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Zhang Z, Shi G, Xing Y, Men K, Lei J, Ma Y, Zhang Y. Examining the potential impacts of intensive blood pressure treatment on the socioeconomic inequity in hypertension prevalence in China: a nationally representative cross-sectional study. Hypertens Res 2023; 46:2746-2753. [PMID: 37789112 DOI: 10.1038/s41440-023-01441-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/20/2023] [Accepted: 09/07/2023] [Indexed: 10/05/2023]
Abstract
Few studies focused on the equity of hypertension prevalence before and after the diagnostic threshold change. The study aimed to analyze the 130/80 mmHg hypertension diagnostic threshold on the equity of hypertension prevalence in China. The baseline survey data from the China Health and Retirement Longitudinal Study (CHARLS) conducted from 2011 to 2012 were utilized to evaluate the impact of the 130/80 mmHg diagnostic threshold on the equity of hypertension prevalence in China using the concentration index and its decomposition which was an index reflecting the health inequality caused by social and economic factors. The prevalence of hypertension was 41.56% and 57.33% under the diagnostic thresholds of 140/90 mmHg and 130/80 mmHg, respectively. The concentration index for hypertension prevalence in China was -0.017 (95%CI: -0.028, -0.006) under the 140/90 mmHg threshold and -0.010 (95%CI: -0.018, -0.002) under the 130/80 mmHg threshold. Concentration index decomposition analysis of hypertension prevalence diagnosed at both diagnostic thresholds showed that age, BMI, and economic status contributed more to the inequitable situation of hypertension prevalence. Higher age, higher BMI, and poorer economic status increased the inequity of hypertension prevalence. No significant difference in the increase in hypertension among individuals of different economic status after implementing the blood pressure control standard (130/80 mmHg), and the prevalence of hypertension in the region did not show a significant bias towards the low economic status population. Therefore, implementing this standard will not increase the risk of hypertension prevalence biased toward people of low economic status. Implementing the 130/80 mmHg diagnostic threshold will not increase the risk of hypertension prevalence biased towards people of low economic status.
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Affiliation(s)
- Zhuo Zhang
- School of Health Services Management, Xi'an Medical College, Xi'an, Shaanxi, China
| | - Guoshuai Shi
- School of Public Health, Xi'an Medical College, Xi'an, Shaanxi, China.
| | - Yuan Xing
- School of Public Health, Xi'an Medical College, Xi'an, Shaanxi, China
| | - Ke Men
- School of Public Health, Xi'an Medical College, Xi'an, Shaanxi, China
| | - Jing Lei
- School of Public Health, Xi'an Medical College, Xi'an, Shaanxi, China
| | - Yonghong Ma
- School of Public Health, Xi'an Medical College, Xi'an, Shaanxi, China
| | - Yijia Zhang
- School of Health Services Management, Xi'an Medical College, Xi'an, Shaanxi, China
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Li C, Tang C. Income-related health inequality among rural residents in western China. Front Public Health 2022; 10:1065808. [PMID: 36589999 PMCID: PMC9797679 DOI: 10.3389/fpubh.2022.1065808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/29/2022] [Indexed: 12/16/2022] Open
Abstract
Objective Health equality has drawn much public attention in both developed and developing countries. China, the largest developing country, has implemented a new round of health system reform to improve health equality since 2009. This study aims to examine the magnitude and sources of income-related health inequality in western rural regions of China. Methods Data were obtained from the Survey of Rural Economic and Social Development in Western China conducted in 2014, in which 14,555 individuals from 5,299 households in 12 provinces were included. Health outcome variables of interest were self-rated health status, prevalence of chronic disease and four-week illness. Concentration index was calculated to assess magnitude of income-related health inequality, and nonlinear decomposition analysis was performed to identify the sources of health inequality. Results The Concentration indexes for poor self-rated health status, prevalence of chronic disease and four-week illness were -0.0898 (P<0.001),-0.0860 (P<0.001) and -0.1284 (P<0.001), respectively. Income and education were two main sources of health inequality, accounting for about 25-50% and 15% contribution to the inequality. Ethnicity made <10% contribution to income-related health inequality, and enrollment in New Rural Cooperative Medical Scheme contributed to <1%. Conclusion This study found slight income-related health inequality among rural residents in western China, implying that although China has made substantial progress in economic development and poverty alleviation, health inequality in western rural region should still be concerned by the government. To achieve health equality further, the Chinese government should not only strengthen its reimbursement mechanism of the current health insurance scheme to improve affordability of primary healthcare for residents in western rural regions, but also implement health poverty alleviation policies targeting socioeconomically vulnerable population and ethnic minorities in future.
