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Zhou Y, Wu Q, Li C, Meng P, Ding L. Inequalities in non-communicable disease management in China and progress toward universal health coverage: an analysis of nationwide household survey data from 2004 to 2018. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 44:100989. [PMID: 38226331 PMCID: PMC10788262 DOI: 10.1016/j.lanwpc.2023.100989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/16/2023] [Accepted: 12/04/2023] [Indexed: 01/17/2024]
Abstract
Background Prevention and control of non-communicable diseases (NCDs) become a policy priority in Universal Health Coverage (UHC) in China, while NCD management has never been comprehensively estimated at national and subnational levels. We aimed to assess NCD management in China nationally and in key subpopulations, investigate inequalities from multidimensions, and further examine its association with health financing and resources. Methods Data included were from China Chronic Disease and Risk Factors Surveillance (CCDRFS) and China Health and Nutrition Survey (CHNS). Following the WHO recommended frameworks, we selected eight NCD health service and risk management indicators and used meta-analysis to construct the composite NCD index. We explored the trends in and projections of NCD management index and indicators at national and subnational levels by using Bayesian regression models with average annual percentage change (AAPC) from 2004 to 2018 and probability of reaching the UHC target by 2030. We further conducted comprehensive inequality analyses of NCD indicators from multidimensions with patterns of changes over time using absolute difference and relative ratio. Finally, we quantified the associations between NCD management performance with health financing and resources using stochastic frontier analysis. Findings In China, the NCD management index increased slowly from 62.0% (95% CI 36.0 to 84.0) in 2004 to 64.3% (95% CI 44.0 to 82.2) in 2018, with lagging performance being observed in prevention domain (AAPC -0.1%, 95% CrI -1.0 to 0.8). And all management indicators presented low probabilities of accomplishing 2030 targets in China. Notably, based on subnational analysis, diverse tendency and magnitude of inequalities in multiple NCD indicators were identified with widening gaps between genders (non-overweight, diabetes treatment), age groups (non-use of tobacco), urban-rural areas (non-use of alcohol, non-use of tobacco), regions (sufficient physical activity), and wealth quintiles (non-overweight, sufficient physical activity). Additionally, it was observed that compared with urban area, rural area had constantly lower health resources and presented 2.2% lower NCD management performance in 2018. Importantly, we found that health financing and resources especially distributed in primary health care (PHC) facilities were closely and positively associated with NCD management performance. A 1000 yuan increase of government health expenditure (GHE) per capita and a 10 increase of medical beds per 1000 capita in PHC facilities were associated with a 4.0% (95% CI 2.0 to 6.0) and 6.8% (95% CI 0.2 to 13.5) increase of NCD management index, respectively. Interpretation The progress towards NCD management is slow at national level and in key subpopulations in China, with great challenges of existing and widening inequalities between genders, age groups, urban-rural areas, regions and socioeconomic groups. Rural and old people were still vulnerable populations who were lagging behind in NCD prevention and control. Optimising resource allocation by strengthening PHC especially in rural area, developing tailor-made programmes targeting specific populations such as old individuals, simultaneously integrating gender, education, and economic interventions to reduce inequalities should be prioritised to help China tackle NCDs during the progress towards UHC. Funding National Natural Science Foundation of China.
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Affiliation(s)
- Ying Zhou
- Center for Smart and Healthy Buildings, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, China
| | - Qi Wu
- Center for Smart and Healthy Buildings, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, China
| | - Chenshuang Li
- Center for Smart and Healthy Buildings, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, China
| | - Pu Meng
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Lieyun Ding
- Center for Smart and Healthy Buildings, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, China
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Yang X, Yan J, Lai S, Shen C, Duan N. What affects the direct economic burden of non-communicable diseases on middle-aged and older adult people in Shaanxi Province? Front Public Health 2023; 11:1219199. [PMID: 38186709 PMCID: PMC10766749 DOI: 10.3389/fpubh.2023.1219199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024] Open
Abstract
Non-communicable diseases (NCDs) are the leading cause of death worldwide. NCDs affect the health status and the quality of life. In addition, continuous NCDs treatment expenses place a heavy economic burden on families and cause huge economic losses to the society. The prevention and treatment of NCDs and reduction of their economic burden are key public health issues. Considering middle-aged and older adult people as the focus, their basic socio-demographic characteristics and health behavior status of this group, and a pooled cross-sections regression model was then used to analyze the main factors affecting the direct economic burden. The results showed that from 2013 to 2018, the prevalence of NCDs among the middle-aged and older adult people in Shaanxi province as well as the direct economic burden of NCDs increased. The effect factors primarily included sex, age, employment status, income level, type of medical insurance, urban or rural residency, level of the health care-providing institutions, visiting times of 2-week, and length of hospital stay. Several measures can be taken to control the onset of NCDs and reduce their direct economic burden.
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Affiliation(s)
- Xiaowei Yang
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Ju’e Yan
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Sha Lai
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Chi Shen
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Ning Duan
- Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
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Wu M, Qin S, Tan C, Li S, Xie O, Wan X. Estimated projection of incidence and mortality of alcohol-related liver disease in China from 2022 to 2040: a modeling study. BMC Med 2023; 21:277. [PMID: 37501074 PMCID: PMC10375628 DOI: 10.1186/s12916-023-02984-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND China has one of the highest numbers of liver disease cases in the world, including 6.4 million cirrhosis associated with alcohol-related liver disease (ALD) cases. However, there is still a lack of urgent awareness about the growth of alcohol consumption and the increased burden of ALD in China. Therefore, we aimed to project the potential impact of changes in alcohol consumption on the burden of ALD in China up to 2040 under different scenarios. METHODS We developed a Markov model to simulate the natural history of ALD until 2040 in China. We estimated the incidence and mortality of alcohol-related cirrhosis and hepatocellular carcinoma between 2022 and 2040 under four projected scenarios: status quo scenario and scenarios with a 2%, 4%, and 8% annual decrease in excessive alcohol consumption, respectively. RESULTS Under the status quo scenario, the cumulative new cases of cirrhosis from 2022 to 2040 was projected to be 3.61 million (95% UI 3.03-4.44 million), resulting in a cumulative 1.96 million (1.66-2.32 million) deaths from alcohol-related cirrhosis and hepatocellular carcinoma. However, a 2% annual reduction in excessive alcohol consumption was expected to avert 0.3 million deaths associated with ALD, and a 4% annual reduction was projected to prevent about 1.36 million new cases of cirrhosis and prevent 0.5 million ALD-related deaths. Moreover, an 8% annual reduction would prevent about 2 million new cases of cirrhosis and 0.82 million deaths. CONCLUSIONS Without any substantial change in alcohol attitudes and policies to regulate excessive drinking, the disease burden of ALD in China will increase enormously. Strengthening the implementation of alcohol restriction interventions is critical and urgent to reduce the impact of ALD on the Chinese population.
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Affiliation(s)
- Meiyu Wu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Institute of Clinical Pharmacy, Central South University, Changsha, 410011, Hunan, China
| | - Shuxia Qin
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Institute of Clinical Pharmacy, Central South University, Changsha, 410011, Hunan, China
| | - Chongqing Tan
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Institute of Clinical Pharmacy, Central South University, Changsha, 410011, Hunan, China
| | - Sini Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ouyang Xie
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Institute of Clinical Pharmacy, Central South University, Changsha, 410011, Hunan, China
| | - Xiaomin Wan
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
- Institute of Clinical Pharmacy, Central South University, Changsha, 410011, Hunan, China.
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Zou S, Wang Z, Tang K. Social inequalities in all-cause mortality among adults with multimorbidity: a 10-year prospective study of 0.5 million Chinese adults. Int Health 2023; 15:123-133. [PMID: 35922875 PMCID: PMC9977254 DOI: 10.1093/inthealth/ihac052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 06/12/2022] [Accepted: 07/13/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Chinese individuals face an increase in multimorbidity, but little is known about the mortality gradients of multimorbid people in different socio-economic groups. This study measures relative and absolute socio-economic inequality in mortality among multimorbid Chinese. METHODS For this study, the prospective China Kadoorie Biobank (CKB) enrolled 512 712 participants ages 30-79 y from 10 areas of China between 25 June 2004 and 15 July 2008. All-cause mortality was accessed with a mean follow-up period of 10 y (to 31 December 2016). Associations between multimorbidity and mortality were assessed using Cox proportional hazards models, with the relative index of inequality (RII) and slope index of inequality (SII) in mortality calculated to measure disparities. RESULTS Mortality risk was highest for those who had not attended formal school and with four or more long-term conditions (LTCs) (hazard ratio 3.11 [95% confidence interval {CI} 2.75 to 3.51]). Relative educational inequality was lower in participants with four or more LTCs (RII 1.92 [95% CI 1.60 to 2.30]), especially in rural areas. Absolute disparities were greater in adults with more LTCs (SII 0.18 [95% CI 0.14 to 0.21] for rural participants with three LTCs). CONCLUSIONS Whereas the relative inequality in all-cause mortality was lower among multimorbid people, absolute inequality was greater among multimorbid men, especially in rural areas.
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Affiliation(s)
- Siyu Zou
- Vanke School of Public Health, Tsinghua University, 30 Shuangqing Road, Haidian District, Beijing 100084, China
- School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Zhicheng Wang
- Vanke School of Public Health, Tsinghua University, 30 Shuangqing Road, Haidian District, Beijing 100084, China
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, 30 Shuangqing Road, Haidian District, Beijing 100084, China
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Yang J, Ma J, Sun Q, Han C, Guo Y, Li M. Health benefits by attaining the new WHO air quality guideline targets in China: A nationwide analysis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 308:119694. [PMID: 35777592 DOI: 10.1016/j.envpol.2022.119694] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 04/15/2022] [Accepted: 06/25/2022] [Indexed: 06/15/2023]
Abstract
To reduce the high disease burden caused by air pollution, World Health Organization (WHO) issued a new air quality guideline (AQG) on the 22nd September 2021. A timely quantitative assessment of health benefits by meeting these targets is a key measure to advocate and inform national and regional disease control policies. We collected daily major air pollution data in 315 Chinese cities from the 1st January to the 31st December 2019, and the corresponding annual population and mortality rate in the whole population of each city. Then, the mortality benefits were estimated when daily air pollution levels attained WHO's new AQG targets (15 μg/m3 for PM2.5, 25 μg/m3 for NO2 and 100 μg/m3 for O3) in 315 Chinese cities and 31 provinces by using pollutant- and cause-specific concentration-response functions. In total, 134,025 (95%CI: 92,768; 173,029) air pollution-associated non-accidental deaths could be avoided in 315 Chinese cities in 2019 by attaining WHO's new AQG targets, with 43,800 (95%CI: 29,945; 55,616) avoidable deaths from PM2.5, 58,070 (95%CI: 45,333; 70,714) from NO2, and 32,155 (95%CI: 17,490; 46,699) from O3. Cardiovascular diseases and respiratory diseases accounted for 72,698 (95%CI: 46,561; 101,680) and 17,726 (95%CI: 8603; 26,925) avoidable deaths, respectively. Health benefits from reduction in air pollution levels were 99.26 avoided non-accidental deaths per million population at national level, ranging from 12.48 per million in Tibet to 166.26 per million in Hebei. These findings suggest that the compliance with the WHO updated AQG standards would save substantial amount of air pollution-related premature deaths in China. More stringent air pollution control and management measures are urgently warranted to reduce the disease burden from air pollutants in China, particularly for the worsening O3 pollution.
