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Zhang Z. Survey and analysis on the resource situation of primary health care institutions in rural China. Front Public Health 2024; 12:1394527. [PMID: 38919917 PMCID: PMC11196621 DOI: 10.3389/fpubh.2024.1394527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
Background China's rural population is immense, and to ensure the well-being of rural residents through healthcare services, it is essential to analyze the resources of rural grassroots healthcare institutions in China. The objective is to examine the discrepancies and deficiencies in resources between rural grassroots healthcare institutions and the national average, providing a basis for future improvements and supplementation of rural healthcare resources. Methodology The study analyzed data from 2020 to 2022 on the number of healthcare establishments, the capacity of hospital beds, the number of healthcare professionals, and the number of physicians in both rural and national settings. Additionally, it examined the medical service conditions and ratios of township health centers in rural areas to assess the resource gap between rural areas and the national average. Results Healthcare establishments: On average, there were 2.2 fewer healthcare institutions per 10,000 persons in rural areas compared to the national average over three years. Hospital beds: On average, there were approximately 36 fewer hospital beds per 10,000 persons in rural areas compared to the national average over three years. Healthcare professionals and physicians: On average, there were about 48 fewer healthcare technical personnel and 10 fewer practicing (including assistant) physicians per 10,000 persons in rural areas compared to the national average over three years. Conclusion Compared to the national average, there are significant discrepancies and deficiencies in grassroots healthcare resources in rural China. This underscores the necessity of increasing funding to progressively enhance the number of healthcare institutions in rural areas, expand the number of healthcare personnel, and elevate medical standards to better align with national benchmarks. Improving rural healthcare resources will strategically equip these institutions to cater to rural communities and effectively handle public health emergencies. Ensuring that the rural population in China has equal access to healthcare services as the rest of the country is crucial for promoting the well-being of rural residents and achieving health equity.
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Affiliation(s)
- Zhaoting Zhang
- School of Public Policy and Management, China University of Mining and Technology, Xuzhou, China
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Wang J, Zhao Z, Yang J, Ng M, Zhou M. The association between education and premature mortality in the Chinese population: a 10-year cohort study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 47:101085. [PMID: 38751727 PMCID: PMC11091532 DOI: 10.1016/j.lanwpc.2024.101085] [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: 02/12/2024] [Revised: 03/23/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
Background Recent studies have shown significant associations between education and premature mortality. However, the relationship differs across countries. We aimed to present the latest evidence on the educational inequalities in premature mortality in the Chinese population. Methods We linked two databases, to establish a population-based, ten-year cohort spanning 2010 to 2020. Cox proportional hazard regression analyses adjusting for age, sex and urbanicity were conducted for all-cause mortality, and competing risk models were fitted for cause-specific mortality. We calculated population attributable fraction (PAF) using the hazard ratios (HRs) obtained by regression analyses. Additionally, we fitted models adjusting for risk factors and investigated the mediating effect of income, smoking, alcohol consumption and diets. Findings Compared with individuals with upper secondary and above education, the HR for premature all-cause mortality for those with less than primary education was 1.93 (95% CI: 1.72-2.19). The HRs were the highest for deaths from respiratory diseases (HR = 3.09, 95% CI 1.82-5.27). The excess risk of premature mortality associated with low education was higher among women and urban population. The association of education remained significant after accounting for risk factors, and income was the main mediator, which accounted for 23.0% of mediation in men and 11.1% in women. Interpretation The study's findings support the increased risk of premature mortality associated with low education, particularly in women and urban populations. The considerable number of deaths attributed to educational inequality underscores the necessity for more effective and targeted public health interventions. Funding Chinese Central Government.
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Affiliation(s)
- Jifei Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhenping Zhao
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jing Yang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Marie Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Maigeng Zhou
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Du S, Yang Y, Zheng M, Zhang H, Li T, Cai F. Health inequality of rural-to-urban migrant workers in eastern China and its decomposition: a comparative cross-sectional study. Front Public Health 2024; 12:1365241. [PMID: 38803809 PMCID: PMC11128589 DOI: 10.3389/fpubh.2024.1365241] [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: 01/05/2024] [Accepted: 04/30/2024] [Indexed: 05/29/2024] Open
Abstract
Objectives As a specific group with high health inequality, it is crucial to improve the health status and health inequalities of rural-to-urban migrant workers. This study aimed to evaluate the health inequality of migrant and urban workers in China and decompose it. Methods A cross-sectional study was carried out, using a standardized questionnaire to obtain basic information, self-rated health to evaluate health status, concentration index to measure health inequalities, and WDW decomposition to analyze the causes of health inequalities. Results The concentration index of health for migrants was 0.021 and 0.009 for urban workers. The main factors contributing to health inequality among rural-to-urban migrant workers included income, exercise, and age. In contrast, the main factors of health inequality among urban workers included income, the number of chronic diseases, social support, and education. Conclusion There were health inequalities in both rural-to-urban migrant and urban workers. The government and relevant authorities should formulate timely policies and take targeted measures to reduce income disparities among workers, thereby improving health inequality.
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Affiliation(s)
- Sisi Du
- College of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Yufan Yang
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Miaomiao Zheng
- College of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Haiyan Zhang
- College of Nursing, Wenzhou Medical University, Wenzhou, China
- Cixi Biomedical Research Institute, Wenzhou Medical University, Wenzhou, China
| | - Tingting Li
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Fuman Cai
- College of Nursing, Wenzhou Medical University, Wenzhou, China
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Zhao Y, Qiao Q, Xu X, Bian Y. Effectiveness of hierarchical medical system and economic growth: based on China's urban vs. rural health perspectives. Front Public Health 2024; 12:1364584. [PMID: 38799681 PMCID: PMC11116612 DOI: 10.3389/fpubh.2024.1364584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Background The hierarchical medical system is an important measure to promote equitable healthcare and sustain economic development. As the population's consumption level rises, the demand for healthcare services also increases. Based on urban and rural perspectives in China, this study aims to investigate the effectiveness of the hierarchical medical system and its relationship with economic development in China. Materials and methods The study analyses panel data collected from Chinese government authorities, covering the period from 2009 to 2022. According to China's regional development policy, China is divided into the following regions: Eastern, Middle, Western, and Northeastern. Urban and rural component factors were downscaled using principal component analysis (PCA). The factor score formula combined with Urban-rural disparity rate (ΔD) were utilized to construct models for evaluating the effectiveness of the hierarchical medical system from an urban-rural perspective. A Vector Autoregression model is then constructed to analyze the dynamic relationship between the effects of the hierarchical medical system and economic growth, and to predict potential future changes. Results Three principal factors were extracted. The contributions of the three principal factors were 38.132, 27.662, and 23.028%. In 2021, the hierarchical medical systems worked well in Henan (F = 47245.887), Shandong (F = 45999.640), and Guangdong (F = 42856.163). The Northeast (ΔDmax = 18.77%) and Eastern region (ΔDmax = 26.04%) had smaller disparities than the Middle (ΔDmax = 49.25%) and Western region (ΔDmax = 56.70%). Vector autoregression model reveals a long-term cointegration relationship between economic development and the healthcare burden for both urban and rural residents (βurban = 3.09, βrural = 3.66), as well as the number of individuals receiving health education (β = -0.3492). Both the Granger causality test and impulse response analysis validate the existence of a substantial time lag between the impact of the hierarchical medical system and economic growth. Conclusion Residents in urban areas are more affected by economic factors, while those in rural areas are more influenced by time considerations. The urban rural disparity in the hierarchical medical system is associated with the level of economic development of the region. When formulating policies for economically relevant hierarchical medical systems, it is important to consider the impact of longer lags.
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Affiliation(s)
- Yongze Zhao
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau, China
| | - Qingyu Qiao
- Department of Accounting and Information Management, Faculty of Business Administration, University of Macau, Macau, China
| | - Xian Xu
- School of Clinical Medicine, Kangda College of Nanjing Medical University, Lianyungang, China
| | - Ying Bian
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau, China
- Institute of Chinese Medical Sciences, University of Macau, Macau, China
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Tobada SB, Chatelet V, Bechade C, Lanot A, Boyer A, Couchoud C, Toure F, Boime S, Lobbedez T, Beaumier M. Is social deprivation associated with the peritoneal dialysis outcomes? A cohort study with REIN registry data. Perit Dial Int 2024:8968608241237685. [PMID: 38632672 DOI: 10.1177/08968608241237685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Social deprivation is associated with lower peritoneal dialysis (PD) uptake. This study was carried out to evaluate the role of social deprivation on the outcome of PD. METHODS This was a retrospective study of data extracted from the Renal Epidemiology and Information Network registry for patients older than 18 years who started PD in metropolitan France between 1 January 2017 and 30 June 2018. The end of the observation period was 31 December 2020. The exposure was the European Deprivation Index calculated using the patient's address. The events of interest were death, transfer to haemodialysis (HD), transplantation and the composite event of death or transfer to HD. A Cox model and Fine and Gray model were used for the analysis. RESULTS A total of 1581 patients were included, of whom 418 (26.5%) belonged to Quintile 5 of the European Deprivation Index (the most deprived patients). In the Cox model, the most deprived subjects did not have a greater risk of death (cause-specific hazard ratio (cs-HR): 0.76 [95% confidence interval (CI): 0.53-1.10], transfer to HD (cs-HR 1.37 [95% CI: 0.95-1.98]) or the composite event of death or transfer to HD (cs-HR: 1.08 [95% CI: 0.84-1.38]) or a lower risk of kidney transplantation (cs-HR: 0.73 [95% CI: 0.48-1.10]). In the competing risk analysis, the most deprived subjects had a higher risk of transfer to HD (subdistribution hazard ratio (sd-HR): 1.54 [95% CI: 1.08-2.19]) and lower access to kidney transplantation (sd-HR: 0.68 [0.46-0.99]). CONCLUSION In PD patients, social deprivation was not associated with death or the composite event of death or transfer to HD. Socially deprived individuals had a greater risk of transfer to HD and lower access to kidney transplantation in the competing risk analysis.
