Du R, Gao D. Analysis of diverse factors influencing the health status as well as medical and health service utilization in the floating elderly of China. BMC Health Serv Res. 2021;21:438.PubMedPubMedCentralCrossRef
30.
Zhao S, Yu Y, Yin D, He J, Liu N, Qu J, et al. Annual and diurnal variations of gaseous and particulate pollutants in 31 provincial capital cities based on in situ air quality monitoring data from China National Environmental Monitoring Center. Environ Int. 2016;86:92–106.PubMedCrossRef
31.
Chen S, Guo C, Huang X. Air Pollution, Student Health, and School Absences: Evidence from China. J Environ Econ Manag. 2018;92:465–97.CrossRef
32.
He J, Gong S, Yu Y, Yu L, Wu L, Mao H, et al. Air pollution characteristics and their relation to meteorological conditions during 2014–2015 in major Chinese cities. Environ Pollut. 2017;223:484–96.PubMedCrossRef
33.
Faridi S, Niazi S, Yousefian F, Azimi F, Pasalari H, Momeniha F, et al. Spatial homogeneity and heterogeneity of ambient air pollutants in Tehran. Sci Total Environ. 2019;697:134123.PubMedCrossRef
34.
Kasl SV, Cobb S. Some psychological factors associated with illness behavior and selected illnesses. J Chronic Dis. 1964;17:325–45.PubMedCrossRef
35.
Chen F, Chen Z. Cost of economic growth: Air pollution and health expenditure. Sci Total Environ. 2021;755:142543.PubMedCrossRef
36.
Liu T, He G, Lau A. Avoidance behavior against air pollution: evidence from online search indices for anti-PM2.5 masks and air filters in Chinese cities. Environ Econ Policy Stud. 2018;20:325–63.CrossRef
37.
Ghanem D, Zhang J. ‘Effortless Perfection:’Do Chinese cities manipulate air pollution data? J Environ Econ Manag. 2014;68:203–25.CrossRef
38.
Bao J, Yang X, Zhao Z, Wang Z, Yu C, Li X. The spatial-temporal characteristics of air pollution in China from 2001–2014. Int J Environ Res Public Health. 2015;12:15875–87.PubMedPubMedCentralCrossRef
39.
Ke J, Zhang J, Tang M. Does city air pollution affect the attitudes of working residents on work, government, and the city? An examination of a multi-level model with subjective well-being as a mediator. J Clean Prod. 2021;295:126250.CrossRef
40.
Song Y, Zhou A, Zhang M. Exploring the effect of subjective air pollution on happiness in China. Environ Sci Pollut Res. 2020;27:43299–311.CrossRef
41.
Trinh TT, Trinh TT, Le TT, Nguyen TDH, Tu BM. Temperature inversion and air pollution relationship, and its effects on human health in Hanoi City, Vietnam. Environ Geochem Health. 2019;41:929–37.PubMedCrossRef
42.
Li D, Xiao H, Ma S, Zhang J. Health Benefits of Air Quality Improvement: Empirical Research Based on Medical Insurance Reimbursement Data. Front Public Health. 2022;10:855457.PubMedPubMedCentralCrossRef
43.
Andersen RM. National Health Surveys and the Behavioral Model of Health Services Use. Med Care. 2008;46:647–53.PubMedCrossRef
44.
Fenn B, Morris SS, Frost C. Do childhood growth indicators in developing countries cluster? Implications for intervention strategies. Public Health Nutr. 2004;7:829–34.PubMedCrossRef
45.
Zhong C, Kuang L, Li L, Liang Y, Mei J, Li L. Equity in patient experiences of primary care in community health centers using primary care assessment tool: a comparison of rural-to-urban migrants and urban locals in Guangdong, China. Int J Equity Health. 2018;17:51.PubMedPubMedCentralCrossRef
46.
Zou G, Zeng Z, Chen W, Ling L. Self-reported illnesses and service utilisation among migrants working in small-to medium sized enterprises in Guangdong, China. Public Health. 2015;129:970–8.PubMedCrossRef
47.
Westin M, Åhs A, Bränd Persson K, Westerling R. A large proportion of Swedish citizens refrain from seeking medical care—lack of confidence in the medical services a plausible explanation? Health Policy. 2004;68:333–44.PubMedCrossRef
48.
Schoevers MA, Loeffen MJ, van den Muijsenbergh ME, Lagro-Janssen AL. Health care utilisation and problems in accessing health care of female undocumented immigrants in the Netherlands. Int J public health. 2010;55:421–8.PubMedCrossRef
49.
Zhang P, Zheng S, Wang Y, Yuan J, Li J. Meta-analysis of the Rate of Not Seeking Medical Care by Patients With Two Weeks’ Sickness History of Floating Population From 2013 to 2018 in China. Occup Health Damage. 2018;33(03):136–9. (in Chinese).
50.