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Affiliation(s)
- Jun Yang
- School of Public Health, Guangzhou Medical University, Guangzhou, 511436, China
| | - Jinxiang Ma
- School of Public Health, Guangzhou Medical University, Guangzhou, 511436, China
| | - Qinghua Sun
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Chunlei Han
- School of Public Health and Management, Binzhou Medical University, Yantai, Shandong Province, 264003, China; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Mengmeng Li
- Department of Cancer Prevention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.
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Jiang Y, Guo H, Zhang W, Gan CCR, Mao F, Zhou M, Phung H, Phung D, Dong J, Chu C. Gaps and Directions in Addressing Non-Communicable and Chronic Diseases in China: A Policy Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159761. [PMID: 35955116 PMCID: PMC9368287 DOI: 10.3390/ijerph19159761] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Non-communicable and chronic diseases (NCDs) have become a public health problem that seriously threatens the population's health, especially in rapidly industrialized countries. Given the complexity of managing NCDs, there is growing evidence that interventions embedding or incorporating health promotion strategies can help reduce the disease burden of NCDs. This review aims to identify and map existing control and prevention policies for NCDs in China and identify gaps or opportunities for policy modifications and development, to transfer evidence-based guidelines into empirical public health intervention practices and research. DESIGN A review was conducted to evaluate the policy documents to manage NCDs in China. Keywords "chronic disease", "health", and "policy" were used to search documents published on the Chinese official national websites. Nvivo 12.0 was used to conduct a content analysis of the policy documents. RESULTS Fifty-six NCD prevention policies were retrieved from the search, and ten documents that incorporated the health promotion component were analyzed. The Healthy China 2030 Plan and Recommendations on Implementing the Healthy China Action are the core health policies of China's Central Government. These, coupled with three nationwide community-based projects, have provided a foundational transformation platform for health promotion implementation. CONCLUSION This review revealed the Chinese Government's determination and commitment toward the prevention and control of NCDs and the promotion public health. Additional efforts and a focus on accelerating policy transformation and strengthening policy evaluation are required to achieve this commitment.
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Affiliation(s)
- Yingying Jiang
- Centre for Environment and Population Health, School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4111, Australia
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Haijun Guo
- Centre for Environment and Population Health, School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4111, Australia
| | - Weiwei Zhang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Connie C. R. Gan
- Centre for Environment and Population Health, School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4111, Australia
| | - Fan Mao
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Hai Phung
- Centre for Environment and Population Health, School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4111, Australia
| | - Dung Phung
- School of Public Health, University of Queensland, Brisbane, QLD 4072, Australia
| | - Jianqun Dong
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Cordia Chu
- Centre for Environment and Population Health, School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4111, Australia
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Cai W, Wang Y, Peng K, Zhao R, Liu F, Lin K, Xie F, Lei L, Peng J. Prevalence of hypertension in Shenzhen, China: a population-based, cross-sectional study. BMJ Open 2022; 12:e061606. [PMID: 35728907 PMCID: PMC9214353 DOI: 10.1136/bmjopen-2022-061606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Hypertension (HTN) is an important public health issue worldwide, associated with the rapid economic development and urbanisation over the last decades. This is especially the case in Shenzhen, which has benefited greatly from the reform and opening-up policies. However, there is limited information on the epidemiology of HTN in this region. This study was designed to investigate the prevalence, awareness, treatment and control of HTN and the associated factors among adult residents in Shenzhen, China. DESIGN Population-based, cross-sectional study. PARTICIPANTS Through the multistage stratified random sampling method, a representative sample of 10 043 urban population aged ≥18 years were selected. Three consecutive blood pressure (BP) readings were measured after resting for a 5 min seat by trained staff and HTN was defined as mean systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg and/or self-reported current use of antihypertensive drugs. Participants were interviewed using a structured questionnaire. Anthropometric details, BP, blood and urine samples were also collected. PRIMARY OUTCOME MEASURE Prevalence of HTN. RESULTS Overall, the weighted prevalence of HTN among residents in Shenzhen was 19.2% (95% CI 18.5 to 20.0). Among patients with HTN, 55.0% (95% CI 52.9 to 57.1) were aware of their condition and 44.9% (95% CI 42.8 to 47.1) were taking antihypertensive medications, but only 21.7% (95% CI 20.0 to 23.5) achieved BP control. Among those who knew their HTN, 81.7% (95% CI 79.3 to 83.8) were under treatment and 48.3% (95% CI 45.1 to 51.5) were controlled among those with treated HTN. Male, older age, lower educational level, overweight and obesity, family history of HTN, tobacco smoking, alcohol intake, diabetes mellitus, dyslipidaemia and high uric acid were associated with HTN. CONCLUSIONS HTN is a major public health concern in Shenzhen, which has low awareness, treatment and control rates, and is associated with several risk factors. Effective multifaceted implementation strategies are highly needed to combat the emerging burden of HTN.
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Affiliation(s)
- Weicong Cai
- Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Yirong Wang
- Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Ke Peng
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China
| | - Rencheng Zhao
- Bao'an District Hospital for Chronic Diseases Prevention and Cure, Shenzhen, Guangdong, China
| | - Fangjiang Liu
- Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Kaihao Lin
- Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Fengzhu Xie
- Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Lin Lei
- Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Ji Peng
- Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
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Zou S, Wang Z, Bhura M, Tang K. Association of multimorbidity of non-communicable diseases with mortality: a 10-year prospective study of 0.5 million Chinese adults. Public Health 2022; 205:63-71. [DOI: 10.1016/j.puhe.2022.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 01/11/2022] [Accepted: 01/21/2022] [Indexed: 10/19/2022]
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Li Y, Teng D, Shi X, Teng X, Teng W, Shan Z, Lai Y. Changes in the prevalence of obesity and hypertension and demographic risk factor profiles in China over 10 years: two national cross-sectional surveys. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 15:100227. [PMID: 34528008 PMCID: PMC8342963 DOI: 10.1016/j.lanwpc.2021.100227] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/25/2021] [Accepted: 07/05/2021] [Indexed: 12/22/2022]
Abstract
Background Previous studies have shown increases in the prevalence of obesity and hypertension, but nationally representative data on recent changes in prevalence adjusted for population structure changes are lacking. Two nationwide surveys were conducted in 2007 and 2017 to assess the prevalence changes of these conditions in China. Methods A multistage stratified random sampling method was used to obtain a nationally representative sample of adults aged 20 years and older in mainland China in 2007 and 2017. Temporal changes in the prevalence of hypertension and obesity were investigated. Changes in blood pressure, body mass index (BMI) and waist circumference were also assessed. Logistic regression models were constructed to assess the changes in prevalence over time. Findings The weighted prevalence of hypertension (25.7% vs. 31.5%, P=0.04), high-normal blood pressure (11.7% vs. 14.3%, P<0.0001), general obesity (31.9% vs. 37.2%, P=0.008), and central obesity (25.9% vs. 35.4%, P=0.0002) was significantly higher in 2017 (n=72824) than in 2007 (n=45956) in the overall population. No significant changes in the prevalence of overweight and grade 1 or grade 2 hypertension were observed in the overall population, but a significantly higher prevalence was observed among participants aged 20-29 years for grade 1 hypertension (P=0.002) and among participants aged 70 years and older for grade 2 hypertension (P=0.046) in 2017. Interpretation Compared with 2007, the prevalence of hypertension and obesity was significantly higher among adults in mainland China after adjusting for demographic confounding factors in 2017. More targeted interventions and prevention strategies are needed to offset the increasing risk of cardiovascular disease due to increases in the prevalence of hypertension and obesity. Funding The Clinical Research Fund of the Chinese Medical Association (Grant No. 15010010589), the National Natural Science Foundation of China (Grant No. 82000753), and the Chinese Medical Association Foundation and Chinese Diabetes Society (Grant No. 07020470055).
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Affiliation(s)
- Yongze Li
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, First Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Di Teng
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, First Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Xiaoguang Shi
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, First Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Xiaochun Teng
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, First Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Weiping Teng
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, First Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, First Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Yaxin Lai
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, First Hospital of China Medical University, Shenyang, 110001, Liaoning, China
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Liu S, Chen Z, Han L, Dong W, Li H, Koplan J, Wu J, Li X. Integrated multisectoral non-communicable disease prevention and control in China: A review of agencies and policies. J Glob Health 2021; 10:020304. [PMID: 33110508 PMCID: PMC7533431 DOI: 10.7189/jogh.10.020304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Shiwei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.,Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhuo Chen
- College of Public Health, University of Georgia, Athens, Georgia, USA.,School of Economics, University of Nottingham Ningbo China, Ningbo, Zhejiang Province, China
| | - Liyuan Han
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China.,Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Wenlan Dong
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Li
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, Zhejiang Province, China
| | - Jeffrey Koplan
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Jing Wu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xinhua Li
- Chinese Center for Disease Control and Prevention, Beijing, China
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Liu Y, Zhou B, Wang J, Zhao B. Health benefits and cost of using air purifiers to reduce exposure to ambient fine particulate pollution in China. JOURNAL OF HAZARDOUS MATERIALS 2021; 414:125540. [PMID: 33684813 DOI: 10.1016/j.jhazmat.2021.125540] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/03/2021] [Accepted: 02/24/2021] [Indexed: 06/12/2023]
Abstract
Understanding the cost-effectiveness of possible interventions to reduce air pollution levels is crucial to developing sustainable mitigation and adaption strategies. Although people spend more than 80% of their time indoors, the role of air purifiers in mitigating personal exposure to indoor PM2.5 of outdoor origin has not yet been quantified, especially in under-developed regions. Here, we performed a comprehensive simulation at the 10 km × 10 km geographical resolution in mainland China to quantify the health benefits and costs of indoor air purification in four intervention scenarios, S1 to S4, where target indoor PM2.5 concentrations were 35, 25, 15, and 10 μg/m3. In intervention scenarios S1 to S4, 93,200 (95% uncertainty interval 78,900-113,600), 115,300 (97,700-140,800), 163,400 (138,300-198,800), and 207,900 (176,300-251,800) deaths that cost 82, 175, 438, and 798 billion Chinese Yuan can be avoided and 93%, 80%, 53%, and 26% of the cities have a positive net monetary benefit. We found that achieving indoor PM2.5 concentration of 35 or 25 μg/m3 using air purifiers is cost-effective at reducing PM2.5 related deaths and PM2.5 concentration of 25 μg/m3 is a suitable indoor PM2.5 target for China. Multifaceted efforts are necessary to ensure equitable access to air purifiers and the knowledge to effectively operate them to make sure the benefits reach the whole population.
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Affiliation(s)
- Yumeng Liu
- Department of Building Science, School of Architecture, Tsinghua University, Beijing 100084, China
| | - Bin Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, United Kingdom; MRC Centre for Environment and Health, Imperial College London, London W2 1PG, United Kingdom
| | - Jianghao Wang
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China; Sustainable Urbanization Lab, Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - Bin Zhao
- Department of Building Science, School of Architecture, Tsinghua University, Beijing 100084, China; Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Tsinghua University, Beijing 100084, China.