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Affiliation(s)
- Steve Biko Tobada
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen Cedex, France
| | - Valérie Chatelet
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen Cedex, France
- INSERM U1086 - ANTICIPE - Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen Cedex, France
| | - Clemence Bechade
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen Cedex, France
- INSERM U1086 - ANTICIPE - Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen Cedex, France
| | - Antoine Lanot
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen Cedex, France
- INSERM U1086 - ANTICIPE - Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen Cedex, France
| | - Annabel Boyer
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen Cedex, France
- INSERM U1086 - ANTICIPE - Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen Cedex, France
| | - Cécile Couchoud
- REIN Registry, Agence de la Biomédecine, Saint Denis La Plaine, France
| | - Fatouma Toure
- REIN Registry, Agence de la Biomédecine, Saint Denis La Plaine, France
- Service de Néphrologie, Dialyse et Transplantation, CHU de Limoges, Limousin, France
| | - Sabrina Boime
- REIN Registry, Agence de la Biomédecine, Saint Denis La Plaine, France
- Grand Est, Observatoire Régional de Santé (ORS), Alsace, France
| | - Thierry Lobbedez
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen Cedex, France
- INSERM U1086 - ANTICIPE - Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen Cedex, France
| | - Mathilde Beaumier
- Néphrologie, Centre Hospitalier Public du Cotentin, Cherbourg-en-Cotentin, Basse-Normandie, France
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Terada S, Nishimura H, Miyasaka N, Fujiwara T. Ambient temperature and preterm birth: A case-crossover study. BJOG 2024; 131:632-640. [PMID: 37984435 DOI: 10.1111/1471-0528.17720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/25/2023] [Accepted: 10/29/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To investigate the association between ambient temperature and preterm birth (PTB) and to estimate the population attributable fraction (PAF) of PTBs due to low and high temperatures. DESIGN Time-stratified case-crossover design. SETTING Japan (46 prefectures, excluding Okinawa), 2011-2020. SAMPLE 214 050 PTBs registered in the Japan Perinatal Registry Network database among 1 908 168 singleton live births. METHODS A quasi-Poisson regression model with a distributed lag nonlinear model was employed to assess the associations between daily mean temperature and PTBs for a lag of 0-27 days in each prefecture. A random effects meta-analysis was conducted by combining effect estimates from the 46 prefectures to estimate pooled relative risks (RRs). The PAFs of the PTBs due to below or above the mean of the 46 median temperatures (16.0°C) were calculated. MAIN OUTCOME MEASURES Preterm singleton live births. RESULTS The association between daily mean temperature and PTB risk exhibited a U-shaped curve. The adjusted RRs were 1.15 (95% confidence interval [CI] 1.05-1.25) at the mean of the 1st percentiles (0.8°C) and 1.08 (95% CI 1.00-1.17) at the mean of the 99th percentiles (30.2°C) of 46 prefectures, with 16.0°C as the reference temperature. Approximately 2.3% (95% CI 0.6-4.0) of PTBs were attributable to low temperatures. CONCLUSIONS Both low and possibly high temperatures were associated with an increased risk of PTBs. These findings may help to inform preventive measures for pregnant women.
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Affiliation(s)
- Shuhei Terada
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hisaaki Nishimura
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoyuki Miyasaka
- Department of Obstetrics and Gynaecology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
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Zhang W, Neupane D, Zhao Z, Jiang B, Zhang M, Zhang X, Huang Z, Li C, Sharman JE, Hu C, Ye P, Wang L. Knowledge and practices related to salt consumption in China: findings from a national representative cross-sectional survey. J Hum Hypertens 2024; 38:155-167. [PMID: 37857758 PMCID: PMC10844095 DOI: 10.1038/s41371-023-00861-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 08/31/2023] [Indexed: 10/21/2023]
Abstract
There is limited information on the knowledge and practice of salt-reduction in China. The purpose of this study was to describe the status of the knowledge and practice of salt-reduction among the Chinese population from a nationally representative survey stratified according to hypertension status. The association between hypertensive status and salt-reduction knowledge and practice was calculated using multivariate hierarchical logistic regression adjusting for related confounders. The study included 179,834 participants; 51.7% were women, and the mean age was 44 years. The levels of overall salt-reduction knowledge (7.9%) and practice (37.1%) were low. The percentage of the use of salt-control spoons and low-sodium salt was 10.7% and 12.2%. The aging population (≥60 years) had the lowest levels of salt-reduction knowledge (5.7%) than other age groups (P < 0.0001). People living in rural areas (OR = 0.64; 95% CI: 0.51, 0.81) had lower odds of using salt-control spoons. Females (OR = 1.23; 95% CI: 1.10, 1.36) had higher odds of using salt-control spoons. People living in rural areas (OR = 0.48; 95% CI: 0.36, 0.63) had lower odds of using low-sodium salt. Females (OR = 1.26; 95% CI: 1.13, 1.41) and people living in the southern region (OR = 1.43; 95% CI: 1.11, 1.83) had higher odds of using low-sodium salt. Our work highlights the need to promote education related to hypertension, salt-reduction knowledge and methods among the public and the need to strengthen strategies for the popularization of salt-reduction knowledge and practices among males, people living in rural areas, people living in the northern region and the aging population in China.
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Affiliation(s)
- Wenrong Zhang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Zhenping Zhao
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Bo Jiang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mei Zhang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiao Zhang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhengjing Huang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chun Li
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Caihong Hu
- Nanjing Center for Disease Control and Prevention, Nanjing, China
| | - Pengpeng Ye
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Limin Wang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Yin Y, Tam HL, Quint J, Chen M, Ding R, Zhang X. Epidemiology of Dementia in China in 2010-2020: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2024; 12:334. [PMID: 38338219 PMCID: PMC10855047 DOI: 10.3390/healthcare12030334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/19/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Dementia has become one of the leading causes of death across the world. AIMS The aim of this study was to investigate the incidence, prevalence, and mortality of dementia in China between 2010 and 2020, and to investigate any geographical, age, and sex differences in the prevalence and incidence of dementia. METHODS Five databases were searched. The Joanna Briggs Institute (JBI) critical appraisal tool was used to assess the quality of the included studies. A random-effects meta-analysis was performed to estimate the pooled prevalence of dementia. Subgroup analysis was based on the type of dementia. The incidence and mortality of dementia were synthesized qualitatively. RESULTS A total of 19 studies were included. The meta-analysis showed that the prevalence of dementia was 6% (95%CI 5%, 8%), the prevalence of Alzheimer's disease (AD) was 5% (95%CI 4%, 6%), and the prevalence of vascular dementia (VaD) was 1% (95%CI 0%, 2%). The subgroup analysis showed that the prevalence rates of dementia in rural (6%, 95%CI 4%, 8%) and urban areas were similar (6%, 95%CI 4%, 8%). Deaths due to dementia increased over time. CONCLUSION The prevalence, incidence, and mortality of dementia increased with age and over time. Applying consistent criteria to the diagnosis of cognitive impairment and dementia is necessary to help with disease monitoring. Promoting dementia knowledge and awareness at the community level is necessary.
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Affiliation(s)
- Yueheng Yin
- School of Nursing, Nanjing Medical University, Nanjing 210029, China;
| | - Hon Lon Tam
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China;
| | - Jennifer Quint
- School of Public Health, National Heart and Lung Institute, Imperial College London, London W12 7RQ, UK; (J.Q.); (R.D.)
| | - Mengyun Chen
- School of Nursing, Lanzhou University, Lanzhou 730000, China;
| | - Rong Ding
- School of Public Health, National Heart and Lung Institute, Imperial College London, London W12 7RQ, UK; (J.Q.); (R.D.)
| | - Xiubin Zhang
- School of Public Health, National Heart and Lung Institute, Imperial College London, London W12 7RQ, UK; (J.Q.); (R.D.)
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Soleimanvandiazar N, Mohaqeqi Kamal SH, Basakha M, Karim S, Ahmadi S, Ghaedamini Harouni G, Sajjadi H, Setareh Forouzan A. Decomposition of Healthcare Utilization Inequality in Iran: The Prominent Role of Health Literacy and Neighborhood Characteristics. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241229622. [PMID: 38339828 PMCID: PMC10859068 DOI: 10.1177/00469580241229622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/27/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024]
Abstract
Unequal utilization in healthcare can potentially affect the right to health. Access to healthcare services and achieving positive health outcomes and health equity are essential principles in promoting human rights. This study aims to assess and analyze socioeconomic-related inequalities in outpatient health services utilization (OHSU) among various socio-demographic subgroups to inform policies that foster health equity. Data were collected through a cross-sectional survey of 1200 households in Tehran, Iran. Inequality in OHSU among the socio-demographic subgroups was calculated by concentration, Wagstaff, and Erigers indices. Decomposition was used to identify the factors contributing to inequality in OHSU. Marginal effect and elasticity were used to calculate the relative absolute shares of socio-demographic variables in the inequality. The rate of OHSU was 63.61% (CI: 60-66.80) which concentrated among households with better socioeconomic status. Based on the results, living in an affluent neighborhood (Relative share (RS): 85.48) and having a disabled member in the household (RS: 6.58) were the most important factors in the concentration of OHSU in favor of the privileged groups. In contrast, very low levels of health knowledge (RS: -83.79) and having basic insurance coverage (RS: -3.92) concentrated OHSU in favor of the lower socioeconomic households. The study was conducted based on survey data, and this may lead to some limitations. Given that this study was a cross-sectional study, we were unable to establish causal relationships between explanatory variables and outpatient health service utilization and its relevant predictors. Households with disabled member(s), as well as a member(s) with chronic diseases, may experience severe inequalities in access to healthcare services. Policies that facilitate access to health services for these households can play a significant role in improving health equity.