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Affiliation(s)
- Chaofan Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Chengxiang Tang
- Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia,*Correspondence: Chengxiang Tang
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Mahdavi M, Parsaeian M, Farzadfar F, Mohamadi E, Olyaeemanesh A, Takian A. Inequality in prevalence, awareness, treatment, and control of hypertension in Iran: the analysis of national households’ data. BMC Public Health 2022; 22:2349. [DOI: 10.1186/s12889-022-14768-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
Providing an equitable Universal Health Coverage (UHC) is key for progressing towards the sustainable development goals in the health systems. To help policymakers make hypertension services more equitable with existing (limited) resources in Iran, we examined the inequality of the prevalence, awareness, treatment, and control (PATC) of hypertension as the four indicators of hypertension UHC in Iran.
Methods
This research was a cross-sectional study of inequality of PATC of hypertension using a representative sample of Iranians aged ≥ 25 years from the Iran 2016 STEP wise approach to Surveillance study (STEPS). Outcome variables consisted of PATC of hypertension. Covariates were demographic (age, sex, and marital status) and living standard (area of residence, wealth status, education, and health insurance) indicators. We drew concentration curves (CC) and estimated concentration indices (C). We also conducted normalized Erreygers decomposition analysis for binary outcomes to identify covariates that explain the wealth-related inequality in the outcomes. Analysis was conducted in STATA 14.1.
Results
The normalized concentration index of hypertension prevalence and control was -0.066 (p < .001) and 0.082 (p < .001), respectively. The C of awareness and treatment showed nonsignificant difference between the richest and poorest. Inequality in the hypertension prevalence of females was significantly higher than males (C = -0.103 vs. male C = -0.023, p < .001). Our analyses explained 33% of variation in the C of hypertension prevalence and 99.7% of variation in the C of control. Education, wealth index, and complementary insurance explained most inequality in the prevalence. Area of residence, education, wealth status, and complementary insurance had the largest contribution to C of control by 30%, 28%, 26%, and 21%, respectively.
Conclusions
This study showed a pro-rich inequality in the prevalence and control of hypertension in Iran. We call for expanding the coverage of complementary insurance to reduce inequality of hypertension prevalence and control as compared with other factors it can be manipulated in short run. We furthermore advocate for interventions to reduce the inequality of hypertension control between rural and urban areas.
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Cao D, Zhou Z, Ren Y, Deng Q, Zhai X, Liu G, Zhao D, Zhao Y, Shen C. The relationship between duration of subjective poverty and health among Chinese adults: Evidence from the China Family Panel Study. Front Public Health 2022; 10:939569. [PMID: 36276380 PMCID: PMC9581302 DOI: 10.3389/fpubh.2022.939569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/02/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction The disadvantaged socioeconomic status could have accumulated negative effects on individual. In the Chinese context, studying subjective and relative poverty is more important under the implementation of the Targeted Poverty Alleviation campaign. This study aims to provide evidence of the relationship between the duration of subjective poverty and both physical and mental health among Chinese adults, using nationally longitudinal data from 2010 to 2018. Materials and methods Data were extracted from a nationally representative survey database-the China Family Panel Study (CFPS). The total sample size contains 12,003 adults, with 3,532 in the urban area and 8,471 in the rural area. Self-rated health and depressive symptoms were set as indicators of physical health and mental health, respectively. The duration of subjective poverty was measured by self-rated income level in the local area from 2010 to 2016. A series of ordinary least square regression was adopted to measure the relationship between duration of subjective poverty and health. Results For the urban residents, the average duration of subjective poverty is 1.99 time points, while 1.98 time points for the rural residents. Net of objective poverty, duration of subjective poverty has a significantly negative association with individual's self-rated health in the rural sample (Coef. = -0.10, p < 0.001). Compared with those who have not experienced subjective poverty, the self-rated health score of people who experienced four time points is likely to decrease by 0.54 in the rural area and 0.30 in the urban area. In terms of mental health, 1 unit increase in the duration of subjective poverty is related to 0.15 unit increase in Center for Epidemiologic Studies Depression Scale-8 (CES-D8) scores in the urban sample and 0.46 in the rural sample. Compared with those who have not experienced subjective poverty, the CES-D8 scores of people who experienced four time points are likely to increase by 1.47 in the rural area and 0.95 in the urban area. Conclusion A longer duration of subjective poverty has a cumulatively negative effect on Chinese residents' physical and mental health, especially in rural area. Our study advocates researchers and policymakers pay more attention to the cumulative effect of subjective poverty on health.
