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Song M, Zheng L, Chen L, Zhang C, Chen X, Zhao C. Epidemiological characteristics of chronic non-communicable diseases in Dongfang, China, 2021: a cross-sectional survey. BMJ Open 2024; 14:e081710. [PMID: 38803260 PMCID: PMC11129020 DOI: 10.1136/bmjopen-2023-081710] [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: 11/12/2023] [Accepted: 05/03/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVES The study aimed to understand the composition, epidemiological characteristics and disease burden of chronic non-communicable diseases and to evaluate the association between sociodemographic factors and chronic non-communicable diseases. DESIGN A cross-sectional study. SETTING AND PARTICIPANTS Medical records of 196 761 residents were collected from Dongfang disease surveillance system from January to December 2021. PRIMARY OUTCOME Prevalence and disability burden were recorded. Logistic regression was used to investigate the relationship between sociodemography factors and diseases. RESULTS Cardiovascular diseases, chronic lower respiratory diseases and other upper respiratory tract diseases were the main chronic non-communicable diseases. In multivariable analysis, men were associated with increased risk of cardiovascular diseases (OR=1.210, 95% CI 1.162 to 1.261) and chronic lower respiratory diseases (OR=1.128, 95% CI 1.079 to 1.180). Older age was associated with increased risk of cardiovascular diseases (OR=83.952, 95% CI 58.954 to 119.550), whereas was associated with decreased risk of chronic lower respiratory diseases (OR=0.442, 95% CI 0.415 to 0.471) and other upper respiratory tract diseases (OR=0.450, 95% CI 0.411 to 0.493). The unemployed and poor household were associated with decreased risk of cardiovascular diseases (OR=0.463, 95% CI 0.412 to 0.521 and OR=0.390, 95% CI 0.342 to 0.444, respectively), whereas were associated with increased risk of chronic lower respiratory diseases (OR=12.219, 95% CI 6.343 to 23.539 and OR=10.954, 95% CI 5.666 to 21.177, respectively) and other upper respiratory tract diseases (OR=2.246, 95% CI 1.719 to 2.936 and OR=3.035, 95% CI 2.308 to 3.991, respectively). Gender and age moderated the association between personnel category and major diseases. CONCLUSIONS The spectrum and epidemiological characteristics of chronic diseases observed in Dongfang is good evidence for developing prevention guides and health policies for region.
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Affiliation(s)
- Meixuan Song
- Department of Nursing, Tongji University School of Medicine, Shanghai, China
- Research Center for Translational Medicine, Tongji University Affilliated East Hospital, Shanghai, China
| | - Liang Zheng
- Research Center for Translational Medicine, Tongji University Affilliated East Hospital, Shanghai, China
| | - Lan Chen
- Department of Internal Medicine, Dongfang People's Hospital, Dongfang, Hainan, China
| | - Chunmei Zhang
- Dongfang Municipal Health Commission, Dongfang, Hainan, China
| | - Xingyi Chen
- Department of Medical, Tongji University Affilliated East Hospital, Shanghai, China
| | - Chunyan Zhao
- Department of Nursing, Tongji University Affilliated East Hospital, Shanghai, China
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Gao J, Kim H, Mitra S. Out-of-Pocket Health Expenditures Associated with Chronic Health Conditions and Disability in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6465. [PMID: 37569006 PMCID: PMC10418713 DOI: 10.3390/ijerph20156465] [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: 05/28/2023] [Revised: 07/13/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023]
Abstract
The objective of this study is to estimate the extra costs of living associated with chronic health conditions and disabilities in China. Leveraging the 2018 China Health and Retirement Longitudinal Study involving 13,530 respondents aged 50 and over, we apply both an ordinary least squares linear regression model and a logistic model to analyze the correlation between medical out-of-pocket expenditures (OOPEs) and chronic health conditions, as well as disabilities measured by Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) limitations. This paper bridges the gap in the literature on OOPEs and their association with disabilities and chronic health conditions, respectively. We find that ADL limitations, IADL limitations, and chronic health conditions are consistently associated with higher OOPEs. The odds that older persons with disabilities and chronic health conditions incur OOPEs are two to three times higher than for persons without disabilities and chronic health conditions, respectively. Persons with disabilities and chronic health conditions have the highest OOPEs. The findings suggest that more policy and research attention is necessary to improve the financial protection of those with chronic health conditions and disabilities, including through access to comprehensive health insurance coverage.