Naing T, Geater A, Pungrassami P. Migrant workers’ occupation and healthcare-seeking preferences for TB-suspicious symptoms and other health problems: a survey among immigrant workers in Songkhla province, southern Thailand. BMC Int Health Hum Rights. 2012;12:1–13.CrossRef
51.
52.
Viegi G, Maio S, Pistelli F, Baldacci S, Carrozzi L. Epidemiology of chronic obstructive pulmonary disease: Health effects of air pollution. Respirology. 2006;11:523–32.PubMedCrossRef
53.
Yuan L, Shin K, Managi S. Subjective Well-being and Environmental Quality: The Impact of Air Pollution and Green Coverage in China. Ecol Econ. 2018;153:124–38.CrossRef
54.
Wang B, Zheng S. Air pollution lowers travel demand in a consumer city. Transp Res Part D: Transp Environ. 2020;89:102616.CrossRef
55.
Graff Zivin J, Neidell M. Days of haze: Environmental information disclosure and intertemporal avoidance behavior. J Environ Econ Manag. 2009;58:119–28.CrossRef
56.
Deschenes O, Greenstone M, Shapiro JS. Defensive investments and the demand for air quality: Evidence from the NOx budget program. Am Econ Rev. 2017;107:2958–89.CrossRef
57.
Ruan W, Kang S, Song H. Applying protection motivation theory to understand international tourists’ behavioural intentions under the threat of air pollution: A case of Beijing, China. Curr Issues Tourism. 2020;23:2027–41.CrossRef
58.
on behalf of the PASTA Consortium. Dons E, Laeremans M, Anaya-Boig E, Avila-Palencia I, Brand C, et al. Concern over health effects of air pollution is associated to NO2 in seven European cities. Air Qual Atmos Health. 2018;11:591–9.CrossRef
59.
Yang Q, Wu S. Air pollution in China: health information seeking and protective behaviors. Health Promot Int. 2020;35:1495–506.PubMedCrossRef
60.
Hong Y, Li X, Stanton B, Lin D, Fang X, Rong M, et al. Too costly to be ill: health care access and health seeking behaviors among rural-to-urban migrants in China. World Health Popul. 2006;8:22.PubMedPubMedCentralCrossRef
61.
Callahan ST, Cooper WO. Uninsurance and Health Care Access Among Young Adults in the United States. Pediatrics. 2005;116:88–95.PubMedCrossRef
62.
63.
Salazar MA, Hu X. Health and lifestyle changes among migrant workers in China: implications for the healthy migrant effect. The Lancet Diabetes & Endocrinology. 2016;4:89–90.CrossRef
64.
Song X, Zou G, Chen W, Han S, Zou X, Ling L. Health service utilisation of rural-to-urban migrants in Guangzhou, China: does employment status matter? Trop Med Int Health. 2017;22:82–91.PubMedCrossRef
65.
66.
Kalich A, Heinemann L, Ghahari S. A Scoping Review of Immigrant Experience of Health Care Access Barriers in Canada. J Immigr Minor Health. 2016;18:697–709.PubMedCrossRef
67.
Kohlenberger J, Buber-Ennser I, Rengs B, Leitner S, Landesmann M. Barriers to health care access and service utilization of refugees in Austria: Evidence from a cross-sectional survey. Health Policy. 2019;123:833–9.PubMedCrossRef
68.
Wamala S, Merlo J, Bostrom G, Hogstedt C. Perceived discrimination, socioeconomic disadvantage and refraining from seeking medical treatment in Sweden. J Epidemiol Community Health. 2007;61:409–15.PubMedPubMedCentralCrossRef
69.
Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000;15:259–67.CrossRef
70.
Paasche-Orlow MK, Wolf MS. The causal pathways linking health literacy to health outcomes. Am J Health Behav. 2007;31:19–26.CrossRef
71.
Shi Y, Ji Y, Sun J, Wang Y, Sun X, Li C, et al. Lack of health risk awareness in low-income Chinese youth migrants: assessment and associated factors. Environ Health Prev Med. 2012;17:385–93.PubMedPubMedCentralCrossRef
72.
Shao S, Wang M, Jin G, Zhao Y, Lu X, Du J. Analysis of health service utilization of migrants in Beijing using Anderson health service utilization model. BMC Health Serv Res. 2018;18:462.PubMedPubMedCentralCrossRef
73.
He S, Haifeng Liao F, Li G. A spatiotemporal analysis of county economy and the multi-mechanism process of regional inequality in rural China. Appl Geogr. 2019;111:102073.CrossRef
Metadata
Title
Air pollution and refraining from visiting health facilities: a cross-sectional study of domestic migrants in China
Authors
Zhixin Liu
Chaojie Liu
Yu Cui
Junping Liu
Huanyu Zhang
Yajie Feng
Nan Wang
Mingli Jiao
Zheng Kang
Xiaoxue Xu
Juan Zhao
Chen Wang
Dandan Zou
Libo Liang
Qunhong Wu
Yanhua Hao
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2022
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-022-14401-4

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