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Affiliation(s)
- Dan Cao
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China,School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Zhongliang Zhou
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China,School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China,*Correspondence: Zhongliang Zhou
| | - Yangling Ren
- School of Public Administration, Southwestern University of Finance and Economics, Chengdu, China
| | - Qiwei Deng
- School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Xiaohui Zhai
- School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Guanping Liu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Dantong Zhao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Yaxin Zhao
- School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Chi Shen
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
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Zhao Y, Anindya K, Atun R, Marthias T, Han C, McPake B, Duolikun N, Hulse E, Fang X, Ding Y, Oldenburg B, Lee JT. Provincial heterogeneity in the management of care cascade for hypertension, diabetes, and dyslipidaemia in China: Analysis of nationally representative population-based survey. Front Cardiovasc Med 2022; 9:923249. [PMID: 36093142 PMCID: PMC9458474 DOI: 10.3389/fcvm.2022.923249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/29/2022] [Indexed: 11/19/2022] Open
Abstract
Background This study aims to examine (1) province-level variations in the levels of cardiovascular disease (CVD) risk and behavioral risk for CVDs, (2) province-level variations in the management of cascade of care for hypertension, diabetes, and dyslipidaemia, and (3) the association of province-level economic development and individual factors with the quality of care for hypertension, diabetes, and dyslipidaemia. Methods We used nationally representative data from the China Health and Retirement Longitudinal Study in 2015, which included 12,597 participants aged 45 years. Using a care cascade framework, we examined the quality of care provided to patients with three prevalent NCDs: hypertension, diabetes, and dyslipidaemia. The proportion of WHO CVD risk based on the World Health Organization CVD risk prediction charts, Cardiovascular Risk Score (CRS) and Behavior Risk Score (BRS) were calculated. We performed multivariable logistic regression models to determine the individual-level drivers of NCD risk variables and outcomes. To examine socio-demographic relationships with CVD risk, linear regression models were applied. Results In total, the average CRS was 4.98 (95% CI: 4.92, 5.05), while the average BRS was 3.10 (95% confidence interval: 3.04, 3.15). The weighted mean CRS (BRS) in Fujian province ranged from 4.36 to 5.72 (P < 0.05). Most of the provinces had a greater rate of hypertension than diabetes and dyslipidaemia awareness and treatment. Northern provinces had a higher rate of awareness and treatment of all three diseases. Similar patterns of regional disparity were seen in diabetes and dyslipidaemia care cascades. There was no evidence of a better care cascade for CVDs in patients who reside in more economically advanced provinces. Conclusion Our research found significant provincial heterogeneity in the CVD risk scores and the management of the cascade of care for hypertension, diabetes, and dyslipidaemia for persons aged 45 years or more. To improve the management of cascade of care and to eliminate regional and disparities in CVD care and risk factors in China, local and population-based focused interventions are necessary.
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Affiliation(s)
- Yang Zhao
- The George Institute for Global Health, Beijing, China
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- *Correspondence: Yang Zhao ;
| | - Kanya Anindya
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Tiara Marthias
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Department of Public Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Chunlei Han
- College of Public Health and Management, Binzhou Medical University, Yantai, China
| | - Barbara McPake
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Emily Hulse
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Xinyue Fang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yimin Ding
- School of Software, Tongji University, Shanghai, China
| | - Brian Oldenburg
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - John Tayu Lee
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
- Department of Health Service Research and Policy, Australian National University, Canberra, NSW, Australia
