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Zhang J, Tong H, Jiang L, Zhang Y, Hu J. Trends and disparities in China's cardiovascular disease burden from 1990 to 2019. Nutr Metab Cardiovasc Dis 2023; 33:2344-2354. [PMID: 37596135 DOI: 10.1016/j.numecd.2023.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/30/2023] [Accepted: 07/21/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND AND AIMS In order to find the exact strategies in the prevention of cardiovascular diseases (CVD), it is necessary to assess their risk factors systematically. Here, we used the Global Burden of Disease (GBD) to review the long-term trends and epidemiological characteristics among Chinese. METHODS AND RESULTS We comprehensively analyzed the burden of CVD for the Chinese population using GBD 2019, including prevalence, incidence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs). Then, we analyzed trends over time, and predicted mortality and morbidity, using joinpoint regression, age-period-cohort (APC) model, and Bayesian APC approach. Finally, we analyzed the attributable burden of CVD. In 2019, the prevalence of CVD in China was 120 million, representing a 140.02% increase since 1990. The number of DALYs attributed to CVD increased by 52.56% compared to 1990. Joinpoint showed a fluctuating incidence downward, while mortality significantly declined. The APC fitting results indicated that recent generations have a higher prevalence than the past, and the prevalence has increased among individuals of the same age group. The BAPC predicted that CVD's prevalence and mortality in the Chinese would stabilize and decline between 2020 and 2030, with a significant decline among males. The main CVD-attributable burdens in 2019 were metabolic risks, especially high blood pressure. CONCLUSION Given China's large and rapidly aging population, the burden of CVD is a major concern. Practical strategies to prevent and manage CVD are urgently needed to address this public health challenge.
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Affiliation(s)
- Jiale Zhang
- Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China.
| | - Hongxuan Tong
- Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China.
| | - Lijie Jiang
- Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China.
| | - Yiwen Zhang
- Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China.
| | - Jingqing Hu
- Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China.
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Hao H, Yeo YH. Does the integration of urban and rural health insurance influence the functional limitations of the middle-aged and elderly in rural China? SSM Popul Health 2023; 23:101439. [PMID: 37287716 PMCID: PMC10241964 DOI: 10.1016/j.ssmph.2023.101439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/18/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023] Open
Abstract
In January 2016, the Chinese government integrated the two systems of urban resident basic medical insurance and new rural cooperative medical system to establish a unified Urban and Rural Resident Medical Insurance. The integration of medical insurance is purported to enhance access for the rural population; however, a dearth of literature exists regarding its effect on functional impairment among middle-aged and elderly residing in rural areas. This study aims to evaluate the impact of urban-rural health insurance integration on functional limitation among middle-aged and elderly individuals in rural China. A longitudinal survey was conducted among 7855 middle-aged and elderly individuals in rural China. Using a nonequivalent control group pretest-posttest design, we exploit these policy changes to evaluate their impact on middle-aged and elderly individuals' functional limitation. The results showed that the integration of urban and rural health insurance systems was significantly associated with reduced functional limitation (Odds ratio .742; 95%CI 0.603, 0.914) among middle-aged and elderly individuals in rural China. Our findings also indicate that prevalent behaviors such as tobacco use, and alcohol consumption may exacerbate functional limitation among middle-aged and elderly individuals. These findings suggest that the integration of urban and rural health insurance systems can have a positive impact on the functional limitation of middle-aged and elderly individuals in rural China and could be an important factor in improving the health and well-being of middle-aged and elderly individuals in rural areas.
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Affiliation(s)
| | - Yeong Hun Yeo
- Corresponding author. Department of Social Welfare, Jeonbuk National University, 567- Baekje-daero, Jeonju-si, 54896, South Korea.
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Zeng Y, Xu W, Tao X. What factors are associated with utilisation of health services for the poor elderly? Evidence from a nationally representative longitudinal survey in China. BMJ Open 2022; 12:e059758. [PMID: 35760535 PMCID: PMC9237900 DOI: 10.1136/bmjopen-2021-059758] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the status and factors of healthcare service utilisation among the poor elderly in China. METHODS We selected the poor elderly from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015. The main outcome measures include utilisation indicators for the probability and costs of outpatient/inpatient services. Based on modified Andersen behaviour model, a two-part model is designed to analyse the factors of the health service utilisation of the poor elderly. RESULTS The visit rate of outpatient services increased from 15.05% in 2011 to 21.26% in 2015, and the hospitalisation rate increased from 7.26% to 14.32%. The median cost of outpatient and inpatient services in 2015 for the poor elderly were 350 RMB and 10 000 RMB, respectively, and the out-of-pocket ratios were 85.2% and 53.3%, respectively. 78.44% of the people who actually needed healthcare did not use health services, and the main reason was financial difficulties (42.32%). The poor elderly who are higher educated, have children, live in central regions and have social security and a poor health status and who do not smoke or drink are more likely to use health services. The need factor plays a crucial role in determining health service utilisation. CONCLUSIONS The poor elderly tends to have a worse health status and a heavier medical burden but had a lower utilisation of health services. Predisposing, enabling, need and health behaviour variables should be considered to improve the health service utilisation and the health of the poor elderly.
