From economic development to public health improvement: China faces equity challenges

Internet access during COVID-19 and depressive symptoms in middle-aged and older adults: Evidence from a quasi-experimental study in China

BACKGROUND

Amid the COVID-19 pandemic, the mental health of middle-aged and older adults has become an increasing concern, and the role of the internet in addressing this public health crisis has drawn the attention of researchers. This study evaluated the impact of internet access during COVID-19 on depressive symptoms among middle-aged and older adults.

METHODS

Data were derived from China Health and Retirement Longitudinal Study (CHARLS) 2018 and 2020. Difference-in-differences analysis was performed to compare changes in depressive symptoms between the internet users during COVID-19 and those who didn't have access to the internet before and during the pandemic.

RESULTS

We found that internet access during COVID-19 pandemic significantly reduced middle-aged and older adults' depressive symptoms. Further investigation identified the underlying mechanisms through which internet access helps in alleviating depressive symptoms by reducing the likelihood of experiencing negative emotions about COVID-19. Heterogeneity analyses showed that rural residents and middle-aged individuals benefited more from internet access during the pandemic.

CONCLUSIONS

Since internet access can alleviate middle-aged and older adults' depressive symptoms amidst public health crisis, policy makers should focus on enhancing their access to the internet.

Did internet usage reduce the impact of COVID-19 on the mental health of middle-aged and older adults? A difference-in-differences study based on CFPS data

Introduction

Mental health is the cornerstone of public health, especially where middle-aged and older adults during the COVID-19 pandemic were concerned. The impact of Internet usage on mental health in the time of the crisis still presents a mixed picture.

Methods

This study employs the PSM-DID method according to longitudinal data (CFPS) to explore whether Internet usage reduced the impact of COVID-19 on the mental health of middle-aged and older adults.

Results

The results reveal that Internet use improves the mental health of middle-aged and older adults during the pandemic in China, but that the impact varies between urban and rural residents. Furthermore, the moderator effects model shows that people's perceptions of the Internet have an impact upon the length of time spent online and its consequent effect on mental health.

Discussion

These findings suggested that Internet use had a significant effect on alleviating the levels of depression in middle-aged and older adults. Greater marginal gains may be realized by enhancing the digital capacity of and narrowing the digital divide that exists among rural residents. The enhancement of digital capacity and proper guidance in digital education should be taken into consideration where the mental health of middle-aged and older adults is at issue.

Aging With Emerging Social Welfare and Disappearing Filial Piety: Chinese Migrant Workers' Pathways Toward Financial Retirement Planning

This study examines the pathways and mechanisms linking Chinese migrant workers' migration experiences and their financial retirement planning. Using a mixed-methods approach with 1083 surveys and 32 interviews, this study finds that having a good financial status and social support system and maintaining a hopeful attitude toward retirement are direct pathways toward good financial retirement planning. Good health and hope for retirement are further enhanced by a good financial status and social support. Conversely, poor health and negative employment experiences are linked to poor financial retirement planning. The qualitative findings provide a contextual understanding of the pathways identified in the quantitative analyses. Migrant workers often face a dilemma between self-reliance for retirement and relying on filial piety. These findings apply not only to Chinese migrant workers but also to all migrant workers with limited access to healthcare and public pensions for retirement.

Effect of health rights accessibility on the urban integration of minority rural migrants in China: a cross-sectional study

BACKGROUND

Accessing health rights is an integral component of people's aspirations for a better life. Existing discussions and evaluations regarding the accessibility of health rights for minority rural migrants are insufficient. In comparison to objective health conditions, inequalities in health rights lead to chronic and long-term depletion of human capital among minority rural migrants. This study aimed to assess the overall impact, heterogeneity effects, and mechanisms of health rights accessibility on the urban integration of minority rural migrants.

METHODS

Based on the 2017 China Migrants Dynamic Survey Data (CMDS), this study employs OLS models, 2SLS models, conditional mixed process (CMP) methods, and omitted variable tests to estimate the impact of health rights accessibility on the urban integration of minority rural migrants. Additionally, from the perspectives of migration scope and illness experience, this study explored the heterogeneity in the relationship between health rights accessibility and urban integration. Finally, using the Karlson-Holm-Breen (KHB) model, this study dissects the mechanisms through which health rights accessibility influences the urban integration of minority rural migrants.

RESULTS

Health rights accessibility significantly enhances the urban integration of minority rural migrants. Moreover, compared to minority rural migrants who move across provinces and who have no history of illness, those who migrate within the same province and who have experienced illness are more sensitive to the positive impact of health rights accessibility. However, the enhancing effect of health rights accessibility does not significantly differ between the new and old generations of minority rural migrants. Furthermore, health rights accessibility can indirectly improve the urban integration of minority rural migrants by elevating health levels, improving health habits, and reinforcing health behaviors. Among these, the indirect effects mediated by health habits are more pronounced.

CONCLUSION

The research conclusions underscore the issue of health accessibility and urban integration among minority rural migrants, providing a reexamination and clarification of the policy effects of health rights in promoting the urban integration of minority rural migrants. Relevant policy design should commence with improving the health rights of minority rural migrants, enhancing their health integration capabilities, and effectively boosting their ability to integrate into urban life.

Population ageing and sustainability of healthcare financing in China

BACKGROUND

In China, the healthcare financing structure involves multiple parties, including the government, society and individuals. Medicare Fund is an important way for the Government and society to reduce the burden of individual medical costs. However, with the aging of the population, the demand of Medicare Fund is increasing. Therefore, it is necessary to explore the sustainability of the healthcare financing structure in the context of population ageing.

OBJECTIVE

The purpose of this paper is to organize the characteristics of population ageing as well as healthcare financing in China. On this basis, it analyzes the impact mechanism of population ageing on healthcare financing and the sustainability of existing healthcare financing.