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Chang X, Chen X, Ji JS, Luo G, Chen X, Sun Q, Zhang N, Guo Y, Pei P, Li L, Chen Z, Wu X. Association between sleep duration and hypertension in southwest China: a population-based cross-sectional study. BMJ Open 2022; 12:e052193. [PMID: 35760551 PMCID: PMC9237882 DOI: 10.1136/bmjopen-2021-052193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Hypertension is a major risk factor and cause of many non-communicable diseases in China. While there have been studies on various diet and lifestyle risk factors, we do not know whether sleep duration has an association to blood pressure in southwest China. This predictor is useful in low-resource rural settings. We examined the association between sleep duration and hypertension in southwest China. DESIGN Population-based cross-sectional study. SETTING This study was part of the baseline survey of a large ongoing prospective cohort study, the China Kadoorie Biobank. Participants were enrolled in 15 townships of Pengzhou city in Sichuan province during 2004-2008. PARTICIPANTS 55 687 participants aged 30-79 years were included. Sleep duration was assessed by a self-reported questionnaire. MAIN OUTCOME MEASURES Hypertension was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg, or prior physician-diagnosed hypertension in hospitals at the township (community) level or above. RESULTS The prevalence of hypertension was 25.17%. The percentages of subjects with sleep durations of <6, 6, 7, 8 and ≥9 hours were 17.20%, 16.14%, 20.04%, 31.95% and 14.67%, respectively. In multivariable-adjusted analyses, the increased ORs of having hypertension were across those who reported ≥9 hours of sleep (men: 1.16, 95% CI 1.04 to 1.30; women: 1.19, 95% CI 1.08 to 1.32; general population: 1.17, 95% CI 1.08 to 1.26). The odds of hypertension was relatively flat until around 6.81 hours of sleep duration and then started to increase rapidly afterwards in subjects and a J-shaped pattern was observed. There was a U-shaped relationship between sleep duration and hypertension in females. CONCLUSION Long sleep duration was significantly associated with hypertension and a J-shaped pattern was observed among rural adults in southwest China, independent of potential confounders. However, this association was not obvious between short sleep duration and hypertension.
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Affiliation(s)
- Xiaoyu Chang
- Department of Chronic and Non-communicable Disease Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Xiaofang Chen
- Department of Epidemiology and Statistics, Chengdu Medical College, Chengdu, Sichuan, China
| | - John S Ji
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Guojin Luo
- Pengzhou Center for Disease Control and Prevention, Pengzhou, Sichuan, China
| | - Xiaofang Chen
- Pengzhou Center for Disease Control and Prevention, Pengzhou, Sichuan, China
| | - Qiang Sun
- Pengzhou Center for Disease Control and Prevention, Pengzhou, Sichuan, China
| | - Ningmei Zhang
- Department of Chronic and Non-communicable Disease Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Pei Pei
- Chinese Academy of Medical Sciences, Beijing, China
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Center for Public Health and Epidemic Preparedness and Response, Peking University, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit (CTSU) and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Xianping Wu
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
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The contribution of Urban and Rural Resident Basic Medical Insurance to income-related inequality in depression among middle-aged and older adults: Evidence from China. J Affect Disord 2021; 293:168-175. [PMID: 34198032 DOI: 10.1016/j.jad.2021.06.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/07/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Previous studies have not investigated the contribution of medical insurance to income-related inequality in depressive symptoms. To fulfill this research gap, this study aimed to assess the contribution of Urban and Rural Resident Basic Medical Insurance (URRBMI) to income-related inequality in depressive symptoms among middle-aged and older adults in China. METHODS The data of this study was obtained from the 2018 wave of China Health and Retirement Longitudinal Study (CHARLS). The data of Particulate Matter 2.5 (PM2.5) concentrations were sourced from Atmospheric Composition Analysis Group. Furthermore, concentration curve and concentration index were employed to measure the extent of income-related inequality in depressive symptoms. Moreover, decomposition method of concentration index was used to quantify the contribution of URRBMI to the income-related inequality in depressive symptoms. RESULTS The concentration index values of depression occurrence and score were -0.1067 and -0.0712, respectively, indicating pro-rich inequality. The decomposition results reveal that the contribution rate of URRBMI to concentration index of depression occurrence was 18.88%, which indicates that it reduced the pro-rich inequality in depression occurrence. In addition, the contribution rate of URRBMI to concentration index of depression score was 3.55%, indicating that it relieved the pro-rich inequality in depression score. CONCLUSION This study found pro-rich inequalities in depression occurrence and score which were reduced with the coverage of URRBMI. It is quite necessary to further expand the coverage of URRBMI.