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Affiliation(s)
- Yanbing Zeng
- School of Public Health, Capital Medical University, Beijing, China
| | - Weiqian Xu
- Tsinghua Shenzhen International Graduate School, Tsinghua university, Shenzhen, China
| | - Xiaomeng Tao
- School of Public Health, Capital Medical University, Beijing, China
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Xie X, Hu Y. The Reimbursement Rate of New Rural Cooperative Medical Scheme and Self-Rated Health Among Rural Middle-Aged and Elderly. Front Public Health 2022; 10:627169. [PMID: 35462832 PMCID: PMC9024035 DOI: 10.3389/fpubh.2022.627169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives The ultimate goal of the New Rural Cooperative Medical Scheme (NRCMS) is to improve physical and psychological health and aim to provide equitable, affordable, cost-effective healthcare services for all rural people. One of our major concerns from the perspective of policy outcome is whether middle-aged and elderly can benefit from the insurance to improve self-rated health. The main objectives of this study are to answer the questions that the reimbursement rate of the NRCMS is a possible explanation of why and how rural middle-aged and elderly shift from non-medical service inputs to medical service to produce health based on a family production theory. Methods Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2018, which involved 1,030 rural adults aged 45 years and older, and ordinal logistic regression estimator and two-step regression were used to examine these assumptions. Our approach controlled for the health status of those people at the same administrative level of the hospital. Results Our study shows some interesting results. First, the reimbursement rate of NRCMS predicted a higher level of SRH among rural middle-aged and elderly, but that all of the indirect effect of it on SRH could be explained in total by satisfaction of local medical services utilization (ab = 0.0492). Second, the results further showed that the odds ratio of satisfaction from affordable, convenient, high-quality medical services is 2.402 times (p < 0.01) greater for those with higher reimbursement levels than for their counterparts with lower reimbursement. Third, the odds ratios of inpatient care visit, outpatient care visit, and physical examination among policyholders of NRCMS are also 1.116, 1.628, and 1.08 times greater, respectively, than their counterparts who are not satisfied with these local medical services. Conclusions Our results concluded that generous insurance reimbursement can reduce the price of healthcare and costs of utilization that both had a dramatic effect on SRH among middle-aged and elderly when their demand for medical treatment is incurred. The government should focus on the healthcare cost, utilization, and health benefit calculations of health insurance policy options at the stage of rapid aging in rural China.
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Affiliation(s)
- Xingquan Xie
- Department of Public Affairs Management, Chengdu University of Technology, Chengdu, China
- *Correspondence: Xingquan Xie
| | - Ying Hu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
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Yu H, Luo J, Chen K, Pollitt KJG, Liew Z. Solid fuels use for cooking and sleep health in adults aged 45 years and older in China. Sci Rep 2021; 11:13304. [PMID: 34172775 PMCID: PMC8233310 DOI: 10.1038/s41598-021-92452-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/04/2021] [Indexed: 12/04/2022] Open
Abstract
Outdoor air pollution has been linked to poor sleep health, but limited studies have investigated the relationship between solid cooking fuels and sleep health in adults. Therefore, we analyzed data from the China Health and Retirement Survey (CHARLS), a national survey of about 17,000 residents aged over 45. Participants were restricted to those who participated in CHARLS 2011, 2013 and 2015 (n = 8,668). Sleep health was indicated by self-reported average sleep hours at night and the numbers of unrested days/week in CHARLS 2015. We analyzed cooking fuel types reported and assessed the duration of solid fuels usage as consistent (indicated use in all three surveys or 6 + years) or inconsistent use (indicated use in one or two surveys or 1-4 years). We found consistent use of solid fuels was associated with a shorter sleep duration (OR = 1.17 95% CI 1.01, 1.35 for ≤ 6 h vs. 7-9 h/day) and higher frequencies of feeling unrested (OR = 1.32 95% CI 1.12, 1.55 for ≥ 5 days/week vs. none) compared with cleaner fuels use. The associations for inconsistent solid fuels use and sleep health were in the similar direction but smaller in magnitude. Further research is needed to confirm our findings and evaluate the exposure impact of specific fuel types to inform intervention strategies.
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Affiliation(s)
- Haiqing Yu
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA
| | - Jiajun Luo
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA
| | - Kai Chen
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA
| | - Krystal J Godri Pollitt
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA
- Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Zeyan Liew
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA.
- Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, 06510, USA.
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Yu J, Huang W, Kahana E. Investigating Factors of Active Aging among Chinese Older Adults: A Machine Learning Approach. THE GERONTOLOGIST 2021; 62:332-341. [PMID: 33942091 DOI: 10.1093/geront/gnab058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES With the extension of healthy life expectancy, promoting active aging has become a policy response to rapid population aging in China. Yet, it has been inconclusive about the relative importance of the determinants of active aging. By applying a machine learning approach, this study aims to identify the most important determinants of active aging in three domains, i.e., paid/unpaid work, caregiving, and social activities, among Chinese older adults. RESEARCH DESIGN AND METHOD Data were drawn from the first wave of the China Health and Retirement Longitudinal Study (CHARLS), which surveys a nationally representative sample of adults aged 60-year-old and above (N=7,503). We estimated Random Forest and the least absolute shrinkage and selection operator (LASSO) regression models to determine the most important factors related to active aging. RESULTS Health has a generic effect on all outcomes of active aging. Our findings also identified the domain-specific determinants of active aging. Urban/rural residency is among the most important factors determining the likelihood of engaging in paid/unpaid work. Living in a multi-generational household is especially important in predicting caregiving activities. Neighborhood infrastructure and facilities have the strongest influence on older adults' participation in social activities. DISCUSSION AND IMPLICATIONS The application of feature selection models provides a fruitful first step in identifying the most important determinants of active aging among Chinese older adults. These results provide evidence-based recommendations for policies and practices promoting active aging.