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Affiliation(s)
| | | | - Mehdi Basakha
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Sina Ahmadi
- Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Homeira Sajjadi
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Zhang M, Sit JWH, Wang T, Chan CWH. Exploring the sources of cervical cancer screening self-efficacy among rural females: A qualitative study. Health Expect 2023; 26:2361-2373. [PMID: 37504888 PMCID: PMC10632632 DOI: 10.1111/hex.13840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 06/02/2023] [Accepted: 07/26/2023] [Indexed: 07/29/2023] Open
Abstract
AIM Evidence showed self-efficacy was relevant to rural females' cervical cancer screening behaviour. However, little is known about sources of self-efficacy in cervical cancer screening among rural females. This study aimed to explore sources of self-efficacy in cervical cancer screening among rural females. DESIGN A qualitative descriptive study was conducted. Both users and providers of cervical cancer screening services in rural areas of China were recruited through maximum variation sampling. METHODS Individual semi-structured interviews through telephone calls were conducted. Data were analysed via six main stages of the framework method, with the social cognitive theory as a reference. RESULTS Four main sources were identified, including personal screening experience, hearing about other women's screening experiences, professional health education and consultation, and emotional status. Personal screening experience included enactive mastery of completing the screening behaviour and cognitive mastery of internalisation of the screening. Only the experience of completing cervical cancer screening behaviour was not strong enough to improve self-efficacy. Cognitive mastery showed more critical influence. CONCLUSION These four sources of rural females' cervical cancer screening self-efficacy matched with the major sources of self-efficacy of the social cognitive theory. Cognition was critical to influencing the screening self-efficacy. Intervention strategies aimed at enhancing rural females' cervical cancer screening self-efficacy can be developed from these four major sources. PUBLIC CONTRIBUTION A registered nurse with rich experience in cervical cancer-related research and qualitative study was the interviewer of this study. Rural females and cervical cancer screening services providers (healthcare professionals and village staff) were recruited as interviewees. The interview guides were developed by the research team and evaluated by an expert panel including two nurse leaders of gynaecological cancer, one doctor specialised in cervical cancer, and one medical director in a local rural hospital.
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Affiliation(s)
- Mengyue Zhang
- The Nethersole School of Nursing, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Janet W. H. Sit
- The Nethersole School of Nursing, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Tingxuan Wang
- School of Nursing, LKS Faculty of MedicineThe University of Hong KongHong KongChina
| | - Carmen W. H. Chan
- The Nethersole School of Nursing, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
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Zhang T, Su M, Li D, Zhang W, Yang F, Li W. Equity in health service utilisation among middle-aged and elderly people with multiple chronic conditions in China: evidence from longitudinal data of 2011-2018 CHARLS. BMJ Open 2023; 13:e072320. [PMID: 37816559 PMCID: PMC10565265 DOI: 10.1136/bmjopen-2023-072320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/04/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVES Equity in health service utilisation is a central objective for health systems. Middle-aged and elderly patients with multiple chronic conditions (MCCs) are particularly vulnerable to healthcare inequity. This study aimed to update the information on the trends in the incidence and equity of outpatient health service utilisation (OHSU) and inpatient health service utilisation (IHSU) for middle-aged and elderly MCCs patients in China, identify socioeconomic determinants that may contribute to inequity, and suggest optimisation strategies to mitigate this disparity. METHODS Panel data obtained from four waves of the China Health and Retirement Longitudinal Study (CHARLS) were used to determine the trends in OHSU and IHSU. The inequity in OHSU and IHSU was measured by the Concentration Index (CI) and Horizontal Inequity Index (HI), which is a valid measure of health service utilisation equity. The decomposition model of the CI was set up to explore the contribution of various determinants of overall equity. RESULTS The annual rate of OHSU gradually decreased from 29.32% in 2011 to 27.27% in 2018. The HI remained positive and decreased from 0.0803 in 2011 to 0.0662 in 2018, indicating the existence of pro-rich inequity. The annual rate of IHSU gradually increased from 13.31% in 2011 to 19.89% in 2018. The HI remained positive and showed a declining trend from 0.2363 in 2011 to 0.0574 in 2018, evidencing pro-rich inequity; however, a trend towards the easing of inequity was observed. CONCLUSIONS Pro-rich inequity was present in both OHSU and IHSU among middle-aged and elderly MCCs patients in China. Economic status, area, education and age were the main contributors to pro-rich inequity. Concerted efforts are needed to allocate resources for mitigating health service utilisation inequity in middle-aged and elderly people with MCCs.
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Affiliation(s)
- Tianjiao Zhang
- School of Public Administration, Inner Mongolia University, Hohhot, China
| | - Min Su
- School of Public Administration, Inner Mongolia University, Hohhot, China
| | - Dongxu Li
- School of Public Administration, Inner Mongolia University, Hohhot, China
| | - Weile Zhang
- School of Public Administration, Inner Mongolia University, Hohhot, China
| | - Fan Yang
- School of Public Administration, Inner Mongolia University, Hohhot, China
| | - Wenhui Li
- School of Public Administration, Inner Mongolia University, Hohhot, China
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Jiang X, Lu W, Luo H, Yang J, Chen M, Wang J, Wu M, Chen X, Tang Y, Hu Y, Zhang L. Spirituality and Attitudes Toward Death Among Older Adults in Rural and Urban China: A Cross-Sectional Study. JOURNAL OF RELIGION AND HEALTH 2023; 62:3070-3094. [PMID: 37012553 PMCID: PMC10071228 DOI: 10.1007/s10943-023-01794-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 06/19/2023]
Abstract
The purpose of this study was to investigate spirituality and attitudes toward death among rural and urban elderly. We asked 134 older adults from rural areas and 128 from urban areas to complete a self-administrated questionnaire including the Spiritual Self-assessment Scale and Death Attitude Scale. The fear and anxiety of death, escape acceptance, natural acceptance, approach acceptance, and death avoidance scores of older adults living in rural areas were higher than those living in urban areas. The construction of social infrastructure and medical care should be strengthened in rural areas so as to improve older adults' attitudes toward death.
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Affiliation(s)
- Xiucheng Jiang
- School of Nursing, Chengdu Medical College, No. 783, Xindu Avenue, Xindu District, Chengdu, Sichuan Province, China
| | - Weinan Lu
- School of Nursing, Chengdu Medical College, No. 783, Xindu Avenue, Xindu District, Chengdu, Sichuan Province, China
- Nursing Department, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Hui Luo
- School of Nursing, Chengdu Medical College, No. 783, Xindu Avenue, Xindu District, Chengdu, Sichuan Province, China
| | - Jianhua Yang
- School of Nursing, Chengdu Medical College, No. 783, Xindu Avenue, Xindu District, Chengdu, Sichuan Province, China
| | - Min Chen
- Nursing Department, Pidu District People's Hospital, Chengdu, Sichuan, China
| | - Jiayu Wang
- School of Nursing, Chengdu Medical College, No. 783, Xindu Avenue, Xindu District, Chengdu, Sichuan Province, China
| | - Mengping Wu
- School of Nursing, Chengdu Medical College, No. 783, Xindu Avenue, Xindu District, Chengdu, Sichuan Province, China
| | - Xiyao Chen
- School of Nursing, Chengdu Medical College, No. 783, Xindu Avenue, Xindu District, Chengdu, Sichuan Province, China
| | - Yuanyuan Tang
- School of Nursing, Chengdu Medical College, No. 783, Xindu Avenue, Xindu District, Chengdu, Sichuan Province, China
| | - Yanli Hu
- School of Nursing, Guangzhou Medical University, No.1, Xinzao Road, Xinzao Town, Panyu District, Guangzhou, Guangdong Province, China.
| | - Limei Zhang
- School of Nursing, Chengdu Medical College, No. 783, Xindu Avenue, Xindu District, Chengdu, Sichuan Province, China.
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Jakovljevic M, Chang H, Pan J, Guo C, Hui J, Hu H, Grujic D, Li Z, Shi L. Successes and challenges of China's health care reform: a four-decade perspective spanning 1985-2023. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:59. [PMID: 37649062 PMCID: PMC10469830 DOI: 10.1186/s12962-023-00461-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/26/2023] [Indexed: 09/01/2023] Open
Abstract
Chinese health system remains the crucial one for understanding the wider healthcare landscape across the Global South and in particular the leading Emerging Markets. Purpose of our observation was to understand the inner dynamics of mainland Chinese health reforms adopting a lengthy time horizon. We have analysed the public reports and seminal evidence on Chinese of multiple waves of national health reforms taking place since 1980s in terms of medical care and pharmaceuticals provision and financing. Chinese international trade with ASEAN nations and wider South-East Asia is accelerating its growth after the recovery of trade routes. In terms of health sector this means that global demand and supply of medical goods, services and pharmaceuticals remains largely driven by Chinese domestic developments. Furthermore, Chinese domestic manufacturing and sales of decent quality medical devices and services have grown exponentially. Some temporary pitfalls and increasing in rural-urban inequalities in equity of access and affordability of medical care and pharmaceuticals did take place. Despite these difficulties to generate a balanced development strategy for the largest global market, this is a clear path upwards. Further upcoming improvements expanding health insurance coverage are in strong demand for certain layers of the society. Domestic bottleneck weaknesses yet remain manufacturing, import and market penetration of cutting-edge pharmaceuticals such as monoclonal antibodies and targeted oncology agents. Yet some of these obstacles are likely to be overcome in foreseeable future with the adoption of responsible strategies by governmental agencies in health care arena.