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Pan XF, Wang L, Pan A. Epidemiology and determinants of obesity in China. Lancet Diabetes Endocrinol 2021; 9:373-392. [PMID: 34022156 DOI: 10.1016/s2213-8587(21)00045-0] [Citation(s) in RCA: 622] [Impact Index Per Article: 207.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 01/15/2021] [Accepted: 02/12/2021] [Indexed: 12/11/2022]
Abstract
Obesity has become a major public health issue in China. Overweight and obesity have increased rapidly in the past four decades, and the latest national prevalence estimates for 2015-19, based on Chinese criteria, were 6·8% for overweight and 3·6% for obesity in children younger than 6 years, 11·1% for overweight and 7·9% for obesity in children and adolescents aged 6-17 years, and 34·3% for overweight and 16·4% for obesity in adults (≥18 years). Prevalence differed by sex, age group, and geographical location, but was substantial in all subpopulations. Strong evidence from prospective cohort studies has linked overweight and obesity to increased risks of major non-communicable diseases and premature mortality in Chinese populations. The growing burden of overweight and obesity could be driven by economic developments, sociocultural norms, and policies that have shaped individual-level risk factors for obesity through urbanisation, urban planning and built environments, and food systems and environments. Substantial changes in dietary patterns have occurred in China, with increased consumption of animal-source foods, refined grains, and highly processed, high-sugar, and high-fat foods, while physical activity levels in all major domains have decreased with increasing sedentary behaviours. The effects of dietary factors and physical inactivity intersect with other individual-level risk factors such as genetic susceptibility, psychosocial factors, obesogens, and in-utero and early-life exposures. In view of the scarcity of research around the individual and collective roles of these upstream and downstream factors, multidisciplinary and transdisciplinary studies are urgently needed to identify systemic approaches that target both the population-level determinants and individual-level risk factors for obesity in China.
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Affiliation(s)
- Xiong-Fei Pan
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Limin Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - An Pan
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Du X, Patel A, Anderson CS, Dong J, Ma C. Epidemiology of Cardiovascular Disease in China and Opportunities for Improvement: JACC International. J Am Coll Cardiol 2020; 73:3135-3147. [PMID: 31221263 DOI: 10.1016/j.jacc.2019.04.036] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/16/2019] [Accepted: 04/22/2019] [Indexed: 12/24/2022]
Abstract
The burden of cardiovascular (CV) disease is very high in China, due to highly prevalent and poorly controlled risk factors resulting from changing sociodemographic structure and lifestyles in its large population. Rapid economic development and urbanization have been accompanied by changing patterns, expression, and management of CV disease. However, the health care system in China lacks a hierarchical structure, with a focus on treating acute diseases in hospital while ignoring long-term management, and primary health care is too weak to effectively control CV risk factors. To address these challenges, the Chinese central government has ensured health is a national priority and has introduced reforms that include implementing policies for a healthy environment, strengthening primary care, and improving affordability and accessibility within the health system. Turning the inverted pyramid of the health care system is essential in the ongoing battle against CV disease.
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Affiliation(s)
- Xin Du
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Heart Health Research Center, Beijing, China; The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Anushka Patel
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Craig S Anderson
- Heart Health Research Center, Beijing, China; The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; The George Institute for Global Health China at Peking University Health Science Center, Beijing, China
| | - Jianzeng Dong
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Changsheng Ma
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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Ma W, Liu T. Injury prevention and control: China's health priority. THE LANCET PUBLIC HEALTH 2019; 4:e432-e433. [DOI: 10.1016/s2468-2667(19)30149-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/16/2019] [Indexed: 11/28/2022] Open
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15
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Leilei D, Pengpeng Y, Haagsma JA, Ye J, Yuan W, Yuliang E, Xiao D, Xin G, Cuirong J, Linhong W, Bannick MS, Mountjoy-Venning WC, Hawley CN, Liu Z, Smith M, James SL, Vos T, Murray CJL. The burden of injury in China, 1990-2017: findings from the Global Burden of Disease Study 2017. Lancet Public Health 2019; 4:e449-e461. [PMID: 31493842 PMCID: PMC6739690 DOI: 10.1016/s2468-2667(19)30125-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/20/2019] [Accepted: 06/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND A comprehensive evaluation of the burden of injury is an important foundation for selecting and formulating strategies of injury prevention. We present results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 of non-fatal and fatal outcomes of injury at the national and subnational level, and the changes in burden for key causes of injury over time in China. METHODS Using the methods and results from GBD 2017, we describe the burden of total injury and the key causes of injury based on the rates of incidence, cause-specific mortality, and disability-adjusted life years (DALYs) in China estimated using DisMod-MR 2.1. We additionally evaluated these results at the provincial level for the 34 subnational locations of China in 2017, measured the change of injury burden from 1990 to 2017, and compared age-standardised DALYs due to injuries at the provincial level against the expected rates based on the Socio-demographic Index (SDI), a composite measure of development of income per capita, years of education, and total fertility rate. FINDINGS In 2017, in China, there were 77·1 million (95% uncertainty interval [UI] 72·5-81·6) new cases of injury severe enough to warrant health care and 733 517 deaths (681 254-767 006) due to injuries. Injuries accounted for 7·0% (95% UI 6·6-7·2) of total deaths and 10·0% (9·5-10·5) of all-cause DALYs in China. In 2017, there was a three-times variation in age-standardised injury DALY rates between provinces of China, with the lowest value in Macao and the highest in Yunnan. Between 1990 and 2017, the age-standardised incidence rate of all injuries increased by 50·6% (95% UI 46·6-54·6) in China, whereas the age-standardised mortality and DALY rates decreased by 44·3% (41·1-48·9) and 48·1% (44·6-51·8), respectively. Between 1990 and 2017, all provinces of China experienced a substantial decline in DALY rates from all injuries ranging from 16·3% (3·1-28·6) in Shanghai and 60·4% (53·7-66·1) in Jiangxi. Age-standardised DALY rates for drowning; injuries from fire, heat and hot substances; adverse effects of medical treatments; animal contact; environmental heat and cold exposure; self-harm; and executions and police conflict each declined by more than 60% between 1990 and 2017. INTERPRETATION Between 1990 and 2017, China experienced a decrease in the age-standardised DALY and mortality rates due to injury, despite an increase in the age-standardised incidence rate. These trends occurred in all provinces. The divergent trends in terms of incidence and mortality indicate that with rapid sociodemographic improvements, the case fatality of injuries has declined, which could be attributed to an improving health-care system but also to a decreasing severity of injuries over this time period. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Duan Leilei
- Division of Injury Prevention and Mental Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ye Pengpeng
- Division of Injury Prevention and Mental Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Juanita A Haagsma
- Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jin Ye
- Division of Injury Prevention and Mental Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wang Yuan
- Division of Injury Prevention and Mental Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Er Yuliang
- Division of Injury Prevention and Mental Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Deng Xiao
- Division of Injury Prevention and Mental Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Gao Xin
- Division of Injury Prevention and Mental Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ji Cuirong
- Division of Injury Prevention and Mental Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wang Linhong
- Division of Injury Prevention and Mental Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Marlena S Bannick
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Caitlin N Hawley
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Zichen Liu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mari Smith
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Spencer L James
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Shi J, Tang L, Jing L, Geng J, Liu R, Luo L, Chen N, Liu Q, Gong X, Bo X, Yang Y, Wang Z. Disparities in mental health care utilization among inpatients in various types of health institutions: a cross-sectional study based on EHR data in Shanghai, China. BMC Public Health 2019; 19:1023. [PMID: 31366334 PMCID: PMC6668074 DOI: 10.1186/s12889-019-7343-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/19/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Reform of the health care system in China has prompted concerns about the utilization of mental health services. This study aims to compare the utilization of mental health services among inpatients in various types of health institutions in Shanghai (community health care centres, secondary general hospitals, tertiary general hospitals, and specialty hospitals). METHODS Based on electronic health record (EHR) data, we extracted all of the mental hospitalization data from various types of public health institutions in Pudong New Area, Shanghai, China, from 2013 to 2016. The distribution of mentally ill inpatients and the possible factors contributing to the observed differences in these institutions were analysed. RESULTS Specialty psychiatric hospitals in Pudong New Area, Shanghai, admitted more inpatients and treated in patients with more severe disorders (49.73%). However, those who were male (OR = 0.545), were elderly (OR = 20.133), had inferior insurance (urban social insurance for citizens: OR = 4.013; paying themselves, OR = 29.489), had a longer length of stay (OR = 1.001) and had lower costs (OR = 0.910) were more likely to choose community health centres than specialty hospitals. Those who preferred the secondary and tertiary hospitals to the specialty ones were more likely to be in the male, elderly, married, shorter length of stay and higher-cost groups. Notably, compared to those with urban social insurance for workers, those who had urban social insurance for citizens (OR = 3.136) or paid out-of-pocket (OR = 9.822) were significantly clustered in the tertiary hospitals rather than the specialty hospitals. CONCLUSIONS Inpatients who were male, were older, had inferior insurance, had a longer length of stay and had lower costs preferred the elementary health services. However, the utilization of mental health care in high-tier institutions reflected defects, especially the fact that the current health insurance system does not adequately restrict patients' choices, and those who paid more tended to choose tertiary hospitals instead of professional specialty ones. We suggest that psychiatric services should be enhanced by instituting reforms, including public education, improved health insurance, a forceful referral system, and competency reinforcement for primary care physicians, to provide a more integrated mental health system.
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Affiliation(s)
- Jianwei Shi
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025 China
- Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090 China
| | - Lan Tang
- Pudong Weifang Community Health Center, Shanghai, 200120 China
| | - Limei Jing
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203 China
| | - Jinsong Geng
- Department of Medical Informatics, Evidence-based Medical Center, Medical School of Nantong University, Nantong, 226001 China
| | - Rui Liu
- Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072 China
| | - Li Luo
- School of Public Health, Fudan University, Shanghai, 200032 China
| | - Ning Chen
- School of Medicine, Tongji University, Shanghai, 200092 China
| | - Qian Liu
- School of Economics and Management, Tongji University, Shanghai, 200092 China
| | - Xin Gong
- School of Medicine, Tongji University, Shanghai, 200092 China
| | - Xiaojie Bo
- School of Medicine, Tongji University, Shanghai, 200092 China
| | - Yan Yang
- School of Economics and Management, Tongji University, Shanghai, 200092 China
| | - Zhaoxin Wang
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025 China
- General Practice Center, Nanhai Hospital, Southern Medical University, 227 Chongqing South RD, Shanghai, 200025, 528244 Guangdong China
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Meng Z, Zou K, Ding N, Zhu M, Cai Y, Wu H. Cesarean delivery rates, costs and readmission of childbirth in the new cooperative medical scheme after implementation of an episode-based bundled payment (EBP) policy. BMC Public Health 2019; 19:557. [PMID: 31088443 PMCID: PMC6515611 DOI: 10.1186/s12889-019-6962-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/09/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In the past decade, the rate of cesarean delivery increased dramatically in rural China under the fee-for-service (FFS) system. In September 2011, the New Cooperative Medical Scheme (NCMS) agency in Yong'an county in Fujian province of China adopted a policy of reforming payment for childbirth by transforming the FFS payment into episode-based bundled payment (EBP), which made the cesarean deliveries less profitable. Thus, this study was conducted to determine the effect of EBP policy on reducing cesarean use and controlling delivery costs for rural patients in the NCMS. METHODS Data from the inpatient information database of the NCMS agency from January 2010 to March 2013 was collected, in which Yong'an county was employed as a reform county and 2 other counties as controls. We investigated the effects of EBP on cesarean delivery rate, costs of childbirth and readmission for rural patients in the NCMS using a natural experiment design and difference in differences (DID) analysis method. RESULTS The EBP reform was associated with 33.97% (p<0.01) decrease in the probability of cesarean delivery. The EBP reform, on average, reduced the total spending per admission, government reimbursement expenses per admission, and out-of-pocket (OOP) payments per admission by ¥ 649.61, ¥ 575.01, and ¥ 74.59, respectively. The OOP payments had a net decrease of 14.24% (p<0.01); whereas the OOP payments as a share of total spending had a net increase of 8.72% (p<0.01). There was no evidence of increase in readmission rates. CONCLUSIONS These results indicate that the EBP policy has achieved at least a short-term success in lowering the increase of cesarean delivery rate and costs of childbirth. Considering both the cesarean rate and the OOP payments as a share of total spending after the reform were still high, China still has a long way to go to achieve the ideal level of cesarean rate and improve the benefits of deliveries for rural population.
