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The number of women over the age of 50 in China is estimated to increase to more than 280 million by 2030 (1). With an increase in age, the mortality rate of people aged 50 and above in China is rising rapidly, and the prevalence of chronic diseases in middle-aged and older people (45 years old and above) is much higher than that in other age groups (2). With the aging of the population, the health of menopausal and older women has become prioritized. The purpose of this study is to investigate the health status of menopausal and older women in different areas of China through a survey of women aged 50–70 years to provide a scientific basis for promoting the health of women. A cross-sectional survey involving 5,049 women aged 50–70 years was conducted across eastern, central, and western China. The main result of this study showed that the health problems of menopausal and older women in the western region and rural areas were more prominent. Taking effective measures is necessary to narrow the gap in health between different age groups of women and different regions.
This study was a survey of women aged 50–70 years in the National Survey of Women’s Health conducted in 2018. The national survey was conducted to represent the three socioeconomic regions of China: eastern (Jiangsu and Shandong provinces), central (Hunan and Anhui provinces), and Western (Shaanxi and Sichuan provinces). In each province, one urban and one rural area were selected as investigation sites. A total of 5,049 women aged 50–70 years were selected by multistage stratified random cluster sampling and completed face-to-face interview questionnaires in the national survey. This study analyzed the relevant survey results of women aged 50–70 years. The reported chronic diseases and gynecological diseases in this study were required to be diagnosed by secondary hospitals or above.
The average age of the respondents was 58.94±6.195 years. Among the respondents, 1,703 (33.7%) came from the eastern region, 1,667 (33.0%) from the central region, and 1,679 (33.3%) from the western region. Most respondents (85.5%) were married, and 11.7% were widowed. The main occupation of the cohort was farming, accounting for 55.2%, followed by retirees, accounting for 17.1%. Most of the participants (55.0%) had only a primary school education or were illiterate, followed by those who had junior and senior high school educations, accounting for 42.0%. Only 3.0% had junior college degrees or higher. The majority (89.9%) of the women were postmenopausal.
Among the 5,049 women, 55.1% (95% CI: 53.7%–56.5%) reported that they had chronic diseases diagnosed by the hospital. The proportions of women suffering from chronic diseases in the western region (58.5%, 95% CI: 56.2%–60.9%) and rural areas (57.8%, 95% CI: 55.9%–59.7%) were higher than that in the eastern (51.8%, 95% CI: 49.4%–54.2%), central (55.0%, 95% CI: 52.6%–57.4%), and urban areas (52.5%, 95% CI: 50.5%–54.4%). There were differences between different regions and areas (p<0.001). The proportion of self-reported overweight and obesity was the highest (46.5%, 95% CI: 45.0%–47.9%). The prevalence of overweight and obesity among women in the eastern region (55.8%, 95% CI: 53.3%–58.2%) was significantly higher than the western (45.4%, 95% CI: 42.7%–48.0%) and central regions (37.8%, 95% CI: 35.4%–40.3%) (p<0.001). The prevalence of cardiovascular disease (11.9%, 95% CI: 10.4%–13.5%), osteoporosis (10.9%, 95% CI: 9.4%–12.4%), and kidney disease (2.6%, 95% CI: 1.9%–3.4%) among women in the western region were significantly higher than those in the eastern and central regions (p<0.005). The prevalence of osteoarthrosis (15.0%, 95% CI: 13.6%–16.4%) in rural women was higher than that of urban women (11.4%, 95% CI: 10.1%–12.6%). However, the prevalence of osteoporosis (9.8%, 95% CI: 8.6%–11.0%), oral disease (2.6%, 95% CI: 2.0%–3.2%), and thyroid disease (1.6%, 95% CI: 1.1%–2.1%) in urban women were higher than those in rural women (5.7%, 95% CI: 4.8%–6.6%, 1.3%, 95% CI: 0.9%–1.8%, and 0.8%, 95% CI: 0.4%–1.1%, respectively)(p<0.01)(Table 1).
