Health opportunity inequality in middle-aged and older adult cardiovascular and cerebrovascular patients

Objective: To measure and decompose health opportunity inequality among middle-aged and older adult patients with cardiovascular and cerebrovascular diseases, providing scientific evidence for the development of targeted health policies, particularly those aimed at ensuring health equity for middle-aged and older adult individuals with cardiovascular and cerebrovascular diseases. Methods: Based on inpatient medical record data from H Province, China, we employed a pre-parameter method, combining linear regression, conditional inference trees, and random forests to measure health opportunity inequality among middle-aged and older adult patients aged 45 and above with cardiovascular and cerebrovascular diseases. The relative contributions of various environmental factors to health opportunity inequality were quantified. Additionally, unconditional quantile regression models were used to further examine the contributions of environmental factors to health opportunity inequality at different quantiles. Results: The indices of opportunity inequality for major health and overall health ranged between 7.25-12.72% and 7.13-12.54%, respectively. Key influencing factors included surgical level, the number of doctors per 1,000 people, and the number of hospital beds per 1,000 people. Furthermore, the contribution of the variance in medical expenses to opportunity inequality significantly increased with quantile values, with contributions at higher quantiles only second to the aforementioned core environmental factors. Conclusion: To promote global health equity, this study proposes several policy directions: establishing a disease-resource alignment mechanism to optimize the allocation of advanced medical resources, strengthening primary healthcare and human resource systems, reforming healthcare financing toward equitable protection, and advancing prevention-oriented, data-driven health governance.