Can China afford rapid aging?

Implications for household health expenditure in China's ageing population: based on Red Herring hypothesis

The rising healthcare costs due to population aging present a complex issue, with debate centering on whether these costs are driven by aging or end-of-life care. This study examines healthcare expenditures in Chinese households using data from the 2005 and 2018 Chinese Longitudinal Healthy Longevity Survey. By applying the Heckman select model and a two-part model, the research innovatively includes time to death, income, social security and health level in the benchmark regression in order to validate the recent some new Red Herring hypothesis. The findings show that time to death is the primary determinant of healthcare expenditures, while the effect of aging is minimal. Income, social security, and health status also significantly influence health expenditure, but they do not function as Red Herring variables.

Childhood intra- and extra-familial maltreatment and later-life trajectories of depressive symptoms: evidence from China

BACKGROUND

Both late-life depression and childhood maltreatment have become major global public health issues, given their prevalence and social-economic and health consequences. However, previous studies have solely focused on the relationship of childhood maltreatment to average levels of depressive symptoms. The current study addresses this gap of knowledge by simultaneously examining the impacts of childhood intra- and extra-familial maltreatment on age trajectories of depressive symptoms in later life in the Chinese context.

METHODS

Hierarchical linear models were applied to data from the China Health and Retirement Longitudinal Study (2011-2018, N = 12,669 individuals aged 45 to 80, comprising N = 43,348 person-years). Depressive symptoms were measured by the CES-D-10 scale. Childhood intra-familial maltreatments were measured by physical abuse and emotional neglect, while extra-familial maltreatment was measured by peer bullying. All analyses were conducted separately by gender in Stata 16.

RESULTS

Childhood extrafamilial peer bullying (β = 1.628, p < 0.001), and intrafamilial physical abuse (β = 0.746, p < 0.001) and emotional neglect (β = 0.880, p < 0.001) were associated with higher later-life depressive symptoms levels in the whole sample. Peer bullying differences in depressive symptoms widened with age for both men and women. Physical abuse differences in depressive symptoms remained stable over the life course among men but increased among women. Emotional neglect differences in depressive symptoms decreased with age among men, while it increased first and then decreased among women.

CONCLUSIONS

Findings in this study suggest that childhood maltreatment is not only associated with later-life poorer mental health but contributes to increasing inequalities in mental health as people age, especially among peer-bullying victims and women.

Factors related to satisfaction with community-based home aging services in Shandong, China

Purpose

This study investigated the satisfaction of current community-based home care services and its factors in adults aged ≥60 years.

Methods

Using stratified cluster random sampling, we surveyed 1,494 older adults in Jinan and Qingdao, Shandong province, between 2021 and 2023. The baseline and satisfaction surveys were designed by our research team, and the questionnaires were conducted in the form of structured interviews. Kruskal-Wallis H-test and Logistic regression analysis were used to explore the influencing factors of satisfaction.

Results

The satisfaction was mainly affected by age (p = 0.007), marital status (p < 0.001), pre-retirement occupation (p = 0.003), economic source (p < 0.001), and mode of residence (p = 0.001) in the study of 1,494 older adults. Under the influence of multiple factors, the evaluation of older adults services, married [OR = 4.039, 95% CI: 1.176-13.877] were more inclined to be average, and their occupations were agriculture, forestry, animal husbandry, fishery, and water production workers [OR = 0. 237, 95% CI: 0.068-0.819] and production and transportation equipment operators and related personnel [OR = 0.153, 95% CI: 0.024-0.966] or [OR = 0.153, 95% CI: 0.029-0.820] tended to be more dissatisfied.

Conclusion

The satisfaction level of community-based home care services is relatively high among older adults, and it is mainly affected by factors such as age, marital status, pre-retirement occupation, source of financial resources, and mode of residence. Addressing the emotional needs of older adults, lowering the cost of aging, and integrating health care and aging seamlessly are among the ongoing challenges that we need to tackle.

Population ageing and sustainability of healthcare financing in China

BACKGROUND

In China, the healthcare financing structure involves multiple parties, including the government, society and individuals. Medicare Fund is an important way for the Government and society to reduce the burden of individual medical costs. However, with the aging of the population, the demand of Medicare Fund is increasing. Therefore, it is necessary to explore the sustainability of the healthcare financing structure in the context of population ageing.

