Evolution of non-communicable disease prevention and control in China

Nation-Wide Routinely Collected Health Datasets in China: A Scoping Review

Objectives: The potential for using routinely collected data for medical research in China remains unclear. We sought to conduct a scoping review to systematically characterise nation-wide routinely collected datasets in China that may be of value for clinical research. Methods: We searched public databases and the websites of government agencies, and non-government organizations. We included nation-wide routinely collected databases related to communicable diseases, non-communicable diseases, injuries, and maternal and child health. Database characteristics, including disease area, data custodianship, data volume, frequency of update and accessibility were extracted and summarised. Results: There were 70 databases identified, of which 46 related to communicable diseases, 20 to non-communicable diseases, 1 to injury and 3 to maternal and child health. The data volume varied from below 1000 to over 100,000 records. Over half (64%) of the databases were accessible for medical research mostly comprising communicable diseases. Conclusion: There are large quantities of routinely collected data in China. Challenges to using such data in medical research remain with various accessibility. The potential of routinely collected data may also be applicable to other low- and middle-income countries.

Trend Analysis of the Mortality Rates of the Top Three Causes of Death Among Chinese Residents from 2003 to 2019

Objective: To delineate the mortality trends of malignant tumors, heart disease and cerebrovascular disease in China.

Methods: The crude mortality from 2003 to 2019 was derived from the China Health Statistical Yearbook, and the mortality rates were analyzed through joinpoint regression supplemented by descriptive statistics and χ2 tests.

Results: The fitting model of age-standardized mortality due to malignant tumors showed three joinpoints. The APCs from 2003 to 2005, 2005–2008, 2008–2012 and 2012–2019 were −11.00%, 9.63%, −4.67% and −1.40%, respectively, and the AAPC was −1.54%. The mortality rate of cerebrovascular disease consistently decreased (APC = AAPC = −0.98%). In the subgroup analyses, significant differences were observed between sexes and regions. The mortality rate of heart disease among rural females exhibited an upward trend (APC = AAPC = 2.33%). Older adults aged over 75 years had the highest mortality rates and the most drastic change.

Conclusion: The three diseases had variable change trends. The government should focus more on policies that promote the equalization of basic public health services. Continuous education on heart disease, which includes not only beneficial behaviors but also knowledge of first aid, should be strengthened for rural females.

PPSV-23 recommendation and vaccination coverage in China: a cross-sectional survey among healthcare workers, older adults and chronic disease patients

BACKGROUND

: 23-valent pneumococcal polysaccharide vaccine (PPSV-23) is crucial to protecting high-risk groups. This study aimed to investigate the influencing factors of PPSV-23 recommendation among healthcare workers, and PPSV-23 coverage among Chinese older adults and chronic disease patients.

RESEARCH DESIGN AND METHODS

: In 2019, a cross-sectional questionnaire survey was conducted in ten provinces in China among older adults aged ≥65 years, chronic disease patients aged 18-64 years, and primary healthcare workers. Multiple logistic regression model was adopted to identify the influencing factors of PPSV-23 recommendation and vaccination uptake.

RESULTS

: Of the 1138 healthcare workers, 46.75% often recommended PPSV-23 to target groups, and public health workers were more likely to recommend than general practitioners. PPSV-23 vaccination rate was 3.29% among chronic disease patients aged <65 years, 6.69% among older adults without chronic disease(s), and 8.87% among chronic disease patients aged ≥65 years. Multiple logistic regression revealed that only general practitioners' recommendation was associated with increased PPSV-23 coverage (p < 0.05).

CONCLUSIONS

: The findings highlighted the suboptimal PPSV-23 coverage rate in China and the strong association between healthcare workers' recommendation and residents' vaccination uptake. Targeted and coherent PPSV-23-related training is suggested for general practitioners to encourage effective health promotion in clinical practices.

The Economic Burden of Influenza-Like Illness among Children, Chronic Disease Patients, and the Elderly in China: A National Cross-Sectional Survey