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Affiliation(s)
- Jiao Yu
- Sociology Department, Case Western Reserve University, Cleveland, Ohio, USA
| | - Wenxuan Huang
- Sociology Department, Case Western Reserve University, Cleveland, Ohio, USA
| | - Eva Kahana
- Sociology Department, Case Western Reserve University, Cleveland, Ohio, USA
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Xie Y, Li Q, Qiao H, Zhao T, Chen Y, Yang B. Measuring and decomposing the effort regarding the equity of inpatient benefits based on the adjustment of the new cooperative medical scheme in western rural China. Int Health 2020; 12:344-353. [PMID: 31951258 PMCID: PMC7322205 DOI: 10.1093/inthealth/ihz104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/13/2019] [Accepted: 10/30/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The ultimate objective of rural health reform and development is to establish a mature healthcare service system that adapts to the socialist market economy and the developmental level of the Chinese economy and meets the health demands of the people. Reform of the payment system is one of the key elements. This article explores the effect of the system and the causes of benefit inequity, provides an objective evaluation of policy implementation and offers data support for policy adjustment. METHODS A two-stage stratified random sampling data collection method comprising a survey in 2009 (the sample size was 3832 families) and a follow-up survey in 2015 (the sample size was 3992 families) was used. Qualitative data are presented as rates or ratios and the χ2 test was used for descriptive statistics. Quantitative data were analysed using a t test. A generalized linear model (GLM) with gamma distribution of the log connection function was adopted to analyse the factors of the compensation benefit inequity. The degree of the compensation benefit inequity contribution was analysed using the concentration index (CI) decomposition method and the Oaxaca decomposition method. RESULTS Reimbursement refers to the reimbursement expense received by inpatients from the New Cooperative Medical System (NCMS). In the GLM, there were some positive factors for reimbursement in the NCMS, including economic level, level of health facility and deductibles. The CI decomposition analysis results show that the main factors that increased the compensation benefit inequity were economic levels and deductibles over the past 2 y. However, inpatient days (2009) and the actual reimbursement ratio (2015) decreased the inequity. The Oaxaca decomposition analysis results suggest that changes in compensation benefit inequity between 2009 and 2015 were more attributable to changes in economic status and variables related to policy compensation than to demographic variables. Conclusions: This study showed that inequity decreased from 2009 to 2015, which could be the result of adjustment of the compensation policy. However, we should remain vigilant lest the gap between the rich and the poor leads to an increase in inequity.
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Affiliation(s)
- Yongxin Xie
- Department of Epidemiology and Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region 750004, China
| | - Qin Li
- Department of Epidemiology and Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region 750004, China
| | - Hui Qiao
- Department of Epidemiology and Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region 750004, China
| | - Ting Zhao
- Department of Epidemiology and Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region 750004, China
| | - Ya’nan Chen
- Department of Epidemiology and Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region 750004, China
| | - Biao Yang
- Department of Epidemiology and Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region 750004, China
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Fan G, Deng Z, Wu X, Wang Y. Medical insurance and health equity in health service utilization among the middle-aged and older adults in China: a quantile regression approach. BMC Health Serv Res 2020; 20:553. [PMID: 32552901 PMCID: PMC7302153 DOI: 10.1186/s12913-020-05423-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 06/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China has achieved nearly universal coverage of the Social Basic Medical Insurance (SBMI), which aims to reduce the disease burden and improve the utilization of health services. We investigated the association between China's health insurance schemes and health service utilization of middle-aged and older adults at different quantiles, and then explored whether the SBMI could help reduce the underutilization of health services among the middle-aged and older adults in China. METHODS Survey data of middle-aged and older adults were drawn from the China Health and Retirement Longitudinal Study (CHARLS). A linear quantile mixed regression model was utilized to provide a comprehensive understanding of the relationship between SBMI and health service utilization, which was measured by the total medical expenditure. We took the New Rural Cooperative Medical Scheme (NCMS) as the reference level and examined the associations of the Urban Employee Basic Medical Insurance (UEBMI) and the Urban Resident Basic Medical Insurance (URBMI) with health service utilization. RESULTS The quantile regression analysis revealed a significant positive association between URBMI and health service utilization at the 0.75 (β = 1.608, p < 0.01), 0.8 (β = 1.578, p < 0.01), 0.85 (β = 1.473, p < 0.01), 0.9 (β = 1.403, p < 0.01) and 0.95 (β = 1.152, p < 0.01) quantiles, and also a significant positive association between UEBMI and health service utilization at the 0.85 (β = 1.196, p < 0.01), 0.9 (β = 1.070, p < 0.01) and 0.95 (β = 0.736, p < 0.01) quantiles. Results showed that URBMI was significantly associated with an improvement in inpatient health service utilization of the middle-aged and older adults, and a significant positive association between UEBMI and inpatient health service utilization was observed at 0.1 (β = 0.559, p < 0.01), 0.25 (β = 0.420, p < 0.05), 0.5 (β = 0.352, p < 0.05), and 0.75 (β = 0.306, p < 0.05) quantiles. CONCLUSIONS Inequity in health service utilization exists among the middle-aged and older adults across urban and rural Chinese areas, and it can be explained by the different reimbursement benefits of SBMI types.
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Affiliation(s)
- Guorui Fan
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, China
| | - Zhaohua Deng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, China
| | - Xiang Wu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, China
| | - Yang Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, China.
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Huang J, Yuan L, Liang H. Which Matters for Medical Utilization Equity under Universal Coverage: Insurance System, Region or SES. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4131. [PMID: 32531889 PMCID: PMC7312584 DOI: 10.3390/ijerph17114131] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND China has achieved universal coverage, with a higher rate of 95% medical insurance. However, huge inequalities are concealed under universal coverage. This article aims to explore the medical insurance utilization disparities over different insurance schemes, regions, and socioeconomic statuses (SES). METHODS This study was based on an open-access dataset in 2010, 2012, 2014, and 2016. A longitudinal analysis and separate logistic models were performed. RESULTS Urban Employee Basic Medical Insurance (UEBMI) members had an outstanding advantage in specialist visiting over those on the Urban Resident Basic Medical Insurance Scheme (URBMI) (OR = 0.607, p < 0.001) and New Cooperative Medical System (NCMS) (OR = 0.262, p < 0.001). However, in terms of a doctor visiting if a person is sick, the odds of patients in the NCMS receiving a visit were 55.1% ((OR = 1.551; p < 0.05) higher than those on the UEBMI. Compared with west China, the odds of those in the north-east and east were 2.1% (p > 0.05) and 97.2% (OR = 1.972; p < 0.001) higher for seeking medical treatment if sick, and 10.8% (OR = 0.892; p < 0.01) and 42.7% lower (OR = 0.573; p < 0.001) for a specialist visiting. In terms of SES, for each unit of increase in the Standard International Occupational Prestige Scale (SIOPS), the odds of seeking medical treatment decreased by 4.3% (OR = 0.958; p < 0.05), and the odds of a specialist visiting increased by 17.1% (OR = 1.171; p < 0.001) for each unit of the annual income logarithm. CONCLUSIONS NCMS members and residents in west China were in a disadvantage status in terms of access to specialists, though had a higher probability of medical care if sick. SES variables were positively correlated with a specialist visiting consistently. We suggest a further focus on healthcare quality in the west and rural areas.