OBJECTIVE

The purpose of this paper is to organize the characteristics of population ageing as well as healthcare financing in China. On this basis, it analyzes the impact mechanism of population ageing on healthcare financing and the sustainability of existing healthcare financing.

METHODS

This paper mainly adopts the method of literature research and inductive summarization. Extracting data from Health Statistics Yearbook of China and Labor and Social Security Statistics Yearbook of China. Collected about 60 pieces of relevant literature at home and abroad.

RESULTS

China has already entered a deeply ageing society. Unlike developed countries in the world, China's population ageing has distinctive feature of ageing before being rich. A healthcare financing scheme established by China, composing of the government, society, and individuals, is reasonable. However, under the pressure of population ageing, China's current healthcare financing scheme will face enormous challenges. Scholars are generally pessimistic about the sustainability of China's healthcare financing scheme.

CONCLUSIONS

Population ageing will increase the expenditure and reduce the income of the Medicare Fund. This will further affect the sustainability of the healthcare financing structure. As a consequence, the state should pay particular attention to this issue and take action to ensure that the Fund continues to operate steadily.

Investigating patients' preferences for new anti-diabetic drugs to inform public health insurance coverage decisions: a discrete choice experiment in China

Background

Diabetes is a major public health concern with a considerable impact on healthcare expenditures. Deciding on health insurance coverage for new drugs that meet patient needs is a challenge facing policymakers. Our study aimed to assess patients’ preferences for public health insurance coverage of new anti-diabetic drugs in China.

Methods

We identified six attributes of new anti-diabetic drugs and used the Bayesian-efficient design to generate choice sets for a discrete choice experiment (DCE). The DCE was conducted in consecutive samples of type 2 diabetes patients in Jiangsu Province. The mixed logit regression model was applied to estimate patient-reported preferences for each attribute. The interaction model was used to investigate preference heterogeneity.

Results

Data from 639 patients were available for analysis. On average, the most valued attribute was the improvement in health-related quality of life (HRQoL) (β = 1.383, p < 0.001), followed by positive effects on extending life years (β = 0.787, p < 0.001), and well-controlled glycated haemoglobin (β = 0.724, p < 0.001). The out-of-pocket cost was a negative predictor of their preferences (β = -0.138, p < 0.001). Elderly patients showed stronger preferences for drugs with a lower incidence of serious side effects (p < 0.01) and less out-of-pocket costs (p < 0.01). Patients with diabetes complications favored more in the length of extended life (p < 0.01), improvement in HRQoL (p < 0.05), and less out-of-pocket costs (p < 0.001).

Conclusion

The new anti-diabetic drugs with significant clinical effectiveness and long-term health benefits should become the priority for public health insurance. The findings also highlight the value of accounting for preference heterogeneity in insurance policy-making.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14244-z.

Prevalence of self-care disability among older adults in China

BACKGROUND

Self-care disability among older adults is a global public health issue. However, it lacks the up-to-date information based on nationally representative, more comprehesive data in China.

METHODS

Using China's 2020 population census data, this paper provides a macro-analysis of the prevalence and socio-demographic characteristics of self-care disability among older adults.

RESULTS

25.5 million older adults aged 60 and over participated in the health status survey, of which 48.2% were male, and 51.8% were female. We find that the prevalence of self-care disability among older adults aged 60 and above in China is 2.34%, and the older the population, the higher the prevalence. A higher prevalence was reported by female older adults, rural older adults, and older adults in western China. Single (never married) and widowed older adults are at higher risk of self-care disability. Compared to 2010, the prevalence of self-care disability among older adults decreased. However, the urban-rural difference still exists. Self-care disabled older adults rely mainly on family members for livelihood and mainly cohabitate with them. While pension is an essential source of livelihood for urban older adults with self-care disability, fewer rural self-care disabled older adults rely on pension.

CONCLUSION

The prevalence of self-care disability among older adults aged 60 and over in China is low and has decreased compared to 2010. Older adults with self-care disability are not a homogeneous group, and they have apparent socio-demographic disparities and regional differences. The Chinese government should continue to reduce inequalities between urban and rural areas, especially in pension and long-term care systems.