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Affiliation(s)
- Zhaolin Meng
- Department of Health Service Management, School of Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang, 110122, Liaoning, China
| | - Kun Zou
- Department of Health Policy and Management, West China School of Public Health and Fourth West China Hospital, West China Research Centre for Rural Health Development, Sichuan University, Chengdu, Sichuan, China
| | - Ning Ding
- Institute for International Healthcare Professionals Education and Research, China Medical University, Shenyang, Liaoning, China
| | - Min Zhu
- Department of Health Service Management, School of Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang, 110122, Liaoning, China
| | - Yuanyi Cai
- Department of Health Service Management, School of Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang, 110122, Liaoning, China
| | - Huazhang Wu
- Department of Health Service Management, School of Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang, 110122, Liaoning, China.
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Xu Q, Chen B, Jin D, Yin L, Huang Y. An assessment for health education and health promotion in chronic disease demonstration districts: a comparative study from Hunan Province, China. PeerJ 2019; 7:e6579. [PMID: 30867995 PMCID: PMC6409084 DOI: 10.7717/peerj.6579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/06/2019] [Indexed: 11/20/2022] Open
Abstract
Background Cost-effective strategies of chronic disease control, integrated health education and health promotion play important roles in the programs of chronic disease demonstration districts in China. The performance of these districts can be directly assessed by their health education and promotion work. However, there have been only a few performance assessments done on these programs, most of which made without the inclusion of proper quality indicators. This study was designed to establish a framework of indicators for outcome evaluation of health education and promotion efforts in Chinese districts, and explore the factors involved in promoting these efforts. Methods A modified two-round Delphi survey was first used to construct quality indicators on a nine-point Likert scale. With those indicators, the rank sum ratio (RSR) method was then conducted through rank conversion and parametric statistics, to assess and classify the performance of ten districts or counties randomly chosen both from demonstration and non-demonstration districts in the Hunan province. Results The Delphi process produced seven themes and 25 sub-themes as quality indicators. The seven themes included organizational management, financial support, professional personnel, health education and promotion, residents' health awareness and behaviors, residents' satisfaction, and residents' health literacy. The districts were classified into four levels by RSR as follows: One demonstration district at the first-ranked level, five other demonstration districts at the second-ranked level, all non-demonstration districts at the third-ranked level. None were at the fourth-qualified level. Discussion Chronic disease demonstration districts performed better on the work of health education and health promotion than the non-demonstration districts. The work should be focused on the following measures of chronic diseases: organizational management, financial support, media-related broadcasting, technical support, community-based promotion and supportive environment, and people's enhanced awareness and health literacy.
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Affiliation(s)
- Qiaohua Xu
- Department of Chronic Diseases Control and Prevention, Hunan Provincial Center for Diseases Control and Prevention, Changsha, Hunan, China
| | - Biyun Chen
- Department of Chronic Diseases Control and Prevention, Hunan Provincial Center for Diseases Control and Prevention, Changsha, Hunan, China
| | - Donghui Jin
- Department of Chronic Diseases Control and Prevention, Hunan Provincial Center for Diseases Control and Prevention, Changsha, Hunan, China
| | - Li Yin
- Department of Chronic Diseases Control and Prevention, Hunan Provincial Center for Diseases Control and Prevention, Changsha, Hunan, China
| | - Yuelong Huang
- Department of Chronic Diseases Control and Prevention, Hunan Provincial Center for Diseases Control and Prevention, Changsha, Hunan, China
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Cai L, Dai M, Lin L, Yang W, Chen Y, Ma J, Jing J. Incidence of childhood overweight and obesity and its association with weight-related attitudes and behaviors in China: a national longitudinal study. Int J Behav Nutr Phys Act 2018; 15:108. [PMID: 30390717 PMCID: PMC6215687 DOI: 10.1186/s12966-018-0737-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/16/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Childhood obesity is a major public health challenge. We aimed to investigate the incidence of overweight/obesity among Chinese children; and prospectively examine the associations of weight-change intention with risk of overweight/obesity and behavioral changes in initially normal-weight children. METHODS A national sample of 21,796 children aged 6-17 years were investigated in September 2013 and followed up nine months later, of which 19,887 (91%) were normal weight and 1909 (9%) were underweight at baseline. Weight and height were objectively measured. Weight perception, weight-change intention, weight control practices, weight-related behaviors, and demographic information were obtained by questionnaires. RESULTS Among children with underweight or normal-weight, the cumulative incidence of overweight/obesity was 2.77% (95% CI 2.55-2.99). Among normal-weight children, those who overestimated their weight had higher baseline BMI z-scores and an increased relative risk (RR) of overweight/obesity (RR 1.51, 95% CI 1.15-1.99). Children who misperceived themselves as underweight or overweight had stronger weight-change intention than their counterparts. However, children with weight-change intention did not develop greater changes in dietary intakes, physical activities, or sedentary behaviors than those without intention. There was no significant association between weight-change intention and incidence after adjusting for BMI z-scores at baseline. Self-reported improving diet, increasing physical activity, and dieting were associated with certain actual behavioral improvements and smaller increase in BMI z-score, but not associated with decreased risk of overweight/obesity. CONCLUSION The 9-months cumulative incidence of overweight/obesity was 2.77% among Chinese children. Weight-change intention was not associated with incidence of overweight/obesity in normal-weight children, regardless of their weight perception. More importantly, children's weight-change intention was insufficient in achieving desirable behavioral changes. Future overweight and obesity prevention programs should directly target on promoting children's actual behavioral changes.
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Affiliation(s)
- Li Cai
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Meixia Dai
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Lizi Lin
- School of Public Health, Peking University, Beijing, China
| | - Wenhan Yang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yajun Chen
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Jun Ma
- School of Public Health, Peking University, Beijing, China
| | - Jin Jing
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
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Jia X, Yu Y, Xia W, Masri S, Sami M, Hu Z, Yu Z, Wu J. Cardiovascular diseases in middle aged and older adults in China: the joint effects and mediation of different types of physical exercise and neighborhood greenness and walkability. ENVIRONMENTAL RESEARCH 2018; 167:175-183. [PMID: 30029039 DOI: 10.1016/j.envres.2018.07.003] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 06/12/2018] [Accepted: 07/02/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Both physical exercise and the built environment are associated with cardiovascular diseases (CVDs). Yet, the influence of the multiple dimensions of the built environment and different types of physical exercise on CVDs is not well understood. Further, little is known about the joint effects of physical exercise and the built environment, nor whether one mediates the effect of the other on the risk of CVDs. We aim to investigate the risk of CVDs on middle aged and older Chinese adult populations by analyzing the independent effects, as well as potential interactions and mediation effects of different types of physical exercise and two dimensions of the built environment; namely, greenness and walkability. METHODS Data were collected from a community-based cross-sectional study (n = 1944). The study participants, aged 40 years or older, came from 32 communities across urban, suburban, and rural areas in Longzihu district of Bengbu, a typical second-tier city in eastern China. Physical exercise data were obtained from the International Physical Activity Questionnaire (IPAQ) question survey. We used a satellite-based Normalized Difference Vegetation Index (NDVI) score to assess greenness exposure. We used both the Walk Score index and the Neighborhood Environment Walkability Scale (NEWS) to assess walkability. Multilevel logistic regression, also known as mixed-effects logistic regression, was used to estimate the associations between physical exercise and the built environment (greenness and walkability) on CVD outcomes while accounting for within-community and within-subdistrict correlations. We followed Baron and Kenny's framework and used bootstrapping to quantify the mediation of physical exercise between built environment and CVD outcomes. Stratified analysis was conducted by age (middle aged and older adults) and gender. RESULTS Compared to the reference group with little to low physical activities, we found a significantly reduced risk of hypertension (about 20-45% reduction) and coronary heart disease (about 35-55% reduction) among those with moderate to high activities in walking/square dancing or morning exercising/Tai Chi, and a significantly reduced risk of stroke (about 25% reduction) among those with moderate to high activities in walking/square dancing. Compared to the reference group with low NDVI-based greenness exposure, we found a significant reduction in risk of hypertension (about 55-85% reduction), coronary heart disease (about 75% reduction) and stroke (about 45% reduction) among those with moderate to high levels of exposure. Compared to the reference groups with low walkability, we observed about 30-60% lower risk of hypertension and coronary heart disease associated with moderate to high levels of Walk score, and about 20-30% lower risk of hypertension and stroke associated with moderate to high levels of NEWS-based walkability. We found no interactions between physical exercise and the built environment. The associations of greenness and walkability with CVDs were partially explained by physical exercise (up to 55% of the total effect). CONCLUSIONS Both physical exercise and built environment factors were associated with the risk of CVDs. Our observed association between CVDs and neighborhood greenness exposure and walkability was explained, in part, by physical exercises. Such a role, if confirmed in future studies, could have important implications for policies and programs aimed at increasing green spaces and improving walkability in both urban and rural settings as strategies to promote physical exercise in middle aged and older population.
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Affiliation(s)
- Xianjie Jia
- Department of Epidemiology and Statistics, Bengbu Medical College, Bengbu, China
| | - Ying Yu
- Department of Physiology, Bengbu Medical College, Bengbu, China
| | - Wanning Xia
- Department of Epidemiology and Statistics, Bengbu Medical College, Bengbu, China
| | - Shahir Masri
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, USA
| | - Mojgan Sami
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, USA
| | - Zhixiong Hu
- Department of Statistics, University of California, Irvine, USA
| | - Zhaoxia Yu
- Department of Statistics, University of California, Irvine, USA
| | - Jun Wu
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, USA.
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Sun Y, Sin DD. Crisis of COPD in China: the future is now. THE LANCET RESPIRATORY MEDICINE 2018; 6:404-405. [PMID: 29650406 DOI: 10.1016/s2213-2600(18)30133-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 03/13/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Yilan Sun
- Centre for Heart Lung Innovation, St Paul's Hospital and Division of Respiratory Medicine, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada; The Respiratory Department of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Don D Sin
- Centre for Heart Lung Innovation, St Paul's Hospital and Division of Respiratory Medicine, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada.