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Affiliation(s)
- Jingyi Gao
- Department of Economics, Fordham University, Bronx, NY 10458, USA
| | - Hoolda Kim
- College of Business and Economics, Fayetteville State University, Fayetteville, NC 28301, USA;
| | - Sophie Mitra
- Department of Economics, Fordham University, Bronx, NY 10458, USA
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Liu H, Wen Y, Wu C, Zhao Y, Lai W, Zhao Y, Yuan J, Liu Y, Zhou X, Sharma M, Chen Y, Zeng H. Exploring health literacy in patients with chronic diseases in Chongqing, China: a cross-sectional study. BMJ Open 2023; 13:e064609. [PMID: 37433732 DOI: 10.1136/bmjopen-2022-064609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVES Personal health literacy is the degree to which individuals have the ability to find, understand and use information and services to inform health-related decisions and actions for themselves and others. Health literacy levels remain low, despite the many measures that have been taken to improve it. In addition, the number of patients with chronic diseases is increasing. Our study aimed to explore the different aspects and factors influencing health literacy among patients with chronic diseases in Chongqing, China. DESIGN Cross-sectional study. SETTING AND PATIENTS This study was conducted in Chongqing using the 2018 National Questionnaire on Health Literacy of Residents administered to 27 336 patients with chronic diseases. OUTCOME MEASURES The prevalence and factors of health literacy in patients with chronic diseases. RESULTS Among the patients who participated in the study (n=27 336), 51.3% were males. Only 21.6% of the patients with chronic diseases had adequate health literacy (questionnaire score was equal to or exceeded 80% of the total questionnaire score). Patients with chronic diseases aged 25-34 years (OR=1.18, 95% CI 1.02 to 1.36) and 35-44 years (OR=1.18, 95 % CI 1.03 to 1.35) had higher health literacy than patients aged 65-69 years. Patients from rural areas had higher health literacy levels than those from urban areas (OR=0.92, 95% CI 0.86 to 1.00). Furthermore, married patients had lower health literacy than unmarried patients (OR=0.88, 95% CI 0.80 to 0.97). Patients who were illiterate or slightly literate (OR=0.10, 95% CI 0.08 to 0.12) had lower health literacy than patients who were in junior college or had a bachelor's degree or above. In addition, non-farmers had higher health literacy levels than farmers (OR=1.18, 95% CI 1.08 to 1.28). In terms of inadequate health literacy, patients who self-rated themselves as healthy had higher health literacy than those who self-rated as unhealthy (OR=1.80, 95% CI 1.33 to 2.43). CONCLUSIONS The health literacy of patients with chronic conditions remains at a low level and varies significantly with their demographic and social characteristics. These findings indicate that targeted interventions may be useful to improve health literacy in patients with chronic conditions in China.
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Affiliation(s)
- Hongyan Liu
- College of Public Health, Chongqing Medical University, Chongqing, China
| | - Yaqi Wen
- College of Public Health, Chongqing Medical University, Chongqing, China
| | - Chengbin Wu
- Project Office, Chongqing Health Education Institute, Chongqing, China
| | - Yu Zhao
- Project Office, Chongqing Health Education Institute, Chongqing, China
| | - Weiyun Lai
- Project Office, Chongqing Health Education Institute, Chongqing, China
| | - Yong Zhao
- College of Public Health, Chongqing Medical University, Chongqing, China
| | - Jun Yuan
- College of Public Health, Chongqing Medical University, Chongqing, China
| | - Yaxin Liu
- College of Public Health, Chongqing Medical University, Chongqing, China
| | - Xiangxi Zhou
- College of Public Health, Chongqing Medical University, Chongqing, China
| | - Manoj Sharma
- Social & Behavioral Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Yao Chen
- Health Management Center, Chongqing Medical University Affiliated Second Hospital, Chongqing, China
| | - Huan Zeng
- College of Public Health, Chongqing Medical University, Chongqing, China
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Wang Y, Jia S, Qi W, Huang C. Examining Poverty Reduction of Poverty-Stricken Farmer Households under Different Development Goals: A Multiobjective Spatio-Temporal Evolution Analysis Method. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12686. [PMID: 36231986 PMCID: PMC9565161 DOI: 10.3390/ijerph191912686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