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Affiliation(s)
- Mihajlo Jakovljevic
- Institute of Comparative Economic Studies, Hosei University Faculty of Economics, Tokyo, Japan.
- Department of Global Health Economics and Policy, University of Kragujevac, 34000, Kragujevac, Serbia.
- Institute of Advanced Manufacturing Technologies, Peter the Great St. Petersburg Polytechnic University, Saint Petersburg, Russian Federation.
| | - Hanyu Chang
- Department of Medical Insurance, The First Hospital of Lanzhou University, Lanzhou, China
| | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- School of Public Administration, Sichuan University, Chengdu, China
| | - Chao Guo
- Institute of Population Research, Peking University, Beijing, China
| | - Jin Hui
- School of Economics and Management, Zhejiang Sci-Tech University, Hangzhou, China
| | - Hao Hu
- Institute of Chinese Medical Sciences, University of Macau, Macao, SAR, China
| | - Danko Grujic
- Clinic for Cardiac Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Zhong Li
- School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lizheng Shi
- Health Systems Analytics Research Center, Tulane University, New Orleans, USA
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Zhang M, Sit JW, Choi KC, Chan CW. A theory-driven, culture-tailored educational intervention for cervical cancer screening among rural Chinese females: A feasibility and pilot study. Asia Pac J Oncol Nurs 2023; 10:100218. [PMID: 37288349 PMCID: PMC10242496 DOI: 10.1016/j.apjon.2023.100218] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/20/2023] [Indexed: 06/09/2023] Open
Abstract
Objective This study aimed to evaluate the feasibility and preliminarily estimate the effects of a theory-driven, culture-tailored, community-based educational intervention promoting cervical cancer screening among rural females. Methods An experimental study with the two-arm parallel, nonrandomized control trial design was implemented, followed by individual semi-structured interviews. Thirty rural females between 26 and 64 were recruited, with 15 in each group. Both groups were exposed to the usual care about cervical cancer screening promotion from the local clinics, while participants in the intervention group additionally received five educational sessions in 5 weeks. Data were collected at baseline and immediately postintervention. Results All participants completed the study, and the retention rate was 100%. Participants in the intervention group had more significant increments in cervical cancer screening-related self-efficacy (P < 0.001), knowledge (P < 0.001), and intention levels (P = 0.003) than those in the control group. Most participants showed acceptance and satisfaction with this educational intervention. Conclusions This study revealed that the theory-driven, culture-tailored, community-based educational intervention was feasible among the rural populations to promote cervical cancer screening. A large-scale interventional study with a prolonged follow-up duration is warranted to explore this educational intervention's effectiveness further.
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Chen Q, Cheng J, Tu J. Analysing the global and local spatial associations of medical resources across Wuhan city using POI data. BMC Health Serv Res 2023; 23:96. [PMID: 36709274 PMCID: PMC9883876 DOI: 10.1186/s12913-023-09051-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 01/09/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND There is a sharp contradiction between the supply and demand of medical resources in the provincial capitals of China. Understanding the spatial patterns of medical resources and identifying their spatial association and heterogeneity is a prerequisite to ensuring that limited resources are allocated fairly and optimally, which, along with improvements to urban residents' quality of life, is a key aim of healthy city planning. However, the existing studies on medical resources pattern mainly focus on their spatial distribution and evolution characteristics, and lack the analyses of the spatial co-location between medical resources from the global and local perspectives. It is worth noting that the research on the spatial relationship between medical resources is an important way to realize the spatial equity and operation efficiency of urban medical resources. METHODS Localized colocation quotient (LCLQ) analysis has been used successfully to measure directional spatial associations and heterogeneity between categorical point data. Using point of interest (POI) data and the LCLQ method, this paper presents the first analysis of spatial patterns and directional spatial associations between six medical resources across Wuhan city. RESULTS (1) Pharmacies, clinics and community hospitals show "multicentre + multicircle", "centre + axis + dot" and "banded" distribution characteristics, respectively, but specialized hospitals and general hospitals present "single core" and "double core" modes. (2) Overall, medical resources show agglomeration characteristics. The degrees of spatial agglomeration of the five medical resources, are ranked from high to low as follows: pharmacy, clinic, community hospital, special hospital, general hospital and 3A hospital. (3) Although pharmacies, clinics, and community hospitals of basic medical resources are interdependent, specialized hospitals, general hospitals and 3A hospitals of professional medical resources are also interdependent; furthermore, basic medical resources and professional medical resources are mutually exclusive. CONCLUSIONS Government and urban planners should pay great attention to the spatial distribution characteristics and association intensity of medical resources when formulating relevant policies. The findings of this study contribute to health equity and health policy discussions around basic medical services and professional medical services.
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Affiliation(s)
- Qiao Chen
- grid.464325.20000 0004 1791 7587School of Tourism and Hospitality Management, Hubei University of Economics, Wuhan, 430205 China
| | - Jianquan Cheng
- grid.25627.340000 0001 0790 5329Department of Natural Sciences, Manchester Metropolitan University, Manchester, M1 5GD UK ,grid.411856.f0000 0004 1800 2274Centre for Health Geographic Information, Key Laboratory of Environmental Change and Resource Use in Beibu Gulf (Ministry of Education), Nanning Normal University, 175 MingxiuDonglu Road, 530051 Nanning, PR China
| | - Jianguang Tu
- grid.49470.3e0000 0001 2331 6153School of Remote Sensing and Information Engineering, Wuhan University, Wuhan, 430070 PR China ,China Aero Geophysical Survey and Remote Sensing Center for Natural Resource, Beijing, 100083 China
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Inequality of opportunity in health service utilization among middle-aged and elderly community-dwelling adults in China. Arch Public Health 2023; 81:13. [PMID: 36698213 PMCID: PMC9878938 DOI: 10.1186/s13690-022-01010-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/06/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The inequality caused by circumstances is known as "inequality of opportunity" (IOp). Many scholars have studied IOp in the health field, but few studies have quantified contributors to the IOp of health service utilization among middle-aged and elderly people. This study measured the IOp of health service utilization and decomposed the contributors to IOp present among Chinese middle-aged and elderly people. METHODS Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) in 2013, 2015 and 2018. A mean-based regression method was adopted to measure the IOp of health service utilization. Shapley-Shorrocks decomposition was used to analyze the main contributors to IOp seen among the middle-aged and elderly. RESULTS Although the absolute IOp of health service utilization decreased over time, IOp still explains the total inequality to a large extent. The absolute IOp and relative IOp were greatest in the areas of self-treatment and inpatient care utilization, respectively. Shapley decomposition results showed that the out-of-pocket (OOP) ratio contributed most to the IOp of outpatient care utilization; and the residence area highly explains the IOp of inpatient service utilization. Meanwhile, social and economic factors such as work status and income contribute more to the IOp of inpatient care utilization than outpatient and self-treatment. CONCLUSIONS Strategies aimed at achieving equal opportunities remain necessary to ensure the fairness of health service utilization. Policies and measures should further adjust the medical insurance compensation policies, and pay more attention to the middle-aged and elderly residents in rural areas, optimize health resource allocation, improve the social security systems, and narrow the socioeconomic gap between urban and rural areas in China.
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Valls Martínez MDC, Montero JM, Biggeri A. Editorial: National health services: Efficiency, welfare and economy. Front Public Health 2022; 10:1095825. [PMID: 36530661 PMCID: PMC9755878 DOI: 10.3389/fpubh.2022.1095825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- María del Carmen Valls Martínez
- Mediterranean Research Center on Economics and Sustainable Development, Economics and Business Department, University of Almería, Almería, Spain,*Correspondence: María del Carmen Valls Martínez
| | - José-María Montero
- Department of Political Economy and Public Finance, Economic and Business Statistics, and Economic Policy, University of Castilla-La Mancha, Toledo, Spain
| | - Annibale Biggeri
- Department of Cardio-Thoracic-Vascular Science and Public Health, University of Padua, Padua, Italy
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18
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Asmare G, Madalicho M, Sorsa A. Disparities in full immunization coverage among urban and rural children aged 12-23 months in southwest Ethiopia: A comparative cross-sectional study. Hum Vaccin Immunother 2022; 18:2101316. [PMID: 36054825 DOI: 10.1080/21645515.2022.2101316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Vaccination coverage worldwide fell from 86% in 2019 to 83% in 2020. The purpose of this research was to determine the level of full immunization coverage among children aged 12 to 23 months in both urban and rural Southwest Ethiopia. A comparative cross-sectional study of sampled 644 children aged 12 to 23 months was conducted in the community (296 from urban areas and 348 from rural areas). Chi-square testing was used to determine whether there was a significant difference in full immunization coverage between urban and rural children, and binary logistic regression was used to identify predictors of full immunization. This study included 635 caregivers of children aged 12-23 months (292 from urban areas and 343 from rural areas), yielding a 98.4% response rate. The overall, full immunization coverage among the whole children was 66.1%. There was a significant difference in fully immunization coverage between urban 74.3% and rural 59.2% of children (χ2 = 16.126, P = .000). Residence, wealth index, ANC follow up and fear of COVID 19 infection at health institutions were predictor variables for overall full vaccination. Knowledge and place of delivery were predictor variables for full vaccination in the urban area whereas distance and male partner involvement in the rural area. Vaccination coverage was higher in urban compared to rural areas but it is still far below the WHO recommended target. Promoting male involvement, health education, and communication are crucial for alleviating poor knowledge about child immunization.