Background: The disease burden of seasonal influenza is substantial in China, while there is still a lack of nationwide economic burden estimates. This study aims to examine influenza-like illness (ILI) prevalence, healthcare-seeking behaviors, economic impact of ILI, and its influencing factors among three priority groups during the 2018–19 influenza season. Methods: From August to October 2019, 6668 children’s caregivers, 1735 chronic disease patients, and 3849 elderly people were recruited from 10 provinces in China to participate in an on-site survey. The economic burden of ILI consisted of direct (medical or non-medical) and indirect burdens, and a two-part model was adopted to predict the influencing factors of total economic burden. Results: There were 45.73% children, 16.77% chronic disease patients, and 12.70% elderly people reporting ILI, and most participants chose outpatient service or over-the-counter (OTC) medication after ILI. The average economic burden was CNY 1647 (USD 237.2) for children, CNY 951 (USD 136.9) for chronic disease patients, and CNY 1796 (USD 258.6) for the elderly. Two-part regression showed that age, gender, whether the only child in the family, region, and household income were important predictors of ILI economic burden among children, while age, region, place of residence, basic health insurance, and household income were significant predictors of ILI economic burden among chronic disease patients and the elderly. Conclusions: A large economic burden of ILI was highlighted, especially among the elderly with less income and larger medical burdens, as well as children, with higher prevalence and higher self-payment ratio. It is important to adopt targeted interventions for high-risk groups, and this study can help national-level decision-making on the introduction of influenza vaccination as a public health project.

Willingness to Pay for Seasonal Influenza Vaccination among Children, Chronic Disease Patients, and the Elderly in China: A National Cross-Sectional Survey

Background: The disease burden of seasonal influenza is substantial in China, while the vaccination rate is extremely low, and most people have to pay 100% for vaccination. This study aims to examine willingness to pay (WTP) and recommended financing sources for influenza vaccination among children, chronic disease patients, and the elderly in China and determine feasible measures to expand vaccination coverage. Methods: From August to October 2019, 6668 children's caregivers, 1735 chronic disease patients, and 3849 elderly people were recruited from 10 provinces in China. An on-site survey was conducted via a especially designed PAD system. Tobit regression was adopted to predict the influencing factors of WTP. Results: The average WTP was 127.5 yuan (USD18.0) for children, 96.5 yuan (USD13.7) for chronic disease patients, and 88.1 yuan (USD12.5) for the elderly. Most participants in the three groups thought government subsidies (94.8%, 95.8%, and 95.5%) or health insurance (94.3%, 95.3%, and 94.5%) should cover part of the cost, and nearly four-fifths (80.1%, 79.5%, and 76.8%) believed that individuals should also pay for part. Tobit regression showed that a higher perceived importance of vaccination, knowing about priority groups, and considering that individuals should co-pay were promoters of WTP, while considering price as a hindrance lowered WTP. Conclusions: The WTP for influenza vaccination among children, chronic disease patients, and the elderly in China is fairly high, suggesting that price is not the primary hindrance and there is room to expand immunization. Most participants expected the government and/or health insurance to pay part of the cost, and such supportive funding could act as a promotive policy "signal" to improve vaccine uptake. Influenza-related health education is also needed to expand vaccine coverage.

Electronic Health Record-Based Screening for Major Cancers: A 9-Year Experience in Minhang District of Shanghai, China

Background: An electronic health record (e-HR) system has been developed in Minhang District of Shanghai, China, since 2005, making it convenient for local health institutions to provide integrative and comprehensive health care and management for major diseases.

Methods: In 2008, an e-HR-based cancer prevention program was initiated to screen multiple cancers, including colorectal, gastric, liver, lung, cervical, and breast cancers, and provide subsequent health education and health management to cancer patients and high-risk individuals. This study was designed in prospective analysis, based on the constructive analysis of key information, observation of cancer screening and healthcare processes and organizations, and stages of cancers detected by the e-HR-based programs.

Results: From 2008 to 2016, health education was conducted for over 5 million attendances, and more than 3 million screening tests were performed for eligible residents over 40 years old. A total of 2,948 cancer cases were detected, accounting for 13.3% of all newly diagnosed cancers in the district during the 9-year period. Thirty point seven percent detected cancer cases were at the early stage, significantly higher than the 22.9% in cases identified by e-HR-based follow-up and 13.8% in cases diagnosed due to signs or symptoms. More than 136,000 residents were identified as individuals at high risk of cancer and subject to sustainable clinical follow-up and health management.

Conclusions: The successful application of e-HR system in cancer prevention and control in Minhang district of Shanghai, China, implies that the system may act as an extendable and sustainable infrastructure for comprehensive health care and services for a broad spectrum of diseases and health events.

Non-communicable diseases control in China and Japan

China and Japan share numerous similarities other than their geographical proximity. Facing the great challenges of non-communicable diseases (NCDs), China and Japan have developed different preventive strategies and systems. While Japan has made great progress in primary prevention of NCDs through strong legislation, the ‘Specific Health Check and Guidance System’ and a unique licensed health professional system, China is attempting to catch up by changing its strategies in NCDs control. In this manuscript, we compared disease burden of NCDs, health care systems and preventive strategies against NCDs between China and Japan. In this light, we summarized the points that the two countries can learn from each other, and proposed recommendations for the two countries in NCDs control.