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Wang Y, Jiang N, Shao H, Wang Z. Exploring unmet healthcare needs and associated inequalities among middle-aged and older adults in Eastern China during the progression toward universal health coverage. HEALTH ECONOMICS REVIEW 2024; 14:46. [PMID: 38935169 PMCID: PMC11212176 DOI: 10.1186/s13561-024-00521-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 06/20/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Given the rapid population aging in China, achieving universal health coverage (UHC) presents a primary challenge in addressing unmet healthcare needs and associated inequalities among middle-aged and older adults. Several studies have focused on healthcare utilization and its inequalities, but little attention has been paid to the inequality in unmet healthcare needs. This study aimed to analyze the inequalities in unmet the healthcare needs of middle-aged and older adults in eastern China during the progression toward UHC. METHODS Data were obtained from the fourth, fifth, and sixth National Health Service Survey (NHSS) of Jiangsu Province, located in eastern China, during the years 2008, 2013, and 2018, respectively. Logistic regression models were used to assess the associated factors of unmet healthcare needs. The inequality was measured according to the concentration index (CI) and its decomposition. RESULTS In this study, we found that 12.86%, 2.22%, and 48.89% of middle-aged and older adults reported unmet needs for outpatient and inpatient services and physical examinations, respectively. The prevalence of unmet outpatient needs increased from 2008 to 2018, while the prevalence of unmet inpatient services was lower but maintained. The prevalence of unmet needs for physical examinations among middle-aged and older adults markedly decreased since 2008. Rural areas had a higher prevalence of unmet needs for inpatient services and physical examinations than urban areas. Unmet healthcare needs were more prevalent among the poor. The pro-poor inequalities of unmet healthcare needs have been mitigated during the progression toward UHC; however, they remain predominant among rural middle-aged and older adults for outpatient and inpatient services. Socioeconomic factors significantly influenced unmet healthcare needs and contributed to their inequalities. CONCLUSIONS The findings characterize the prevalence and inequality of unmet healthcare need among middle-aged and older adults in eastern China during the progression toward UHC. Policy interventions should be actively advocated to effectively mitigate the unmet healthcare needs and address the associated inequalities.
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Affiliation(s)
- Yunhan Wang
- School of Health Policy & Management, Nanjing Medical University, Nanjing, 211166, China
| | - Nan Jiang
- School of Health Policy & Management, Nanjing Medical University, Nanjing, 211166, China
| | - Haiya Shao
- School of Health Policy & Management, Nanjing Medical University, Nanjing, 211166, China.
| | - Zhonghua Wang
- School of Health Policy & Management, Nanjing Medical University, Nanjing, 211166, China.
- The Public Health Policy and Management Innovation Research Team, Nanjing Medical University, Nanjing, 211166, China.
- School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
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Tian J, Wang J, Wang D, Fang C. Influence of urbanization on meteorological conditions and ozone pollution in the Central Plains Urban Agglomeration, China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 356:124290. [PMID: 38825221 DOI: 10.1016/j.envpol.2024.124290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/24/2024] [Accepted: 05/30/2024] [Indexed: 06/04/2024]
Abstract
Changes in aerodynamic and thermal conditions caused by urbanization can impact regional meteorological conditions, subsequently affecting air quality. Updated Moderate-resolution Imaging Spectroradiometer (MODIS) land use data and coupled with the urban canopy models (UCMs) in the Weather Research and Forecasting (WRF) model. This enabled the impact of urban land expansion on meteorological conditions and ozone (O3) concentrations to be evaluated. Urban expansion increased the temperature at 2 m (T2) and the probability of precipitation in urban expansion areas, and enhanced the surface urban heat island at night. As the expansion areas became progressively larger, the increase in T2 became more pronounced. The proportions of urban surfaces in June 2016, 2018, and 2020 compared to 2001 increased by 0.69%, 0.83%, and 1.04%, respectively, while T2 increased by 0.12, 0.19, and 0.20 °C in urban areas, respectively. With urban expansion, the O3 concentration increased by 1.12, 1.37, and 0.76 μg/m3 (three-year averages) in urban, suburban, and rural areas, respectively. After coupling a multi-layer urban canopy model (building effect parameterization, BEP), or a multi-layer urban canopy model with a building energy model including anthropogenic heat due to air conditioning (BEP + BEM, abbreviated as BEM simulation), the O3 concentration changed significantly in the urban expansion area, compared to the results of a single-layer urban canopy model (UCM). O3 concentrations decreased most in the BEP simulation (-0.77 μg/m3), while O3 concentrations increased most in the BEM simulation (+1.85 μg/m3). The average observed O3 concentration was 108.35 μg/m3 (three-year average), while the simulated value was 75.65-83.72 μg/m3 (R = 0.69-0.77). The validation results in the BEM and Global Optimal Scenario (GOS) simulations were relatively good, with the GOS simulation producing slightly better results than the BEM. The simulation of O3 in urban agglomerations could be improved by integrating the results of the UCMs.