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Affiliation(s)
- Getachew Asmare
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Merkine Madalicho
- Department of Expanded Program of Immunization, Wolaita Zone Health Department, Wolaita Sodo, Ethiopia
| | - Abebe Sorsa
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Zhao Q, Xu S, Aziz N, He J, Wang Y. Dialect culture and the utilization of public health service by rural migrants: Insights from China. Front Public Health 2022; 10:985343. [PMID: 36438266 PMCID: PMC9687394 DOI: 10.3389/fpubh.2022.985343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/26/2022] [Indexed: 11/12/2022] Open
Abstract
The right to health is a fundamental human right for human beings to live in dignity. Everyone has the right to enjoy the fair and accessible highest standard of health by utilizing public health services. However, access to essential public health services also highly depends on the dialect culture. It is believed that the dialect culture also influences the efficiency of public health policies. To explore the phenomenon empirically, the current study utilized data sourced from geographical distribution information of Chinese dialects and the China Migrants Dynamic Survey for 2017. The study employed the Probit, IVprobit, and Eprobit models to estimate the impact of dialect culture on migrants' use of public health services. The findings revealed that the dialect culture significantly hinders the migrants' utilization of public health services. Further, by employing heterogeneity analysis, the findings revealed that the results are more pronounced in migrants, born after 1980, and are female with low educational background and also those migrants having local medical experiences and moving toward non-provincial cities. Finally to explore the mechanism of dialect culture influencing migrants' public health service, the study employed mediation analysis and KHB Method. The findings revealed that information transmission, health habits, social capital, and cultural identity are the potential pathways influencing the migrants' use of public health services. The findings conclude that rural-to-urban migrants' access to public health services is influenced by their cultural adaptation. Hence, the study proposes that the government should amend the policy inefficiency concerns caused by cultural differences and strengthen the regional cultural exchanges to build trust.
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Affiliation(s)
- Qingjun Zhao
- College of Economics and Management, Nanjing Agricultural University, Nanjing, China
| | - Siyu Xu
- College of Economics and Management, Nanjing Agricultural University, Nanjing, China
| | - Noshaba Aziz
- School of Economics, Shandong University of Technology, Zibo, China
| | - Jun He
- College of Economics and Management, Nanjing Agricultural University, Nanjing, China,*Correspondence: Jun He
| | - Yue Wang
- Institute of Agricultural Economics and Development, Jiangsu Academy of Agricultural Sciences, Nanjing, China
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Analysis of inequality in the distribution of general practitioners in China: evidence from 2012 to 2018. Prim Health Care Res Dev 2022; 23:e59. [PMID: 36117274 PMCID: PMC9532852 DOI: 10.1017/s1463423622000408] [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] [Indexed: 11/26/2022] Open
Abstract
Aim: This paper aims to analyze the inequalities in general practitioner (GP) distribution in China. Background: GPs-based primary health care (PHC) has been implemented from 2011 in China, aiming to improve the accessibility and quality of basic medical and healthcare services. GPs in China, as the gatekeeper of people’s health, mainly undertake integrated health services at the grass-roots level. Methods: The number of GPs and inequality in GPs distribution from 2012 to 2018 was analyzed by the Lorenz Curve/Gini coefficient and Theil L index. Data were extracted from China Health Statistical Yearbook 2013–2019. Findings: The demographic Gini coefficient of GPs changed from 2012 (0.234) to 2018 (0.167), showing high equality in China. In contrast, the Thiel L index from 2012 (0.372) to 2018 (0.345) showed less equality. The decomposition of Thiel L index implicated the inequalities within the divisions. The number of GPs in China shows a fast growth trend since the general practice system established, and the GPs distribution becomes more demographically equitable. However, the shortage of GPs and inequality in their distribution remains severe. More incentive and supportive policies need to be made to enhance the quantity, quality, and structure of GPs in China.
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Zhang H, Fu Y, Chen M, Si L. Socioeconomic inequality in health care use among cancer patients in China: Evidence from the China health and retirement longitudinal study. Front Public Health 2022; 10:942911. [PMID: 35983352 PMCID: PMC9379281 DOI: 10.3389/fpubh.2022.942911] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCancer is a major public health problem worldwide and the leading cause of death in China, with increasing incidence and mortality rates. This study sought to assess socioeconomic-related inequalities in health care use among cancer patients in China and to analyze factors associated with this disparity.MethodsThis study used data collected for the China Health and Retirement Longitudinal Study in 2018. Patients who reported having cancer were included. The annual per capita household expenditure was classified into five groups by the quintile method. We calculated the distribution of actual, need-predicted, and need-standardized health care use across different socioeconomic groups among patients with cancer. The concentration index (CI) was used to evaluate inequalities in health care use. Influencing factors of inequalities were measured with the decomposition method.ResultsA total of 392 people diagnosed with cancer were included in this study. The proportion of cancer patients who utilized outpatient and inpatient services was 23.47% and 40.82%, respectively, and the CIs for actual outpatient and inpatient service use were 0.1419 and 0.1960. The standardized CIs (CI for outpatient visits = 0.1549; CI for inpatient services = 0.1802) were also both positive, indicating that affluent cancer patients used more health services. The annual per capita household expenditure was the greatest factor favoring the better-off, which contributed as much as 78.99% and 83.92% to the inequality in outpatient and inpatient services use, followed by high school education (26.49% for outpatient services) and living in a rural village (34.53% for inpatient services). Urban Employee Basic Medical Insurance exacerbated the inequality in inpatient services (21.97%) while having a negative impact on outpatient visits (−22.19%).ConclusionsThere is a pro-rich inequality in outpatient and inpatient services use among cancer patients in China. A lower socioeconomic status is negatively associated with cancer care use. Hence, more targeted financial protection for poor people would relieve cancer patients of the burden caused by the high cost of cancer care.
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Affiliation(s)
- Huiru Zhang
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Yu Fu
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Mingsheng Chen
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
- Center for Global Health, Nanjing Medical University, Nanjing, China
- *Correspondence: Mingsheng Chen
| | - Lei Si
- The George Institute for Global Health, UNSW Sydney, Kensington, NSW, Australia
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22
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Li W, Gao G, Sun F, Jiang L. The role of community factors in predicting depressive symptoms among Chinese workforce: a longitudinal study in rural and urban settings. BMC Public Health 2022; 22:1429. [PMID: 35897001 PMCID: PMC9326139 DOI: 10.1186/s12889-022-13647-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background The dual urban–rural division system in China has led to distinguishes in economic development, medical services, and education as well as in mental health disparities. This study examined whether community factors (community cohesion, supportive network size, foreseeable community threat, and medical insurance coverage) predict the depressive symptoms of Chinese workers and how community factors may work differently in rural and urban settings. Methods This secondary data analysis was conducted using data from the 2014 and 2016 China Labor-force Dynamics Survey (CLDS). The sample of this study includes 9,140 workers (6,157 rural labors and 2,983 urban labors) who took part in both the 2014 and 2016 CLDS. This study discusses the relation between community factors and depressive symptoms of Chinese workers by correlation analysis and regression analysis. All analyses were conducted using SPSS 24.0. Results The results indicate that rural workers have higher levels of depressive symptoms than urban workers. Medical benefits coverage predicts depressive symptoms of rural workforces (B = -0.343, 95%CI = -0.695 ~ 0.009, p < . 10), and community supportive network size predicts depressive symptoms of urban workforces (B = -.539, 95%CI = -0.842 ~ 0.236, p < . 01). Conclusions Policymakers may address depressive symptoms of rural labor through improved coverage of medical benefits. In urban areas, efforts can be made to strengthen community supportive network for the urban labor force.
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Affiliation(s)
- Wanlian Li
- Emergency Management Teaching and Research Department, Guangdong Institute of Public Administration, No. 3 Jianshe Ave., Yuexiu District, Guangzhou, Guangdong, China
| | - Guanghan Gao
- Zhou Enlai School of Government, Nankai University, No. 38 Tongyan Road, Jinnan District, Tianjin, China
| | - Fei Sun
- School of Social Work, Michigan State University, 150 Baker Hall, 655 Auditorium Rd., East Lansing, MI, USA
| | - Lin Jiang
- School of Social Work, University of Texas Rio Grande Valley, 1201 W. University Drive, TX, Edinburg, USA.