Accurately identifying the degree of poverty and poverty-causing factors of poverty-stricken farmer households is the first key step to alleviating absolute and relative poverty. This paper introduces a multiobjective spatio-temporal evolution analysis method to examine poverty reduction of poverty-stricken farmer households under different development goals. A G-TOPSIS model was constructed to evaluate poverty-stricken households under short-, medium-, and long-term development goals. Then, GIS analysis methods were employed to reveal the spatio-temporal distribution of poverty-stricken households, and poverty causing factors were detected using the obstacle degree model. Taking Fugong County in Yunnan Province, China, as an example, the empirical results show that: (1) Great progress has been made in poverty reduction during the study period; however, some farmer households which have escaped absolute poverty are still in relative poverty and are still highly vulnerable. (2) Farmers with higher achievement rates under three different development goals are mainly distributed in the central and northern regions of study area, with a pattern of high-high agglomeration under the medium and low development goals, while low-low agglomeration mostly appears in central-southern regions. (3) Under the short-term development goals, the main poverty-causing factors are per capita net income, safe housing, sanitary toilets, years of education of labor force and family health. Under the medium- and long-term goals, per capita net income, labor force education and safe housing are the development limitations. (4) Infrastructure and public service are crucial to ending absolute poverty, and the endogenous force of regional development should be applied to alleviate the relative poverty through sustainable development industries and high-quality national education.
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Affiliation(s)
- Yanhui Wang
- Key Laboratory of 3-Dimensional Information Acquisition and Application, Ministry of Education, Capital Normal University, Beijing 100048, China
| | - Shoujie Jia
- Key Laboratory of 3-Dimensional Information Acquisition and Application, Ministry of Education, Capital Normal University, Beijing 100048, China
| | - Wenping Qi
- Key Laboratory of 3-Dimensional Information Acquisition and Application, Ministry of Education, Capital Normal University, Beijing 100048, China
- China Siwei Surveying and Mapping Technology Co., Ltd., Beijing 100086, China
| | - Chong Huang
- Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China
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He Z, Cao X, Zhao D, Tang Z, Zhao J, Beasley M, Renne A, Liu L, Zhu S, Gao Y, Yan LL. Promoting the adoption of local governmental policy on the reimbursement of chronic disease medicines (PAPMed): study protocol of a field-based cluster randomized trial in rural Nantong, China. Trials 2022; 23:785. [PMID: 36109757 PMCID: PMC9479297 DOI: 10.1186/s13063-022-06710-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/02/2022] [Indexed: 11/14/2022] Open
Abstract
Background Among rural Chinese patients with non-communicable diseases (NCDs), low socioeconomic status increases the risk of developing NCDs and associated financial burdens in paying for medicines and treatments. Despite the chronic disease medicine reimbursement policy of the local government in Nantong City, China, various barriers prevent patients from registering for and benefitting from the policy. This study aims to develop a behavior science-based intervention program for promoting the adoption of the policy and to evaluate the effectiveness of the program compared with usual practices. Methods Barriers and opportunities affecting stakeholders in adopting the policy were identified through contextual research and summarized through behavior mapping. The intervention is designed to target these barriers and opportunities through behavior science theories and will be evaluated through a 6-month cluster randomized controlled trial in Tongzhou District, Nantong, China. A total of 30 villages from two townships are randomized in a 1:1 ratio to either the intervention or the control arm (usual practices). Village doctors in the intervention arm (1) receive systematic training on policy details, registration procedures, and intervention protocol, (2) promote the policy and encourage registration, (3) follow up with patients in the first, third, and sixth months after the intervention, and (4) receive financial incentives based on performance. The primary outcome is policy registration rate and the secondary outcomes include the number of patients registering for the policy, medical costs saved, frequency of village doctor visits, and health measures such as blood pressure and glucose levels. Discussion This study is one of very few that aims to promote adoption of NCDs outpatient medication reimbursement policies, and the first study to evaluate the impact of these policies on patients’ financial and physical wellbeing in China. The simple, feasible, and scalable intervention is designed based on the theories of behavior science and is applicable to similar low-income regions nationwide where outpatient medical costs remain a financial burden for patients. Trial registration ClinicalTrials.govNCT04731194, registered on 29 January 2021; Chinese Clinical Trial Registry ChiCTR2100042152, registered on 14 January 14 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06710-1.