METHODS

This paper mainly adopts the method of literature research and inductive summarization. Extracting data from Health Statistics Yearbook of China and Labor and Social Security Statistics Yearbook of China. Collected about 60 pieces of relevant literature at home and abroad.

RESULTS

China has already entered a deeply ageing society. Unlike developed countries in the world, China's population ageing has distinctive feature of ageing before being rich. A healthcare financing scheme established by China, composing of the government, society, and individuals, is reasonable. However, under the pressure of population ageing, China's current healthcare financing scheme will face enormous challenges. Scholars are generally pessimistic about the sustainability of China's healthcare financing scheme.

CONCLUSIONS

Population ageing will increase the expenditure and reduce the income of the Medicare Fund. This will further affect the sustainability of the healthcare financing structure. As a consequence, the state should pay particular attention to this issue and take action to ensure that the Fund continues to operate steadily.

Measurement and characteristics of the temporal-spatial evolution of China's healthcare services efficiency

BACKGROUND

Healthcare services efficiency (HSE) is directly related to the healthcare demands of the general public and also plays an essential role in the country's coordinated economic and social development.

METHODS

In this study, the stochastic frontier approach (SFA)-Malmquist model was applied to measure the HSE of 31 Chinese provinces based on panel data from 2010-2020. Then, kernel density estimation, Markov chain, and exploratory spatial data analysis were adopted to study the temporal-spatial dynamic evolution characteristics of the HSE.

RESULTS

The study found that China's HSE showed an average value of approximately 0.841, indicating room for improvement. The HSE varied significantly across regions, presenting an "East > Central > West" distribution layout. The TFP of healthcare services in China grew by 1.6% per year, driven mainly by technological progress of 1.8% per year. The trend of the HSE shifting to a high level in China was significant, but its evolution exhibited stability of maintaining the original state, and it was harder to achieve leapfrog transfer. The temporal-spatial evolution of the HSE was also significantly affected by geospatial factors, with a clear spatial spillover effect and spatial agglomeration characteristics. Provinces with high-level HSE exhibited positive spatial spillover effects, while provinces with low-level HSE had negative spatial spillover effects. Thus, the "club convergence" phenomenon of "high efficiency concentration, low efficiency agglomeration, high levels of radiation, and low levels of suppression" was formed in the spatial distribution.

CONCLUSIONS

The results indicate that countermeasures should be taken to improve the HSE in China. Theoretical support for the improvement of HSE is provided in this paper.

Urban-rural disparities in the prevalence and trends of depressive symptoms among Chinese elderly and their associated factors

BACKGROUND

This study aimed to examine urban-rural disparities in the prevalence and trends of depressive symptoms (DS) among Chinese elderly and associated factors.

METHODS

A total of 8025, 7808, and 4887 respondents aged 60 years and above were selected from the China Family Panel Studies (CFPS) in 2016, 2018, and 2020, respectively. DS was assessed using a short version of Center for Epidemiologic Studies Depression Scale (CES-D). Twenty-two associated factors from six categories were included in random forest (RF) models. All urban-rural comparisons were conducted based on good model performance.

RESULTS

The DS prevalence among all rural elderly was significantly higher than corresponding urban elderly. This disparity continued to widen among younger elderly, while it continued to narrow among older elderly. The top 10 common leading factors were sleep quality, self-rated health, life satisfaction, memory ability, child relationship, IADL disability, marital status, educational level, and gender. Urban-rural disparities in sleep quality, interpersonal trust, and child relationship continued to widen, while disparities in multimorbidity, hospitalization status, and frequency of family dinner continued to narrow.

LIMITATION

This study may exist recall bias and lacks causal explanation.

CONCLUSIONS

Significant and continuing disparities in the DS prevalence were observed between urban and rural elderly in China, showing opposite trends in younger and older elderly. The top 10 leading associated factors for DS were nearly consistent across urban and rural elderly, with sleep quality having strongest contribution. Urban-rural disparities in associated factors also showed different trends. This study provides a reference for mental health promotion among Chinese elderly.

The effect of equalization of public health services on the health China's migrant population: Evidence from 2018 China Migrants Dynamic Survey

Objectives

China has implemented an equalization of public health Services policy for migrants in 40 pilot cities since 2013. The main objective of this study is to explore the effect of this migrant-based reform policy on the health status of the migrant population in China.

Methods

Using the China Migrants Dynamic Survey (CMDS), we included 152,000 migrants aged 15 years or over in 2018. Standardized questionnaires were used to collect socio-economic information and self-reported health status. The Associations between the equalization of public health services and health status were estimated using Multiple regression estimation models and Propensity Score Matching (PSM) methods.

Results

Public health equalization reform in China has a significant and positive effect on the health status of the migrant population (β = 0.033, p < 0.001). Compared to males, higher income, under 60 years of age, inter-provincial mobility, and migrants those already living in urban areas, the equalization of public health Services had shown more significant positive effects on the groups who were inter-provincial migration (β = 0.055, p < 0.001), females (β = 0.055, p < 0.001), having low-income (β = 0.077, p < 0.001), aged over 60 years old (β = 0.191, p < 0.001), and living in rural areas (β = 0.038, p < 0.001). And multiple robustness tests prove that the above results are reliable.

Conclusions and implications

Our findings confirmed the positive health effect of the equalization of public health services reform on china's migrant population, especially among vulnerable groups such as those in low income groups, in rural areas and females. And we recommend that it is necessary to further promote the practices and experiences of the pilot cities. First, strengthen health education for the mobile population and improve their health literacy. Second, further increase the financial investment to improve the coverage of public health services and the equity in resource allocation among regions. Last, strengthen the information-based management of the migrant population and prevent and control infectious diseases.