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Deng SY, Zhao IY, Ho MH, Saravanakumar P, Molassiotis A, Montayre J. Rural-urban disparities in healthy ageing: Evidence from a national study in China. Collegian 2022. [DOI: 10.1016/j.colegn.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dai B, Larnyo E, Larnyo A, Nutakor JA, Amerley Amarteifio EN, Frimpong Y, Addai-Dansoh S. Predictors of Healthcare Utilization Among Older Adults with Moderate to Severe Cognitive Limitations in Ghana: A Cross-Sectional Analysis of the WHO Study on Global Ageing and Adult Health (SAGE) Wave 1. Curr Alzheimer Res 2022; 19:585-605. [PMID: 36065914 DOI: 10.2174/1567205019666220905153301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/24/2022] [Accepted: 08/09/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND As the number of older adults in Ghana keeps increasing, so does the prevalence of aging-related diseases and conditions that tend to lead to cognitive decline. However, knowledge on the predicting factors of healthcare utilization among older adults with cognitive limitations is still scarce. OBJECTIVE This study examines the predictive factors of healthcare-seeking behavior among older adults with moderate-to-severe cognitive limitations in Ghana. METHODS Based on Andersen's behavioral model of health service utilization, the study analyzed data from 3106 older adults with moderate to severe cognitive limitations in Ghana aged 50+ using Bivariate Probit Regression and the Heckman Selection Model. RESULTS Results showed that individuals who were aged 75+, living in urban settlements, educated, higher income levels and parents who had some level of education, pension benefits, and both mandatory and voluntary health insurance were more likely to seek inpatient care. Enabling resources such as the national health insurance scheme and other types of medical insurance, household income, pension benefits, and predisposition factors like education influenced outpatient and inpatient healthcare consumption for older adults with moderate to severe cognitive limitations but had little influence on the choice of healthcare facility except for health insurance. CONCLUSION Since the healthcare-seeking behavior of older adults with moderate-to-severe cognitive limitations is driven by an amalgamation of several internal and external factors, there is a need for policy change to understand and cautiously incorporate these factors into the decision to improve equitable access to healthcare services for these individuals, as not all sizes fit all in providing quality care for them.
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Affiliation(s)
- Baozhen Dai
- Department of Labor and Social Security, School of Public Health, Southeast University, Nanjing, Jiangsu Province 210009, China
| | - Ebenezer Larnyo
- Department of Health Policy and Management, School of Management, Jiangsu University, Zhenjiang, Jiangsu Province 212013, China
| | - Abigail Larnyo
- School of Management, Jiangsu University, Zhenjiang, Jiangsu Province 212013, China
| | - Jonathan Aseye Nutakor
- Department of Health Policy and Management, School of Management, Jiangsu University, Zhenjiang, Jiangsu Province 212013, China
| | - Edwina Naa Amerley Amarteifio
- Department of Health Policy and Management, School of Management, Jiangsu University, Zhenjiang, Jiangsu Province 212013, China
| | - Yaw Frimpong
- Department of Health Policy and Management, School of Management, Jiangsu University, Zhenjiang, Jiangsu Province 212013, China
| | - Stephen Addai-Dansoh
- Department of Health Policy and Management, School of Management, Jiangsu University, Zhenjiang, Jiangsu Province 212013, China
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Fu L, Fang Y, Dong Y. The healthcare inequality among middle-aged and older adults in China: a comparative analysis between the full samples and the homogeneous population. HEALTH ECONOMICS REVIEW 2022; 12:34. [PMID: 35761111 PMCID: PMC9238267 DOI: 10.1186/s13561-022-00383-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In the Chinese population, the middle-aged and older adults are the two main segments that utilize a large portion of healthcare. With the fast growth of the two segments, the demands of healthcare services increases significantly. The issue related to inequality in utilization of healthcare emerges with the growth and it deserves more attention. Most existing studies discuss overall inequality. Less attention is paid to inequality among subdivisions, that is, relative inequality. This study focuses on the inequality of healthcare utilization among the homogeneous population and the inequality of the full samples in China. METHODS Data were obtained from four waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013, 2015 and 2018. First, the Concentration Index (CI) was used to measure the inequality of outpatient, inpatient and preventive care for the samples, and regression analysis was applied to decompose the contributing factors of inequality. Then SOM is introduced to identify homogeneous population through clustering and measure the inequality in three types of healthcare utilization among homogeneous population. Based on this, the difference between absolute inequalities and relative inequalities was discussed. RESULTS The preventive care is shown to have the highest degree of inequality inclined to the rich and has the largest increase (CI: 0.048 in 2011 ~ 0.086 in 2018); The inequality degree in outpatient care appears to be the smallest (CI: -0.028 in 2011 ~ 0.014 in 2018). The decomposition results show that age, education, income, chronic disease and self-reported health issues help explain a large portion of inequality in outpatient and inpatient care. And the contribution of socioeconomic factors and education to the inequality of preventive care is the largest. In regards to three types of healthcare among the homogeneous population, the degree of inequality seems to be higher among group with high socioeconomic status than those with lower socioeconomic status. In particular, for the people who are in the high socioeconomic group, the degree of inequality in preventive care is consistently higher than in outpatient and inpatient care. The inequality degree of preventive care in the low socioeconomic status group varies significantly with the flexibility of their response to policies. CONCLUSIONS Key policy recommendations include establishing a health examination card and continuously improving the fit of free preventive care with the needs of the middle-aged and older adults; developing CCB activities to avoid people's excessive utilization in the high socioeconomic status group or insufficient utilization in the low socioeconomic status group; reasonable control of reimbursement and out-of-pocket payments.
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Affiliation(s)
- Liping Fu
- College of Management and Economics, Tianjin University; Center for Social Science Survey and Data, Tianjin University, Tianjin, 300072, China
- College of Politics and Public Administration, Qinghai Minzu University, Qinghai, 810007, China
| | - Ya'nan Fang
- College of Management and Economics, Tianjin University; Center for Social Science Survey and Data, Tianjin University, Tianjin, 300072, China.
| | - Yongqing Dong
- College of Management and Economics, Tianjin University; Center for Social Science Survey and Data, Tianjin University, Tianjin, 300072, China
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Zhang M, Sit JWH, Chan DNS, Akingbade O, Chan CWH. Educational Interventions to Promote Cervical Cancer Screening among Rural Populations: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116874. [PMID: 35682457 PMCID: PMC9180749 DOI: 10.3390/ijerph19116874] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/27/2022] [Accepted: 06/01/2022] [Indexed: 02/04/2023]
Abstract
The urban-rural gap in cervical cancer screening uptake is a significant public health consideration. Educational interventions are commonly adopted to promote cervical cancer screening among females in rural areas; however, the characteristics and effectiveness of these educational interventions remain unclear. In this review, we aimed to identify the characteristics of educational interventions used in rural populations and to evaluate the effects of these interventions on cervical cancer screening-related outcomes. Seven English databases were searched in January 2022. Randomized controlled trials (RCTs) and quasi-experimental studies were included. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Randomized Controlled Trials and the JBI Critical Appraisal Checklist for Quasi-Experimental Studies were used for quality appraisal. RevMan 5.4 software was used for the meta-analysis. A narrative synthesis was conducted in instances where a meta-analysis was inappropriate. Three RCTs and seven quasi-experimental studies conducted in six countries were included. A social cognitive theory-based framework, the community setting, group sessions, healthcare professional-led approaches, and culture-tailored materials were implemented in the educational interventions for cervical cancer screening. The educational content mainly included basic information on cervical cancer screening, psychological issues, barriers and strategies to overcome them, and locally available resources. Educational interventions increased the knowledge and uptake of cervical cancer screening in the rural population. However, the studies only evaluated the short-term effects of these educational interventions, with the cervical screening behavior only being assessed in one instance for each participant. Educational interventions promote cervical cancer screening among females in rural areas. Theory-driven, community-involved, group-based, and healthcare professional-led approaches should be prioritized in the application of educational interventions in rural populations. Both the short- and long-term, influences of educational interventions on the cervical cancer screening behavior of females in rural areas need to be recognized.
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Affiliation(s)
- Mengyue Zhang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Janet W H Sit
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Dorothy Ngo Sheung Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Oluwadamilare Akingbade
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Carmen W H Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
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Ai F, Wan X. Gini coefficient decomposition-based and mortality-rate-difference-based description of mortality causes in the Chinese population from 1991 to 2019: a retrospective cross-sectional surveillance study. BMJ Open 2022; 12:e059395. [PMID: 35487722 PMCID: PMC9058791 DOI: 10.1136/bmjopen-2021-059395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Improved national Disease Surveillance Points systems (DSPs) in China have clarified mortality causes in the Chinese population. This study aimed to investigate the variations and drivers of multiple mortality causes. DESIGN This was a retrospective cross-sectional surveillance study. SETTING Original data in 1991 and 2000, and secondary data in 2010 and 2019 were collected from DSPs across China. PARTICIPANTS Standardised mortality rates (SMRs) and crude mortality rates (CMRs) of the Chinese population in 1991, 2000, 2010 and 2019 were ascertained. MAIN OUTCOME MEASURES Changes in the Gini coefficients (G), computed using SMR, were decomposed into reranking (R) and proportionality (P) to identify variations in communicable, maternal, neonatal and nutritional diseases (CMNN); non-communicable diseases (NCDs) and injury. The CMR difference (in %) was partitioned into the demographic structure and non-demographic factors using the mortality-rate-difference method. RESULTS From 1991 to 2019, the overall CMR increased from 591.327/100 000 to 674.505/100 000, whereas the SMR continually decreased. An increasing concentration of NCDs contributed to the increased all-cause G from 0.443 to 0.560 during 1991-2019. Between 1991 and 2019, compared with CMNN (R=0.054) and NCDs (R=0.037), the ranking of injury changed the most (R=0.174). The ranking of diabetes, falls and road traffic accidents increased markedly over time. The decreased SMR of NCDs (P=-0.013) was mainly due to low-ranking causes, whereas changes in CMNN (P=0.003) and injury (P=0.131) were due to high-ranking causes. All-cause CMR increased by 14.06% from 1991 to 2019 due to greater contributions from the demographic structure (68.46%) than the non-demographic factors (-54.40%). Demographic structural changes accounted more for CMR increases in males (70.52%) and urban populations (75.58%). CONCLUSIONS Prevention and control measures targeting NCDs and specific causes are imperatively needed, and should be strengthened as the population ages, especially for males and rural populations.