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He Z, Guo Q, Ling Y, Hong C, Liu Y, Jin X, Thanaporn P, Zhao D, Wang L, Liu L, Yan LL. Aldehyde dehydrogenase 2 rs671 polymorphism and multiple diseases: protocol for a quantitative umbrella review of meta-analyses. Syst Rev 2022; 11:185. [PMID: 36050775 PMCID: PMC9438126 DOI: 10.1186/s13643-022-02050-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The mutant allele (*2) of aldehyde dehydrogenase type 2 (ALDH2) caused by a single nucleotide variant (rs671) inhibits enzymatic activity and is associated with multiple diseases. In recent years, an explosive number of original studies and meta-analyses have been conducted to examine the associations of ALDH2 rs671 polymorphism with diseases. Due to conflicting results, the overall associations of ALDH2 rs671 polymorphism and multiple diseases remain unclear. METHODS A quantitative umbrella review will be conducted on meta-analyses of genetic association studies to examine the pleiotropic effects of ALDH2 rs671, mainly including cardio-cerebral vascular disease, diabetes mellitus, cancer, neurodegenerative disease, and alcohol-induced medical disease. A search of relevant literature according to comprehensive search strategies will be performed on studies published before July 1st, 2022 in PubMed, MEDLINE Ovid, Embase, Cochrane Database of Systematic Reviews, and Web of Science. Study selection, data extraction, methodology quality assessment, and strength of evidence assessment will be conducted by two reviewers independently and in duplicate. Included meta-analyses will be grouped by outcomes. Data conflicts and overlap between meta-analyses will be managed through updated standardized and customized methods including the calculation of CCA for study selection reference, application of Doi plots to assess small-study effects and others. Evidence from included meta-analyses will be quantitatively synthesized by overlap-corrected analyses and meta-analysis using primary studies. DISCUSSION This umbrella review is expected to generate systematic evidence on the association between ALDH2 rs671 and diseases. Specific approaches were developed to address key challenges in conducting an umbrella review, including assessment tools of methodology and evidence quality of meta-analyses, methods to manage overlap between meta-analyses, a "stop-light" plot to summarize key findings. These approaches provide applicable methods for future umbrella reviews of meta-analyses on genetic association studies. TRIAL REGISTRATION CRD42021223812.
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Affiliation(s)
- Zhengting He
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu, 215316, China.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, 21205, USA
| | - Qi Guo
- Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu, 215316, China
| | - Yikai Ling
- Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu, 215316, China
| | - Chuan Hong
- Department of Biostatistics & Bioinformatics, Duke University, 2424 Erwin Road, Durham, NC, 27705, USA
| | - Yuqing Liu
- Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu, 215316, China
| | - Xurui Jin
- MindRank AI Ltd., Hangzhou, Zhejiang, 310000, China
| | - Porama Thanaporn
- Department of Internal Medicine, University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 48109, USA
| | - Duan Zhao
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu, 215316, China.,School of Public Health, Hong Kong University, 7 Sassoon Road, Pokfulam, Hong Kong
| | - Leiting Wang
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu, 215316, China
| | - Liang Liu
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu, 215316, China
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu, 215316, China. .,Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA. .,School of Public Health, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, 430071, China. .,Institute for Global Health and Development, Peking University, No. 5 Yiheyuan Road, Beijing, 100871, China.
