Objective  To explore the status and contributing factors of health inequality among rural elder residents in Shaanxi province．

  Methods  The data on 6 857 rural elderly aged 65 years and over were extracted from the dataset of Fifth National Health Services Survey held in 32 counties of Shaanxi province during 2013. Concentration index was employed to evaluate the health inequality. Decomposition of concentration index was used to quantify the contribution of every determinant to total inequality.

  Results  The two-week prevalence and the prevalence rate of chronic diseases among the elderly were 37.15% and 47.15% in 2013. The concentration indexes were 0.0896 (95% confidence interval 95% CI: 0.0716, 0.1075) and 0.0565 (95% CI: 0.0420, 0.0710) for the probability of two-week disease prevalence and the prevalence rate of chronic diseases. The main influencing factors of inequality in two-week prevalence and chronic disease prevalence were economic condition (with the contribution rates of 98.40% and 63.93%) and physical exercise (5.47% and 4.30%); economic status accounted for most of the existing inequality.

  Conclusion  There was a relatively small pro-rich health inequality among rural elderly in Shaanxi province; the health inequality could be improved by further improving health system and rural social endowment insurance system, and promotion of health attitude and behaviors among the elderly population.