Chronic diseases Total
N (%, 95% CI)Regions Area Type Eastern Central Western χ2 p Urban Rural χ2 p N (%, 95% CI) N (%, 95% CI) N (%, 95% CI) N (%, 95% CI) N (%, 95% CI) Having one or more chronic diseases 2,783
(55.1, 53.7−56.5)883
(51.8, 49.4−54.2)917
(55.0, 52.6−57.4)983
(58.5, 56.2−60.9)15.341 0.000 1,324
(52.5, 50.5−54.4)1,459
(57.8, 55.9−59.7)14.236 0.000 Overweight and obesity 2,047
(46.5, 45.0−47.9)870
(55.8, 53.3−58.2)571
(37.8, 35.4−40.3)606
(45.4, 42.7−48.0)111.642 0.000 1,115
(46.0, 44.0−47.9)932
(47.1, 44.9−49.3)3.353 0.187 Hypertension 1437
(28.5, 27.2−29.7)479
(28.1, 26.0−30.3)509
(30.5, 28.3−32.7)449
(26.7, 24.6−28.9)6.048 0.049 699
(27.7, 26.0−29.5)738
(29.2, 27.4−31.0)1.415 0.234 Osteoarthrosis 665
(13.2, 12.2−14.1)196
(11.5, 10.0−13.0)213
(12.8, 11.2−14.4)256
(15.2, 13.5−17.0)10.667 0.005 287
(11.4, 10.1−12.6)378
(15.0, 13.6−16.4)14.217 0.000 Diabetes 517
(10.2, 9.4−11.1)183
(10.7, 9.3−12.2)189
(11.3, 9.8−12.9)145
(8.6, 7.3−10.0)7.359 0.025 244
(9.7, 8.5−10.8)273
(10.8, 9.6−12.0)1.774 0.183 Cardiovascular diseases 496
(9.8, 9.0−10.6)151
(8.9, 7.5−10.2)145
(8.7, 7.3−10.1)200
(11.9, 10.4−13.5)12.408 0.002 250
(9.9, 8.7−11.1)246
(9.7, 8.6−10.9)0.041 0.839 Osteoporosis 392
(7.8, 7.0−8.5)72
(4.2, 3.3−5.2)137
(8.2, 6.9−9.3)183
(10.9, 9.4−12.4)53.266 0.000 247
(9.8, 8.6−11.0)145
(5.7, 4.8−6.6)28.906 0.000 Oral diseases 99
(2.0, 1.6−2.3)16
(0.9, 0.5−1.4)42
(2.5, 1.8−3.3)41
(2.4, 1.7−3.2)13.969 0.001 65
(2.6, 2.0−3.2)34
(1.3, 0.9−1.8)9.939 0.000 Kidney disease 75
(1.5, 1.2−1.8)14
(0.8, 0.4−1.3)17
(1.0, 0.5−1.5)44
(2.6, 1.9−3.4)22.376 0.000 36
(1.4, 1.0−1.9)39
(1.5, 1.1−2.0)0.118 0.731 Thyroid disease 60
(1.2, 0.9−1.5)22
(1.3, 0.8−1.8)21
(1.3, 0.7−1.8)17
(1.0, 0.5−1.5)0.670 0.715 40
(1.6, 1.1−2.1)20
(0.8, 0.4−1.1)6.771 0.009 Table 1. Comparison of the prevalence of self-reported chronic diseases among women aged 50–70 years old by regions and area type, 2018, China.
Of the participating women, 39.6% (95% CI: 38.3%–40.9%) reported that they had gynecological diseases diagnosed by the hospital. The proportion of women suffering from gynecological diseases in the central (42.6%, 95% CI: 40.2%–45.0%), western (42.7%, 95% CI: 40.3%–45.1%), and rural areas (42.2%, 95% CI: 40.3%–44.1%) was higher than that in the eastern (33.6%, 95% CI: 38.3%–40.9%) and urban areas (37%, 95% CI: 35.1%–38.9%) (p<0.001)（Table 2).