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7
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Li Y, Huang L. Assessing the impact of public transfer payments on the vulnerability of rural households to healthcare poverty in China. BMC Health Serv Res 2022; 22:242. [PMID: 35193575 PMCID: PMC8863513 DOI: 10.1186/s12913-022-07604-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China completed the task of eliminating absolute poverty, following the 18th National Congress. However, after 2020, rural poverty in China has entered a new stage that is characterised by transformational secondary poverty and relative poverty; thus, the poverty vulnerable group is the new target group. Public transfer payments play a vital role in reducing the vulnerability of rural households to healthcare poverty. Assessing the effectiveness of public transfer payments in rural households can improve the vulnerability of rural households to healthcare poverty. METHODS In total, 5754 rural households were included each year, which accounted for a total of 16,722 rural households during the three-year study period. The multidimensional poverty and the vulnerability to healthcare poverty of rural households were assessed and compared. Two series of multivariate logistic regression models were further used to assess the effects of public transfer payments on improving the vulnerability of rural households to healthcare poverty. RESULTS When the poverty line was set at $1.90 and $3.20, rural households in all the three study years exhibited a higher vulnerability to healthcare poverty than the actual incidence of multidimensional poverty in healthcare, and the Eastern regions exhibited higher vulnerability to poverty than the Western regions of China. The series of multivariate logistic models employed to evaluate the effects of public transfer payments on the rural households' vulnerability to healthcare poverty indicated that considering the differences in rural households' demands for healthcare is vital for the government to fulfill the effects of public transfer payments. When income elasticity indicators for health care needs were included, the effect of public transfer payments on improving the vulnerability of rural households changed from less significant in 2014 and 2016. In 2018, however, the effect of public transfers on improving the vulnerability of rural households has increased compared to the non-inclusion elasticity. CONCLUSIONS The imbalance of development between urban and rural areas in China is increasing, and rural households with heavy economic burdens are facing the risk of low healthcare services. Our findings highlight the importance of government departments in improving public transfer payments to reduce rural households' vulnerability to healthcare poverty.
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Affiliation(s)
- Yali Li
- School of Business, Jiangxi University of Science and Technology, Nanchang, 330013, China.,North Carolina State University, P. O. Box 8005, Raleigh, NC, 27695-8005, USA
| | - Lei Huang
- School of Accounting, Jiangxi University of Finance and Economics, Nanchang, 330013, China.
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Xia Q, Wu L, Tian W, Miao W, Zhang X, Xu J, Li Y, Shi B, Wang N, Yang H, Huang Z, Yang H, Li Y, Shan L, Wu Q. Ten-Year Poverty Alleviation Effect of the Medical Insurance System on Families With Members Who Have a Non-communicable Disease: Evidence From Heilongjiang Province in China. Front Public Health 2021; 9:705488. [PMID: 34568256 PMCID: PMC8459741 DOI: 10.3389/fpubh.2021.705488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/16/2021] [Indexed: 12/05/2022] Open
Abstract
Aims: Non-communicable diseases (NCD) drag the NCD patients' families to the abyss of poverty. Medical insurance due to weak control over medical expenses and low benefits levels, may have actually contributed to a higher burden of out-of-pocket payments. By making a multi-dimensional calculation on catastrophic health expenditure (CHE) in Heilongjiang Province over 10 years, it is significant to find the weak links in the implementation of medical insurance to achieve poverty alleviation. Methods: A logistic regression was undertaken to predict the determinants of catastrophic health expenditure. Results: The average CHE of households dropped from 18.9% in 2003 to 14.9% in 2013. 33.2% of the households with three or more NCD members suffered CHE in 2013, which was 7.2 times higher than the households without it (4.6%). The uninsured households with cardiovascular disease had CHE of 12.0%, which were nearly 10% points lower than insured households (20.4–22.4%). For Medical Insurance for Urban Employees Scheme enrolled households, the increasing number of NCD members raised the risk of impoverishment from 3.4 to 20.0% in 2003, and from 0.3 to 3.1% in 2008. Households with hospital in-patient members were at higher risk of CHE (OR: 3.10–3.56). Conclusions: Healthcare needs and utilization are one of the most significant determinants of CHE. Households with NCD and in-patient members are most vulnerable groups of falling into a poverty trap. The targeting of the NCD groups, the poorest groups, uninsured groups need to be primary considerations in prioritizing services that are contained in medical insurance and poverty alleviation.