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Sun J, Lyu X, Lyu S, Zhao R. The effect of social participation on income-related inequality in health outcome among Chinese older adults. Int Health 2021; 13:80-88. [PMID: 33443288 PMCID: PMC7807233 DOI: 10.1093/inthealth/ihaa023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 04/06/2020] [Accepted: 04/23/2020] [Indexed: 12/03/2022] Open
Abstract
Background This study aimed to investigate the effect of social participation on income-related inequality in health outcome among older adults in China. Methods The panel data used in this study were sourced from the 2011 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Furthermore, this study employed a concentration index to assess the income-related inequality in health outcome. Moreover, this study used the decomposition method of concentration index to analyse the effect of social participation on income-related inequality in health outcome. Results The total concentration index of Instrumental Activity of Daily Living (IADL) status decreased from 0.0257 in 2011 to 0.0172 in 2014. Furthermore, the total concentration index of psychological health decreased from 0.0309 in 2011 to 0.0269 in 2014. The decomposition analysis indicates that social participation made a major contribution to the pro-rich inequality in IADL status. Moreover, the results also indicate that social participation made a minor contribution to the pro-rich inequality in psychological health. Conclusions This study demonstrated that overall there were pro-rich inequalities in IADL status and psychological health among older adults in China. Moreover, social participation made a major contribution to the pro-rich inequality in IADL status, while it made a minor contribution to the pro-rich inequality in psychological health.
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Affiliation(s)
- Jian Sun
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyin Lyu
- High School Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Shoujun Lyu
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China.,China Institute of Urban Governance, Shanghai Jiao Tong University, Shanghai, China
| | - Rui Zhao
- Affiliated Hospital of Hebei University, Baoding, Hebei, China
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Mi J, Song J, Zhao Y, Wu X. Association of hemoglobin glycation index and its interaction with obesity/family history of hypertension on hypertension risk: a community-based cross-sectional survey. BMC Cardiovasc Disord 2020; 20:477. [PMID: 33148181 PMCID: PMC7640660 DOI: 10.1186/s12872-020-01762-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/29/2020] [Indexed: 01/12/2023] Open
Abstract
Background Hemoglobin glycation index (HGI) is considered to be a convenient measurable indicator to assess the inter-individual variation of HbA1c. In the present study, we tested the relationship between HGI and risk of hypertension, and further explored the possible interacting influences of HGI with other such factors on hypertension risk among Chinese individuals. Methods The eligible subjects were chosen from a community-based cross-sectional survey in China. We collected relevant data and clinical indicators for each participant. HGI was calculated as “measured HbA1c-predicted HbA1c” and divided into four categories according to quartile. The following indicators were used to assess interactive effects: (1) relative excess risk due to interaction (RERI); (2) attributable proportion due to interaction (AP); and (3) synergy index (SI). Statistical analysis was performed using R software. Results Specifically, 1777 eligible participants were selected in this cross-sectional survey. There were 433 subjects who were identified to have hypertension (24.4%). A significant increase in the prevalence of hypertension from Q1 to Q4 of HGI was observed (p < 0.001). Multivariable logistic model demonstrated that subjects at the highest HGI group had a substantially increased risk of being hypertensive than subjects in the first quartile of HGI, as indicated by the OR value of 1.87 (95% CI 1.26–2.78). Moreover, a significant interaction between family history of hypertension and HGI on hypertension risk was detected (RERI: 1.36, 95% CI 0.11–2.63; AP: 0.43, 95% CI 0.17–0.69; and SI:2.68, 95% CI 1.10–6.48). The interactive effect between HGI and abdominal obesity was also found to be significant, as estimated by the value of RERI (1.04, 95% CI 0.24–1.85), AP (0.33, 95% CI 0.11–0.56) and SI (1.96, 95% CI 1.01–3.79). However, in the analysis of the interaction between HGI and general obesity, only the AP value (0.28, 95% CI 0.01–0.54) was observed to be significant. Conclusion High HGI was independently associated with the risk of hypertension. Moreover, HGI significantly shared interactions with obesity and family history of hypertension that influenced the risk of hypertension.
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Affiliation(s)
- Jing Mi
- School of Public Health, Bengbu Medical College, 2600 Donghai road, Bengbu, 233000, Anhui Province, China
| | - Jian Song
- School of Public Health, Bengbu Medical College, 2600 Donghai road, Bengbu, 233000, Anhui Province, China
| | - Yingying Zhao
- Bengbu Health Board, 568 Nanhu road, Bengbu, 233000, Anhui Province, China
| | - Xuesen Wu
- School of Public Health, Bengbu Medical College, 2600 Donghai road, Bengbu, 233000, Anhui Province, China.