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Affiliation(s)
- Jiaqi Tian
- College of New Energy and Environment, Jilin University, Changchun, 130012, China; Key Laboratory of Groundwater Resources and Environment, Ministry of Education, Jilin University, Changchun, 130021, China.
| | - Ju Wang
- College of New Energy and Environment, Jilin University, Changchun, 130012, China; Key Laboratory of Groundwater Resources and Environment, Ministry of Education, Jilin University, Changchun, 130021, China; Jilin Province Key Laboratory of Water Resources and Environment, Jilin University, Changchun, 130021, China.
| | - Dali Wang
- Environmental Sciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, 37831, USA.
| | - Chunsheng Fang
- College of New Energy and Environment, Jilin University, Changchun, 130012, China; Key Laboratory of Groundwater Resources and Environment, Ministry of Education, Jilin University, Changchun, 130021, China; Jilin Province Key Laboratory of Water Resources and Environment, Jilin University, Changchun, 130021, China.
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Zhang J, Chandola T, Zhang N. Understanding the longitudinal dynamics of rural-urban mental health disparities in later life in China. Aging Ment Health 2022:1-10. [PMID: 35822456 DOI: 10.1080/13607863.2022.2098912] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Understanding longitudinal patterns of rural-urban mental health disparities is vital for effective intervention and policy development in China. However, few studies have estimated separate effects of birth-cohort and ageing and examined the role of community resources on health inequalities. METHODS Drawing data from the China Health and Retirement Longitudinal Study (2011-2018), this study employed multilevel modelling to identify the mental health trajectories of rural, peri-urban, urban older adults by cohort and the community effects. RESULTS The changes in the mental health gap between rural, peri-urban and urban older adults over time varied by birth cohorts. Among younger cohorts aged under 65, the mental health disparities between rural, peri-urban and urban residents increased as they got older. Underdeveloped community infrastructure greatly explained the rural health disadvantage. CONCLUSION The study indicates increasing rural-urban health disparities at the onset of later life. Improving community infrastructure in rural and peri-urban areas is vital to minimise rural-urban health gaps.