The life of people with dementia who have multiple children in rural China: A phenomenological case study

OBJECTIVES

The aim of this study was to explore the lived experiences of a rural dwelling person living with dementia and his children. Using a phenomenological case study methodology, it aims to explore the health-related and personal dilemmas faced by multiple family members who provide care to a person living with dementia in a rural area in Henan, China. The study also investigates the barriers to quality dementia care in this kind of setting in order to inform the relevant stakeholders.

METHOD

A phenomenological case study was designed for this study. The case that formed the focus of the research included a person living with dementia and multiple family members. Semi-structured in-depth interviews were undertaken with the five family members of the person living with dementia. Smith's interpretative phenomenological analysis was used for data analysis.

FINDINGS

Three major themes were identified: (1) Dementia as a normal ageing process or a bad disease; (2) Commitment to and challenges of family caring and (3) Life in rural areas.

CONCLUSION

With the development of China's economy and its social-cultural changes, traditional home-based care provision in rural areas of China is being challenged for people with dementia who have multiple children. It suggests that there needs to be an exploration into providing more appropriate care for people with dementia living in rural settings. It also suggests that more support is required to increase dementia awareness and to improve the quality of life of people with dementia and their families in rural China.

Life Course Socioeconomic Status and Healthy Longevity in China

In 2020, China's population aged 60 or older exceeded 264 million, representing 25% of the global population in that age-group. Older adults in China experienced periods of dramatic political and social unrest in early life, as well as economic transformations leading to drastic improvements in living standards during adulthood and older age. However, the implications of life course socioeconomic status (SES) trajectories for healthy longevity in later life have not been systematically studied in China. We utilize data from the China Health and Retirement Longitudinal Study (CHARLS) to comprehensively investigate how early-life conditions and adult SES combine to influence healthy longevity in later life. We find that both childhood and adulthood SES are associated with late-life health. The largest disparities in life expectancy (LE) and disability-free LE are found between those with persistently low SES throughout life and those with consistently high SES. At age 45, the gap in total LE between the most advantaged and least advantaged groups is six years for men and five years for women. Despite China's major policy changes prioritizing equity in income and health care in recent decades, our findings suggest that dramatic health inequalities among older adults remain. Our findings extend the literature on the effect of socioeconomic patterns across the life course on gradients in later-life health and highlight continuing disparities in healthy longevity among older adults in China.

Urban-Rural Differences in Patterns and Associated Factors of Multimorbidity Among Older Adults in China: A Cross-Sectional Study Based on Apriori Algorithm and Multinomial Logistic Regression

Introduction: Multimorbidity has become one of the key issues in the public health sector. This study aimed to explore the urban–rural differences in patterns and associated factors of multimorbidity in China and to provide scientific reference for the development of health management strategies to reduce health inequality between urban and rural areas.

Methods: A cross-sectional study, which used a multi-stage random sampling method, was conducted effectively among 3,250 participants in the Shanxi province of China. The chi-square test was used to compare the prevalence of chronic diseases among older adults with different demographic characteristics. The Apriori algorithm and multinomial logistic regression were used to explore the patterns and associated factors of multimorbidity among older adults, respectively.

Results: The findings showed that 30.3% of older adults reported multimorbidity, with significantly higher proportions in rural areas. Among urban older adults, 10 binary chronic disease combinations with strong association strength were obtained. In addition, 11 binary chronic disease combinations and three ternary chronic disease combinations with strong association strength were obtained among rural older adults. In rural and urban areas, there is a large gap in patterns and factors associated with multimorbidity.

Conclusions: Multimorbidity was prevalent among older adults, which patterns mainly consisted of two or three chronic diseases. The patterns and associated factors of multimorbidity varied from urban to rural regions. Expanding the study of urban–rural differences in multimorbidity will help the country formulate more reasonable public health policies to maximize the benefits of medical services for all.

Study on the quality of life and its related factors for older adults in communities in Beijing, China†

Objectives

To describe the quality of life (QOL) of adults ≥60 years of age in communities in Beijing and explore demographic, clinical, and psychological factors associated with QOL.