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Wang Z, Chen Z, Zhang L, Wang X, Hao G, Zhang Z, Shao L, Tian Y, Dong Y, Zheng C, Wang J, Zhu M, Weintraub WS, Gao R. Status of Hypertension in China: Results From the China Hypertension Survey, 2012-2015. Circulation 2018; 137:2344-2356. [PMID: 29449338 DOI: 10.1161/circulationaha.117.032380] [Citation(s) in RCA: 1032] [Impact Index Per Article: 172.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/30/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although the prevalence of hypertension (HTN) continues to increase in developing countries, including China, recent data are lacking. A nationwide survey was conducted from October 2012 to December 2015 to assess the prevalence of HTN in China. METHODS A stratified multistage random sampling method was used to obtain a nationally representative sample of 451 755 residents ≥18 years of age from 31 provinces in mainland China from October 2012 to December 2015. Blood pressure (BP) was measured after resting for 5 minutes by trained staff using a validated oscillometric BP monitor. HTN was defined as systolic BP (SBP) ≥140 mm Hg/or diastolic BP (DBP) ≥90 mm Hg or use of antihypertensive medication within 2 weeks. Pre-HTN was defined as SBP 120 to 139 mm Hg and DBP 80 to 89 mm Hg without antihypertensive medication. HTN control was defined as SBP <140 mm Hg and DBP<90 mm Hg. In addition, the prevalence of HTN (SBP ≥130 or DBP ≥80 mm Hg) and control rate (SBP <130 and DBP <80 mm Hg) of HTN were also estimated according to the 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline. RESULTS Overall, 23.2% (≈244.5 million) of the Chinese adult population ≥18 years of age had HTN, and another 41.3% (≈435.3 million) had pre-HTN according to the Chinese guideline. There were no significant differences of HTN prevalence between urban and rural residents (23.4% versus 23.1%, P=0.819). Among individuals with HTN, 46.9% were aware of their condition, 40.7% were taking prescribed antihypertensive medications, and 15.3% had controlled HTN. Calcium channel blockers were the most commonly used antihypertensive medication (46.5%) as monotherapy, and 31.7% of treated hypertensive patients used ≥2 medications. The prevalence of HTN based on the 2017 American College of Cardiology/American Heart Association guideline was twice as high as that based on 2010 Chinese guideline (46.4%), whereas the control rate fell to 3.0%. CONCLUSIONS In China, there is a high prevalence of HTN and pre-HTN, and awareness, treatment, and control of HTN were low. Management of medical therapy for HTN needs to improve.
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Affiliation(s)
- Zengwu Wang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease (Z.W., Z.C., L.Z., X.W., L.S., Y.T., Y.D., C.Z., J.W., M.Z.)
| | - Zuo Chen
- Division of Prevention and Community Health, National Center for Cardiovascular Disease (Z.W., Z.C., L.Z., X.W., L.S., Y.T., Y.D., C.Z., J.W., M.Z.)
| | - Linfeng Zhang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease (Z.W., Z.C., L.Z., X.W., L.S., Y.T., Y.D., C.Z., J.W., M.Z.)
| | - Xin Wang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease (Z.W., Z.C., L.Z., X.W., L.S., Y.T., Y.D., C.Z., J.W., M.Z.)
| | - Guang Hao
- Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China. Georgia Prevention Institute, Medical College of Georgia, Augusta University (G.H.)
| | - Zugui Zhang
- Christiana Care Health System, Newark, DE (Z.Z.)
| | - Lan Shao
- Division of Prevention and Community Health, National Center for Cardiovascular Disease (Z.W., Z.C., L.Z., X.W., L.S., Y.T., Y.D., C.Z., J.W., M.Z.)
| | - Ye Tian
- Division of Prevention and Community Health, National Center for Cardiovascular Disease (Z.W., Z.C., L.Z., X.W., L.S., Y.T., Y.D., C.Z., J.W., M.Z.)
| | - Ying Dong
- Division of Prevention and Community Health, National Center for Cardiovascular Disease (Z.W., Z.C., L.Z., X.W., L.S., Y.T., Y.D., C.Z., J.W., M.Z.)
| | - Congyi Zheng
- Division of Prevention and Community Health, National Center for Cardiovascular Disease (Z.W., Z.C., L.Z., X.W., L.S., Y.T., Y.D., C.Z., J.W., M.Z.)
| | - Jiali Wang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease (Z.W., Z.C., L.Z., X.W., L.S., Y.T., Y.D., C.Z., J.W., M.Z.)
| | - Manlu Zhu
- Division of Prevention and Community Health, National Center for Cardiovascular Disease (Z.W., Z.C., L.Z., X.W., L.S., Y.T., Y.D., C.Z., J.W., M.Z.)
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China's Multisectoral Approach to Chronic Disease. Glob Heart 2018; 11:441-442. [PMID: 27938836 DOI: 10.1016/j.gheart.2016.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 11/21/2022] Open
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24
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Chang A, Schulz PJ, Schirato T, Hall BJ. Implicit Messages Regarding Unhealthy Foodstuffs in Chinese Television Advertisements: Increasing the Risk of Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15010070. [PMID: 29300366 PMCID: PMC5800169 DOI: 10.3390/ijerph15010070] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/29/2017] [Accepted: 12/30/2017] [Indexed: 12/22/2022]
Abstract
Previous studies indicated that television (TV) advertising is associated with higher rates of obesity. The rate of obesity and overweight continues to rise in mainland China, bringing into question whether TV advertising to young audiences might be partly to blame. This study investigated messaging delivered through TV advertisements regarding healthy and unhealthy foodstuffs. A total of 42 major food brands and 480 advertisements were analysed for content in this study. The results showed that the majority of TV spots advertised products with poor nutritional content and had a potential to mislead audiences concerning products' actual nutritional value. The tactics of repetition and appeals of premium offerings on food brands have a potential to influence the purchase intentions. Additional qualitative observation involving the social bond, social context and cultural factors pertaining to mood alterations were highlighted. The discussion addressed product attributes reflected by culture and the implicit messages of marketing claims may increase the risk of obesity. Thus, public health policymakers and researchers were encouraged to act urgently to evaluate the obesity risks of unhealthy food advertised in the media and to support healthy foods.
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Affiliation(s)
- Angela Chang
- Department of Communication, University of Macau, E21, Avenida da Universidade, Taipa, Macau, China.
| | - Peter J Schulz
- Institute of Communication and Health, Lugano University, Switzerland, Ex Laboratorio, Office 010 (Level 0), Via Buffi 13, 6904 Lugano, Switzerland.
| | - Tony Schirato
- Department of Communication, University of Macau, E21, Avenida da Universidade, Taipa, Macau, China.
| | - Brian J Hall
- Department of Psychology, University of Macau, E21, Avenida da Universidade, Taipa, Macau, China.
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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25
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Xie X, Zhou W, Lin L, Fan S, Lin F, Wang L, Guo T, Ma C, Zhang J, He Y, Chen Y. Internet Hospitals in China: Cross-Sectional Survey. J Med Internet Res 2017; 19:e239. [PMID: 28676472 PMCID: PMC5516104 DOI: 10.2196/jmir.7854] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/30/2017] [Indexed: 11/13/2022] Open
Abstract
Background The Internet hospital, an innovative approach to providing health care, is rapidly developing in China because it has the potential to provide widely accessible outpatient service delivery via Internet technologies. To date, China’s Internet hospitals have not been systematically investigated. Objective The aim of this study was to describe the characteristics of China’s Internet hospitals, and to assess their health service capacity. Methods We searched Baidu, the popular Chinese search engine, to identify Internet hospitals, using search terms such as “Internet hospital,” “web hospital,” or “cloud hospital.” All Internet hospitals in mainland China were eligible for inclusion if they were officially registered. Our search was carried out until March 31, 2017. Results We identified 68 Internet hospitals, of which 43 have been put into use and 25 were under construction. Of the 43 established Internet hospitals, 13 (30%) were in the hospital informatization stage, 24 (56%) were in the Web ward stage, and 6 (14%) were in full Internet hospital stage. Patients accessed outpatient service delivery via website (74%, 32/43), app (42%, 18/43), or offline medical consultation facility (37%, 16/43) from the Internet hospital. Furthermore, 25 (58%) of the Internet hospitals asked doctors to deliver health services at a specific Web clinic, whereas 18 (42%) did not. The consulting methods included video chat (60%, 26/43), telephone (19%, 8/43), and graphic message (28%, 12/43); 13 (30%) Internet hospitals cannot be consulted online any more. Only 6 Internet hospitals were included in the coverage of health insurance. The median number of doctors available online was zero (interquartile range [IQR] 0 to 5; max 16,492). The median consultation fee per time was ¥20 (approximately US $2.90, IQR ¥0 to ¥200). Conclusions Internet hospitals provide convenient outpatient service delivery. However, many of the Internet hospitals are not yet mature and are faced with various issues such as online doctor scarcity and the unavailability of health insurance coverage. China’s Internet hospitals are heading in the right direction to improve provision of health services, but much more remains to be done.
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Affiliation(s)
- Xiaoxu Xie
- Graduate School of Peking Union Medical College, Beijing, China.,National Research Institute for Health and Family Planning, Beijing, China
| | - Weimin Zhou
- Department of Urology, Jiangxi Cancer Hospital, Nanchang, China
| | - Lingyan Lin
- College of Electronic Information Science, Fujian Jiangxia University, Fuzhou, China
| | - Si Fan
- Department of Obstetrics & Gynecology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fen Lin
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Long Wang
- Graduate School of Peking Union Medical College, Beijing, China.,National Research Institute for Health and Family Planning, Beijing, China
| | - Tongjun Guo
- Graduate School of Peking Union Medical College, Beijing, China.,National Research Institute for Health and Family Planning, Beijing, China
| | - Chuyang Ma
- Beijing Luhe International Academy, Beijing, China
| | | | - Yuan He
- National Research Institute for Health and Family Planning, Beijing, China
| | - Yixin Chen
- Graduate School of Peking Union Medical College, Beijing, China.,Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, MO, United States
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He Y, Pan A, Yang Y, Wang Y, Xu J, Zhang Y, Liu D, Wang Q, Shen H, Zhang Y, Yan D, Peng Z, Hu FB, Ma X. Prevalence of Underweight, Overweight, and Obesity Among Reproductive-Age Women and Adolescent Girls in Rural China. Am J Public Health 2017; 106:2103-2110. [PMID: 27831775 DOI: 10.2105/ajph.2016.303499] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To provide prevalence and trends of underweight, overweight, and obesity among reproductive-age women and adolescent girls in rural China. METHODS We measured weight and height in 16 742 344 women aged 20 to 49 years and 178 556 girls aged 15 to 19 years from the National Free Preconception Health Examination Project between 2010 and 2014. RESULTS Among women, the prevalence of underweight was 7.8% (95% confidence interval [CI] = 7.7%, 7.9%), and overweight or obesity was 16.5% (95% CI = 16.4%, 16.6%; World Health Organization criteria). Among adolescents, prevalence of underweight was 6.0% (95% CI = 5.7%, 6.2%; Centers for Disease Control and Prevention criteria) and overweight or obesity was 8.3% (95% CI = 7.9% to 8.8%; International Obesity Task Force criteria). According to Chinese criteria, overweight and obesity prevalence was 24.8% (95% CI = 24.7%, 24.9%) for women and 17.2% (95% CI = 16.6%, 17.8%) for adolescents, and underweight prevalence was 2.9% (95% CI = 2.8%, 3.1%) for adolescents. Considerable disparities existed in prevalence and trends within subpopulations (age groups, parity, region, education levels, and socioeconomic status). CONCLUSIONS Our results reveal coexisting underweight and overweight or obesity among rural women and adolescents of reproductive age, which requires public health attention.