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Zhou L, Cao D, Si Y, Zhu X, Du L, Zhang Y, Zhou Z. Income-related inequities of adult obesity and central obesity in China: evidence from the China Health and Nutrition Survey 1997-2011. BMJ Open 2020; 10:e034288. [PMID: 33127627 PMCID: PMC7604817 DOI: 10.1136/bmjopen-2019-034288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 07/29/2020] [Accepted: 09/18/2020] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES The aim of this study was to analyse the status regarding inequities in adult obesity and central obesity in China. Thus, income-related inequality for both diseases and the underlying factors were examined. METHODS AND DESIGN The China Health and Nutrition Survey (CHNS)-conducted from 1997 to 2011-included 128 307 participants; in this study, 79 566 individuals classified as obese and 65 250 regarded as suffering from central obesity according to the CHNS were analysed. A body mass index greater than 27 was considered indicative of obesity; men and women with a waist circumference of more than 102 cm and 80 cm, respectively, were considered as suffering from central obesity. The concentration index was employed to analyse inequality in adult obesity and central obesity. The decomposition of this index based on a probit model was used to calculate the horizontal inequality index. RESULTS The prevalence of adult obesity increased from 8.34% in 1997 to 17.74% in 2011, and that of central obesity increased from 6.52% in 1997 to 16.79% in 2011. The horizontal inequality index for adult obesity decreased from 0.1377 in 1997 to 0.0164 in 2011; for central obesity, it decreased from 0.0806 in 1997 to -0.0193 in 2011. The main causes of inequality for both diseases are, among others, economic status, marital status and educational attainment. CONCLUSIONS From 1997 to 2011, the prevalence of adult obesity and central obesity increased annually. The pro-rich inequalities in both adult and central obesity decreased from 1997 to 2011. The inequality in central obesity was more prominent in the low-income group in 2011. Future policies may need to address obesity reduction among the poor.
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Affiliation(s)
- Ling Zhou
- Health Science Center, School of Public Health, Xi'an Jiaotong University, Xi'an, China
- School of Public Health, Dalian Medical University, Dalian, China
| | - Dan Cao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Yafei Si
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales, Sydney, New South Wales, Australia
| | - Xuexue Zhu
- School of Public Health, Dalian Medical University, Dalian, China
| | - Liang Du
- School of Public Health, Dalian Medical University, Dalian, China
| | - Yu Zhang
- School of Public Health, Dalian Medical University, Dalian, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
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Sun J, Lyu S, Zhao R. Socioeconomic Inequality in Health Outcomes Among the Elderly: Evidence from a Cross-Sectional Study in China. Risk Manag Healthc Policy 2020; 13:397-407. [PMID: 32523387 PMCID: PMC7234974 DOI: 10.2147/rmhp.s248019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/24/2020] [Indexed: 01/19/2023] Open
Abstract
Background and Aim Health is viewed as a form of human capital and a necessary basis for people to realize capabilities. Moreover, socioeconomic inequality in health outcome widens income inequality and exacerbates social inequality. The aim of this study is to measure socioeconomic inequality in health outcomes among the elderly in China. Methods The data used in this study were sourced from China Health and Retirement Longitudinal Study in 2015, including 5643 participants aged 60 and above. Concentration curve and concentration index were applied to measure the extent of socioeconomic inequality in health outcomes among older adults. Furthermore, the decomposition method of concentration index proposed by Wagstaff was employed to quantify each determinant's contribution to the measured socioeconomic inequality in health outcomes. Results The concentration index of Activity of Daily Living Scale and Center of Epidemiological Survey-Depression Scale score were -0.0064 and -0.0158, respectively, indicating pro-rich inequality in physical and mental health among the elderly. The decomposition analysis revealed that household income (41.15%), aged 70-79 (17.37%), being male (8.38%), and living in urban area (5.78%) were key factors to explain the pro-rich inequality in physical health. Furthermore, the results also suggested that household income (68.41%), being male (17.55%), having junior high school education (10.67%), and living in urban area (6.49%) were key factors to explain the pro-rich inequality in mental health. Conclusion This study revealed that there are pro-rich inequalities in physical and mental health among the elderly in China, and the degree of pro-rich inequality in mental health is higher than that in physical health. Moreover, the results also suggested that household income is the biggest contributor to socioeconomic inequality in physical and mental health. Furthermore, this study found that educational attainment makes a substantial contribution to socioeconomic inequality in health outcomes, while the contribution of health insurance to health inequality is limited.
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Affiliation(s)
- Jian Sun
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai 200030, People's Republic of China
| | - Shoujun Lyu
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai 200030, People's Republic of China.,China Institute for Urban Governance, Shanghai Jiao Tong University, Shanghai 200030, People's Republic of China
| | - Rui Zhao
- Affiliated Hospital of Hebei University, Hebei 071000, People's Republic of China
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