Methods

This was a cross-sectional study. A total of 363 older adults were recruited, in which 313 completed the questionnaires. Depressive symptoms were measured with the Self-Rating Depression Scale (SDS) and QOL was analyzed with the 36-item short form (SF-36). The t-test and Mann-Whitney U tests were used to compare QOL by gender and age group. Factors associated with QOL were determined using multiple linear regression.

Results

Among 313 older adults, depressive symptoms were observed to be prevalent to the extent of 16.6%. Overall, participants had higher QOL in the domains of social role functioning and emotional role functioning, with lower QOL in the domains of physical functioning and general health perceptions. There were no significant differences in QOL between women and men. However, there were significant differences between different age groups, with older adults having better mental QOL than younger adults. Better physical QOL was associated with less depressive symptoms, having a partner, and younger age (R 2 = 28.7%). Better mental QOL was associated with less depressive symptoms, less chronic disease, and older age (R 2 = 34.7%).

Conclusions

With aging, physical QOL was lower and mental QOL was better. Less depressive symptoms, having a spouse or partner, and young–old age assert positive influence on physical QOL of the older adults; and less depressive symptoms, no chronic disease, and older age assert positive influence on mental QOL.

The longitudinal relationship between income and social participation among Chinese older people

The vital role of active social participation in older people's lives is widely acknowledged. The maintenance of adequate levels of social participation is an essential element of successful aging. Low income may inhibit older people from engaging in social activities. Given its recent rapid economic growth, China provides a unique setting for the study of changes in income and social participation among older people over time. In this study, the longitudinal relationship between income and social participation among Chinese older people was investigated using a nationally representative dataset from three waves of the China Health and Retirement Longitudinal Study (CHARLS). At baseline, a total of 3863 participants with a mean age of 60.4 years (range: 50-89) were included in our study; 49.9% of the participants were female, and 64.4% lived in rural areas. Generalized estimating equations were used to analyze the longitudinal relationship between income and social participation, with and without adjustment for background variables (age, gender, marital status, educational level, empty-nest status, area of residence, and multimorbidity). The results of unadjusted and adjusted analyses clearly showed a longitudinal association between income and social participation. People from the highest income group were almost two times more likely to participate in social activities than were those from the lowest income group. People with a higher educational level are also more likely to participate in social activities compared to people with a lower educational level. Being married and living with children decreased the odds of social participation. Social participation is also less likely among older aged and those living in rural areas. Our findings indicate that higher income levels are associated positively with social participation over time among older people in China.

Prevalence of hepatitis B surface antigen in coastal area of Tianjin, China

Aim: The hepatitis B surface antigen (HBsAg) prevalence in coastal area of Tianjin, China was investigated. Methods: This was a cross-sectional study. A total of 12,074 participants aged from 1 month to 98 years old were enrolled (the number of participants were 136, 431, 1648, 1718, 1957, 2184, 2069, 1370 and 561 in age groups 0–10, 11–20, 21–30, 31–40, 41–50, 51–60, 61–70, 71–80 and greater than 80, respectively). Hepatitis B serological markers were detected. Results: The results showed that HBsAg prevalence was 5.52% (666/12,074). For children and teenagers the HBsAg positivity was 0–1.39%. Whereas for the middle-aged population, the HBsAg positivity was relatively high (6.74–8.58%). In the elderly (greater than 60 years old), HBsAg prevalence was 1.43–3.24%. The anti-hepatitis B core antibody-positive proportion was 43.09% (5230/12,074). Hepatitis B surface antibody seroprevalence was 49.83% (5685/11,408) in HBsAg-negative participants. Conclusion: HBsAg prevalence was at intermediate endemicity in this region. Management of HBsAg-positive patients and strategies for the expansion of an immune population were suggested.

Risk Factors for Depression in Empty Nesters: A Cross-Sectional Study in a Coastal City of Zhejiang Province and China

The elderly are susceptible to depression, especially empty nesters. This study investigated the risk factors associated with depression in empty nesters. The participants were selected via multi-stage random cluster sampling. Depression symptoms were assessed using the Geriatric Depression Scale. The questionnaire surveyed demographic characteristics, underlying diseases, behaviors and lifestyles, negative life experiences, social support, self-care ability, etc. Chronic health conditions, such as being overweight/obese, smoking cessation, cancer, and chronic pain, as well as negative life experiences, such as the death of a loved one and financial loss, increased the risk of depression in empty nesters. In addition, the incapability of performing self-care also increased the risk of depression in empty nesters. The prevalence of depression in empty nesters was high. Being overweight/obese, cancer, chronic pain, smoking cessation, the death of a loved one, financial loss, and the incapability to deliver self-care were risk factors for depression in empty nesters. It is recommended that comprehensive measures be taken to enhance health interventions for this population, including encouraging a proper diet and physical activity for weight control, providing psychological counseling after negative life experiences, and teaching correct methods of smoking cessation.

