Objective  To examine spatial and temporal distribution patterns of household-based multidimensional health poverty (MHP) indexes among middle-aged and elderly populations in China, and to provide evidence to precise elimination of MHP in the populations.

  Methods  The data of the analysis were extracted from four rounds of China Health and Retirement Longitudinal Survey (CHARLS) conducted in 2011, 2013, 2015, and 2018 across China, which collected the information of residents aged ≥ 45 years in 37 296 households on demographics, income and consumption, family structure, economic support, health status, health service utilization and medical insurance. The MHP was assessed and deconstructed with self-established health poverty evaluation index system and multidimensional health poverty measurement index (MHPI) covering three dimensional components (health right, health capability and health risk) of MHP. The year- and region-specific distribution of MHPI were described.

  Results  For all the middle-aged and elderly residents surveyed in 2011, 2013, 2015, and 2018, the health MHPI were 0.320, 0.326, 0.349, and 0.29 and the MHP prevalence were 69.7%, 69.0%, 71.9%, and 63.0%, respectively. The mean values of index measuring the contribution of health right, health capacity and health risk to MHP were 0.143, 0.450 and 0.416 for all the residents surveyed in the four rounds of CHARLS study. The results of regional decomposition analysis on MHPI showed that following six provincial-level administrative divisions (PLADs) could be assessed as with severe prevalence of health poverty in 2011: Guizhou, Gansu, Xinjiang Uygur Autonomous Region (Xinjiang), Sichuan, Anhui, and Jilin, with the mean MHPI of 0.365, 0.364, 0.395, 0.377, 0.402, and 0.413,respectively; in 2013, the six PLADs assessed as having severe prevalence of health poverty were Yunnan, Qinghai, Inner Mongolia Autonomous Region (Inner Mongolia), Sichuan, Anhui, and Guizhou and the mean MHPI for those PLADs were 0.359, 0.361, 0.381, 0.378, 0.389, and 0.402; while in 2015 the number of PLADs with severe prevalence of health poverty increased to 16, including Yunnan (mean MHPI = 0.395), Xinjiang (0.388), Qinghai (0.448), Sichuan (0.406), Inner Mongolia (0.39), Anhui (0.388), Chongqing (0.391), Guizhou (0.373), Tianjin (0.370), Heilongjiang (0.366), Guangxi (0.362), Shandong (0.362), Jiangxi (0.359), Jilin (0.355), Fujian (0.351), and Liaoning (0.350); but in 2018, only 3 PLADs (Sichuan, Guizhou, and Yunnan, with the mean MHPI of 0.352, 0.352, and 0.351) could be assessed as with severe prevalence of health poverty.

  Conclusion  According to this analysis, both mean index and prevalence of health poverty declined generally among middle-aged and elderly populations in China during 2011 – 2018; there were regional differences in health poverty prevalence and the multidimensional health poverty was more severe in southwest region.