To the best of our knowledge, the present study is the first community-based study focused on the association of socio-demographic and cough characteristics with health seeking behavior in the Chinese population. We found that 19.3% of the respondents reported a cough in the past month, 40% of them had sought medical treatment. Individuals more than 65 years old, female, with cough for 3-8 weeks and with more accompanying symptoms were more likely to seek medical treatment. For those had sought medical treatment, 26.5% of them chose hospitals at county level or above. Male, people live in urban areas, individuals graduated from college and above and with cough for more than 2 weeks were more likely to choose hospitals at county level or above.
Health-seeking decision
Contrary to some previous studies on health-seeking behavior[12, 14, 15], we found that some of the socio-demographic characteristics, such as education, occupation, family size and household income do not seem to be associated with the probability of seeking medical treatment after coughing. Smoking status and history of chronic disease were also not significantly associated with health-seeking decision after adjusting for other factors. These may be related to population selection,and heterogeneity in different countries.
The present study found that individuals aged ≥ 65 years old and living in rural areas were more likely to seek medical treatment. Besides, women were more likely to seek medical treatment than men, which is in parallel with studies conducted in Zambia and Vietnam [15, 24]. This may be explained by the fact that women were more troubled by cough than men [25, 26]. What’s more, some studies focusing on gender differences in health-seeking behavior have pointed out that men were more likely to behave masculinity and a healthy state thus less likely to seek care [27].
The present study was the first to focus on the association between cough duration and health-seeking decision in China. It is highly worth noting that individuals with cough for 3-8 weeks were more likely to seek medical treatment, while those coughed for > 8 weeks were not. The possible explanation for this phenomenon could be that individuals who have been coughing for >8 weeks were already used to coughing and regard it as a lifestyle habit rather than a disease. However, in addition to common causes of chronic cough, recent studies have found that pertussis has became a prevalent disease in some areas [7, 8], and B. pertussis infection should be considered as a significant pathogenic infection in adult patients presenting a cough of more than 3 weeks duration [28, 29]. And tuberculosis should be evaluated also among persons with unexplained productive cough lasting 2–3 weeks or more[6]. Thus there is no doubt that prolonged coughing without seeking medical treatment timely will bring an increased risk of transmission of such respiratory infectious disease. It is extremely desirable to undertake extensive educational campaigns about cough especially persistent one, so as to encourage individuals to visit medical facilities in time.
What’s more, the number of accompanying symptoms showed a clear increasing trend with health-seeking decision, as were observed in India and Tanzania [13, 20]. Previous studies have also indicated that if a cough is not distressing or associated with any other symptoms that restrict one’s ability to function/work, people do not usually seek medical care [30, 31]. Because the cough often be regarded as very common symptom and not an illness, whereas cough together with other symptoms, such as fever, expectoration, is more consistently felt to be an illness.
Choice of medical facility
In the present study, the multivariate analysis consistently show that individuals living in rural areas and women were less likely to choose hospitals at or above the county level, while the most educated persons were more likely. Studies conducted in Vietnam[24] and China[23, 32] also found that women took more health-care actions than men, but chose less qualified providers (like self-medication, pharmacist, or private practitioner) and individuals living in rural areas had poor access to medical facility. But contrary to previous studies conducted in China [21, 22, 33], the household income was not significant associated with the choice of medical facility after adjusting for other confounders in the present study.This change may be due to a decline in health spending variance as the economy develops, with rising living standards and incomes.
We also found that individuals who coughed for more than 2 weeks were associated with a higher likelihood of choosing hospitals at or above the county level, while number of accompanying symptoms did not show any significant relationship with their choice. This reveals an interesting fact that people were more likely to seek medical treatment when the accompany symptoms of cough appear, but pay more attention to the duration of cough when choosing a hospital. The result echoes a call in a Japanese study [34], which suggested that individuals suffering from cough that does not resolve within a short period of time should be taken seriously regardless of the severity, as cough can be a sign of serious diseases such as lung cancer, pertussis and pulmonary tuberculosis [2, 35, 36]. Based on the fact, it is recommended to strengthen the training of relevant personnel in such facilities to improve their attention to persistent cough, as well as the level of surveillance and case detection of the above serious diseases.
Limitations
Although the data in the present study was based on a community-based population and corrected for established and potential confounding factors (both socio-demographic and cough characteristics), these findings should also be interpreted in light of some limitations. First, it is important to acknowledge the limitations of the subjective perceptions and self-reports and therefore may be biased by potential under-reporting or over-reporting and recall bias, even though we asked for information within the past month to reduce recall bias. Second, due to the limited sample size, some significant positive associations may not be demonstrated in the present study. Finally, the study cannot exclude the effects of residual confounding by unmeasured risk factors, such as medical insurance and cause of cough. Therefore, larger sample size studies with more adjusted confounders are warranted to examine the further association and make a firm complement to the current study.