Disability Prior to Death Among the Oldest-Old in China

Background

To estimate the prevalence of disability during the last 3 years prior to death among the oldest-old (≥80 years) in China.

Methods

We used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a nationally representative study of the oldest-old in China. The analytic sample included 23,934 decedents who died between 1998 and 2014 and had at least one interview within the last 3 years of life. Disability was defined as being incontinent or needing assistance in performing one or more of five other essential activities (bathing, transferring, dressing, eating, and toileting).

Results

About 57.8% (weighted) of the study decedents were female. The prevalence of disability increased modestly from 36 months to 24 months prior to death (20% to 23%), more rapidly from 24-months to 12-months before death (23% to 31%), and substantially from 12 months before death to the last month of life (31% to 48%). The disability rates were lowest for participants who died between 80 and 89 years, intermediate for those who died between 90 and 99 years, and highest for those who died at age 100 or older, although the patterns over the 3-year period were comparable for the three age groups. At each time point prior to death, a higher percentage of women was disabled than men.

Conclusions

In this large nationally representative sample of the oldest-old in China, the prevalence of disability during the 3 years prior to death is high and is greater in women than men and those who die at the oldest ages.

Quality of life of older Chinese adults receiving primary care in Wuhan, China: a multi-center study

Background

Quality of life (QOL) is an important primary care outcome, but the QOL of older adults treated in primary care is understudied in China. This study examined QOL and its associated factors in older adults treated in Chinese primary care.

Methods

A total of 752 older patients (65+ years) were consecutively recruited from 13 primary care centers in Wuhan, China, and interviewed with a standardized questionnaire, concerning socio-demographics, major medical conditions, loneliness, and depression. QOL and depression were measured with the Chinese six-item QOL questionnaire and the shortened Geriatric Depression Scale, respectively. Multiple linear regression was used to identify factors associated with poor QOL.

Results

The average QOL score of primary care older adults was (20.7 ± 2.5), significantly lower than that of the Chinese general population. Factors significantly associated with poor QOL of Chinese primary care older adults included engaging in manual labor before older adulthood (unstandardized coefficient [β]: −0.702, P < 0.001), no living adult children (β: −1.720, P = 0.001), physical inactivity (β: −0.696, P < 0.001), having ≥ four major medical conditions (β: −1.813, P < 0.001), hearing problem (β: −1.004, P = 0.017), depression (β: −1.153, P < 0.001), and loneliness (β: −1.396, P < 0.001).

Conclusions

Older adults treated in Chinese primary care have poorer QOL than the general population. Addressing psychosocial problems at Chinese primary care settings could be helpful in improving QOL in Chinese older adults.

Dilemmas in caring for older adults in Zhejiang Province, China: a qualitative study

Background

Owing to the increase in life expectancy and sickliness, caring for older adults has become a major challenge in China, where the traditional care system is disintegrating and community- and home-based care have been introduced to respond to this ‘silver wave’. However, there is limited knowledge of the dilemmas associated with caring for older adults and the acceptability of community- and home-based care for this population.

Methods

Participants were recruited from Xihu District, Hangzhou, from June to July 2017. In-depth interviews were conducted using semi-structured questionnaires. Audio recording, verbatim transcription, and thematic analysis were conducted.

Results

A total of 64 older adults from four communities were interviewed. Half of the participants had multiple chronic diseases. The very old individuals and those with severe diseases and in poor financial conditions were observed to be struggling the most. Health status, financial capability, and personality were the main factors affecting the care process. Participants cited the following reasons for staying away from nursing homes: misunderstanding, negative environment, a sense of shame, loneliness, and financial limitations. Community- and home-based cares are popular forms of old-age care; however, some participants exhibited a lack of knowledge about such services.