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Affiliation(s)
- Qi Xia
- Harbin Medical University, Harbin, China
| | - Lichun Wu
- Department of Stomatology, Heilongjiang Provincial Hospital, Harbin, China
| | | | | | - Xiyu Zhang
- Harbin Medical University, Harbin, China
| | - Jing Xu
- Department of Urology, Heilongjiang Provincial Hospital, Harbin, China
| | - Yuze Li
- Department of Medicine, Jiamusi University, Jiamusi, China
| | - Baoguo Shi
- Department of Economics, School of Economics, Minzu University of China, Beijing, China
| | - Nianshi Wang
- The Department of Hospital Offices, Nanjing Medical University, Wuxi, China
| | - Huiying Yang
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Huiqi Yang
- Harbin Medical University, Harbin, China
| | - Ye Li
- Harbin Medical University, Harbin, China
| | | | - Qunhong Wu
- Harbin Medical University, Harbin, China
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Hu H, Jian W, Fu H, Zhang H, Pan J, Yip W. Health service underutilization and its associated factors for chronic diseases patients in poverty-stricken areas in China: a multilevel analysis. BMC Health Serv Res 2021; 21:707. [PMID: 34275449 PMCID: PMC8286576 DOI: 10.1186/s12913-021-06725-5] [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] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/01/2021] [Indexed: 12/17/2022] Open
Abstract
Background Underutilization of health services among chronic non-communicable disease sufferers, especially for hypertension (HBP) and diabetes mellitus (DM), was considered as a significant contributing factor to substantial cases in terms of both avoidable morbidity and mortality. However, evidence on health services underutilization and its associated factors in poverty-stricken areas remain scarce based on previous literature. This study aims to describe health services underutilization for people diagnosed with chronic diseases in impoverished regions and to identify its associated factors, which are expected to provide practical implications for the implementations of interventions tailored to the specific needs of disadvantaged residents in rural China to achieve effective utilization of health services in a timely manner. Methods Data were collected from a cross-sectional survey conducted through face-to-face interviews among 2413 patients from six counties in rural central China in 2019. The Anderson behavioral model was adopted to explore the associated factors. A two-level logistic model was employed to investigate the association strengths reflected by adjusted odds ratios (AOR) and 95% confidence intervals in forest plots. Results On average, 17.58% of the respondents with HBP and 14.87% with DM had experienced health services underutilization during 1 month before the survey. Multilevel logistic regression indicated that predisposing factors (age), enabling factors (income and a regular source of care), and need factors (self-reported health score) were the common predictors of health service underutilization both for hypertensive and diabetic patients in impoverished areas, among which obtaining a regular source of care was found to be relatively determinant as a protective factor for health services underutilization after controlling for other covariates. Conclusions Our results suggested that the implementation of a series of comprehensive strategies should be addressed throughout policy-making procedures to improve the provision of regular source of care as a significant determinant for reducing health services underutilization, thus ultimately achieving equal utilization of health services in impoverished regions, especially among chronic disease patients. Our findings are expected to provide practical implications for other developing countries confronted with similar challenges resulting from underdeveloped healthcare systems and aging population structures. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06725-5.
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Affiliation(s)
- Haiyan Hu
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, 610041, China.,Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, 610041, China
| | - Weiyan Jian
- School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100871, China
| | - Hongqiao Fu
- School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100871, China
| | - Hao Zhang
- Harvard T.H. Chan School of Public Health, No. 665 Huntington Avenue, Boston, MA, 02115, USA
| | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, 610041, China. .,Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, 610041, China.
| | - Winnie Yip
- Harvard T.H. Chan School of Public Health, No. 665 Huntington Avenue, Boston, MA, 02115, USA
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10
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Yang C, Hu S, Ye D, Jiang M, Babar ZUD, Fang Y. Evaluating Price and Availability of Essential Medicines in China: A Mixed Cross-Sectional and Longitudinal Study. Front Pharmacol 2020; 11:602421. [PMID: 33381042 PMCID: PMC7768899 DOI: 10.3389/fphar.2020.602421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/12/2020] [Indexed: 12/18/2022] Open
Abstract
Objectives: To evaluate the price and availability of medicines in China. Methods: A standard methodology developed by WHO and Health Action International was used to collect medicine price and availability data. We obtained cross-sectional data for 48 medicines from 519 facilities (280 public hospitals and 239 private retail pharmacies) in five provinces in China in 2018. We also collected longitudinal data for 31 medicines in Shaanxi Province in 2010, 2012, 2014, and 2018. Medicine price was compared with the international reference price to obtain a median price ratio (MPR). The availability and price in five provinces were compared in matched sets. We used general estimating equations to calculate differences in availability and median prices from 2010 to 2018. Findings: Mean availability of surveyed medicines in five provinces was low in both public (4.29–32.87%) and private sectors (13.50–43.75%). The MPR for lowest priced generics (LPGs) was acceptable (1.80–3.02) and for originator brands (OBs) was much higher (9.14–12.65). The variation was significant for both availability and price of medicines across provinces. In Shaanxi Province, the availability of medicines decreased between 2010 and 2018, but this was not significant in the public or private sector. Compared with 2010, the median adjusted patient price was significantly lower in 2018 for nine OBs (difference −22.4%; p = 0.005) and 20 LPGs (−20.5%; p = 0.046) in the public sector and 10 OBs (−10.2%; p = 0.047) in the private sector. Conclusion: Access to medicines was found to be poor and unequal across China in 2018. Future interventions are needed, and possible strategies include effective and efficient procurement, promoting the development of retail pharmacies and increasing medicine price transparency.