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Affiliation(s)
- Yuan He
- Yuan He, Ying Yang, Yuanyuan Wang, Jihong Xu, Ya Zhang, Dujia Liu, Zuoqi Peng, and Xu Ma are with the National Research Institute for Family Planning, Beijing, People's Republic of China. An Pan is with the Department of Epidemiology and Biostatistics, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China. Qiaomei Wang, Haiping Shen, Yiping Zhang, and Donghai Yan are with the Department of Maternal and Child Health, National Health and Family Planning Commission, Beijing. Frank B. Hu is with Harvard T.H. Chan School of Public Health, Boston, MA
| | - An Pan
- Yuan He, Ying Yang, Yuanyuan Wang, Jihong Xu, Ya Zhang, Dujia Liu, Zuoqi Peng, and Xu Ma are with the National Research Institute for Family Planning, Beijing, People's Republic of China. An Pan is with the Department of Epidemiology and Biostatistics, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China. Qiaomei Wang, Haiping Shen, Yiping Zhang, and Donghai Yan are with the Department of Maternal and Child Health, National Health and Family Planning Commission, Beijing. Frank B. Hu is with Harvard T.H. Chan School of Public Health, Boston, MA
| | - Ying Yang
- Yuan He, Ying Yang, Yuanyuan Wang, Jihong Xu, Ya Zhang, Dujia Liu, Zuoqi Peng, and Xu Ma are with the National Research Institute for Family Planning, Beijing, People's Republic of China. An Pan is with the Department of Epidemiology and Biostatistics, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China. Qiaomei Wang, Haiping Shen, Yiping Zhang, and Donghai Yan are with the Department of Maternal and Child Health, National Health and Family Planning Commission, Beijing. Frank B. Hu is with Harvard T.H. Chan School of Public Health, Boston, MA
| | - Yuanyuan Wang
- Yuan He, Ying Yang, Yuanyuan Wang, Jihong Xu, Ya Zhang, Dujia Liu, Zuoqi Peng, and Xu Ma are with the National Research Institute for Family Planning, Beijing, People's Republic of China. An Pan is with the Department of Epidemiology and Biostatistics, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China. Qiaomei Wang, Haiping Shen, Yiping Zhang, and Donghai Yan are with the Department of Maternal and Child Health, National Health and Family Planning Commission, Beijing. Frank B. Hu is with Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jihong Xu
- Yuan He, Ying Yang, Yuanyuan Wang, Jihong Xu, Ya Zhang, Dujia Liu, Zuoqi Peng, and Xu Ma are with the National Research Institute for Family Planning, Beijing, People's Republic of China. An Pan is with the Department of Epidemiology and Biostatistics, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China. Qiaomei Wang, Haiping Shen, Yiping Zhang, and Donghai Yan are with the Department of Maternal and Child Health, National Health and Family Planning Commission, Beijing. Frank B. Hu is with Harvard T.H. Chan School of Public Health, Boston, MA
| | - Ya Zhang
- Yuan He, Ying Yang, Yuanyuan Wang, Jihong Xu, Ya Zhang, Dujia Liu, Zuoqi Peng, and Xu Ma are with the National Research Institute for Family Planning, Beijing, People's Republic of China. An Pan is with the Department of Epidemiology and Biostatistics, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China. Qiaomei Wang, Haiping Shen, Yiping Zhang, and Donghai Yan are with the Department of Maternal and Child Health, National Health and Family Planning Commission, Beijing. Frank B. Hu is with Harvard T.H. Chan School of Public Health, Boston, MA
| | - Dujia Liu
- Yuan He, Ying Yang, Yuanyuan Wang, Jihong Xu, Ya Zhang, Dujia Liu, Zuoqi Peng, and Xu Ma are with the National Research Institute for Family Planning, Beijing, People's Republic of China. An Pan is with the Department of Epidemiology and Biostatistics, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China. Qiaomei Wang, Haiping Shen, Yiping Zhang, and Donghai Yan are with the Department of Maternal and Child Health, National Health and Family Planning Commission, Beijing. Frank B. Hu is with Harvard T.H. Chan School of Public Health, Boston, MA
| | - Qiaomei Wang
- Yuan He, Ying Yang, Yuanyuan Wang, Jihong Xu, Ya Zhang, Dujia Liu, Zuoqi Peng, and Xu Ma are with the National Research Institute for Family Planning, Beijing, People's Republic of China. An Pan is with the Department of Epidemiology and Biostatistics, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China. Qiaomei Wang, Haiping Shen, Yiping Zhang, and Donghai Yan are with the Department of Maternal and Child Health, National Health and Family Planning Commission, Beijing. Frank B. Hu is with Harvard T.H. Chan School of Public Health, Boston, MA
| | - Haiping Shen
- Yuan He, Ying Yang, Yuanyuan Wang, Jihong Xu, Ya Zhang, Dujia Liu, Zuoqi Peng, and Xu Ma are with the National Research Institute for Family Planning, Beijing, People's Republic of China. An Pan is with the Department of Epidemiology and Biostatistics, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China. Qiaomei Wang, Haiping Shen, Yiping Zhang, and Donghai Yan are with the Department of Maternal and Child Health, National Health and Family Planning Commission, Beijing. Frank B. Hu is with Harvard T.H. Chan School of Public Health, Boston, MA
| | - Yiping Zhang
- Yuan He, Ying Yang, Yuanyuan Wang, Jihong Xu, Ya Zhang, Dujia Liu, Zuoqi Peng, and Xu Ma are with the National Research Institute for Family Planning, Beijing, People's Republic of China. An Pan is with the Department of Epidemiology and Biostatistics, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China. Qiaomei Wang, Haiping Shen, Yiping Zhang, and Donghai Yan are with the Department of Maternal and Child Health, National Health and Family Planning Commission, Beijing. Frank B. Hu is with Harvard T.H. Chan School of Public Health, Boston, MA
| | - Donghai Yan
- Yuan He, Ying Yang, Yuanyuan Wang, Jihong Xu, Ya Zhang, Dujia Liu, Zuoqi Peng, and Xu Ma are with the National Research Institute for Family Planning, Beijing, People's Republic of China. An Pan is with the Department of Epidemiology and Biostatistics, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China. Qiaomei Wang, Haiping Shen, Yiping Zhang, and Donghai Yan are with the Department of Maternal and Child Health, National Health and Family Planning Commission, Beijing. Frank B. Hu is with Harvard T.H. Chan School of Public Health, Boston, MA
| | - Zuoqi Peng
- Yuan He, Ying Yang, Yuanyuan Wang, Jihong Xu, Ya Zhang, Dujia Liu, Zuoqi Peng, and Xu Ma are with the National Research Institute for Family Planning, Beijing, People's Republic of China. An Pan is with the Department of Epidemiology and Biostatistics, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China. Qiaomei Wang, Haiping Shen, Yiping Zhang, and Donghai Yan are with the Department of Maternal and Child Health, National Health and Family Planning Commission, Beijing. Frank B. Hu is with Harvard T.H. Chan School of Public Health, Boston, MA
| | - Frank B Hu
- Yuan He, Ying Yang, Yuanyuan Wang, Jihong Xu, Ya Zhang, Dujia Liu, Zuoqi Peng, and Xu Ma are with the National Research Institute for Family Planning, Beijing, People's Republic of China. An Pan is with the Department of Epidemiology and Biostatistics, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China. Qiaomei Wang, Haiping Shen, Yiping Zhang, and Donghai Yan are with the Department of Maternal and Child Health, National Health and Family Planning Commission, Beijing. Frank B. Hu is with Harvard T.H. Chan School of Public Health, Boston, MA
| | - Xu Ma
- Yuan He, Ying Yang, Yuanyuan Wang, Jihong Xu, Ya Zhang, Dujia Liu, Zuoqi Peng, and Xu Ma are with the National Research Institute for Family Planning, Beijing, People's Republic of China. An Pan is with the Department of Epidemiology and Biostatistics, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China. Qiaomei Wang, Haiping Shen, Yiping Zhang, and Donghai Yan are with the Department of Maternal and Child Health, National Health and Family Planning Commission, Beijing. Frank B. Hu is with Harvard T.H. Chan School of Public Health, Boston, MA
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A indicator of visceral adipose dysfunction to evaluate metabolic health in adult Chinese. Sci Rep 2016; 6:38214. [PMID: 27905531 PMCID: PMC5131270 DOI: 10.1038/srep38214] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 11/07/2016] [Indexed: 12/18/2022] Open
Abstract
Visceral adipose dysfunction is a major cause of metabolic disorders. However, there is lack of a clinical index for prediction of visceral fat dysfunction in Asians. The present study aims to establish a visceral adiposity index for evaluation of metabolic health status in Chinese, the largest Asian ethnic group. 485 subjects were recruited from Lianqian Community, Xiamen and received abdominal computed tomography(CT) for visceral fat area. A Chinese visceral adiposity index (CVAI) was created using multivariate linear regression analyses, and was further validated in 6495 subjects recruited from Changfeng Community, Shanghai. CVAI was well associated with visceral obesity (r = 0.68, P < 0.001) and HOMA-IR (r = 0.60, P < 0.001). The AUROCs were 0.89(0.88–0.90), 0.72(0.71–0.73), 0.69(0.68–0.71) and 0.67(0.65–0.68) for determination of metabolic syndrome, hypertension, diabetes and prediabetes, respectively. CVAI was more valuable compared to BMI and waist circumference in evaluation of metabolic risks (all P < 0.001), even in subjects with metabolically unhealthy normal weight (MUNW) and metabolically healthy obese/overweight (MHO). This study demonstrates that CVAI is a reliable and applicable index for evaluation of visceral fat dysfunction in Chinese. It might be used to evaluate metabolic health status in Asians.