Intergenerational support and depressive symptoms in old age: The difference between urban and rural China

Objectives

Intergenerational support is associated with fewer depressive symptoms in old age. Uneven development has resulted in huge urban-rural disparities in China, which could lead to different intergenerational relationships. The present study aimed to examine whether intergenerational support was associated with depressive symptoms differently among urban and rural Chinese older participants.

Methods

A sample of 3,498 participants from nine pairs of urban subdistricts and rural villages were included in the present study. Depressive symptoms were measured by the 10-item Center for Epidemiological Studies Depression Scale, and the intergenerational support mechanisms (financial, instrumental, and emotional) were assessed with a self-designed questionnaire.

Results

Significant areas by support effect for depressive symptoms indicated different associations between intergenerational financial and emotional support and depressive symptoms in urban and rural areas. Specifically, urban older participants receiving emotional support from adult children and rural older participants receiving financial support from adult children showed fewer depressive symptoms. In both areas, participants receiving instrumental support showed fewer depressive symptoms.

Conclusion

Our study is the first to compare the urban-rural disparity in association between intergenerational support and depressive symptoms in a developing country, China. The results support modernization theories proposing weakened economic function but intensified emotional ties in societies with higher level of development. Communication-based intergenerational emotional support should be promoted in urban areas, and formal support systems should provide financial and instrumental support to the vulnerable rural older population.

Impact of intergenerational support and medical expenditures on depression: Evidence from rural older adults in China

Objective

Globally, depression has become a major health issue among older adults, who experience poor physical health and high medical expenditures. In Asian countries, older adults are greatly dependent on their children. This study assessed the impact of different types of intergenerational support and medical expenditures on depression among older adults in rural China.

Method

A three-phase balanced panel was constructed based on data from 1,838 rural older adults with comparable scores on the Center for Epidemiologic Studies Depression Scale (CES-D) from the China Family Panel Studies in 2012, 2016, and 2018. A fixed-effects model was used to analyze the impact of intergenerational support and medical expenditures on CES-D score and of intergenerational support on medical expenditures. The propensity score-matching model was used to test the regression results' robustness.

Results

The findings were as follows. First, different types of intergenerational support had a heterogeneous impact on depression among rural older adults. Emotional support had a significantly negative impact on CES-D score, although too much care-based support had a positive impact on CES-D score. Low-level economic support had no significant effect on CES-D score. Second, medical expenditures impacted depression; among these, non-inpatient medical expenditure had a significant and positive impact on CES-D score. Third, CES-D scores among rural older adults were associated with chronic diseases and per capita family income. Fourth, care-based support was associated with reduced non-inpatient medical expenditures, and the sub-sample regression results indicated that the impact was significant for older adults with no chronic diseases and those younger than 75 years.

Conclusion

Intergenerational emotional support and non-inpatient medical expenditures directly affected rural older adults' CES-D scores. The mediating role of medical expenditures between intergenerational support and CES-D score was not significant. Measures should be taken to encourage intergenerational emotional support and reduce the pressure on children's economic and care-based support. Further, the medical insurance reimbursement policy, as formal support, should be improved to alleviate depression among rural older adults when children's support is limited.

The relationships between social support and loneliness: A meta-analysis and review

The loneliness of modern people is becoming more and more prominent, and has brought profoundly negative effects on mental health. Social support is an important predictor of loneliness. However, the size of the correlation reported by studies on the relation between social support and loneliness varies greatly. The aim of this meta-analysis is to determine the relation between social support and loneliness. One hundred and seventy-seven articles (N = 113,427) were identified, and robust variance estimation with random effects were used. As expected, higher levels of social support were negatively correlated with loneliness (r = -0.39). The association between social support and loneliness were also moderated by several variables. Specifically, the negative relationship between loneliness and social support among rural populations is stronger than that of urban populations in Chinese samples, the effect of perceived social support (r = -0.45) on loneliness is greater than that of other social supports (r = -0.36), and the friend support (r = -0.48) played a more important role in reducing loneliness than that of two other supports (family support: r = -0.34; significant other support: r = -0.40). The current results support robust links between social support and loneliness, emphasizing the important role of social support in reducing levels of loneliness, this may have some implications for future research and loneliness treatments.

Migration and Health—Freedom of Movement and Social Benefits for Chinese Migrant Workers

This study utilized the concept of social right to understand factors affecting migrant workers’ health and healthcare in China. Using mixed methods, this study integrated findings from a survey of 817 migrant workers and a follow-up study of 30 intensive interviews to present an in-depth understanding of cumulative disadvantage of health and healthcare of rural-to-urban migrant workers. Our quantitative results indicated that migrant workers with no more than 5 years of working experience and having a good relationship with employers were 65% and 72.8% more likely to report good self-rated health as compared to their counterparts; those with work-related injury experience and low income were 41.6% and 53.6% less likely to report good self-rated health. Qualitative findings revealed the social contexts of the cumulative effect of the length of work experience and fear of medical cost on migrant workers’ declining health. Even though the participation rate for health insurance in China is reported to be over 99%, the lack of portability in health insurance and different reimbursement rates in health care access are structural barriers in health-seeking behaviors among Chinese migrant workers and in establishing sustainability in China’s healthcare system. This study adds to the literature by delineating the process of the unequal access to social rights in general, healthcare in particular as the major explanation for migrant workers’ poor health beyond the surface of China’s universal healthcare.