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Affiliation(s)
- Jiaoling Huang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;
| | - Li Yuan
- School of Social Development and Public Policy, Fudan University, Shanghai 200433, China
- International Department, All China Youth Federation, Beijing 100051, China
| | - Hong Liang
- School of Social Development and Public Policy, Fudan University, Shanghai 200433, China
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Hao L, Xu X, Dupre ME, Guo A, Zhang X, Qiu L, Zhao Y, Gu D. Adequate access to healthcare and added life expectancy among older adults in China. BMC Geriatr 2020; 20:129. [PMID: 32272883 PMCID: PMC7146971 DOI: 10.1186/s12877-020-01524-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 03/19/2020] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Adequate access to healthcare is associated with lower risks of mortality at older ages. However, it is largely unknown how many more years of life can be attributed to having adequate access to healthcare compared with having inadequate access to healthcare. METHOD A nationwide longitudinal survey of 27,794 older adults aged 65+ in mainland China from 2002 to 2014 was used for analysis. Multivariate hazard models and life table techniques were used to estimate differences in life expectancy associated with self-reported access to healthcare (adequate vs. inadequate). The findings were assessed after adjusting for a wide range of demographic factors, socioeconomic status, family/social support, health practices, and health conditions. RESULTS At age 65, adequate access to healthcare increased life expectancy by approximately 2.0-2.5 years in men and women and across urban-rural areas compared with those who reported inadequate access to healthcare. At age 85, the corresponding increase in life expectancy was 1.0-1.2 years. After adjustment for multiple confounding factors, the increase in life expectancy was reduced to approximately 1.1-1.5 years at age 65 and 0.6-0.8 years at age 85. In women, the net increase in life expectancy attributable to adequate access to healthcare was 6 and 8% at ages 65 and 85, respectively. In men, the net increases in life expectancy were generally greater (10 and 14%) and consistent after covariate adjustments. In contrast, the increase in life expectancy was slightly lower in rural areas (2.0 years at age 65 and 1.0 years at age 85) than in urban areas (2.1 years at age 65 and 1.1 years age 85) when no confounding factors were taken into account. However, the increase in life expectancy was greater in rural areas (1.0 years at age 65 and 0.6 years at age 85) than in urban areas (0.4 years at age 65 and 0.2 years at age 85) after accounting for socioeconomic and other factors. CONCLUSIONS Adequate access to healthcare was associated with longer life expectancy among older adults in China. These findings have important implications for efforts to improve access to healthcare among older populations in China.
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Affiliation(s)
- Lisha Hao
- School of Geographic Sciences, Nanjing Normal University, Nanjing, China
| | - Xin Xu
- School of Geographic Sciences, Nanjing Normal University, Nanjing, China
| | - Matthew E Dupre
- Department of Population Health Sciences, Department of Sociology, & Duke Clinical Research Institute, Duke University, Durham, NC, USA.
| | - Aimei Guo
- Ginling College, Nanjing Normal University, Nanjing, China
| | - Xufan Zhang
- Ginling College, Nanjing Normal University, Nanjing, China
| | | | - Yuan Zhao
- Ginling College & School of Geographic Sciences, Nanjing Normal University, Nanjing, China
| | - Danan Gu
- Independent Researcher, New York, USA.
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Myint CY, Pavlova M, Thein KNN, Groot W. A systematic review of the health-financing mechanisms in the Association of Southeast Asian Nations countries and the People's Republic of China: Lessons for the move towards universal health coverage. PLoS One 2019; 14:e0217278. [PMID: 31199815 PMCID: PMC6568396 DOI: 10.1371/journal.pone.0217278] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 05/08/2019] [Indexed: 11/19/2022] Open
Abstract
We systematically review the health-financing mechanisms, revenue rising, pooling, purchasing, and benefits, in the Association of Southeast Asian Nations (ASEAN) and the People’s Republic of China, and their impact on universal health coverage (UHC) goals in terms of universal financial protection, utilization/equity and quality. Two kinds of sources are reviewed: 1) academic articles, and 2) countries’ health system reports. We synthesize the findings from ASEAN countries and China reporting on studies that are in the scope of our objective, and studies that focus on the system (macro level) rather than treatment/technology specific studies (micro level).The results of our review suggest that the main sources of revenues are direct/indirect taxes and out of pocket payments in all ASEAN countries and China except for Brunei where natural resource revenues are the main source of revenue collection. Brunei, Indonesia, Philippines, Malaysia, and Viet Nam have a single pool for revenue collection constituting a national health insurance. Cambodia, China, Lao, Singapore, and Thailand have implemented multiple pooling systems while Myanmar has no formal arrangement. Capitation, Fee-for-Service, DRGs, Fee schedules, Salary, and Global budget are the methods of purchasing in the studied countries. Each country has its own definition of the basic benefit package which includes the services that are perceived as essential for the population health. Although many studies provide evidence of an increase in financial protection after reforming the health-financing mechanisms in the studied countries, inequity in financial protection continue to exist. Overall, the utilization of health care among the poor has increased as a consequence of the implementation of government subsidized health insurance schemes which target the poor in most of the studied countries. Inappropriate policies and provider payment mechanisms impact on the quality of health care provision. We conclude that the most important factors to attain UHC are to prioritize and include vulnerable groups into the health insurance scheme. Government subsidization for this kind of groups is found to be an effective method to achieve this goal. The higher the percentage of government expenditure on health, the greater the financial protection is. At the same time, there is a need to weigh the financial stability of the health-financing system. A unified health insurance system providing the same benefit package for all, is the most efficient way to attain equitable access to health care. Capacity building for both administrative and health service providers is crucial for sustainable and good quality health care.