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Affiliation(s)
- Jingwen Zhang
- Department of Social Statistics, Manchester Institute for Collaborative Research on Ageing (MICRA), School of Social Sciences, The University of Manchester, Manchester, UK
| | - Tarani Chandola
- Faculty of the Social Sciences, The University of Hong Kong, Hong Kong, China
| | - Nan Zhang
- Department of Social Statistics, Manchester Institute for Collaborative Research on Ageing (MICRA), School of Social Sciences, The University of Manchester, Manchester, UK
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Yu Q, Zuo G. Impact of urbanisation on the gaps of hypertension prevalence, awareness and treatment among older age in China: a cross-sectional study. BMJ Open 2022; 12:e057065. [PMID: 35772814 PMCID: PMC9247652 DOI: 10.1136/bmjopen-2021-057065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To examine the impact of urbanisation on the prevalence, awareness and treatment of hypertension among elderly in China. DESIGN This cross-sectional study used data from the most recent nationally representative Chinese Longitudinal Healthy Longevity Survey, 2018. SETTING People in urban and rural communities from 500 sample areas in 22 Chinese provinces. PARTICIPANTS After exclusion, this study surveyed 9859 participants in the final analysis. PRIMARY AND SECONDARY OUTCOME MEASURES The main dependent variables were prevalence, awareness and treatment of hypertension defined as (1) systolic blood pressure (BP)≥140 mm Hg, diastolic BP≥90 mm Hg or (2) taking antihypertensive drugs. Hypertension awareness was defined as a previous diagnosis of hypertension by a health professional, and hypertension treatment was defined as undergoing BP treatment. RESULTS The prevalence of hypertension was lower among semiurbanised adults than among non-urbanised rural adults (OR=0.94, 95% CI=0.90 to 0.99; p<0.05). The probabilities of awareness (OR=1.10, 95% CI=1.01 to 1.20; p<0.05) and treatment (OR=1.17, 95% CI=1.08 to 1.26; p<0.001) of hypertension were significantly lower among non-urbanised adults than among urban-born adults. Urbanisation in eastern (OR=0.93, 95% CI=0.88 to 0.99; p<0.05) and western China (OR=1.11, 95% CI=1.01 to 1.23; p<0.05) was associated with the prevalence of hypertension. The urbanisation level was also associated with hypertension awareness and treatment in eastern (OR=1.17, 95% CI=1.04 to 1.32; p<0.01; OR=1.26, 95% CI=1.14 to 1.40; p<0.001), central (OR=1.31, 95% CI=1.05 to 1.63; p<0.05; OR=1.29, 95% CI=1.08 to 1.55; p<0.01) and western China (OR=1.28, 95% CI=1.07 to 1.53; p<0.01; OR=1.34, 95% CI=1.15 to 1.57; p<0.001). The Blinder-Oaxaca decomposition suggested that approximately 42% and 39% of the urban-rural gap in hypertension awareness and treatment, respectively, could be attributed to coefficient difference. CONCLUSIONS Public health programmes and policies for chronic diseases should adjust with urbanisation and combine individual-centred strategies.
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Affiliation(s)
- Qiutong Yu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
| | - Genyong Zuo
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
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Abbasi SH, Sundin Ö, Jalali A, Soares J, Macassa G. Mortality from Acute Coronary Syndrome: Does Place of Residence Matter? J Tehran Heart Cent 2022; 17:56-61. [PMID: 36567936 PMCID: PMC9748234 DOI: 10.18502/jthc.v17i2.9838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 02/28/2022] [Indexed: 12/27/2022] Open
Abstract
Background : Current evidence shows inequality in the outcomes of rural and urban patients treated at their place of residence. This study compared in-hospital mortality between rural and urban patients with acute coronary syndrome (ACS) to find whether there were differences in the outcome and received treatment. Methods : Between May 2007 and January 2018, patients admitted with ACS were included. The patients' demographic, clinical, and laboratory data, as well as their in-hospital medical courses, were recorded. The association between place of residence (rural/urban) and in-hospital mortality due to ACS was evaluated using logistic regression adjusted for potential confounders. Results: Of 9088 recruited patients (mean age =61.30±12.25 y; 5557 men [61.1%]), 838 were rural residents. A positive family history of coronary artery disease (P=0.003), smoking (P=0.002), and hyperlipidemia (P=0.026), as well as a higher body mass index (P=0.013), was seen more frequently in the urban patients, while the rural patients had lower education levels (P<0.001) and higher unemployment rates (P=0.009). In-hospital mortality occurred in 135 patients (1.5%): 10 rural (1.2%) and 125 urban (1.5%) patients (P=0.465). The Firth regression model, used to adjust the effects of possible confounders, showed no significant difference concerning in-hospital mortality between the rural and urban patients (OR, 1.57; 95% CI, 0.376 to 7.450; P=0.585). Conclusion : This study found no significant differences in receiving proper treatment and in-hospital mortality between rural and urban patients with ACS.