Conclusion

A multi-layered old-age care system is urgently needed for older adults in Zhejiang Province. Further, it is important that such a system integrates the care provided through community- and home-based services with that offered by nursing homes. Community- and home-based care for older adults needs to be prioritised, and the quality of care provided in nursing homes should be improved.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6637-0) contains supplementary material, which is available to authorized users.

Factors affecting the choice of health care utilisation between private and public services among the elderly population in India

India is experiencing rapid population ageing in recent years. One of the most concomitant issues is the choice of health care services among the elderly, leading to its impact on the magnitude of health expenditure. Applying Andersen's Health Behavioural Model, this study identifies the predictors of the choice of inpatient health care services among the Indian elderly between private and public services. It also examines the nature of interregional disparity in the choice of health care services. Using NSSO data, the results suggest that the elderly belonging to upper caste and having higher levels of education, higher incomes, larger family size, and needing surgery are likely to choose private health care, while those experiencing higher economic dependence, chronic diseases, and higher duration of hospitalisation tend to prefer public inpatient services. The magnitude and significance of these factors, however, vary across regions. The findings of the study provide an understanding of the preferences of the India's geriatric population over hospital services, which may help policymakers better understand their health care needs.

The double edge sword of John Henryism: Impact on patients' health in the People's Republic of China

The People's Republic of China has experienced extraordinary economic growth, which is associated with increases in chronic health stressors. We examined the impact of John Henryism-a coping mechanism-on various health indicators in a sample of patients (n = 642) in China. John Henryism significantly related to increased medical adherence (B=.03,p<.001) and health-promotional behaviors (B=.02,p<.001). John Henryism predicted several indicators of psychological health through social support. John Henryism was also related to increased alcoholism (B=.04,p<.05). The findings highlight the complexity and paradoxical implications of John Henryism on health. Implications are discussed in relation to China's epidemiological and age demographic shifts.

Associations Between Sedentary Behavior, Physical Activity, and Out-of-Pocket Health Care Expenditure: Evidence From Chinese Older Adults

OBJECTIVE

This study examined the associations between sedentary behavior, physical activity, and health care expenditures among Chinese older adults.

METHOD

We conducted a survey on 4,165 older men and women living in major cities in China. Sedentary behavior and physical activity were measured by the Physical Activity Scale for the Elderly questionnaire. Health care costs were assessed by self-reported out-of-pocket health care expenditures across outpatient care, inpatient care, medication, and formal caregiver expenses.

RESULTS

Sedentary behavior was associated with an increase in annual out-of-pocket health care expenditures by approximately USD$37 for each additional sedentary hour (p < .001). Physical activity was associated with a decrease in annual health care expenditures by approximately USD$1.2 for each one Physical Activity Scale for the Elderly score (p < .001). Physical activity was a less salient indicator of health care expenditure for men than women.

CONCLUSIONS

Reducing sedentary behavior among older men and women and promoting physical activity, especially among men, may be important strategies to reduce out-of-pocket health care expenditures in China.

Global commitments and China's endeavors to promote health and achieve sustainable development goals

BACKGROUND

With its immense population and as the largest developing country in the world, China has made remarkable achievements in health promotion at a relatively low cost. However, China is still faced with challenges such as changes of disease spectrum, the coming era of an aging society, and the risk of environmental pollution.

MAIN TEXT

On October 25, 2016, China formally passed the blueprint of "Healthy China 2030," working towards the national goal of reaching a health standard on par with developed countries by 2030, which was also a response to realize the 2030 United Nations Sustainable Development Goals. "Healthy China 2030" is comprised of 29 chapters that cover five health areas. China is sparing no effort to transfer from being merely the most populous country, to becoming a leading nation in health education. In "Healthy China 2030," collaborated construction and resource sharing were clearly stated as the core strategy. A shift in concentration towards coordinated development of health-based economy from a previous pursuit of rapid economic growth was also underlined. There are also several major issues, such as severely aging population, the burden of chronic diseases, the insufficiency of health expenditure, and the great demand on health protection, waiting to be dealt with during the implementation process of "Healthy China 2030".

CONCLUSIONS

"Healthy China 2030" is a momentous move to enhance public health, which is also a response to the global commitments. We also need to rethink our approach to reach the living standards and maintain a better environment.