Gynecological diseases Total
N (%, 95% CI)Regions Area Type Eastern Central Western χ2 p Urban Rural χ2 p N (%, 95% CI) N (%, 95% CI) N (%, 95% CI) N (%, 95% CI) N (%, 95% CI) Having one or more gynecological disease 1,999
(39.6, 38.3−40.9)572
(33.6, 31.4−5.9)710
(42.6, 40.2−45.0)717
(42.7, 40.3−45.1)38.739 0.000 933
(37.0, 35.1−38.9)1,066
(42.2, 40.3−44.1)14.388 0.000 Vaginitis 1,232
(24.4, 23.2−25.6)299
(17.6, 15.7−19.4)440
(26.4, 24.3−28.5)493
(29.4, 27.2−31.5)69.239 0.000 500
(19.8, 18.3−21.4)732
(29.0, 27.2−30.7)57.425 0.000 Cervicitis 602
(11.9, 11.0−12.8)123
(7.2, 6.0−8.5)277
(16.6, 14.8−18.4)202
(12.0, 10.5−13.6)70.819 0.000 257
(10.2, 9.0−11.4)345
(13.7, 12.3−15.0)14.487 0.000 Pelvic inflammation 361
(7.1, 6.4−7.9)73
(4.3, 3.3−5.2)134
(8.0, 6.7−9.3)154
(9.2, 7.8−10.6)33.357 0.000 168
(6.7, 5.7−7.6)193
(7.6, 6.6−8.7)1.833 0.176 Urinary leakage/incontinence 583
(11.5, 10.7−12.4)107
(6.3, 5.1−7.4)244
(14.6, 12.9−16.3)232
(13.8, 12.2−15.5)70.263 0.000 243
(9.6, 8.5−10.8)340
(13.5, 12.1−14.8)18.116 0.000 Benign tumor 511
(10.1, 9.3−11.0)205
(12.0, 10.5−13.6)156
(9.4, 8.0−10.8)150
(8.9, 7.6−10.3)10.545 0.000 284
(11.3, 10.0−12.5)227
(9.0, 7.9−10.1)7.150 0.000 Malignant tumor 43
(0.9, 0.6−1.1)14
(0.8, 0.4−1.3)15
(0.9, 0.4−1.4)14
(0.8, 0.4−1.3)0.070 0.966 27
(1.1, 0.7−1.5)16
(0.6, 0.3−0.9)2.851 0.091 Table 2. Comparison of the prevalence of self-reported gynecological diseases among women aged 50–70 years old by regions and area type, 2018, China
Among the self-reported gynecological diseases, the prevalence of vaginitis was the highest (24.4%, 95% CI: 23.2%–25.6%). The prevalence of vaginitis (29.4%, 95% CI: 27.2%–31.5%) and pelvic inflammation (9.2%, 95% CI: 7.8%–10.6%) in the western region were significantly higher than those in the eastern region (p<0.001). The prevalence of urinary incontinence in the central region (14.6%, 95% CI: 12.9%–16.3%) was significantly higher than that in the eastern region (6.3%, 95% CI: 5.1%–7.4%) (p<0.001). The prevalence of benign tumors in the eastern region (12.0%, 95% CI: 10.5%–13.6%) was significantly higher than that in the western region (8.9%, 95% CI: 7.6%–10.3%) (p<0.001). The prevalence of vaginitis (29.0%, 95% CI: 27.2%–30.7%) and cervicitis (13.7%, 95% CI: 12.3%–15.0%) in rural women were significantly higher than those in urban women (19.8%, 95% CI: 18.3%–21.4% and 10.2%, 95% CI: 9.0%–11.4%, respectively)(p<0.001)(Table 2).
