gms | German Medical Science

MAINZ//2011: 56. GMDS-Jahrestagung und 6. DGEpi-Jahrestagung

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V.
Deutsche Gesellschaft für Epidemiologie e. V.

26. - 29.09.2011 in Mainz

Urban health in China: The role of the Chinese household registration system on people’s health and socioeconomic status based on a survey in the megacity of Guangzhou

Meeting Abstract

  • Heiko J. Jahn - Bielefeld University, Bielefeld
  • Yinghua XIA - Sun Yat-sen University, Guangzhou, China
  • Li LING - Sun Yat-sen University, Guangzhou, China
  • Sven Voigtländer - Bielefeld University, Bielefeld
  • Alexander Krämer - Bielefeld University, Bielefeld

Mainz//2011. 56. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 6. Jahrestagung der Deutschen Gesellschaft für Epidemiologie (DGEpi). Mainz, 26.-29.09.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11gmds381

doi: 10.3205/11gmds381, urn:nbn:de:0183-11gmds3811

Published: September 20, 2011

© 2011 Jahn et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: China’s introduction of economic reforms in 1979 caused large-scale societal, economical and environmental changes including rapid urbanisation accompanied by strong rural-urban migration to the fast growing cities. Internal migrants are disadvantaged since it is difficult for non-locals to obtain an unrestricted registration status as local urban citizens (holding a local urban hukou) in the city of destination. The local urban hukou entitles them to benefit from state-provided services like health care services, jobs, housing and education. This study examined the urban living and working conditions in the megacity of Guangzhou and their associations with health in order to understand the role of the Chinese household registration (hukou) system in terms of structural health inequalities.

Methods: We analyzed cross-sectional data collected from 780 adults (people over 15 years of age) of Guangzhou by means of a standardised questionnaire in 2008 and 2009. Using multivariable binary logistic regression models, we analysed associations of being registered as a local citizen (local urban hukou status = yes vs. no) with demographic and socioeconomic data, living and working conditions, health status and health care utilisation.

Results: Of the 780 adults, 380 were male (49%). The mean age was 34.2 (SD 12.0) years. More than half reported to hold a local Guangzhou hukou (n = 401; 51.4%). Compared to the hukou holders, the non-hukou holders were younger (mean: 29.3 vs. 38.8 years, p < 0.001), had a lower level of education (p < 0.001), reported lower income (mean: 2.516 vs. 3.572 Yuan, p < 0.001), more working hours per week (mean: 53 vs. 43, p < 0.001), a higher prevalence of cold/cough (most reported health problem) within the past 3 months (56% vs. 44%, p = 0.005) and were less likely to utilise health care in high quality hospitals (p < 0.001).

Discussion and conclusion: Despite changes in the hukou policies with more relaxed regulations in recent years, being a local urban hukou holder still plays a significant role in terms of socioeconomic factors, living and working conditions as well as the utilisation of health care services. An easier transformation from the rural hukou status, that most of the Chinese working migrants have, to a local urban hukou is desirable to improve their quality of life.