Telemedicine Assessment for the Mental Health of Rural Residents Based on the Safety Degree of Housing in Seismically Active Regions

Earthquakes inevitably affect the mental health of local residents. In seismically active regions of Southwest China, local rural residents' dilapidated housing with poor seismic performance aggravates the impacts of earthquakes on their mental health. These residents' mental health is difficult to recognize because of the lack of appropriate assessment methods. In addition, rural residents in the area have a low socioeconomic status and cannot access adequate mental treatment. Thus, telemedicine could be an effective approach to assist mental health practice in such areas. However, the lack of telemedicine assessment factors in these areas makes it difficult to complete the correct triage and prioritization of rural residents' mental health quickly and effectively. To provide a foundation for applying telemedicine to assess the risk of mental health problems that rural residents in seismically active regions experience, this paper studied whether the degree of safety of housing can affect mental health. In this study, nine villages near the epicenter of the 2019 6.0-magnitude earthquake in Changning County, China were randomly selected, and 162 valid questionnaires were completed. SPSS statistical software was used to analyze the collected data. First, the satisfaction of rural residents with the degree of safety of housing significantly affected the K6 score and whether they suffered from mental problems. Second, the mental health of rural residents living in reinforced concrete frame structure housing was obviously superior to that of those living in other types of housing. Next, the most significant factor affecting mental health was the degree of wall cracks. Finally, a new approach was developed to assess and prioritize the mental health of rural residents by using degrees of housing safety and smart technology in seismically active regions. The telemedicine assessment approach is expected to be used in the future for mental health evaluation and the large-scale data scoring of rural residents.

Does the Economic Growth Improve Public Health? A Cross-Regional Heterogeneous Study in China

On public health, the effect of economic growth in China is analyzed in this paper by using the panel threshold regression model. The empirical study from 2000 to 2017 shows that China's economic growth has a significant threshold effect on public health. After the threshold is exceeded, public health will be improved dramatically. The threshold effect is heterogeneous at the regional level. The eastern region has no threshold, and both central and western regions have a single significant threshold. However, the threshold value and threshold effect in the central and western regions are also different. The heterogeneity is caused by the different levels of regional economic development. Therefore, based on public health utility maximization, the government should make different health policies according to the characteristics of regional development.

Public Medical Insurance and Healthcare Utilization and Expenditures of Older with Chronic Diseases in Rural China: Evidence from NRCMS

China's rural older are the threat from chronic diseases, making it important to evaluate the effect of public health insurance on the health care utilization and expenditures with chronic diseases. In 2003, China initiated a public health insurance, which was called the New Rural Cooperative Medical System (NRCMS). NRCMS is a voluntary program, targeting rural residents with government subsidies and individual contribution. Using the two-stage residual inclusion approach (2SRI), we analyzed the impact of NRCMS on health-care service utilization and expenditure of rural older with chronic diseases by using the 2011 and 2013 China Health and Retirement Survey (CHARLS) data. The results showed NRCMS did not play an effective role on improving the medical services utilization of rural older with chronic diseases. Although NRCMS immediate reimbursement significantly reduced the outpatient service fee, the actual outpatient reimbursement is the opposite. In addition, NRCMS did not significantly decrease their hospitalization expense. Policy makers should pay attention to health management about chronic diseases in rural China, and some measures should be taken to deepen the medical security system reform and improve the public health service system.

Associations between the supply and utilization of primary care and newborn, children and maternal health in rural counties of Guangdong Province, China

BACKGROUND

The Chinese government is ambitious regarding strengthening the primary care system for women and children. Primary care contributes to better health outcomes among neonates, infants, children and pregnant women, especially for vulnerable groups. However, few published studies have examined this issue in China.

OBJECTIVE

This study examined whether greater supply and utilization of primary care was associated with improved health outcomes among targeted populations in the total and interprovincial migrant populations in the rural counties of Guangdong Province, China.

METHODS

This ecological study analysed annual panel data from all 63 rural counties in Guangdong Province from 2014 to 2016 (n = 189). A linear random-effects panel data model was applied.

RESULTS

Higher proportions of primary care visits were significantly associated with reduced incidences of low birth weight (P < 0.05) and preterm birth rates (P < 0.05) for the total population, and were significantly associated with reduced infant (P < 0.1) and under-five (P < 0.01) mortality rates for migrants. Greater primary care physician supply was significantly associated with reduced maternal mortality (P < 0.1) rates among migrants. However, primary care indicators were insignificant for both the total and migrant populations regarding neonatal mortality rates, as well as the infant and under-five mortality rates in the total population (P > 0.1).

CONCLUSIONS

These findings support existing evidence regarding associations between primary care and improved health outcomes among newborns, children and pregnant women, especially for disadvantaged populations. However, associations were not significant for all studied health outcomes, implying the need for further study.

Variety, frequency, and type of Internet use and its association with risk of depression in middle- and older-aged Chinese: A cross-sectional study

BACKGROUND

Internet use is beneficial to mental health has been acknowledged, but its specific patterns await further investigation in China's context of urban-rural disparity. Therefore, we aimed to understand the patterns of Internet use and measure their associations with risk of depression in China from three dimensions: variety, frequency and type.

METHODS

We selected 18,492 urban and rural Chinses respondents aged 45 years and older from China Health and Retirement Longitudinal Study (CHARLS) 2015 dataset. Risk of depression was measured by 10-item Centre for Epidemiologic Studies (CES-D 10). Internet use was measured from three dimensions: variety, frequency and type, whereas its relationship with risk of depression was examined by multivariate logistic regression model.

RESULTS

In the whole sample, 67.2% of respondents had no risk of depression, and approximately 7% used Internet, which was inversely associated with risk of depression (AOR=0.617, 95% CI=0.444, 0.858). Rural respondents had higher risk of depression (37.1% VS 26.2%) and lower prevalence of Internet use (2.6% VS 13%). Among rural respondents, using Internet occasionally (AOR=0.338; 95% CI=0.130, 0.881), using one type of device (AOR=0.293; 95% CI=0.113, 0.760), especially mobile phone (AOR=0.427; 95% CI=0.187, 0.978) were associated with lower odds of depression. No significant associations were observed in urban respondents.