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Affiliation(s)
- Feiling Ai
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Xia Wan
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
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Zhang X, Ning N, Zhou H, Shan L, Hao Y, Jiao M, Liang L, Kang Z, Li Y, Liu H, Liu B, Wang K, Ruzieva A, Gao L, Wu Q. Inequity in Health Services Utilization in Economically Underdeveloped Regions of Northeast China. Front Public Health 2022; 10:850157. [PMID: 35493377 PMCID: PMC9051237 DOI: 10.3389/fpubh.2022.850157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe Chinese health system has long been committed to eliminating inequalities in health services utilization. However, few studies have analyzed or measured these inequalities in economically underdeveloped regions in China.MethodsA total of 6,627 respondents from 3,000 households in Heilongjiang Province were extracted from the Sixth National Health Services Survey. We measured horizontal inequity in both 2-week outpatient rate and annual inpatient rate, and then identified the factors contributing to inequality.ResultsThe horizontal inequity indices of the 2-week outpatient and annual impatient rates in Heilongjiang Province were 0.0586 and 0.1276, respectively. Household income, health status, place of residence, basic medical insurance, and commercial health insurance were found to be the main factors affecting inequality in health services utilization. The contributions of household income to these two indices were 184.03 and 253.47%, respectively. Health status factors, including suffering from chronic disease, limitations in daily activities, and poor self-rated health, played positive roles in reducing inequality in these two indices. The contributions of place of residence to these two indices were 27.21 and −28.45%, respectively. Urban Employee Basic Medical Insurance made a pro-rich contribution to these two indices: 56.25 and 81.48%, respectively. Urban and Rural Resident Basic Medical Insurance, Urban Resident Basic Medical Insurance, New Rural Cooperative Medical Scheme, and other basic medical insurance made a pro-poor contribution to these two indices: −73.51 and −54.87%, respectively. Commercial health insurance made a pro-rich contribution to these two indices: 20.79 and 7.40%, respectively. Meanwhile, critical illness insurance made a slightly pro-poor contribution to these two indices: −4.60 and −0.90%, respectively.ConclusionsThe findings showed that the “equal treatment in equal need” principle was not met in the health services utilization context in Heilongjiang Province. To address this issue, the government could make policy changes to protect low-income populations from underused health services, and work to improve basic medical insurance, critical illness insurance, and social security systems.
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Affiliation(s)
- Xin Zhang
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Ning Ning
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Hongguo Zhou
- Office of Educational Administration, Ningbo College of Health Sciences, Ningbo, China
| | - Linghan Shan
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Yanhua Hao
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Mingli Jiao
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Libo Liang
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Zheng Kang
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Ye Li
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Huan Liu
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Baohua Liu
- School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, China
| | - Kexin Wang
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Adelina Ruzieva
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Lijun Gao
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
- *Correspondence: Lijun Gao
| | - Qunhong Wu
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
- Qunhong Wu
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Yuan H, Chen S, Pan G, Zheng L. Social Pension Scheme and Health Inequality: Evidence From China's New Rural Social Pension Scheme. Front Public Health 2022; 9:837431. [PMID: 35198537 PMCID: PMC8858825 DOI: 10.3389/fpubh.2021.837431] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/30/2021] [Indexed: 01/05/2023] Open
Abstract
Health equality is an essential component of social justice, and the social policies should be as conducive to promoting health equality as possible. Based on the data from China, this article uses the regression discontinuity design method and the technique of decomposition of concentration index to examine whether the social pension schemes can significantly reduce health inequality among the residents, and tries to compute the contribution rate of pension benefit in alleviating the health inequality. Our results show that the pension benefit can improve the health level of the rural subscribers, especially for the low-income population. Implement of New Rural Pension Scheme contributes to reducing the health inequality among the rural elderly with contribution rate of 39.32%. Our results contain important policy implications.
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Affiliation(s)
- Hui Yuan
- Department of Insurance, School of Finance, Zhongnan University of Economics and Law, Wuhan, China
| | - Shuoqi Chen
- Department of Insurance, School of Finance, Zhongnan University of Economics and Law, Wuhan, China
- *Correspondence: Shuoqi Chen
| | - Guochen Pan
- Department of Insurance and Actuarial Science, Economics and Management School, Wuhan University, Wuhan, China
| | - Lingyun Zheng
- Department of Insurance and Actuarial Science, Economics and Management School, Wuhan University, Wuhan, China
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30
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Liu L, Li Y, Song J, Chen Q, Li S, Mu H, Na J, Zhang R, Yu L, Sun W, Pan G. Current status of premature mortality from four non-communicable diseases and progress towards the Sustainable Development Goal target 3.4: a population-based study in northeast China, 2004-2017. BMC Public Health 2021; 21:1608. [PMID: 34470632 PMCID: PMC8411532 DOI: 10.1186/s12889-021-11611-0] [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: 03/23/2021] [Accepted: 08/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background and aim According to the United Nations’ Sustainable Development Goal (SDG) target 3.4, premature mortality from four non-communicable diseases (cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes mellitus, collectively referred to as NCD4) should achieve a minimum decline of 33% in 2030 relative to 2015. This remains a challenge for China. This study aimed to evaluate the current status and progress towards this target in Liaoning Province, one of the three provinces in northeast China. Methods We calculated the premature mortality rates (PMRs) per year and average annual percentage changes (AAPCs) from NCD4 using mortality data between 2004 and 2017. The trend was analyzed in the whole population, as well as in subpopulations of gender (male/female) and inhabiting area (urban/rural). PMRs from NCD4 for 2030 were projected by fitting a linear regression based on the current trend, which was identified by a Joinpoint model. Findings In the whole population, only chronic respiratory diseases showed a significant decline (AAPC: − 6.5%, p < 0.05), while only cancer showed a significant increase (AAPC: + 1.3%, p < 0.05); taken together, NCD4 showed a significant increase (AAPC: + 0.6%, p < 0.05). In the subpopulations, while males showed a significant increase in NCD4 (AAPC: + 1.5%, p < 0.05), cardiovascular diseases (AAPC: + 1.7%, p < 0.05), cancer (AAPC: + 1.8%, p < 0.05), and diabetes mellitus (AAPC: + 4.2%, p < 0.05), females showed a significant decline in NCD4 (AAPC: − 1.2%, p < 0.05), cardiovascular diseases (AAPC: − 1.8%, p < 0.05), diabetes mellitus (AAPC: − 2.1%, p < 0.05), but showed a mild increase in cancer (AAPC: + 0.5%, p > 0.05). A comparative analysis of the projected PMRs for 2030 with the 2015 levels revealed that only chronic respiratory diseases are expected to achieve the SDG target 3.4, apart from in the urban male subpopulation. Conclusion Except for chronic respiratory diseases, NCD4 cannot be expected to achieve the SDG target 3.4 in the whole population of Liaoning Province. Under these circumstances, special attention should be paid to reducing the risks of cancer and providing preventative interventions for men.
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Affiliation(s)
- Li Liu
- Institute of Preventive Medicine, China Medical University, Shenyang, 110122, People's Republic of China.,Institute of Chronic Diseases, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, People's Republic of China
| | - Yanxia Li
- Institute of Preventive Medicine, China Medical University, Shenyang, 110122, People's Republic of China.,Institute of Chronic Diseases, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, People's Republic of China
| | - Junmin Song
- Institute of Preventive Medicine, China Medical University, Shenyang, 110122, People's Republic of China.,Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
| | - Qian Chen
- Institute of Preventive Medicine, China Medical University, Shenyang, 110122, People's Republic of China.,Research Center for Universal Health, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, China
| | - Shuang Li
- Institute of Preventive Medicine, China Medical University, Shenyang, 110122, People's Republic of China.,Institute of Chronic Diseases, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, People's Republic of China
| | - Huijuan Mu
- Institute of Preventive Medicine, China Medical University, Shenyang, 110122, People's Republic of China.,Institute of Chronic Diseases, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, People's Republic of China
| | - Jun Na
- Institute of Preventive Medicine, China Medical University, Shenyang, 110122, People's Republic of China.,Institute of Chronic Diseases, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, People's Republic of China
| | - Rui Zhang
- Institute of Preventive Medicine, China Medical University, Shenyang, 110122, People's Republic of China.,Institute of Chronic Diseases, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, People's Republic of China
| | - Liya Yu
- Institute of Preventive Medicine, China Medical University, Shenyang, 110122, People's Republic of China.,Institute of Chronic Diseases, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, People's Republic of China
| | - Wei Sun
- Institute of Preventive Medicine, China Medical University, Shenyang, 110122, People's Republic of China.,Research Center for Universal Health, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, China
| | - Guowei Pan
- Institute of Preventive Medicine, China Medical University, Shenyang, 110122, People's Republic of China. .,Research Center for Universal Health, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, China.