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Affiliation(s)
- Seyed Hesameddin Abbasi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden.,Bernard Lown Scholar in Cardiovascular Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Corresponding Author: Seyed Hesameddin Abbasi, Mittuniversitetet, Campus Sundsvall, Storgatan 73, 851 70 Sundsvall, Sweden. Tel: +46 101428000. Fax: +46 704023407. E-mail: .
| | - Örjan Sundin
- Department of Psychology, Mid-Sweden University, Östersund, Sweden.
| | - Arash Jalali
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Joaquim Soares
- Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden.
| | - Gloria Macassa
- Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden.,Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden.
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Zhang M, Zhao Y, Sun L, Xi Y, Zhang W, Lu J, Hu F, Shi X, Hu D. Cohort Profile: The Rural Chinese Cohort Study. Int J Epidemiol 2021; 50:723-724l. [PMID: 33367613 DOI: 10.1093/ije/dyaa204] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Ming Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Yang Zhao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Liang Sun
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yuanlin Xi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Weidong Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Jie Lu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Fulan Hu
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Xuezhong Shi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Dongsheng Hu
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, China
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Social factors tend to decline age-standardized all-cause mortality rates in China during 2005-2015: evidence from an ecological study. Public Health 2021; 196:158-164. [PMID: 34224976 DOI: 10.1016/j.puhe.2021.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/25/2021] [Accepted: 04/30/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES It is important to understand the factors that can substantially decrease mortality rates, as multiple strategies have been implemented to improve economic development and national health in China. We aimed to describe the geographic variations and changes in the all-cause mortality rates in 2005-2015 and to investigate the social factors that tend to decline age-standardized all-cause mortality rates. STUDY DESIGN Ecological study. METHODS The data used came from China's National Census Survey in 2005, 2010 and 2015 and China National Statistical Yearbooks. We conducted provincial-level thematic mapping of age-standardized all-cause mortality rate trajectory groups in 2005-2015 by using ArcGIS. Generalized estimating equation (GEE) models were used to clarify the social factors that may have long-term relevance to declining age-standardized all-cause mortality rates. We compared the characteristics of the three provinces with the lowest mortality rates and the three provinces with the highest mortality rates to further understand the health disparities. RESULTS The age-standardized mortality rates declined from 2000 to 2006 and from 2008 to 2019. Provinces in the low-trajectory tended to be located in the Northeast and Southeast China. The GEE results revealed that the greater the proportion of the population with senior high school education or above, the more families with flushing or pumping toilets that are not shared with other households, the more nurses per 1000 people and a stable economic growth rate were inclined to low age-standardized all-cause mortality rates (P < 0.05). CONCLUSIONS Health disparities between different regions were still in existence even in 2015. Thus, it is critical to improve equality in economic and educational development, the distribution of healthcare professionals, and sanitation facilities, to ensure the equality of opportunities in terms of healthy lives and well-being for all. Furthermore, for developing countries, the improvement of national health urgently needs to prevent the health risks relevant to rapid industrialization and urbanization.
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Luo Y, Xia F, Yu X, Li P, Huang W, Zhang W. Long-term trends and regional variations of hypertension incidence in China: a prospective cohort study from the China Health and Nutrition Survey, 1991-2015. BMJ Open 2021; 11:e042053. [PMID: 33441360 PMCID: PMC7812103 DOI: 10.1136/bmjopen-2020-042053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The aim is to explore the trends of hypertension incidence and regional variations in China from 1991 to 2015. DESIGN A dynamic prospective cohort study. SETTING China Health and Nutrition Survey 1991-2015. PARTICIPANTS 12 952 Chinese adults aged 18+ years. PRIMARY OUTCOME MEASURES Incident hypertension from 1993 to 2015. RESULTS Age-standardised hypertension incidence increased from 40.8 per 1000 person-years (95% CI 38.3 to 43.4) between 1993 and 1997 to 48.6 (95% CI 46.1 to 51.0) between 2011 and 2015. The increasing trends were further supported by results from subsequent extended Cox proportional hazard model. In addition, results from the modelling analysis showed that individuals in eastern, central and northeastern China had greater risks of hypertension occurrence in comparison with their counterparts in western China. CONCLUSION Hypertension incidence increased during the study period. The growth called for more attention on the health education and health promotion of individuals with great risks.