Transnational Research Networks in Chinese Scientific Production. An Investigation on Health-Industry Related Sectors

Transnational research networks (TRN) are becoming increasingly complex. Such complexity may have both positive and negative effects on the quality of research. Our work studies the evolution over time of Chinese TRN and the role of complexity on the quality of Chinese research, given the leading role this country has recently acquired in international science. We focus on the fields of geriatrics and gerontology. We build an original dataset of all scientific publications of China in these areas in 2009, 2012 and 2015, starting from the ISI Web of Knowledge (ISI WoK) database. Using Social Network Analysis (SNA), we analyze the change in scientific network structure across time. Second, we design indices to control for the different aspects of networks complexity (number of authors, country heterogeneity and institutional heterogeneity) and we perform negative binomial regressions to identify the main determinants of research quality. Our analysis shows that research networks in the field of geriatrics and gerontology have gradually become wider in terms of countries and have become more balanced. Furthermore, our results identify that different forms of complexity have different impacts on quality, including a reciprocal moderating effect. In particular, according to our analysis, research quality benefits from complex research networks both in terms of countries and of types of institutions involved, but that such networks should be “compact” in terms of number of authors. Eventually, we suggest that complexity should be carefully taken into account when designing policies aimed at enhancing the quality of research.

Portal vein/superior mesenteric vein resection in pancreatic cancer treatment in the elderly

There is an increased interest in extending surgical criteria for pancreatic cancer by performing pancreaticoduodenectomy (PD) combined with portal vein (PV) or superior mesenteric vein (SMV) resection and reconstruction for borderline resectable patients. However, whether this procedure suitable for elderly patients remains unclear. Here, we studied cases of pancreatic cancer treatment in our medical center to evaluate feasibility and safety of this procedure in the elderly.Eighty-three patients 65 years of age or older who underwent PD from January 2009 to March 2014 were divided into 2 groups: PD only (Group A, 52 cases), and PD combined with PV/SMV resection and reconstruction (Group B, 31 cases). Surgical outcomes and survival rates were compared between groups. Information regarding preoperative, intraoperative and postoperative conditions, and follow-up visits were provided. The outcomes of postoperative complications and survival rates were investigated.No difference in the preoperative data was detected between 2 groups with the exception that the serum albumin level was significantly lower in Group B (P = .013), indicating more deteriorating health conditions in this group. Although intraoperative time and blood loss were higher in Group B (P < .001 and P = .048, respectively), the overall postoperative complications and survival curve showed no statistical differences between 2 groups with one exception in that there was higher incidence of intractable diarrhea in Group B (P = .034). The symptoms, however, resolved later on with conservative treatment. The median survival time for patients in this study was comparable to other reported PD treatments. There was zero postoperative mortality in both groups.PD combined with PV/SMV treatment did not lead to increased morbidity and motility in elderly patients 65 years of age and above. This procedure could provide a promising opportunity for borderline resectable elderly pancreatic cancer patients.

Burden of acute gastroenteritis caused by norovirus in China: A systematic review

BACKGROUND

To understand the epidemiology and disease burden of norovirus (NoVs) gastroenteritis in China, a systematic review was conducted.

METHODS

Studies on acute gastroenteritis (AGE) caused by NoVs from mainland China, published before 2017 were searched. All retrieved articles were screened and reviewed by a standardized algorithm. NoVs detection rates as well as strain variations by ages, seasonal variations and geographic locations were analyzed using random-effects model.

RESULTS

A total of 225 articles were included in the final analysis. Similar detection rates at 21.0% and 19.8% were obtained from the North and the South, respectively. NoVs infection occurred year round, with a peak between October and January in the North and between August and November in the South. High detection rates (∼29%) of NoVs were found in adults and the elderly and in children aged 6-35 months (∼22%). The predominant strains were GII.4 (70.4%), followed by GII.3 (13.5%).

CONCLUSION

NoVs cause significant disease burden in China which warrants development of vaccines against NoVs, particularly for children and the elderly who are vulnerable to gastroenteritis diseases. To achieve a broad protection, continual monitoring NoV epidemics and strain variations for selection of proper vaccine strains is critical.