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Affiliation(s)
- Chaw-Yin Myint
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Water, Research and Training Center (WRTC), Yangon, Myanmar
- * E-mail: ,
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | - Wim Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands
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12
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Yiengprugsawan V, D'Este C, Byles J, Kendig H. Geographical variations in self-rated health and functional limitations among older Chinese in eight WHO-SAGE provinces. BMC Geriatr 2019; 19:10. [PMID: 30634916 PMCID: PMC6330469 DOI: 10.1186/s12877-018-1005-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The proportion of population ageing in China will grow significantly in the next few decades but the pace of population ageing and social change vary considerably across regions. Notably, Eastern coastal areas are economically more advanced compared to the Western region. These economic disparities could result in differing adverse health outcomes. METHODS We investigate geographical variations in self-rated overall health and functional limitations in a national representative sample of Chinese aged 50 years and older (n = 13,175) using the WHO Study on global AGEing and adult health (WHO SAGE). We used multivariable logistic regression to investigate urban-rural inequalities across regions, adjusting for sociodemographic and health covariates. Two main outcomes were self-rated overall health and functional limitations based on the WHO Disability Assessment Schedule 2.0 for a range of daily activities. RESULTS The largest urban-rural differences in adverse health outcomes were in Shandong (AORs for urban versus rural of 6.32 [95% Confidence Interval 4.53-8.82] for poor or very poor self-rated overall health and 5.14 [CI 3.55-7.44] for functional limitations), followed by Jilin (AORs 2.71 [CI 2.04-3.61] and 4.72 [CI 3.43-6.49]), and Hubei (AORs 2.36 [CI 1.82-3.07] and 4.11 [CI 2.80-6.04]), respectively. Covariates significantly associated with both adverse health outcomes were older age, poor income, no health insurance, and increasing number of chronic diseases. CONCLUSION Our study reveals substantial disparities between urban and rural areas observed in both the well-developed areas (eg Shandong) and also the lower end of the economic spectrum (eg Hubei and Jilin). Targeted economic development policy and systematic health prevention and healthcare policies could be beneficial in improving health in later life whilst minimising geographical inequalities.
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Affiliation(s)
- Vasoontara Yiengprugsawan
- Centre for Research on Ageing, Health and Wellbeing (CRAHW), Research School of Population Health, College of Health and Medicine, The Australian National University, 54 Mills Road, Acton, Canberra, 2601, Australia. .,Australian Research Council Centre of Excellence in Population Ageing Research (CEPAR), Canberra, Australia.
| | - Catherine D'Este
- National Centre for Epidemiology and Population Health (NCEPH), Research School of Population Health, The Australian National University, Canberra, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Newcastle, New South Wales, Australia
| | - Julie Byles
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, University of Newcastle, Callaghan, Newcastle, New South Wales, Australia
| | - Hal Kendig
- Centre for Research on Ageing, Health and Wellbeing (CRAHW), Research School of Population Health, College of Health and Medicine, The Australian National University, 54 Mills Road, Acton, Canberra, 2601, Australia.,Australian Research Council Centre of Excellence in Population Ageing Research (CEPAR), Canberra, Australia
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13
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Zhao R, Xu K, Li Y, Qiu M, Han Y. Percutaneous coronary intervention in patients with acute coronary syndrome in Chinese Military Hospitals, 2011-2014: a retrospective observational study of a national registry. BMJ Open 2018; 8:e023133. [PMID: 30361405 PMCID: PMC6224757 DOI: 10.1136/bmjopen-2018-023133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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 Interventional treatment of patients with acute coronary syndrome (ACS) is surging dramatically in China in recent years, whereas nationwide assessments of the quality of percutaneous coronary intervention (PCI) procedural performance and outcomes are scarce. We aimed to provide an updated and real-world overview of the performance of PCI in patients with ACS since 2011 in China after the China PEACE study from 2001 to 2011. METHODS In this cross-sectional study, data were extracted from the National Registry of Cardiovascular Intervention in Military Hospitals database to create a national sample of 144 659 patients with ACS undergoing PCI at 117 military hospitals in all regions of China from calendar years 2011-2014. Patient characteristics, procedural performance, PCI outcomes and adverse events and temporal changes were analysed. RESULTS During 2011-2014, patients with ACS undergoing PCI increased dramatically. Small numbers of high-volume hospitals performed the majority of PCI procedures. However, only half of these patients were adequately covered and proportions for the use of assisted devices and novel medications were relatively small. Radial artery access was still increasing with time. Primary PCIs were performed on 45.4% ST-segment elevation myocardial infarction patients with PCI procedures. 3.8% lesion vessels involve left main artery. Implanted stents, the overall complications and in-hospital mortality were decreasing remarkably. CONCLUSIONS In Chinese military hospitals, interventional resources were limited with great regional disparities, there are still gaps to be filled to better serve patients with ACS. Our findings can serve as an indispensable supplement to a more comprehensive understanding of the practice of contemporary cardiac intervention in China.