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Affiliation(s)
- Yunmei Luo
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- West China Medical Publishers, West China Hospital, Sichuan University, Chngdu, Sichuan, China
| | - Fan Xia
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xuexin Yu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Peiyi Li
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wenzhi Huang
- Department of Infection Control, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Yan S, Shen X, Wang R, Luo Z, Han X, Gan Y, Lv C. Challenges Faced by Emergency Physicians in China: An Observation From the Perspective of Burnout. Front Psychiatry 2021; 12:766111. [PMID: 34867551 PMCID: PMC8635641 DOI: 10.3389/fpsyt.2021.766111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Burnout is considered a global problem, particularly in the emergency health sector; however, no large-sample cross-sectional study has assessed the prevalence of burnout among emergency physicians and its associated factors. Methods: A nationally representative cross-sectional survey of 15,243 emergency physicians was conducted in 31 provinces across China between July and September 2019. Multiple linear regression analysis was performed to identify correlates of burnout. Results: The participants' mean scores were 25.8 (SD = 15.9) on the emotional exhaustion (EE) subscale, 8.1 (SD = 7.9) on the depersonalization (DP) subscale, and 26.80 (SD = 12.5) on the personal accomplishment (PA) subscale, indicating a pattern of moderate EE, moderate DP, and high PA. The results of the large-sample survey found that 14.9% of emergency physicians had a high level of burnout in China, with 46.8% scoring high for EE, 24.1% scoring high for DP, and 60.5% having a high risk of low PA. Having poor self-perceived health status and sleep quality, working in developed regions and governmental hospitals, having an intermediate professional title, experiencing depression, performing shift work and experiencing workplace violence made emergency physicians more likely to experience occupational burnout. Conclusion: Positive measures should be taken to reduce the burnout of emergency physicians and improve their work enthusiasm to maintain the quality of emergency medical services.
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Affiliation(s)
- Shijiao Yan
- School of Public Health, Hainan Medical University, Haikou, China.,Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, China
| | - Xin Shen
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rixing Wang
- Department of Emergency, Hainan Clinical Research Center for Acute and Critical Diseases, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Zhiqian Luo
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, China.,Emergency and Trauma College, Hainan Medical University, Haikou, China.,Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, Haikou, China
| | - Xiaotong Han
- Department of Emergency Medicine, Hunan Provincial Key Laboratory of Emergency and Critical Care Metabolomics, Hunan Provincial Institute of Emergency Medicine, Hunan Provincial People's Hospital/The First Affifiliated Hospital, Hunan Normal University, Changsha, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chuanzhu Lv
- Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, Haikou, China.,Department of Emergency Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Xia F, Yu X, Li Y, Chen Y, Zhang W, You C, Hu X. Geographic Variations of Stroke Incidence in Chinese Communities: An 18-Year Prospective Cohort Study from 1997 to 2015. J Stroke 2020; 22:345-356. [PMID: 33053950 PMCID: PMC7568967 DOI: 10.5853/jos.2020.02383] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/24/2020] [Indexed: 02/05/2023] Open
Abstract
Background and Purpose As a leading cause of disability and death in China, stroke as well as its epidemiologic features have gained increasing attention. Prior studies, however, have overgeneralized the north-to-south gradient in China. Whether the differences exist across urban and rural areas remains unexplored. This study therefore aims to investigate the north-to-south gradient in stroke incidence across urban and rural China.