The prevalence of hypertension, diabetes, cardiovascular disease, osteoporosis, and urinary incontinence increased with age, and there were significant differences among different age groups (p<0.001). The prevalence of vaginitis, cervicitis and gynecological benign tumor was the highest in the age group of 50–54 years old. The prevalence of vaginitis and cervicitis decreased with increasing age, and there were significant differences among different age groups (p<0.001)(Table 3).
Health status 50–54 55–59 60–64 65−70 χ2 p χ2trend p N (%, 95% CI) N (%, 95% CI) N (%, 95% CI) N (%, 95% CI) Chronic diseases 740 (46.3, 43.9−48.8) 538 (50.6, 47.6−53.6) 673 (57.6, 54.8−60.5) 832 (68.2, 65.6−70.8) 145.706 0.000 140.620 0.000 Overweight and obesity 672 (46.4, 43.8−49.0) 460 (47.6, 44.4−50.7) 466 (46.6, 43.5−49.7) 449 (45.3, 42.2−48.4) 1.017 0.797 0.315 0.574 Hypertention 327 (20.5, 18.5−22.5) 281 (26.4, 23.8−29.1) 348 (29.8, 27.1−32.4) 481 (39.4, 36.7−42.2) 125.183 0.000 120.818 0.000 Osteoarthrosis 197 (12.3, 10.7−14.0) 127 (11.9, 10.0−13.9) 160 (13.7, 11.7−15.7) 181 (14.8, 12.8−16.8) 5.596 0.133 4.599 0.032 Diabetes 81 (5.1, 4.0−6.1) 98 (9.2, 7.5−11.0) 162 (13.9, 11.9−15.8) 176 (14.4, 12.5−16.4) 87.522 0.000 81.882 0.000 Cardiovascular diseases 73 (4.6, 3.5−5.6) 84 (7.9, 6.3−9.5) 128 (10.9, 9.2−12.7) 211 (17.3, 15.2−19.4) 132.718 0.000 128.679 0.000 Osteoporosis 82 (5.1, 4.1−6.2) 72 (6.8, 5.3−8.3) 91 (7.8, 6.2−9.3) 147 (12.0, 10.2−13.9) 48.159 0.000 43.954 0.000 Oral diseases 22 (1.4, 0.8−1.9) 17 (1.6, 0.8−2.4) 29 (2.5, 1.6−3.4) 31 (2.5, 1.7−3.4) 7.329 0.062 6.635 0.010 Kidney disease 21 (1.3, 0.8−1.9) 8 (0.8, 0.2−1.3) 20 (1.7, 1.0−2.5) 26 (2.1, 1.3−2.9) 8.100 0.044 4.450 0.035 Thyroid disease 23 (1.4, 0.9−2.0) 9 (0.8, 0.3−1.4) 17 (1.5, 0.8−2.1) 11 (0.9, 0.4−1.4) 3.477 0.324 0.778 0.378 Gynecological diseases 765 (47.9, 45.4−50.4) 421 (36.8, 34.0−39.6) 441 (37.7, 34.9−40.5) 372 (30.5, 27.9−33.1) 90.063 0.000 86.622 0.000 Vaginitis 451 (28.2, 26.0−30.5) 248 (23.3, 20.8−25.9) 268 (22.9, 20.5−25.3) 265 (21.7, 19.4−24.0) 19.551 0.000 16.408 0.000 Cervicitis 234 (14.7, 12.9−16.4) 138 (13.0, 11.0−15.0) 125 (10.7, 8.9−12.5) 105 (8.6, 7.0−10.2) 26.927 0.000 26.835 0.000 Pelvic inflammation 128 (8.0, 6.7−9.3) 90 (8.5, 6.8−10.1) 72 (6.2, 4.8−7.5) 71 (5.8, 4.5−7.1) 9.557 0.000 7.366 0.007 Urinary leakage/incontinence 178 (11.1, 9.6−12.7) 101 (9.5, 7.7−11.3) 128 (10.9, 9.2−12.7) 176 (14.4, 12.5−16.4) 14.917 0.000 6.944 0.008 Benign tumor 219 (13.7, 12.0−15.4) 99 (9.3, 7.6−11.1) 119 (10.2, 8.4−11.9) 74 (6.1, 4.7−7.4) 45.479 0.000 38.896 0.000 Malignant tumor 16 (1.0, 0.5−1.5) 8 (0.8, 0.2−1.3) 13 (1.1, 0.5−1.7) 6 (0.5, 0.1−0.9) 3.360 0.339 1.145 0.285 Table 3. Comparison of the health status among women aged 50−70 years old by different age groups, 2018, China.