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Affiliation(s)
| | | | | | | | - Yaling Han
- Department of Cardiology, General Hospital of Shenyang Military Command, Shenyang, China
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14
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Zhang X, Dupre ME, Qiu L, Zhou W, Zhao Y, Gu D. Urban-rural differences in the association between access to healthcare and health outcomes among older adults in China. BMC Geriatr 2017; 17:151. [PMID: 28724355 PMCID: PMC5516359 DOI: 10.1186/s12877-017-0538-9] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies have shown that inadequate access to healthcare is associated with lower levels of health and well-being in older adults. Studies have also shown significant urban-rural differences in access to healthcare in developing countries such as China. However, there is limited evidence of whether the association between access to healthcare and health outcomes differs by urban-rural residence at older ages in China. METHODS Four waves of data (2005, 2008/2009, 2011/2012, and 2014) from the largest national longitudinal survey of adults aged 65 and older in mainland China (n = 26,604) were used for analysis. The association between inadequate access to healthcare (y/n) and multiple health outcomes were examined-including instrumental activities of daily living (IADL) disability, ADL disability, cognitive impairment, and all-cause mortality. A series of multivariate models were used to obtain robust estimates and to account for various covariates associated with access to healthcare and/or health outcomes. All models were stratified by urban-rural residence. RESULTS Inadequate access to healthcare was significantly higher among older adults in rural areas than in urban areas (9.1% vs. 5.4%; p < 0.01). Results from multivariate models showed that inadequate access to healthcare was associated with significantly higher odds of IADL disability in older adults living in urban areas (odds ratio [OR] = 1.58-1.79) and rural areas (OR = 1.95-2.30) relative to their counterparts with adequate access to healthcare. In terms of ADL disability, we found significant increases in the odds of disability among rural older adults (OR = 1.89-3.05) but not among urban older adults. Inadequate access to healthcare was also associated with substantially higher odds of cognitive impairment in older adults from rural areas (OR = 2.37-3.19) compared with those in rural areas with adequate access to healthcare; however, no significant differences in cognitive impairment were found among older adults in urban areas. Finally, we found that inadequate access to healthcare increased overall mortality risks in older adults by 33-37% in urban areas and 28-29% in rural areas. However, the increased risk of mortality in urban areas was not significant after taking into account health behaviors and baseline health status. CONCLUSIONS Inadequate access to healthcare was significantly associated with higher rates of disability, cognitive impairment, and all-cause mortality among older adults in China. The associations between access to healthcare and health outcomes were generally stronger among older adults in rural areas than in urban areas. Our findings underscore the importance of providing adequate access to healthcare for older adults-particularly for those living in rural areas in developing countries such as China.
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Affiliation(s)
- Xufan Zhang
- Ginling College & International Center for Aging and Health, Nanjing Normal University, Nanjing, China
| | - Matthew E Dupre
- Duke Clinical Research Institute & Department of Sociology, Duke University, Durham, NC, USA
| | - Li Qiu
- Independent Researcher, New York, NY, USA
| | - Wei Zhou
- Ginling College & International Center for Aging and Health, Nanjing Normal University, Nanjing, China
| | - Yuan Zhao
- Ginling College, School of Geography Science & International Center for Aging and Health and Nanjing Normal University, Nanjing, China
| | - Danan Gu
- United Nations Population Division, Two UN Plaza, New York, NY, DC2-1910, USA.
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15
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Xu H, Luo J, Wu B. Self-reported diabetes education among Chinese middle-aged and older adults with diabetes. J Glob Health 2017; 6:020402. [PMID: 27698998 PMCID: PMC5032342 DOI: 10.7189/jogh.06.020402] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background To compare self–reported diabetes education among Chinese middle–aged and older adults with diabetes in three population groups: urban residents, migrants in urban settings, and rural residents. Methods We used data from the 2011 China Health and Retirement Longitudinal Study. The sample included 993 participants age 45 and older who reported having diabetes diagnosed from a health professional. We performed multilevel regressions performed to examine the associations between characteristics and different aspects of diabetes education received. Findings Our study shows that 20.24% of the participants received no diabetes education at all. Among those who received information, 46.82% of respondents with diabetes received weight control advice from a health care provider, 90.97% received advice on exercise, 60.37% received diet advice, 35.12% were spoken to smoking control, and only 17.89% of persons were informed of foot care. After controlling socioeconomic factors, life style, number of comorbidities and community factors, we found that compared with migrant population and rural residents, urban residents were more likely to receive diabetes education on diet. Urban residents were also more likely to obtain diabetes education and more aspects of diabetes education comparison with migrants and rural residents. Conclusions Our study suggests diabetes education is a serious concern in China, and a significant proportion of the participants did not receive advice on smoking control and foot care. Rural residents and migrants from rural areas received much less diabetes education compared with urban residents. Efforts to improve diabetes educations are urgently needed in China.
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Affiliation(s)
- Hanzhang Xu
- Duke University School of Nursing, Durham, North Carolina, USA; Duke Global Health Institute, 310 Trent Drive, Durham, North Carolina, USA
| | - Jianfeng Luo
- Department of Health Statistics and Social Medicine, School of Public Health, Fudan University,130 Dongan Road, Shanghai, China
| | - Bei Wu
- Duke University School of Nursing, Durham, North Carolina, USA; Duke University Center for the Study of Aging and Human Development, Durham, North Carolina, USA; Duke Global Health Institute, 310 Trent Drive, Durham, North Carolina, USA
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16
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Jin Y, Hou Z, Zhang D. Determinants of Health Insurance Coverage among People Aged 45 and over in China: Who Buys Public, Private and Multiple Insurance. PLoS One 2016; 11:e0161774. [PMID: 27564320 PMCID: PMC5001699 DOI: 10.1371/journal.pone.0161774] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 08/11/2016] [Indexed: 11/08/2022] Open
Abstract
Background China is reforming and restructuring its health insurance system to achieve the goal of universal coverage. This study aims to understand the determinants of public, private and multiple insurance coverage among people of retirement-age in China. Methods We used data from the China Health and Retirement Longitudinal Survey 2011 and 2013, a nationally representative survey of Chinese people aged 45 and over. Multinomial logit regression was performed to identify the determinants of public, private and multiple health insurance coverage. We also conducted logit regression to examine the association between public insurance coverage and demand for private insurance. Results In 2013, 94.5% of this population had at least one type of public insurance, and 12.2% purchased private insurance. In general, we found that rural residents were less likely to be uninsured (Relative Risk Ratio (RRR) = 0.40, 95% Confidence Interval (CI): 0.34–0.47) and were less likely to buy private insurance (RRR = 0.22, 95% CI: 0.16–0.31). But rural-to-urban migrants were more likely to be uninsured (RRR = 1.39, 95% CI: 1.24–1.57). Public health insurance coverage may crowd out private insurance market (Odds Ratio = 0.55, 95% CI: 0.48–0.63), particularly among enrollees of Urban Resident Basic Medical Insurance. There exists a huge socioeconomic disparity in both public and private insurance coverage. Conclusion The migrants, the poor and the vulnerable remained in the edge of the system. The growing private insurance market did not provide sufficient financial protection and did not cover the people with the greatest need. To achieve universal coverage and reduce socioeconomic disparity, China should integrate the urban and rural public insurance schemes across regions and remove the barriers for the middle-income and low-income to access private insurance.