Methods The present prospective cohort study analyzed data from the China Health and Nutrition Survey 1997 to 2015. By including 16,917 individuals from diverse social contexts, we calculated the age-standardized incidence of stroke across regions and the age-adjusted risk ratio (aRR). Cox proportional hazards models with time-varying covariates were employed to analyze variations in incident stroke.
Results During the follow-up, age-standardized incidence of stroke ranged from 4.17 per 1,000 person-years (95% confidence interval [CI], 3.38 to 4.96) in the north region to 1.95 (95% CI, 1.60 to 2.30) in the south region (aRR, 2.04; 95% CI, 1.58 to 2.64; P<0.001). The north-to-south gradient of stroke incidence was observed only in rural areas, but not in urban areas. Hierarchical modelling analyses further indicated that the regional differences could be mostly explained by the disparities in the prevalence of hypertension.
Conclusions The present study extends the current evidence on the north-to-south gradient by demonstrating that the difference varied across urban and rural China. Our findings highlight the importance of hypertension management as the measure for alleviating regional differences in stroke incidence.
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Affiliation(s)
- Fan Xia
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xuexin Yu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yunke Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuqi Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Hu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
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Hao L, Xu X, Dupre ME, Guo A, Zhang X, Qiu L, Zhao Y, Gu D. Adequate access to healthcare and added life expectancy among older adults in China. BMC Geriatr 2020; 20:129. [PMID: 32272883 PMCID: PMC7146971 DOI: 10.1186/s12877-020-01524-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 03/19/2020] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Adequate access to healthcare is associated with lower risks of mortality at older ages. However, it is largely unknown how many more years of life can be attributed to having adequate access to healthcare compared with having inadequate access to healthcare. METHOD A nationwide longitudinal survey of 27,794 older adults aged 65+ in mainland China from 2002 to 2014 was used for analysis. Multivariate hazard models and life table techniques were used to estimate differences in life expectancy associated with self-reported access to healthcare (adequate vs. inadequate). The findings were assessed after adjusting for a wide range of demographic factors, socioeconomic status, family/social support, health practices, and health conditions. RESULTS At age 65, adequate access to healthcare increased life expectancy by approximately 2.0-2.5 years in men and women and across urban-rural areas compared with those who reported inadequate access to healthcare. At age 85, the corresponding increase in life expectancy was 1.0-1.2 years. After adjustment for multiple confounding factors, the increase in life expectancy was reduced to approximately 1.1-1.5 years at age 65 and 0.6-0.8 years at age 85. In women, the net increase in life expectancy attributable to adequate access to healthcare was 6 and 8% at ages 65 and 85, respectively. In men, the net increases in life expectancy were generally greater (10 and 14%) and consistent after covariate adjustments. In contrast, the increase in life expectancy was slightly lower in rural areas (2.0 years at age 65 and 1.0 years at age 85) than in urban areas (2.1 years at age 65 and 1.1 years age 85) when no confounding factors were taken into account. However, the increase in life expectancy was greater in rural areas (1.0 years at age 65 and 0.6 years at age 85) than in urban areas (0.4 years at age 65 and 0.2 years at age 85) after accounting for socioeconomic and other factors. CONCLUSIONS Adequate access to healthcare was associated with longer life expectancy among older adults in China. These findings have important implications for efforts to improve access to healthcare among older populations in China.
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Affiliation(s)
- Lisha Hao
- School of Geographic Sciences, Nanjing Normal University, Nanjing, China
| | - Xin Xu
- School of Geographic Sciences, Nanjing Normal University, Nanjing, China
| | - Matthew E Dupre
- Department of Population Health Sciences, Department of Sociology, & Duke Clinical Research Institute, Duke University, Durham, NC, USA.
| | - Aimei Guo
- Ginling College, Nanjing Normal University, Nanjing, China
| | - Xufan Zhang
- Ginling College, Nanjing Normal University, Nanjing, China
| | | | - Yuan Zhao
- Ginling College & School of Geographic Sciences, Nanjing Normal University, Nanjing, China
| | - Danan Gu
- Independent Researcher, New York, USA.
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