The health state utility and influencing factors of six directly-entering-socialism ethnic groups in Yunnan Province

Abstract

Background: “lDirectly-entering-socialism ethnic groups” refer to certain ethnic minorities in Yunnan Province whose social structures shifted directly from primitive to socialist society after the founding of the People's Republic of China. This abrupt transition may lead to psychological maladaptation, such as anxiety and depression, affecting overall well-being. Additionally, their remote, mountainous residence limits access to healthcare services, potentially lowering health outcomes. While some studies have explored health utility among ethnic minorities, research specifically on these groups remains scarce.

Objective: To assess the health state utility and their influencing factors among six directly-entering-socialism ethnic groups in Yunnan Province, providing evidence for the development of health promotion and equity measures.

Methods: This study recruited individuals aged 15 and older from six ethnic groups: Va, Lisu, Nu, Jinuo, Lahu, and Blang in three counties of Yunnan Province from July to December 2022 by a multi-stage random cluster sampling method. Health state utility was measured using the EQ-5D-5-L scale and the EQ-5D-5-L Value Set for China. The Andersen model and Tobit regression analysis were used to identify the factors influencing health state utility among these groups.

Results: A total of 1921 participants were included: 293 Va (15.25 %), 378 Lisu (19.68 %), 300 Nu (15.62 %), 398 Jinuo (20.72 %), 280 Lahu (14.58 %), and 272 Blang (14.16 %). The overall health state utility was 0.958±0.092. Va had the highest health state utility (0.966± 0.059), while Lisu had the lowest (0.950±0.093). A higher proportion of participants reported difficulties in the "Pain/discomfort" and "Anxiety/depression". The Tobit regression model showed that depression was a significant barrier to health state utility across all six ethnic groups. For some groups, age over 60-(Va, Nu, Jinuo, Blang), two-week morbidity (Va, Nu, Jinuo), chronic diseases (Lisu, Nu, Lahu), and sleep disorders (Va, Lisu, Jinuo) were associated with lower health state utility. Physical exercise (Lisu, Nu), education level-(primary school or higher for Jinuo and Lahu), and alcohol consumption-(Lahu) promoted higher health state utility in certain groups.

Conclusion: This study enriches the relevant research objects of health state utility, and provides a basis for the measurement of burden of disease of ethnic minorities. The health state utility of these six ethnic groups is close to those of urban Chinese populations and higher than the general population in Yunnan. Addressing depression and improving health state utility in older adults, chronic disease patients, and those with sleep disorders should be prioritized in future health interventions for these groups.

Keywords

Directly-entering-socialism ethnic groups / Health utility values / EQ-5D-5L / Health-related quality of life / Influencing factors

Authors' contributions

Conceptualization, Y.H. and Y.Z.; Data curation, Y.H., R.D., Y.Z., and X.W.; Formal analysis, Y.Z., X.W., C.D., X.D, X.X., and R.H.; Funding acquisition, Y.H. and R.D.; Investigation: Y.Z., X.W., C.D., X.D, X.X., and R.H.; Methodology, Y.H. and Y.Z.; Project administration, Y.H. and R.D.; Resources, Y.H. and R.D.; Software: Y.Z. and X.W.; Supervision, Y.H.; Validation, Y.H.; Writing—original draft, Y.Z., X.W., C.D., X.D, X.X., and R.H.; Writing—review & editing, Y.H. and R.D. All authors have read and agreed to the published version of the manuscript.

Ethical approval and consent to participate

The study received approval from Kunming Medical University (KMMU2021MEC095).

Consent for publication

Not applicable.

Availability of data and materials

Not applicable.

Funding

This research was supported by grants from the National Natural Science Foundation of China (71904069), Yunnan Fundamental Research Projects (202401AT070178), Yunnan High-level Talent Support Plan (YNQR-QNRC-2018-140), and Philosophy and Social Science Innovation Team of Yunnan Province (2024CX08).

Declaration of competing interest

All authors declare that there are no competing interests.

Acknowledgements

Not applicable.

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