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Affiliation(s)
- Yinzi Jin
- China Center for Health Development Studies, Peking University. 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Zhiyuan Hou
- Department of Social Medicine, School of Public Health, National Key Laboratory of Health Technology Assessment (Ministry of Health), Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China
- * E-mail:
| | - Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Road, Wright Hall, Athens, GA, United States of America
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17
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Pan B, Yuan Z, Zou J, Cook DM, Yang W. Elderly hospitalization and the New-type Rural Cooperative Medical Scheme (NCMS) in China: multi-stage cross-sectional surveys of Jiangxi province. BMC Health Serv Res 2016; 16:436. [PMID: 27557644 PMCID: PMC4997654 DOI: 10.1186/s12913-016-1638-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 08/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies assessing the impacts of China's New-type Rural Cooperative Medical Scheme (NCMS) reform of 2003 among rural elderly have been limited. METHOD Multistage stratified cluster sampling household surveys of 1838, 1924, 1879, 1888, 1890 and 1896 households from 27 villages in Jiangxi province were conducted in 2003/2004, 2006, 2008, 2010, 2012 and 2014. Data from older adults age 65 and above were analyzed. Weighted logistic regression was applied to find factors of elderly hospitalization services. RESULTS Since 2003, hospitalization rates for elderly increased, while rates of patients leaving against medical advice and patients avoiding the hospital decreased (P < 0.05). Factors associated with a higher likelihood of reporting hospitalization in the past year for elderly were the per-capita financial level V in 2012 for NCMS (Adjusted Odds Ratios [aOR]: 2.295), the level VI in 2014 (aOR: 3.045) versus the level I in 2003 and chronic disease (aOR: 2.089) versus not having a chronic disease. Lower rate of elderly left against medical advice was associated with the financial level V in 2012 (aOR: 0.099) versus the level I. The higher rate of hospital avoidance was associated with chronic disease status (aOR: 5.759) versus not having a chronic disease, while the lower rate was associated with the financial level VI in 2014 (aOR: 0.143) versus the level I. Among reporting reasons for elderly hospital avoidance, the cost-related reasons just dropped slightly over the years. CONCLUSIONS NCMS improved access to health services for older adults. The utilization of hospitalization services for rural elderly increased gradually, but cost-related barriers remained the primary reporting barrier to accessing hospitalization services.
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Affiliation(s)
- Bingbing Pan
- School of Public Health, Nanchang University, Nanchang, People's Republic of China
| | - Zhaokang Yuan
- School of Public Health, Nanchang University, Nanchang, People's Republic of China
| | - Jiaojiao Zou
- School of Public Health, Nanchang University, Nanchang, People's Republic of China
| | - Daniel M Cook
- School of Community Health Sciences, University of Nevada, Reno, USA
| | - Wei Yang
- School of Public Health, Nanchang University, Nanchang, People's Republic of China. .,School of Community Health Sciences, University of Nevada, Reno, USA.
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18
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Care Utilization with China’s New Rural Cooperative Medical Scheme: Updated Evidence from the China Health and Retirement Longitudinal Study 2011–2012. Int J Behav Med 2016; 23:655-663. [DOI: 10.1007/s12529-016-9560-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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Gong CH, Kendig H, He X. Factors predicting health services use among older people in China: An analysis of the China Health and Retirement Longitudinal Study 2013. BMC Health Serv Res 2016; 16:63. [PMID: 26892677 PMCID: PMC4758158 DOI: 10.1186/s12913-016-1307-8] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background Rapid population ageing in China is increasing the numbers of older people who are likely to require health services in response to higher levels of poor perceived health and chronic diseases. Understanding factors influencing health services use at late life will help to plan for increasing needs for health care, reducing inequalities in health services use and releasing severe pressures on a highly variable health care system that has constrained public resources and increasing reliance on health insurance and user payments. Methods Drawing on the nationally representative China Health and Retirement Longitudinal Study 2013 data, we apply the Andersen healthcare utilization conceptual model to binary logistic regression multivariate analyses to examine the joint predictors of physical examinations, outpatient and inpatient care among the middle-aged and elderly in China. Results The multivariate analyses find that both physical examinations and inpatient care rates increase significantly by age when health deteriorates. Females are less likely to use inpatient care. Significant socio-economic variations exist in healthcare utilization. Older people with higher education, communist party membership, urban residence, non-agricultural household registration, better financial situation are more likely to have physical examinations or inpatient care. Factors influencing all three types of health care utilization are household expenditure, losing a partner, having multiple chronic diseases or perceiving poor health. With activities of daily living limitations or pain increases the probability of seeing a doctor while with functional loss increases the rates of having physical examinations, but being the ethnic minorities, no social health insurance, with depression, fair or poor memory could be a barrier to having physical examinations or seeing a doctor, which might delay the early diagnose of severe health problems among these groups. Not drinking, not smoking and regular physical exercises are adaptations after having health problems. Conclusions As a rapidly ageing society, in order to address the increasing needs and inequalities in health care utilization, China is facing a massive challenge to reform the current health care system, improve equitable access to health insurance and financial affordability for the most disadvantaged, as well as to provide more health education and information to the general public.
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Affiliation(s)
- Cathy Honge Gong
- Centre for Research on Ageing, Health and Wellbeing and ARC Centre of Excellence in Population Ageing Research, Australian National University, Canberra, Australia. .,Centre for Research on Ageing, Health and Wellbeing, Australian National University, Florey, Building 54, Mills Road, Canberra, ACT 2601, Australia.
| | - Hal Kendig
- Centre for Research on Ageing, Health and Wellbeing and ARC Centre of Excellence in Population Ageing Research, Australian National University, Canberra, Australia.
| | - Xiaojun He
- Economics and Management Research Centre, Hunan University, Changsha, China.