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Deng F, Lv JH, Wang HL, Gao JM, Zhou ZL. Expanding public health in China: an empirical analysis of healthcare inputs and outputs. Public Health 2016; 142:73-84. [PMID: 28057203 DOI: 10.1016/j.puhe.2016.10.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 08/18/2016] [Accepted: 10/12/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The Chinese Government claims that China's health policy is primarily focused on prevention. However, this does not appear to be the case. Researchers with an interest in China's health policy may be aware that the Chinese Government launched a health reform in 2009 to improve the health status of the entire population by 2020.1 This health reform has been in place for 7 years, and only 4 years now remain to achieve the overall objectives by 2020. This study analyzed the main inputs and outputs of China's health reform in order to identify the main problems and highlight the major challenges. It is hoped that this study will provide some reference for health reform in China and other developing countries. STUDY DESIGN This study focused on health, with human resources and healthcare costs as the main input indicators, and 2-week prevalence of illness and prevalence of non-communicable diseases as the main output indicators. By longitudinal comparison of real data from 2009 to 2014, the effects of China's health reform were analyzed to identify the main challenges, enabling suggestions to be made for future reference. METHODS This was a retrospective analysis of empirical data. Data were collected between 2009 and 2014 as follows: (1) data on the distribution of healthcare professionals were collected from the Statistical Bulletin of China's Health Development, issued by the National Health and Family Planning Commission every year between 2009 and 2014; (2) data on government health expenditure were obtained from the Annual National Public Fiscal Expenditure Data, released by the Financial Ministry of the People's Republic of China from 2009 to 2014; (3) data on the prevalence of chronic diseases, 2-week prevalence of illness, residents' medical service demands, and utilization of health services were obtained from the Fourth and Fifth National Health Care Surveys in 2008 and 2013; and (4) data on total healthcare expenditure, medical expenditure and out-of-pocket payments were obtained from the 2015 China Statistical Yearbook. RESULTS From 2009 to 2014, China's healthcare human resources were distributed primarily in hospitals that focus on providing treatment. By 2014, 62.5% of the health professionals and technical personnel were distributed in hospitals. From 2009, the Chinese Government spent more money on health care than previously, with approximately 67% spent on disease treatment and 14.19% spent on disease prevention. However, the 2-week prevalence of illness increased by 5.2 percentage points, and the prevalence of chronic diseases increased by 9 percentage points. Meanwhile, residents' out-of-pocket payments for health care were as high as 50.61% of the total healthcare expenditure and were particularly high in rural areas. CONCLUSION China should adjust the direction of its health reform as soon as possible to focus on improving health status rather than treatment of disease. In the future, as China's population ageing trend intensifies, China must take effective measures or the country's non-communicable disease rates will continue to increase. To meet this challenge, China's health reform should take effective measures to control the rising trend of the incidence of non-communicable diseases. First, China should focus on the core goal of its health reform policy, which is disease prevention. Second, China should focus on strengthening public health systems to effectively prevent and control key epidemic diseases. Third, China should increase the number of public health personnel, improve the level of education and training of public health personnel and increase the input of funds into the field of public health as soon as possible.
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Affiliation(s)
- F Deng
- Xi'an Jiao Tong University Health Science Center, Xi'an, China; Baoji Centre for Disease Control and Prevention, Baoji, China
| | - J H Lv
- Central Hospital of Baoji City, Baoji, Shaanxi Province, China
| | - H L Wang
- Baoji Centre for Disease Control and Prevention, Baoji, China
| | - J M Gao
- Xi'an Jiao Tong University, School of Public Policy and Administration, Xi'an, China.
| | - Z L Zhou
- Xi'an Jiao Tong University, School of Public Policy and Administration, Xi'an, China
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Kostova D, Husain MJ, Chaloupka FJ. Effect of cigarette prices on smoking initiation and cessation in China: a duration analysis. Tob Control 2016; 26:569-574. [DOI: 10.1136/tobaccocontrol-2016-053338] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 08/24/2016] [Indexed: 11/03/2022]
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Greenhalgh S. Neoliberal science, Chinese style: Making and managing the 'obesity epidemic'. SOCIAL STUDIES OF SCIENCE 2016; 46:485-510. [PMID: 28948874 DOI: 10.1177/0306312716655501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Science and Technology Studies has seen a growing interest in the commercialization of science. In this article, I track the role of corporations in the construction of the obesity epidemic, deemed one of the major public health threats of the century. Focusing on China, a rising superpower in the midst of rampant, state-directed neoliberalization, I unravel the process, mechanisms, and broad effects of the corporate invention of an obesity epidemic. Largely hidden from view, Western firms were central actors at every stage in the creation, definition, and governmental management of obesity as a Chinese disease. Two industry-funded global health entities and the exploitation of personal ties enabled actors to nudge the development of obesity science and policy along lines beneficial to large firms, while obscuring the nudging. From Big Pharma to Big Food and Big Soda, transnational companies have been profiting from the 'epidemic of Chinese obesity', while doing little to effectively treat or prevent it. The China case suggests how obesity might have been constituted an 'epidemic threat' in other parts of the world and underscores the need for global frameworks to guide the study of neoliberal science and policymaking.
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Affiliation(s)
- Susan Greenhalgh
- Department of Anthropology, Harvard University, Cambridge, MA, USA
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Affiliation(s)
- Shiwei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
| | - Andrew Page
- Centre for Health Research, Western Sydney University, Penrith, NSW 2571, Australia
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Bjertness MB, Htet AS, Meyer HE, Htike MMT, Zaw KK, Oo WM, Latt TS, Sherpa LY, Bjertness E. Prevalence and determinants of hypertension in Myanmar - a nationwide cross-sectional study. BMC Public Health 2016; 16:590. [PMID: 27430560 PMCID: PMC4950687 DOI: 10.1186/s12889-016-3275-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 07/07/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs), malaria and tuberculosis dominate the disease pattern in Myanmar. Due to urbanization, westernized lifestyle and economic development, it is likely that NCDs such as cerebrovascular disease and ischemic heart disease are on a rise. The leading behavioral- and metabolic NCDs risk factors are tobacco smoke, dietary risks and alcohol use, and high blood pressure and body mass index, respectively. The study aimed at estimating the prevalence and determinants of hypertension, including metabolic-, behavioral- and socio-demographic risk factors. METHODS A nationwide, cross-sectional study of 7429 citizens of Myanmar aged 15-64 years were examined in 2009, using the WHO STEPS methodology. In separate analyses by gender, odds radios (ORs) and 95 % confidence intervals (CIs) for determinants of hypertension were estimated using logistic regression analyses. Confounders included in analyses were chosen based on Directed acyclic graphs (DAGs). RESULTS The prevalence of hypertension was 30.1 % (95 % CI: 28.4-31.8) in males and 29.8 % (28.5-31.1) in females. The mean BMI was 21.7 (SD 4.3) kg/m(2) for males and 23.0 (5.1) kg/m(2) for females. In fully adjusted analyses, we found in both genders increased OR for hypertension if the participants had high BMI (males: OR = 2.6; 95 % CI 2.1-3.3, females: OR = 2.3; 2.0-2.7) and high waist circumference (males: OR = 3.4; 1.8-6.8, females: OR = 2.7; 2.2-3.3). In both sexes, associations were also found between hypertension and low physical activity at work, or living in urban areas or the delta region. Being underweight and use of sesame oil in cooking was associated with lower odds for hypertension. CONCLUSIONS The prevalence of hypertension was high and associated with metabolic-, behavioral- and socio-demographic factors. Due to expected rapid economic growth in Myanmar we recommend similar studies in the future to follow up and describe trends in the risk factors, especially modifiable factors, which will most likely be on rise. Studies on effectiveness on interventions are needed, and policies to reduce the burden of NCD risk factors should be implemented if proven effective in similar settings.
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Affiliation(s)
- Marius B. Bjertness
- />Section for Preventive Medicine and Epidemiology, Department of Community Medicine, University of Oslo, Oslo, Norway
| | - Aung Soe Htet
- />Section for Preventive Medicine and Epidemiology, Department of Community Medicine, University of Oslo, Oslo, Norway
- />International Health Department, Ministry of Health, Nay Pyi Taw, Myanmar
| | - Haakon E. Meyer
- />Section for Preventive Medicine and Epidemiology, Department of Community Medicine, University of Oslo, Oslo, Norway
- />Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Ko Ko Zaw
- />Department of Medical Research, Ministry of Health, Nay Pyi Taw, Myanmar
| | - Win Myint Oo
- />Department of Preventive and Social Medicine, University of Medicine 1, Yangon, Myanmar
| | | | - Lhamo Y. Sherpa
- />Section for Preventive Medicine and Epidemiology, Department of Community Medicine, University of Oslo, Oslo, Norway
| | - Espen Bjertness
- />Section for Preventive Medicine and Epidemiology, Department of Community Medicine, University of Oslo, Oslo, Norway
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Abstract
With one-fifth of the world's total population, China's prevention and control of cardiovascular disease (CVD) may affect the success of worldwide efforts to achieve sustainable CVD reduction. Understanding China's current cardiovascular epidemic requires awareness of the economic development in the past decades. The rapid economic transformations (industrialization, marketization, urbanization, globalization, and informationalization) contributed to the aging demography, unhealthy lifestyles, and environmental changes. The latter have predisposed to increasing cardiovascular risk factors and the CVD pandemic. Rising CVD rates have had a major economic impact, which has challenged the healthcare system and the whole society. With recognition of the importance of health, initial political steps and national actions have been taken to address the CVD epidemic. Looking to the future, we recommend that 4 priorities should be taken: pursue multisectorial government and nongovernment strategies targeting the underlying causes of CVD (the whole-of-government and whole-of-society policy); give priority to prevention; reform the healthcare system to fit the nature of noncommunicable diseases; and conduct research for evidence-based, low-cost, simple, sustainable, and scalable interventions. By pursuing the 4 priorities, the pandemic of CVD and other major noncommunicable diseases in China will be reversed and the global sustainable development goal achieved.
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Affiliation(s)
- Yangfeng Wu
- From Peking University School of Public Health and Clinical Research Institute, Beijing, China (Y.W.); The George Institute for Global Health at Peking University Health Science Center, Beijing, China (Y.W.); Boston University Schools of Medicine and Public Health, MA (E.J.B.); and The George Institute for Global Health, Sydney, Australia (S.M.).
| | - Emelia J Benjamin
- From Peking University School of Public Health and Clinical Research Institute, Beijing, China (Y.W.); The George Institute for Global Health at Peking University Health Science Center, Beijing, China (Y.W.); Boston University Schools of Medicine and Public Health, MA (E.J.B.); and The George Institute for Global Health, Sydney, Australia (S.M.)
| | - Stephen MacMahon
- From Peking University School of Public Health and Clinical Research Institute, Beijing, China (Y.W.); The George Institute for Global Health at Peking University Health Science Center, Beijing, China (Y.W.); Boston University Schools of Medicine and Public Health, MA (E.J.B.); and The George Institute for Global Health, Sydney, Australia (S.M.)
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Barton M, Husmann M, Meyer MR. Accelerated Vascular Aging as a Paradigm for Hypertensive Vascular Disease: Prevention and Therapy. Can J Cardiol 2016; 32:680-686.e4. [PMID: 27118295 DOI: 10.1016/j.cjca.2016.02.062] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 12/21/2022] Open
Abstract
Aging is considered the most important nonmodifiable risk factor for cardiovascular disease and death after age 28 years. Because of demographic changes the world population is expected to increase to 9 billion by the year 2050 and up to 12 billion by 2100, with several-fold increases among those 65 years of age and older. Healthy aging and prevention of aging-related diseases and associated health costs have become part of political agendas of governments around the world. Atherosclerotic vascular burden increases with age; accordingly, patients with progeria (premature aging) syndromes die from myocardial infarctions or stroke as teenagers or young adults. The incidence and prevalence of arterial hypertension also increases with age. Arterial hypertension-like diabetes and chronic renal failure-shares numerous pathologies and underlying mechanisms with the vascular aging process. In this article, we review how arterial hypertension resembles premature vascular aging, including the mechanisms by which arterial hypertension (as well as other risk factors such as diabetes mellitus, dyslipidemia, or chronic renal failure) accelerates the vascular aging process. We will also address the importance of cardiovascular risk factor control-including antihypertensive therapy-as a powerful intervention to interfere with premature vascular aging to reduce the age-associated prevalence of diseases such as myocardial infarction, heart failure, hypertensive nephropathy, and vascular dementia due to cerebrovascular disease. Finally, we will discuss the implementation of endothelial therapy, which aims at active patient participation to improve primary and secondary prevention of cardiovascular disease.