LIMITATIONS

The causal relationship between variables awaits further investigation with a longitudinal design.

CONCLUSION

Internet use was negatively associated with risks of depression, especially in rural but not in urban participants. Rural-urban disparities should be considered when designing strategies to encourage moderate Internet use.

Economic Hardship, Ocular Complications, and Poor Self-reported Visual Function are Predictors of Mental Problems in Patients with Uveitis

PURPOSE

To characterize the quality of life and mental health status of patients with uveitis and investigate predictors of psychological problems.

METHODS

A total of 245 patients and 105 controls were enrolled in this cross-sectional study. Quality of life, psychological status, socio-demographic and clinical data were obtained from questionnaires and medical records. Multivariate regression analyses and Receiver Operating Characteristic (ROC) were applied to obtain the model predicting psychological problems of patients.

RESULTS

Of 245 patients, 16.7% and 26.5% (P < .0001) screened positive for anxiety and depression, respectively. The model predicting anxiety was comprised of low annual household income and poor self-reported visual function (P = .029, P < .0001, respectively), with an AUC of ROC of 0.744. The model predicting depression was comprised of poor self-reported visual function and ocular complications (P < .0001, P = .012, respectively), with an AUC of 0.78.

CONCLUSIONS

Economic hardship, ocular complications, and poor self-reported visual function are predictors of mental problems in patients with uveitis.

Data-Driven Models for Capacity Allocation of Inpatient Beds in a Chinese Public Hospital

Hospital beds are a critical but limited resource shared between distinct classes of elective patients. Urgent elective patients are more sensitive to delays and should be treated immediately, whereas regular patients can wait for an extended time. Public hospitals in countries like China need to maximize their revenue and at the same time equitably allocate their limited bed capacity between distinct patient classes. Consequently, hospital bed managers are under great pressure to optimally allocate the available bed capacity to all classes of patients, particularly considering random patient arrivals and the length of patient stay. To address the difficulties, we propose data-driven stochastic optimization models that can directly utilize historical observations and feature data of capacity and demand. First, we propose a single-period model assuming known capacity; since it recovers and improves the current decision-making process, it may be deployed immediately. We develop a nonparametric kernel optimization method and demonstrate that an optimal allocation can be effectively obtained with one year's data. Next, we consider the dynamic transition of system state and extend the study to a multiperiod model that allows random capacity; this further brings in substantial improvement. Sensitivity analysis also offers interesting managerial insights. For example, it is optimal to allocate more beds to urgent patients on Mondays and Thursdays than on other weekdays; this is in sharp contrast to the current myopic practice.

An Improved Healthcare Accessibility Measure Considering the Temporal Dimension and Population Demand of Different Ages

Healthcare accessibility has become an issue of social equity. An accurate estimation of existing healthcare accessibility is vital to plan and allocate health resources. Healthcare capacity, population demand, and geographic impedance are three essential factors to measure spatial accessibility. Additionally, geographic impedance is usually represented with a function of travel time. In this paper, the three-step floating catchment area (3SFCA) method is improved from the perspectives of the temporal dimension and population demand. Specifically, the travel time from the population location to the service site is precisely calculated by introducing real-time traffic conditions instead of utilizing empirical speed in previous studies. Additionally, with the utilization of real-time traffic, a dynamic result of healthcare accessibility is derived during different time periods. In addition, since the medical needs of the elderly are higher than that of the young, a demand weight index of demand is introduced to adjust the population demand. A case study of healthcare accessibility in Wuhan shows that the proposed method is effective to measure healthcare accessibility during different time periods. The spatial accessibility disparities of communities and crowdedness of hospitals are identified as an important reference for the balance between the supply and demand of medical resources.

Selected indicators and determinants of women's health in the vicinity of a copper mine development in northwestern Zambia

Background

Large projects in the extractive industry sector can affect people’s health and wellbeing. In low- and middle-income countries (LMICs), women’s health is of particular concern in such contexts due to potential educational and economic disadvantages, vulnerability to transactional sex and unsafe sex practices. At the same time, community health interventions and development initiatives present opportunities for women's and maternal health.

Methods

Within the frame of the health impact assessment (HIA) of the Trident copper mining project in Zambia, two health surveys were conducted (baseline in 2011 and follow-up in 2015) in order to monitor health and health-related indicators. Emphasis was placed on women residing in the mining area and, for comparison, in settings not impacted by the project.

Results

All measured indicators improved over time, regardless of whether communities were affected by the project or not. Additionally, the percentage of mothers giving birth in a health facility, the percentage of women who acknowledge that HIV cannot be transmitted by witchcraft or other supernatural means and the percentage of women having ever tested for HIV showed a significant increase in the impacted sites but not in the comparison communities. In 2015, better health, behavioural and knowledge outcomes in women were associated with employment by the project (or a sub-contractor thereof), migration background, increased wealth and higher educational attainment.

Conclusions

Our study reveals that natural resource development projects can positively impact women’s health, particularly if health risks are adequately anticipated and managed. Hence, the conduct of a comprehensive HIA should be a requirement at the feasibility stage of any large infrastructure project, particularly in LMICs. Continued monitoring of health outcomes and wider determinants of health after the initial assessment is crucial to judge the project’s influence on health and for reducing inequalities over time.

Electronic supplementary material

The online version of this article (10.1186/s12905-018-0547-7) contains supplementary material, which is available to authorized users.

