Are there differences in health state preferences between urban and rural respondents? a comparison using time trade-off and discrete choice experiment

ObjectivesTo compare health state preferences elicited using composite time trade-off (cTTO) and discrete choice experiment with duration (DCETTO) between urban and rural respondents.MethodsRespondents from the general population were recruited in urban and rural areas across China. Responses of 8 cTTO tasks and 10 DCETTO tasks for valuing SF-6Dv2 health states and socio-demographic characteristics were collected through face-to-face interviews. Random-effects regression was used to evaluate the effect of residence area on the cTTO values after adjusting for socio-demographic characteristics. The utility value sets developed based on the urban and rural data for cTTO and DCETTO were compared using mean absolute difference (MAD).ResultsOf 3,320 respondents (50.3% male, age range 18–90 years) included, 1,980 (59.6%) resided in urban areas. The mean cTTO value was significantly different between urban and rural respondents across all 295 evaluated states, with the mean (SD) difference of 0.014 (0.119) (range: -0.283 to 0.375). After adjustment, urban respondents assigned significantly higher cTTO values (Coef. = 0.021, p = 0.034). In cTTO value set, the MAD between urban and rural was 0.0276 for states with mean value > 0.5, 0.0327 for states with mean value 0–0.5, and 0.0300 for those states with negative values. For DCETTO value set, the MAD was 0.0359 for states with mean value > 0.5, 0.0409 for states with mean value 0–0.5, and 0.0686 for those states with negative values.ConclusionRural respondents tended to assign a lower utility value than urban respondents when evaluating the same state, reflecting an observable urban–rural preference gap.