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Affiliation(s)
- Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
| | - Shuchen Hu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
| | - Dan Ye
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Department of Pharmacy, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Minghuan Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
| | - Zaheer-Ud-Din Babar
- Center for Pharmaceutical Policy and Practice Research, Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
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Jayathilaka R, Joachim S, Mallikarachchi V, Perera N, Ranawaka D. Chronic diseases: An added burden to income and expenses of chronically-ill people in Sri Lanka. PLoS One 2020; 15:e0239576. [PMID: 33113548 PMCID: PMC7592793 DOI: 10.1371/journal.pone.0239576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 09/10/2020] [Indexed: 01/16/2023] Open
Abstract
In the global context, health and the quality of life of people are adversely affected by either one or more types of chronic diseases. This paper investigates the differences in the level of income and expenditure between chronically-ill people and non-chronic population. Data were gathered from a national level survey conducted namely, the Household Income and Expenditure Survey (HIES) by the Department of Census and Statistics (DCS) of Sri Lanka. These data were statistically analysed with one-way and two-way ANOVA, to identify the factors that cause the differences among different groups. For the first time, this study makes an attempt using survey data, to examine the differences in the level of income and expenditure among chronically-ill people in Sri Lanka. Accordingly, the study discovered that married females who do not engage in any type of economic activity (being unemployed due to the disability associated with the respective chronic illness), in the age category of 40-65, having an educational level of tertiary education or below and living in the urban sector have a higher likelihood of suffering from chronic diseases. If workforce population is compelled to lose jobs, it can lead to income insecurity and impair their quality of lives. Under above findings, it is reasonable to assume that most health care expenses are out of pocket. Furthermore, the study infers that chronic illnesses have a statistically proven significant differences towards the income and expenditure level. This has caused due to the interaction of demographic and socio-economic characteristics associated with chronic illnesses. Considering private-public sector partnerships that enable affordable access to health care services for all as well as implementation of commercial insurance and community-based mutual services that help ease burden to the public, are vital when formulating effective policies and strategies related to the healthcare sector. Sri Lanka is making strong efforts to support its healthcare sector and public, which was affected by the coronavirus (COVID-19) in early 2020. Therefore, findings of this paper will be useful to gain insights on the differences of chronic illnesses towards the income and expenditure of chronically-ill patients in Sri Lanka.
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Affiliation(s)
- Ruwan Jayathilaka
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
| | - Sheron Joachim
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
| | - Venuri Mallikarachchi
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
| | - Nishali Perera
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
| | - Dhanushika Ranawaka
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
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12
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Jayathilaka R, Joachim S, Mallikarachchi V, Perera N, Ranawaka D. Do chronic illnesses and poverty go hand in hand? PLoS One 2020; 15:e0241232. [PMID: 33095818 PMCID: PMC7584216 DOI: 10.1371/journal.pone.0241232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/11/2020] [Indexed: 01/28/2023] Open
Abstract
In the global context, the health and quality of life of people are adversely affected by either one or more types of chronic diseases. The chronic pain associated with diagnosed patients may include heavy medical expenditure along with the physical and mental suffering they undergo. Usually, unbearable amounts of medical expenses are incurred, to improve or sustain the health condition of the patient. Consequently, the heavy financial burden tends to push households from a comfortable or secure life, or even from bad to worse, towards the probability of becoming poor. Hence, this study is conducted to identify the impact chronic illnesses have on poverty using data from a national survey referred as the Household Income and Expenditure Survey (HIES), with data gathered by the Department of Census and Statistics (DCS) of Sri Lanka in 2016. As such, this study is the first of its kind in Sri Lanka, declaring the originality of the study based on data collected from the local arena. Accordingly, the study discovered that married females who do not engage in any type of economic activity, in the age category of 40-65, having an educational level of tertiary level or below and living in the urban sector have a higher likelihood of suffering from chronic diseases. Moreover, it was inferred that, if a person is deprived from access to basic education in the level of education, lives in the rural or estate sector, or suffers from a brain disease, cancer, heart disease or kidney disease, he is highly likely to be poor. Some insights concluded from this Sri Lankan case study can also be applied in the context of other developing countries, to minimise chronic illnesses and thereby the probability of falling into poverty.