Accounting for Selectivity Bias and Correlation Across the Sequence From Elevated Blood Pressure to Hypertension Diagnosis and Treatment

BACKGROUND

It is unknown whether efforts to reduce hypertension burden in countries with very high prevalence, would be more effective if directed at hypertension diagnosis vs. treatment. Most analyses do not address bias and correlation across the sequence from elevated blood pressure (BP) to hypertension diagnosis and treatment, leading to potentially misleading findings.

METHODS

Using data spanning 18 years of the China Health and Nutrition Survey (n = 18,926; ages 18-75 years), we used an innovative 3-step, integrated system of equations to predict the sequence from: (i) elevated BP (systolic/diastolic BP ≥ 140/90 mm Hg) to (ii) diagnosed hypertension conditional on elevated BP, and to (iii) treatment (medication use) conditional on diagnosis, accounting for measured and unmeasured individual- and community-level confounders at each of the 3 steps. We compared results to separate traditional logistic regression models without control for unmeasured confounding.

RESULTS

Using our 3-step model, elevated BP increased from 12.6% and 8.5% (1991) to 36.8% and 29% (2009) in men and women, respectively, but diagnosis remained under 50%. We found widening disparities in hypertension diagnosis (higher hypertension at lower vs. higher education (difference of 2% in 1991 that widened to 5% in 2009)) and narrowing disparities in education (difference of 6% in 1991 to 4% in 2009) and insurance status (difference of 7% in 1991 to 2% in 2009) for treatment.

CONCLUSIONS

Our 3-step model improved model fit over traditionally used models. Our findings highlight serious barriers to hypertension diagnosis in Chinese adults, particularly among men and individuals of low attained education.

Study on Equity and Efficiency of Health Resources and Services Based on Key Indicators in China

BACKGROUND

This study aims to evaluate the dialectical relationship between equity and efficiency of health resource allocation and health service utilization in China.

METHODS

We analyzed the inequity of health resource allocation and health service utilization based on concentration index (CI) and Gini coefficient. Data envelopment analysis (DEA) was used to evaluate the inefficiency of resource allocation and service utilization. Factor Analysis (FA) was used to determine input/output indicators.

RESULTS

The CI of Health Institutions, Beds in Health Institutions, Health Professionals and Outpatient Visits were -0.116, -0.012, 0.038, and 0.111, respectively. Gini coefficient for the 31 provinces varied between 0.05 and 0.43; out of these 23 (742%) were observed to be technically efficient constituting the "best practice frontier". The other 8 (25.8%) provinces were technically inefficient.

CONCLUSIONS

Health professionals and outpatient services are focused on higher income levels, while the Health Institutions and Beds in Health Institutions were concentrated on lower income levels. In China, a few provinces attained a basic balance in both equity and efficiency in terms of current health resource and service utilization, thus serving as a reference standard for other provinces.

Forecasting and Analyzing the Disease Burden of Aged Population in China, Based on the 2010 Global Burden of Disease Study

BACKGROUND

Forecasting the disease burden of the elderly will contribute to make a comprehensive assessment about physical and mental status of the elderly in China and provide a basis for reducing the negative consequences of aging society to a minimum.

METHODS

This study collected data from a public database online provided by Global Burden of Disease Study 2010. Grey model GM (1, 1) was used to forecast all-cause and disease-specific rates of disability adjusted life years (DALYs) in 2015 and 2020.

RESULTS

After cross-sectional and longitudinal analysis, we found that non-communicable diseases (NCDs) were still the greatest threats in the elderly, followed by injuries. As for 136 predicted causes, more than half of NCDs increased obviously with age, less than a quarter of communicable, material, neonatal, and nutritional disorders or injuries had uptrend.

CONCLUSIONS

The findings display the health condition of the Chinese elderly in the future, which will provide critical information for scientific and sociological researches on preventing and reducing the risks of aging society.

Understanding Rural-Urban Differences in Depressive Symptoms Among Older Adults in China

OBJECTIVE

Studies have reported that rural elders in China have higher levels of depression than their urban peers. We aimed to examine the extent to which four sets of factors (socioeconomic status [SES], health care access, health status, and social support and participation) account for such rural-urban differences.

METHOD

Cross-sectional data from the 2011 China Health and Retirement Longitudinal Study were analyzed. A representative sample (N = 5,103) of older Chinese (age 60+) was included. Depressive symptoms were measured by the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). Multilevel linear regression was conducted.

RESULTS

Rural elders had more depressive symptoms than urban elders. When SES at the individual, household, and community level was simultaneously controlled, the rural-urban difference lost its statistical significance. Health status, social support, and social participation accounted for some, whereas health care access explained almost none, of the rural-urban difference.

DISCUSSION

Results suggest that SES is the predominant factor accounting for the rural-urban depression gap in China.

Defining migration and its health impact in China

The scale and rapid expansion of urbanization resulting from socio-economic transformation in China at the beginning of the 21st century has accelerated rural-urban migration. Public health concerns from this increasing internal population mobility are now receiving attention from researchers. The health problems from internal migration pose particular demands on healthcare systems and relate to its demographic characteristics, with many younger and older people being left behind in the rural countryside. A review of literature, census, policy reports, government documents and media was undertaken to look at the classification system and health characteristics of China's internal migrants. It suggests that public health bears the consequences of political and economic decisions made elsewhere in society.

Equity and efficiency preferences of health policy makers in China--a stated preference analysis

BACKGROUND

Macroeconomic growth in China enables significant progress in health care and public health. It faces difficult choices regarding access, quality and affordability, while dealing with the increasing burden of chronic diseases. Policymakers are pressured to make complex decisions while implementing health strategies. This study shows how this process could be structured and reports the specific equity and efficiency preferences among Chinese policymakers.