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Affiliation(s)
- Matthias Barton
- Molecular Internal Medicine, University of Zürich, Zürich, Switzerland.
| | - Marc Husmann
- Division of Angiology, University Hospital Zürich, Zürich, Switzerland
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Yang Z. Do not let precision medicine be kidnapped. Front Med 2015; 9:512-3. [DOI: 10.1007/s11684-015-0425-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/17/2015] [Indexed: 10/22/2022]
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Jiang L, Krumholz HM, Li X, Li J, Hu S. Achieving best outcomes for patients with cardiovascular disease in China by enhancing the quality of medical care and establishing a learning health-care system. Lancet 2015; 386:1493-505. [PMID: 26466053 PMCID: PMC5323019 DOI: 10.1016/s0140-6736(15)00343-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
China has an immediate need to address the rapidly growing population with cardiovascular disease events and the increasing number of people living with this illness. Despite progress in increasing access to services, China faces the dual challenge of addressing gaps in quality of care and producing more evidence to support clinical practice. In this Review, we address opportunities to strengthen performance measurement, programmes to improve quality of care, and national capacity to produce high-impact knowledge for clinical practice. Moreover, we propose recommendations, with implications for other diseases, for how China can immediately make use of its Hospital Quality-Monitoring System and other existing national platforms to assess and improve performance of medical care, and to generate new knowledge to inform clinical decisions and national policies.
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Affiliation(s)
- Lixin Jiang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Xi Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shengshou Hu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Jin C, Cheng J, Lu Y, Huang Z, Cao F. Spatial inequity in access to healthcare facilities at a county level in a developing country: a case study of Deqing County, Zhejiang, China. Int J Equity Health 2015; 14:67. [PMID: 26286033 PMCID: PMC4545554 DOI: 10.1186/s12939-015-0195-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 07/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The inequities in healthcare services between regions, urban and rural, age groups and diverse income groups have been growing rapidly in China. Equal access to basic medical and healthcare services has been recognized as "a basic right of the people" by Chinese government. Spatial accessibility to healthcare facilities has received huge attention in Chinese case studies but been less studied particularly at a county level due to limited availability of high-resolution spatial data. This study is focused on measuring spatial accessibility to healthcare facilities in Deqing County. The spatial inequity between the urban (town) and rural is assessed and three scenarios are designed and built to examine which scenario is instrumental for better reducing the spatial inequity. METHODS This study utilizes highway network data, Digital Elevation Model (DEM), location of hospitals and clinics, 2010 census data at the finest level - village committee, residential building footprint and building height. Areal weighting method is used to disaggregate population data from village committee level to residential building cell level. Least cost path analysis is applied to calculate the travel time from each building cell to its closest healthcare facility. Then an integral accessibility will be calculated through weighting the travel time to the closest facility between three levels. The spatial inequity in healthcare accessibility between the town and rural areas is examined based on the coverages of areas and populations. The same method is used to compare three scenarios aimed at reducing such spatial inequity - relocation of hospitals, updates of weighting values, and the combination of both. RESULTS 50.03% of residents can reach a county hospital within 15 min by driving, 95.77% and 100% within 30 and 60 min respectively. 55.14% of residents can reach a town hospital within 5 min, 98.04% and 100% within 15 and 30 min respectively. 57.86% of residential building areas can reach a village clinic within 5 min, 92.65% and 99.22% within 10 and 15 min. After weighting the travel time between the three-level facilities, 30.87% of residents can reach a facility within 5 min, 80.46%% and 99.88% within 15 and 30 min respectively. CONCLUSIONS The healthcare accessibility pattern of Deqing County has exhibited spatial inequity between the town and rural areas, with the best accessibility in the capital of the county and poorest in the West of the county. There is a high negative correlation between population ageing and healthcare accessibility. Allocation of more advanced medical and healthcare equipment and highly skillful doctors and nurses to village clinics will be an efficient means of reducing the spatial inequity and further consolidating the national medical security system. GIS (Geographical Information Systems) methods have proven successful method of providing quantitative evidence for policy analysis although the data sets and methods could be further improved.
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Affiliation(s)
- Cheng Jin
- School of Geographical Sciences, Nanjing Normal University, Nanjing, 210023, P. R China. .,Jiangsu Center for Collaborative Innovation in Geographical Information Resource Development and Application, Nanjing, 210023, P. R China.
| | - Jianquan Cheng
- Division of Geography and Environmental Management, School of Science and the Environment, Manchester Metropolitan University, Chester Street, Manchester, M1 5GD, UK.
| | - Yuqi Lu
- School of Geographical Sciences, Nanjing Normal University, Nanjing, 210023, P. R China. .,Jiangsu Center for Collaborative Innovation in Geographical Information Resource Development and Application, Nanjing, 210023, P. R China.
| | - Zhenfang Huang
- School of Geographical Sciences, Nanjing Normal University, Nanjing, 210023, P. R China. .,Jiangsu Center for Collaborative Innovation in Geographical Information Resource Development and Application, Nanjing, 210023, P. R China.
| | - Fangdong Cao
- School of Geographical Sciences, Nanjing Normal University, Nanjing, 210023, P. R China. .,Jiangsu Center for Collaborative Innovation in Geographical Information Resource Development and Application, Nanjing, 210023, P. R China.
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Bao C, Mayila M, Ye Z, Wang J, Jin M, He W, Chen K. Forecasting and Analyzing the Disease Burden of Aged Population in China, Based on the 2010 Global Burden of Disease Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:7172-84. [PMID: 26121188 PMCID: PMC4515648 DOI: 10.3390/ijerph120707172] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/11/2015] [Accepted: 06/18/2015] [Indexed: 01/14/2023]
Abstract
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.
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Affiliation(s)
- Chengzhen Bao
- School of Public Health, Zhejiang University, Hangzhou 310058, China.
| | - Mamat Mayila
- School of Public Health, Zhejiang University, Hangzhou 310058, China.
| | - Zhenhua Ye
- School of Public Health, Zhejiang University, Hangzhou 310058, China.
| | - Jianbing Wang
- School of Public Health, Zhejiang University, Hangzhou 310058, China.
| | - Mingjuan Jin
- School of Public Health, Zhejiang University, Hangzhou 310058, China.
| | - Wenjiong He
- School of Public Affairs, Zhejiang University, Hangzhou 310058, China.
| | - Kun Chen
- School of Public Health, Zhejiang University, Hangzhou 310058, China.
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Huang C, Guo C, Nichols C, Chen S, Martorell R. Elevated levels of protein in urine in adulthood after exposure to the Chinese famine of 1959-61 during gestation and the early postnatal period. Int J Epidemiol 2014; 43:1806-14. [PMID: 25298393 DOI: 10.1093/ije/dyu193] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Animal models have suggested that undernutrition during gestation and the early postnatal period may adversely affect kidney development and compromise renal function. As a natural experiment, famines provide an opportunity to test such potential effects in humans. We assessed whether exposure to the Chinese famine of 1959-1961 during gestation and early postnatal life was associated with the levels of proteinuria among female adults three decades after exposure to the famine. METHODS We measured famine intensity using the cohort size shrinkage index and we constructed a difference-in-difference model to compare the levels of proteinuria, measured with a dipstick test of random urine specimens, among Chinese women (n = 70 543) whose exposure status to the famine varied across birth cohorts (born before, during or after the famine) and counties of residence with different degrees of famine intensity. RESULTS Famine exposure was associated with a greater risk [odds ratio (OR) = 1.54; 95% confidence interval (CI): 1.04, 2.28; P = 0.029) of having higher level of proteinuria among women born during the famine years (1959-61) compared with the unexposed post famine-born cohort (1964-65) in rural samples. No association was observed among urban samples. Results were robust to adjustment for covariates. CONCLUSIONS Severe undernutrition during gestation and the early postnatal period may have long-term effects on levels of proteinuria in humans, but the effect sizes may be small.
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Affiliation(s)
- Cheng Huang
- George Washington University - Department of Global Health, Washington, District of Columbia, United States, UC Berkeley School of Public Health - Health Services & Policy Analysis, Berkeley, California, United States, University of Maryland School of Public Health, College Park, Maryland, United States and Emory University - Hubert Department of Global Health, Atlanta, Georgia, United States
| | - Chaoran Guo
- George Washington University - Department of Global Health, Washington, District of Columbia, United States, UC Berkeley School of Public Health - Health Services & Policy Analysis, Berkeley, California, United States, University of Maryland School of Public Health, College Park, Maryland, United States and Emory University - Hubert Department of Global Health, Atlanta, Georgia, United States
| | - Catherine Nichols
- George Washington University - Department of Global Health, Washington, District of Columbia, United States, UC Berkeley School of Public Health - Health Services & Policy Analysis, Berkeley, California, United States, University of Maryland School of Public Health, College Park, Maryland, United States and Emory University - Hubert Department of Global Health, Atlanta, Georgia, United States
| | - Shuo Chen
- George Washington University - Department of Global Health, Washington, District of Columbia, United States, UC Berkeley School of Public Health - Health Services & Policy Analysis, Berkeley, California, United States, University of Maryland School of Public Health, College Park, Maryland, United States and Emory University - Hubert Department of Global Health, Atlanta, Georgia, United States
| | - Reynaldo Martorell
- George Washington University - Department of Global Health, Washington, District of Columbia, United States, UC Berkeley School of Public Health - Health Services & Policy Analysis, Berkeley, California, United States, University of Maryland School of Public Health, College Park, Maryland, United States and Emory University - Hubert Department of Global Health, Atlanta, Georgia, United States
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Abstract
Although China's 2009 health-care reform has made impressive progress in expansion of insurance coverage, much work remains to improve its wasteful health-care delivery. Particularly, the Chinese health-care system faces substantial challenges in its transformation from a profit-driven public hospital-centred system to an integrated primary care-based delivery system that is cost effective and of better quality to respond to the changing population needs. An additional challenge is the government's latest strategy to promote private investment for hospitals. In this Review, we discuss how China's health-care system would perform if hospital privatisation combined with hospital-centred fragmented delivery were to prevail--population health outcomes would suffer; health-care expenditures would escalate, with patients bearing increasing costs; and a two-tiered system would emerge in which access and quality of care are decided by ability to pay. We then propose an alternative pathway that includes the reform of public hospitals to pursue the public interest and be more accountable, with public hospitals as the benchmarks against which private hospitals would have to compete, with performance-based purchasing, and with population-based capitation payment to catalyse coordinated care. Any decision to further expand the for-profit private hospital market should not be made without objective assessment of its effect on China's health-policy goals.
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Affiliation(s)
- Winnie Yip
- Blavatnik School of Government, University of Oxford, Oxford, UK.
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