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Chronic non-communicable diseases in menopausal and older women seriously affected their health. The literature showed that the prevalences of hypertension, diabetes, hyperlipidemia, and cardiovascular disease in women over 50 years old were significantly higher than those below 50 years old, and the risk of cardiovascular and cerebrovascular diseases was close to or even higher than that in men in a short period of time (3–4). In this study, the proportion of women aged 50–70 years old with chronic diseases was 55.1%. Overweight and obesity (46.5%), hypertension (28.5%), osteoarthrosis (13.2%), diabetes (10.2%), cardiovascular disease (9.8%), and osteoporosis (7.8%) were major health problems for menopausal and older women. Moreover, the prevalence of chronic diseases increased gradually with age. The prevalence of chronic diseases in the age group of 50–54 years old was 46.3%, and it had increased to 68.2% in 65–70 age group. However, the prevalence was lower than the results of China's Fifth National Health Service Survey in 2013 (the prevalence of chronic disease in women aged 55–64 years old was 57.0% and that in women aged 65 or above was 82.9%) (5). The reason may be related to the strengthening of health management of the elderly in recent years, increased availability of free physical examinations, and the awareness of the healthy lifestyle of older women. Therefore, in order to improve the health of the elderly, the health management of the elderly should be further strengthened and their health awareness should be improved.
The prevalence of gynecological diseases in menopausal women was higher. This study found that 39.6% of the women were diagnosed with gynecological diseases, and the proportion of gynecological diseases in the 50–54 age group was the highest (47.9%). Most of them were reproductive tract infections (such as vaginitis, cervicitis, and pelvic inflammation). This result is further verified because the decline of ovarian function in menopausal women leads to genitourinary tract atrophy, and they are more prone to reproductive tract infection (6).
The health problems of menopausal and older women in the western region and rural areas were more prominent. Another important result of this study was that an imbalance of regional development was an important factor restricting the health of menopausal and older women. Compared with the eastern and urban areas, the proportions of women suffering from chronic and gynecological diseases in the western and rural areas were significantly higher. However, China’s Fifth National Health Service Survey in 2013 showed that in recent years, the prevalence of chronic diseases among urban and rural residents has increased rapidly, and the growth rate in rural areas was higher than that in urban areas (5). The reason may be due to the gradual economic development and the improvement of living standards in rural and western areas, but the population lacks the awareness of active health and the ability of self-health management and the health care service and infrastructure are relatively insufficient. Therefore, the health problems of menopausal and older women in the western region and rural areas are more prominent and need to more attention. The construction of infrastructure, especially medical and health-related facilities, should be improved and the conditions of health care services should be strengthened in the western region and rural areas. In order to achieve the goal of "Joint construction and sharing, health for all" in the outline of the Plan of Healthy China 2030, the imbalance in regional development should be mitigated and eliminated as soon as possible.
This study was subject to at least some limitations. First, the clinical diagnosis was self-reported and might be subjected to biases. Second, although the age composition of the participants in this study was similar to that of women in the 2018 national population sampling survey (the difference of age composition ratio ranged from 0.36% to 4.88%) (7), the study used convenience sampling, and data were collected in 12 counties/districts in 6 provinces, so the results might not fully be representative of the regional and national levels.
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