METHODS

In total, 78 regional, provincial and national level policymakers with considerable experience participated in a discrete choice experiment, weighting the relative importance of six policy attributes describing equity and efficiency. Results from a conditional logistic model are presented for the six criteria, measuring the associated weights. Observed and unobserved heterogeneities were incorporated and tested in the model. Findings are used to give an example of ranking health interventions in relation to the present disease burden in China.

RESULTS

In general, respondents showed strong preference for efficiency criteria i.e. total beneficiaries and cost-effectiveness as the most important attributes in decision making over equity criteria. Hence, priority interventions would be those conditions that are most prevalent in the country and cost least per health gain.

CONCLUSION

Although efficiency criteria override equity ones, major health threats in China would be targeted. Multicriteria decision analysis makes explicit important trade-offs between efficiency and equity, leading to explicit, transparent and rational policy making.

Eighteen year weight trajectories and metabolic markers of diabetes in modernising China

AIMS/HYPOTHESIS

Although obesity is a major risk factor for diabetes, little is known about weight gain trajectories across adulthood, and whether they are differentially associated with metabolic markers of diabetes.

METHODS

We used fasting blood samples and longitudinal weight data for 5,436 adults (5,734 observations, aged 18-66 years) from the China Health and Nutrition Survey (1991-2009). Using latent class trajectory analysis, we identified different weight gain trajectories in six age and sex strata, and used multivariable general linear mixed effects models to assess elevated metabolic markers of diabetes (fasting glucose, HbA1c, HOMA-IR, insulin) across weight trajectory classes. Models were fitted within age and sex strata, and controlled for baseline weight (or baseline weight by weight trajectory interaction terms), height, and smoking habit, with random intercepts to control for community-level correlations.

RESULTS

Compared with weight gain, classes with weight maintenance, weight loss, or a switch from weight gain to loss had lower values for metabolic markers of diabetes. These associations were stronger among younger women (aged 18-29 and 30-39 years) and men (18-29 years) than in older (40-66 years) men and women. An exception was HOMA-IR, which showed class differences across all ages (at least p < 0.004).

CONCLUSION

Trajectory analysis identified heterogeneity in adult weight gain associated with diabetes-related metabolic markers, independent of baseline weight. Our findings suggest that variation in metabolic markers of diabetes across patterns of weight gain is masked by a homogeneous classification of weight gain.

Identifying determinants of socioeconomic inequality in health service utilization among patients with chronic non-communicable diseases in China

Background

People with chronic non-communicable diseases (NCD) are particularly vulnerable to socioeconomic inequality due to their long-term expensive health needs. This study aimed to assess socioeconomic-related inequality in health service utilization among NCD patients in China and to analyze factors associated with this disparity.

Methods

Data were taken from the 2008 Chinese National Health Survey, in which a multiple stage stratified random sampling method was employed to survey 56,456 households. We analyzed the distribution of actual use, need-expected use, and need-standardized usage of outpatient services (over a two-week period) and inpatient services (over one-year) across different income groups in 27,233 adult respondents who reported as having a NCD. We used a concentration index to measure inequality in the distribution of health services, which was expressed as HI (Horizontal Inequity Index) for need-standardized use of services. A non-linear probit regression model was employed to detect inequality across socio-economic groups.

Results

Pro-rich inequity in health services among NCD patients was more substantial than the average population. A higher degree of pro-rich inequity (HI = 0.253) was found in inpatient services compared to outpatient services (HI = 0.089). Despite a greater need for health services amongst those of lower socio-economic status, their actual use is much less than their more affluent counterparts. Health service underuse by the poor and overuse by the affluent are evident. Household income disparity was the greatest inequality factor in NCD service use for both outpatients (71.3%) and inpatients (108%), more so than health insurance policies. Some medical insurance schemes, such as the MIUE, actually made a pro-rich contribution to health service inequality (16.1% for outpatient and 12.1% for inpatient).

Conclusions

Inequality in health services amongst NCD patients in China remains largely determined by patient financial capability. The current insurance schemes are insufficient to address this inequity. A comprehensive social policy that encompasses a more progressive taxation package and redistribution of social capital as well as pro-poor welfare is needed.

Health-related quality of life and its correlates among Chinese migrants in small- and medium-sized enterprises in two cities of Guangdong

Objectives

To explore the relationship between health-related quality of life (HRQOL) status and associated factors among rural-to-urban migrants in China.

Methods

A cross-sectional survey was conducted with 856 rural-to-urban migrants working at small- and medium-size enterprises (SMEs) in Shenzhen and Zhongshan City in 2012. Andersen's behavioral model was used as a theoretical framework to exam the relationships among factors affecting HRQOL. Analysis was performed using structural equation modeling (SEM).

Results

Workers with statutory working hours, higher wages and less migrant experience had higher HRQOL scores. Need (contracting a disease in the past two weeks and perception of needing health service) had the greatest total effect on HRQOL (β = −0.78), followed by enabling (labor contract, insurance purchase, income, physical examination during work and training) (β = 0.40), predisposing (age, family separation, education) (β = 0.22) and health practices and use of health service (physical exercise weekly, health check-up and use of protective equipments) (β = −0.20).

Conclusions

Priority should be given to satisfy the needs of migrant workers, and improve the enabling resources.

Urban public health: is there a pyramid?