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Affiliation(s)
- Ruwan Jayathilaka
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
| | - Sheron Joachim
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
| | - Venuri Mallikarachchi
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
| | - Nishali Perera
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
| | - Dhanushika Ranawaka
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
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13
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Wang N, Xu J, Ma M, Shan L, Jiao M, Xia Q, Tian W, Zhang X, Liu L, Hao Y, Gao L, Wu Q, Li Y. Targeting vulnerable groups of health poverty alleviation in rural China- what is the role of the New Rural Cooperative Medical Scheme for the middle age and elderly population? Int J Equity Health 2020; 19:161. [PMID: 32928229 PMCID: PMC7489030 DOI: 10.1186/s12939-020-01236-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/13/2020] [Indexed: 12/15/2022] Open
Abstract
Background In light of the health poverty alleviation policy, we explore whether the New Rural Cooperative Medical System (NRCMS) has effectively reduced the economic burden of medical expenses on rural middle-aged and elderly people and other impoverished vulnerable groups. The study aims to provide evidence that can be used to improve the medical insurance system. Methods Data were obtained from the 2015 China Health and Retirement Longitudinal Study (CHARLS). The method of calculating the catastrophic health expenditure (CHE) and impoverishment by medical expense (IME) was adopted from the World Health Organization (WHO). The treatment effect model was used to identify the determinants of CHE for rural middle-aged and elderly people. Results The incidence of CHE in rural China for middle-aged and elderly people is 21.8%, and the IME is 8.0%. The households that had enrolled in the NRCMS suffered higher CHE (21.9%) and IME (8.0%), than those that had not enrolled (CHE: 20.6% and IME: 7.7%). The NRCMS did not provide sufficient economic protection from CHE for households with three or more chronic diseases, inpatients, or households with members aged over 65 years. Key risk factors for the CHE included education levels, households with inpatients, households with members aged over 65 years, and households with disabilities. Conclusions Although the NRCMS has reduced barriers to the usage of household health services by reducing people’s out-of-pocket payments, it has not effectively reduced the risk of these households falling into poverty. Our research identifies the characteristics of vulnerable groups that the NRCMS does not provide enough support for, and which puts them at a greater risk of falling into poverty due to health impoverishment.
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Affiliation(s)
- Nianshi Wang
- Policy and Management Research Center, School of Health Management, Department of Social Medicine, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Jing Xu
- Heilongjiang Provincial Hospital, 82 Zhongshan Road, Xiangfang District, Harbin, 150086, Heilongjiang, China
| | - Meiyan Ma
- Policy and Management Research Center, School of Health Management, Department of Social Medicine, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Linghan Shan
- Policy and Management Research Center, School of Health Management, Department of Social Medicine, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Mingli Jiao
- Policy and Management Research Center, School of Health Management, Department of Social Medicine, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Qi Xia
- Policy and Management Research Center, School of Health Management, Department of Social Medicine, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Wanxin Tian
- Policy and Management Research Center, School of Health Management, Department of Social Medicine, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Xiyu Zhang
- Policy and Management Research Center, School of Health Management, Department of Social Medicine, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Limin Liu
- The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin, 150001, Heilongjiang, China
| | - Yanhua Hao
- Policy and Management Research Center, School of Health Management, Department of Social Medicine, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Lijun Gao
- Policy and Management Research Center, School of Health Management, Department of Social Medicine, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Qunhong Wu
- Policy and Management Research Center, School of Health Management, Department of Social Medicine, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.
| | - Ye Li
- Policy and Management Research Center, School of Health Management, Department of Social Medicine, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.
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14
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Wang H, Dong R. A touching letter vs a terrible tragedy:What we learned. Int J Clin Pract 2020; 74:e13514. [PMID: 32306472 DOI: 10.1111/ijcp.13514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 04/13/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hong Wang
- Department of Pediatrics, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, People's Republic of China
| | - Rui Dong
- Department of Anesthesiology, Qingdao Municipal Hospital, Qingdao University, Qingdao, People's Republic of China
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