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Background <p>Ecosocial theory emphasizes examining individual-, institutional-, and societal-level factors—and their interactions—when investigating racial and ethnic health disparities. This study evaluated the relationship between minority group ethnicity and self-reported health outcomes by comparing ethnic minorities (as a combined group) with the Han majority population in China.</p> Methods <p>Cross-sectional data from seven waves (2010–2021) of the nationally representative Chinese General Social Survey were analyzed. Among 66,057 respondents (61,036 Han and 5,021 ethnic minorities), we first described temporal trends in self-reported overall health, social functioning, and depressive symptoms by ethnicity. We then used mixed-effects ordinal regression models to assess associations between minority (comparison group) versus Han (reference) ethnicity and these three health outcomes. Models were adjusted for individual-level factors (e.g., sociodemographic), institutional factors (e.g., healthcare resources), societal factor (living region), and interactions (minority ethnicity status, living region, and institutional factors). McFadden’s pseudo-R-squared was calculated to determine the relative contributions of individual-, institutional-, and societal-level factors, as well as their interactions.</p> Results <p>Among 66,057 respondents (92.4% Han, 7.6% ethnic minorities), minority ethnicity compared to Han ethnicity was associated with better overall health (Odds Ratio [OR] 2.15, 95% CI 1.52–3.05), social function (OR: 1.68, 95% CI 1.18–2.39), and lower frequency of depressive symptoms (OR: 0.64, 95% CI 0.47–0.86) after adjustments for potential confounding variables. Individual-level factors explained most of the variance: 94.2% (overall health), 90.0% (social function), and 75.0% (frequency of depressive symptoms). Institutional- and societal-level factors contributed 3.0%, 6.1%, and 7.0%, while interactions accounted for 2.8%, 3.8%, and 18%, respectively.</p> Conclusions <p>As a group, ethnic minorities in China were associated with better health outcomes versus the Han majority. While individual-level factors accounted for most of the variation in health outcomes, institutional- and societal-level factors, as well as their interactions, also contributed. Findings demonstrate context-specific applications of social epidemiological theories in China.</p>

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Individual-, institutional-, and societal-level factors and their interactions in the association between minority ethnicity and self-reported health outcomes in China, 2010–2021: a repeated cross-sectional study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月5日

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  • Junjie Lu,
  • Jiarui Yang,
  • Jingyu Zhong,
  • Lumin Liu,
  • David H. Rehkopf

摘要

Background

Ecosocial theory emphasizes examining individual-, institutional-, and societal-level factors—and their interactions—when investigating racial and ethnic health disparities. This study evaluated the relationship between minority group ethnicity and self-reported health outcomes by comparing ethnic minorities (as a combined group) with the Han majority population in China.

Methods

Cross-sectional data from seven waves (2010–2021) of the nationally representative Chinese General Social Survey were analyzed. Among 66,057 respondents (61,036 Han and 5,021 ethnic minorities), we first described temporal trends in self-reported overall health, social functioning, and depressive symptoms by ethnicity. We then used mixed-effects ordinal regression models to assess associations between minority (comparison group) versus Han (reference) ethnicity and these three health outcomes. Models were adjusted for individual-level factors (e.g., sociodemographic), institutional factors (e.g., healthcare resources), societal factor (living region), and interactions (minority ethnicity status, living region, and institutional factors). McFadden’s pseudo-R-squared was calculated to determine the relative contributions of individual-, institutional-, and societal-level factors, as well as their interactions.

Results

Among 66,057 respondents (92.4% Han, 7.6% ethnic minorities), minority ethnicity compared to Han ethnicity was associated with better overall health (Odds Ratio [OR] 2.15, 95% CI 1.52–3.05), social function (OR: 1.68, 95% CI 1.18–2.39), and lower frequency of depressive symptoms (OR: 0.64, 95% CI 0.47–0.86) after adjustments for potential confounding variables. Individual-level factors explained most of the variance: 94.2% (overall health), 90.0% (social function), and 75.0% (frequency of depressive symptoms). Institutional- and societal-level factors contributed 3.0%, 6.1%, and 7.0%, while interactions accounted for 2.8%, 3.8%, and 18%, respectively.

Conclusions

As a group, ethnic minorities in China were associated with better health outcomes versus the Han majority. While individual-level factors accounted for most of the variation in health outcomes, institutional- and societal-level factors, as well as their interactions, also contributed. Findings demonstrate context-specific applications of social epidemiological theories in China.