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Xie Y, Guo Q, Meng Y. The health service use of aged rural-to-urban migrant workers in different types of cities in China. BMC Health Serv Res 2021; 21:606. [PMID: 34182984 PMCID: PMC8237433 DOI: 10.1186/s12913-021-06638-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The association between different types of cities and the use of health services by aged migrant workers in China has not been widely reported in previous studies. This article aims to focus on rural-to-urban migrant workers in China aged 50 years and older to examine the relationship between the region of these migrant workers' destination city (eastern, central or western) and migration city type (first-tier, second-tier, third-tier and smaller cities) and their use of health services (e.g., establishing health records, participating in health education, and seeking medical treatment when ill). METHODS This study's data were obtained from China Migrants Dynamic Survey in 2017. A total of 14,732 rural-to-urban migrant workers aged 50 years and older were included in the analysis; 6,938 of the migrant workers were either ill or had recently experienced physical discomfort. A chi-square test and binary logistic regression were performed to explore the associations between these rural-urban migrants' destination cities and their use of health services. RESULTS This study found that aged rural migrant workers who moved to the east or to first- or second-tier cities were less likely to establish health records, participate in health education programme, and seek medical care. CONCLUSIONS Migrant destination cities are linked to the use of local health services by migrant workers aged 50 years and older in China. We found that aged migrant workers who migrated to relatively developed regions and cities accessed fewer health services. Such results signify that more attention should be paid to aged migrant workers' use of health services in economically developed regions and cities, to eliminate regional differences in healthcare inequality.
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Affiliation(s)
- Yating Xie
- Research Center for Social Governance Innovation, Henan Agricultural University, Zhengzhou, 450006, Henan, China
| | - Qiuju Guo
- Elder Service Research Center, School of Sociology, Huazhong University of Science and Technology, Luoyu Road #1037, Hubei, 430074, Wuhan, China.
| | - Yang Meng
- The Institute for Population and Development Studies, Xi'an Jiaotong University, 710049, Xi'an, Shaanxi, China
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Routine Medical Check-Up and Self-Treatment Practices among Community-Dwelling Living in a Mountainous Area of Northern Vietnam. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8734615. [PMID: 33977109 PMCID: PMC8087461 DOI: 10.1155/2021/8734615] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 04/11/2021] [Accepted: 04/17/2021] [Indexed: 11/17/2022]
Abstract
This study was conducted to evaluate the routine medical check-up and self-treatment behaviors of people living in a remote and mountainous setting in Northern Vietnam and identify their associations. A cross-sectional study was conducted on 175 people in August 2018 in Cao Son commune, Da Bac district, Hoa Binh. Information regarding routine medical check-ups and self-treatment behaviors was collected by using a structured questionnaire. Multivariate logistic regression was used to examine the associations. Results show that 24% of the mountainous people had routine medical check-ups in the last 12 months. The rate of self-treatment in the past three months was 33.7%. The number of chronic diseases (OR = 1.5, 95% CI = 1.0-2.3), health information sources from radio/television (OR = 3.3, 95% CI = 1.2-9.5), or social media (OR = 24.8, 95% CI = 1.2-512.4) was related to routine medical check-up. People who did not have routine medical check-up were more likely to have self-treatment practice (OR = 6.3, 95% CI = 1.9-21.1) than those who had a regular health check. Promoting health education and communication through mass media to raise people's awareness about regular health check-ups is a promising way to improve people's self-treatment status.
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Vahedi S, Ramezani-Doroh V, Shamsadiny M, Rezapour A. Decomposition of gendered socioeconomic-related inequality in outpatient health care utilization: A cross-sectional study from Iran. Int J Health Plann Manage 2021; 36:656-667. [PMID: 33420750 DOI: 10.1002/hpm.3109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 10/26/2020] [Accepted: 12/20/2020] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Unequal access to required health care services could deteriorate inequality in health outcomes and increase mortality and morbidity, especially among disadvantaged groups. One of the most debated factors in shaping health care inequalities is gender. This study aimed to measure and explains gendered socioeconomic-related inequality in outpatient health care utilization in Iran. METHODS This is a cross-sectional research conducted at a national level in Iran. The required data was obtained from an Iranian health care utilization household survey conducted in 2015. Erreygers Concentration Index (ECI) was used to measure the socioeconomic inequality in outpatient health care utilization. A regression-based decomposition analysis was also used to explain socioeconomic-related inequalities. RESULTS There was a significant pro-rich inequality in outpatient health care utilization between males (ECI = 0.115, SE = 0.014) and females (ECI = 0.083 SE = 0.011) indicating that utilization of these services was concentrated on the better-offs. The decomposition analysis revealed that economic status (males = 50.58%, females = 37.42%) was the main contributor to the observed inequality. Location of residence, health insurance and education were other main driver of these inequalities. CONCLUSIONS Different factors have different contribution to socioeconomic-related inequality in utilization of outpatient health care services and these could be diversified considering gender. Hence, it seems that policy makers could be able to address these inequalities effectively through gender-oriented policies.
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Affiliation(s)
- Sajad Vahedi
- Department of Health Care Management, School of Health, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Vajiheh Ramezani-Doroh
- Department of Health Management and Economic, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Shamsadiny
- Health Center of Bandar Khamir, Hormozgan University of Medical Sciences, Hormozgan, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Lai F, Pei L, Yue S, Cao X, Xiao H, Li Y, Li J. Translation and validation of the Chinese version of medical maximizer-minimizer scale: a cross-sectional study. BMJ Open 2021; 11:e042432. [PMID: 33408206 PMCID: PMC7789444 DOI: 10.1136/bmjopen-2020-042432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Medical overutilisation and underutilisation affect optimal healthcare. The Medical Maximizer-Minimizer Scale (MMS) was developed to assess individual medical maximising and minimising tendencies. Despite significant improvement in the healthcare system over the past four decades, no psychometric scales to examine treatment maximising and minimising preferences are available in China. This study aimed to translate the MMS into Chinese and examine its reliability and validity in a Chinese population. DESIGN This cross-sectional study was conducted in December 2019 through an online survey panel. METHODS The MMS was translated into a Chinese version (CN-MMS) using a forward-backward translation procedure. Next, a random online survey of the general population in China was conducted. Exploratory factor analysis (EFA) and confirmatory factor analysis were performed to examine the underlying factor structure of the CN-MMS. The internal consistency reliability of the scale was determined using Cronbach's α coefficient and corrected item-total correlation. A multivariate linear regression analysis was used to examine associations between medical maximising and minimising preferences and demographic variables in the Chinese population. RESULTS This study included 984 participants aged 18-80 years. The CN-MMS retained 10 items, and the EFA supported a two-factor structure. The model fit for this two-factor structure of the CN-MMS was acceptable with χ2/df=3.7, comparative fit index=0.958, goodness-of-fit index=0.951, Tucker-Lewis Index=0.944 and root mean square error of approximation=0.074. The scale had a Cronbach's α coefficient of 0.864, corrected item-total correlation of 0.451-0.667, and test-retest reliability of 0.815. Significant predictors of CN-MMS total score were nationality and household monthly income. CONCLUSIONS The CN-MMS showed satisfactory psychometric properties. Therefore, it can be used to investigate the individual medical maximising and minimising tendencies among the general Chinese population.
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Affiliation(s)
- Fenghua Lai
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ling Pei
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shufan Yue
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaopei Cao
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haipeng Xiao
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanbing Li
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jin Li
- Department of Geriatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Zhang Z, Yin AT, Bian Y. Willingness to Receive Periodic Health Examination Based on the Health Belief Model Among the Elderly in Rural China: A Cross-Sectional Study. Patient Prefer Adherence 2021; 15:1347-1358. [PMID: 34188452 PMCID: PMC8232960 DOI: 10.2147/ppa.s312806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/02/2021] [Indexed: 01/09/2023] Open
Abstract
PURPOSE This study aimed to explore factors affecting behavioral intention of receiving periodic health examinations (hereafter, BIE) among people aged 60 and over in rural China, namely, Shandong Province, using the extended health belief model (EHBM). PATIENTS AND METHODS Participants were selected using stratified multi-stage random sampling. Three cities were selected based on economic level. Subsequently, three counties and three villages were selected from each sample city and county. Finally, 30 respondents were selected from each sample village. Face-to-face surveys were conducted using a structured questionnaire between March and September 2017. Multiple linear regression was conducted to investigate the association between BIE and eight dimensions of EHBM: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived self-efficacy, cues to action, health knowledge, and social support. RESULTS Of the 509 rural respondents aged 60 years and older, the average score of behavioral intention was 4.43±0.80. Multivariate linear regression analysis demonstrated poor BIE among participants who were men, were current smoker, were current drinker, were aged 70 years or over, had lower social support, and perceived lower self-efficacy, less benefits, and more barriers. Among them, barriers were found to have the strongest association with BIE (B'=-0.556; p<0.001). Qualitative interviews revealed that reasons for not receiving periodic health examinations (PHE) included pain, cost, difficulty in finding a health care provider, time and scheduling, potential lack of trust in the physician, and value of the PHE. CONCLUSION This study highlighted the importance of psychological variables in the acceptance of PHE among the elderly in rural China and provided insights for further intervention designs targeting identified groups and performed by general practitioners. Addressing medical mistrust, strengthening, and enhancing one's social support network and health communication channels, such as bulletin boards, may serve to facilitate BIE.
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Affiliation(s)
- Zhuo Zhang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau, People’s Republic of China
| | - Ai-Tian Yin
- School of Health Care Management, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
| | - Ying Bian
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau, People’s Republic of China
- Correspondence: Ying Bian Institute of Chinese Medical Sciences, University of Macau, Avenida da Universidade, Room 2055, N22 Building, Taipa, Macau SAR, People’s Republic of ChinaTel +853-66548926 Email
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