Multidimensional health poverty among diabetic adults in China: evidence from the China Kadoorie Biobank

Abstract Background Despite the rising burden of diabetes in low- and middle-income countries, conventional economic metrics often fail to capture the multidimensional nature of health deprivation. This study aims to bridge this gap by assessing multidimensional health poverty among Chinese adults with diabetes using a survival-anchored multidimensional framework. Methods This study used data from 19,236 adults with diabetes enrolled in the China Kadoorie Biobank. Individual 5-year survival probabilities were estimated using stratified Cox proportional hazards models. Subsequently, we constructed Multidimensional Health Poverty Indices using the Alkire-Foster dual-cutoff method, integrating three dimensions: subjective health, objective health, and healthcare access capability. Scenario analyses were further employed to provide illustrative simulations of behavioral interventions on poverty reduction. Results The overall adjusted headcount ratio (M0) of multidimensional health poverty was 26.92%. We observed significant demographic and socioeconomic gradients, with poverty intensity being most pronounced among older women, rural residents, and individuals with lower socioeconomic status. According to the decomposition results, reducing deprivation in healthcare access capability may warrant prioritization for lower socioeconomic strata, while counterfactual scenarios revealed that behavioral interventions were associated with larger simulated reductions for higher socioeconomic strata. Conclusion Diabetic adults in China face substantial multidimensional health poverty, driven principally by survival risks and structural barriers to healthcare. The divergence in intervention outcomes suggests that achieving health equity requires a targeted strategy, prioritizing financial protection mechanisms for vulnerable populations while promoting lifestyle modifications among higher socioeconomic groups.