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Yi H, Zhang J, Ma C, Ma S. Utilization of the NCMS and its association with expenditures: observations from rural Fujian, China. Public Health 2016; 130:84-6. [DOI: 10.1016/j.puhe.2015.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/06/2015] [Accepted: 05/11/2015] [Indexed: 11/28/2022]
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Shen R, Zhang J, Zhang F, DU Y, Liang W, Xu L, DU X, Chen P, Chen X. Clinical characteristics and therapeutic analysis of 51 patients with Marjolin's ulcers. Exp Ther Med 2015; 10:1364-1374. [PMID: 26622492 PMCID: PMC4578120 DOI: 10.3892/etm.2015.2699] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 07/01/2015] [Indexed: 11/08/2022] Open
Abstract
Marjolin's ulcers, which are epidermoid carcinomas arising on non-healing scar tissue, may be of various pathological types, including squamous cell carcinoma. The pathogenesis of squamous cell carcinoma arising in an ulcer differs from that of the primary cutaneous squamous cell carcinoma. This squamous cell carcinoma is aggressive in nature, and has a high rate of metastasis. Between January 2001 and September 2013, 51 patients with Marjolin's ulcers were admitted to the Departments of Plastic Surgery of the Affiliated Foshan Hospital and the Second Affiliated Hospital of Sun Yat-sen University. The ulcers included 43 cases of squamous cell carcinoma, six of melanoma, one of basal cell carcinoma and one of epithelioid sarcoma. The clinical data of these patients were retrospectively analyzed. Patients were followed until mortality. Among the patients with squamous cell carcinoma, 30.23% exhibited sentinel lymph node metastasis and 11.63% had distant metastasis. Among the patients with melanoma, 66.67% had sentinel lymph node metastasis and 33.33% had distant metastasis. Sentinel lymph node metastasis was successfully detected in 11 patients with Marjolin's ulcer using 18F-fluorodeoxyglucose positron emission tomography-computed tomography and B-mode ultrasound guided biopsy. Squamous cell carcinoma was often treated by extended resection and skin grafting or skin flap repair. Patients with deep, aggressive squamous cell carcinoma of an extremity and sentinel lymph node metastasis underwent amputation and lymph node dissection. This treatment was also used for melanoma type Marjolin's ulcers.
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Affiliation(s)
- Rui Shen
- Department of Plastic Surgery, The Second Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China ; Department of Plastic Surgery, The Affiliated Foshan Hospital of Sun Yat-sen University, Foshan, Guangdong 528000, P.R. China
| | - Jinming Zhang
- Department of Plastic Surgery, The Second Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Fenggang Zhang
- Department of Plastic Surgery, The Affiliated Foshan Hospital of Sun Yat-sen University, Foshan, Guangdong 528000, P.R. China
| | - Yongjun DU
- Department of Plastic Surgery, The Affiliated Foshan Hospital of Sun Yat-sen University, Foshan, Guangdong 528000, P.R. China
| | - Weiqiang Liang
- Department of Plastic Surgery, The Second Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Lusheng Xu
- Department of Plastic Surgery, The Affiliated Foshan Hospital of Sun Yat-sen University, Foshan, Guangdong 528000, P.R. China
| | - Xueliang DU
- Department of Plastic Surgery, The Affiliated Foshan Hospital of Sun Yat-sen University, Foshan, Guangdong 528000, P.R. China
| | - Ping Chen
- Department of Plastic Surgery, The Affiliated Foshan Hospital of Sun Yat-sen University, Foshan, Guangdong 528000, P.R. China
| | - Xiaodong Chen
- Department of Plastic Surgery, The Affiliated Foshan Hospital of Sun Yat-sen University, Foshan, Guangdong 528000, P.R. China
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Ahn S, Smith ML, Cho J, Bailey JE, Ory MG. Hypertension Awareness and Associated Factors among Older Chinese Adults. Front Public Health 2013; 1:67. [PMID: 24350235 PMCID: PMC3859975 DOI: 10.3389/fpubh.2013.00067] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 11/22/2013] [Indexed: 01/13/2023] Open
Abstract
Hypertension is one of the most preventable chronic conditions. Improving hypertension awareness is a critical first step to reducing morbidity and mortality from hypertension in the elderly, yet the factors associated with hypertension awareness in China are poorly understood. The objective of this paper is to examine the extent to which older Chinese adults are aware of their hypertension, and factors associated with this awareness. We included 2404 adults aged 60 years or older clinically identified as hypertensive from panel data surveyed in 1997, 2000, 2004, and 2006 as part of the China Health and Nutrition Survey. Comparing this data with respondents' self-reported diagnosis of hypertension enabled us to characterize hypertension awareness. Covariates included socio-demographic, health status, functional disability, and behavioral factors. Generalized estimating equations were used to identify factors for hypertension awareness. We found 22.9% in 1997 and 42.7% in 2006 of study participants were aware of their hypertensive status. Lower awareness was found among those who lived in rural areas [odds ratio (OR) = 0.64, 95% Confidence Interval (CI), 0.47-0.88]. Higher awareness was noted for persons who were aware of their hypertensive status in a previous survey wave (OR = 7.43, 95% CI, 5.45-10.13), had high income (OR = 1.55, 95% CI, 1.05-2.28), had stage two hypertension (OR = 2.28, 95% CI, 1.69-3.06), had acute condition (OR = 2.54, 95% CI, 1.89-3.42), and had greater activities of daily living limitations (OR = 1.24, 95% CI, 1.08-1.43). Studying dynamics of hypertension awareness can help inform both clinical and public health approaches to improve healthcare.
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Affiliation(s)
- SangNam Ahn
- Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Memphis, TN, USA
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center School of Rural Public Health, College Station, TX, USA
| | - Matthew Lee Smith
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center School of Rural Public Health, College Station, TX, USA
- Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA, USA
| | - Jinmyoung Cho
- Center for Applied Health Research, Scott & White Healthcare, College Station, TX, USA
| | - James E. Bailey
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Marcia G. Ory
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center School of Rural Public Health, College Station, TX, USA
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