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Inequalities in Older age and Primary Health Care Utilization in Low- and Middle-Income Countries: A Systematic Review

Research output: Contribution to journalReview articlepeer-review

Qian Gao, A. Matthew Prina, Yuteng Ma, David Aceituno, Rosie Mayston

Original languageEnglish
Pages (from-to)99-114
Number of pages16
JournalInternational Journal of Health Services
Issue number1
Early online date21 Oct 2021
Accepted/In press2021
E-pub ahead of print21 Oct 2021
PublishedJan 2022

Bibliographical note

Publisher Copyright: © The Author(s) 2021.

King's Authors


The objective of this research was to systematically review and synthesize quantitative studies that assessed the association between socioeconomic inequalities and primary health care (PHC) utilization among older people living in low- and middle- income countries (LMICs). Six databases were searched, including Embase, Medline, Psych Info, Global Health, Latin American and Caribbean Health Sciences Literature (LILACS), and China National Knowledge Infrastructure, CNKI, to identify eligible studies. A narrative synthesis approach was used for evidence synthesis. A total of 20 eligible cross-sectional studies were included in this systematic review. The indicators of socioeconomic status (SES) identified included income level, education, employment/occupation, and health insurance. Most studies reported that higher income, higher educational levels and enrollment in health insurance plans were associated with increased PHC utilization. Several studies suggested that people who were unemployed and economically inactive in older age or who had worked in formal sectors were more likely to use PHC. Our findings suggest a pro-rich phenomenon of PHC utilization in older people living in LMICs, with results varying by indicators of SES and study settings.

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