Early ecologists identified a pyramidal trophic structure in terms of number, biomass and energy transfer. In 1943, the psychologist Maslow put forward a pyramid model to describe layers of human needs. It is indicated that the pyramid principle is universally applicable in natural, humanistic and social disciplines. Here, we report that a pyramid structure also exists in urban public health (UPH). Based on 18 indicators, the UPH states of four cities (Beijing, Tokyo, New York, and London) are compared from the point of view of five aspects, namely physical health, living conditions, social security, environmental quality, and education and culture. A pyramid structure was found in each city when focusing on 2000-2009 data. The pyramid of Beijing is relatively similar to that of Tokyo, and the pyramids of New York and London are similar to each other. A general development trend in UPH is proposed and represented by different pyramid modes. As a basic conjecture, the UPH pyramid model can be verified and developed with data of more cities over a longer period, and be used to promote healthy urban development.

Health of China's rural-urban migrants and their families: a review of literature from 2000 to 2012

BACKGROUND

Socioeconomic transformation in China at the beginning of the twenty-first century has led to rapid urbanization and accelerated rural-urban migration. As a result, the concerns about public health problems triggered by increasing internal population mobility have been more widely studied in recent years.

SOURCES OF DATA

Published data in Chinese and English on health of migrants and their families in mainland China from 2000 to 2012.

AREAS OF AGREEMENT

The shifting patterns of disease distribution due to rural-urban migration, health equity and health reform strategies that cater for this specific yet substantial subpopulation are outstanding concerns. Infectious diseases, mental health, occupational health and women's health are emerging public health priorities related to migration.

AREAS OF CONTROVERSY

The high mobility and large numbers of Chinese rural-urban migrants pose challenges to research methods and the reliability of evidence gained.

GROWING POINTS

While the theme of working migrants is common in the literature, there have also been some studies of health of those left behind but who often remain unregistered. Migration within China is not a single entity and understanding the dynamics of new and emerging societies will need further study.

AREAS TIMELY FOR DEVELOPING RESEARCH

Social, economic, emotional, environmental and behavioural risk factors that impact on health of migrants and their families call for more attention from health policy-makers and researchers in contemporary China.

Multilevel examination of diabetes in modernising China: what elements of urbanisation are most associated with diabetes?

AIMS/HYPOTHESIS

The purpose of this study was to examine the association between urbanisation-related factors and diabetes prevalence in China.

METHODS

Anthropometry, fasting blood glucose (FBG) and community-level data were collected for 7,741 adults (18-90 years) across 217 communities and nine provinces in the 2009 China Health and Nutrition Survey to examine diabetes (FBG ≥7.0 mmol/l or doctor diagnosis). Sex-stratified multilevel models, clustered at the community and province levels and controlling for individual-level age and household income were used to examine the association between diabetes and: (1) a multicomponent urbanisation measure reflecting overall modernisation and (2) 12 separate components of urbanisation (e.g., population density, employment, markets, infrastructure and social factors).

RESULTS

Prevalent diabetes was higher in more-urbanised (men 12%; women 9%) vs less-urbanised (men 6%; women 5%) areas. In sex-stratified multilevel models adjusting for residential community and province, age and household income, there was a twofold higher diabetes prevalence in urban vs rural areas (men OR 2.02, 95% CI 1.47, 2.78; women, OR 1.94, 95% CI 1.35, 2.79). All urbanisation components were positively associated with diabetes, with variation across components (e.g. men, economic and income diversity, OR 1.42, 95% CI 1.20, 1.66; women, transportation infrastructure, OR 1.18, 95% CI 1.06, 1.32). Community-level variation in diabetes was comparatively greater for women (intraclass correlation [ICC] 0.03-0.05) vs men (ICC ≤0.01); province-level variation was greater for men (men 0.03-0.04; women 0.02).

CONCLUSIONS/INTERPRETATION

Diabetes prevention and treatment efforts are needed particularly in urbanised areas of China. Community economic factors, modern markets, communications and transportation infrastructure might present opportunities for such efforts.

Socioeconomic inequality in the use of rituximab therapy among non-Hodgkin lymphoma patients in Chinese public hospitals

Rituximab is a patient-paid effective monoclonal-antibody drug for non-Hodgkin lymphoma (NHL). Little is known in China, a country with unequal distribution of wealth and medical insurance systems, about the impact of socioeconomic status (SES) on selecting rituximab therapy in NHL patients. A total of 328 NHL inpatients in 2 public hospitals in Hangzhou were recruited and divided into 2 equal groups: with rituximab therapy and with no rituximab therapy group. Selection and frequency of rituximab therapy increased with duration of education and in urban citizens (P < .01). Officers and businessmen were more likely to use rituximab therapy compared with farmers (P < .01). Patients covered by Urban Employee Basic Medical Insurance were more likely to select rituximab therapy than those insured with Urban-Rural Residents Basic Medical Insurance (P < .01). There was an inequality in provision of rituximab therapy among Chinese NHL patients, and this was associated with differences in SES status. Effective measures are suggested to ameliorate the inequality issue.

Social determinants of health and depression: a preliminary investigation from rural China

Background

In the last several years, research related to social determinants of health (SDH) has begun to resonate in the medical, behavioral, social and political sciences arena. The aim of the present study was to explore the relationship between SDH and depression, and to provide new evidences and clues for depression control and prevention.

Methodology/Principal Findings

This research was a cross-sectional survey executed door to door from October 2006 to April 2008, with a sample of 3,738 individuals aged 18 and older in rural China. The three variables of SDH were socioeconomic status (years of schooling and self-reported economic status of family), social cohesion and negative life events. Demographic variables and self-perceived physical health were taken as potential confounders. The cross-table analysis showed that variations in levels of depression were associated with variations in SDH, and logistic regression analysis confirmed the association even after adjusting for potential confounding variables.

Conclusions

Although there were some limitations, the current study provides initial evidence of the importance of SDH in depression. Findings indicate that social inequity and the role of policy action emphasized by SDH should be considered high priorities when addressing the issue of depression. In addition, cell-to-society and pill-to-policy approaches should be encouraged in the future.