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Wang Y, Tian Y, Du W, Fan L. Does work after retirement affect health-related quality of life: Evidence from a propensity score matching study in China. Geriatr Gerontol Int 2024; 24:722-729. [PMID: 38766995 DOI: 10.1111/ggi.14893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/15/2024] [Accepted: 05/01/2024] [Indexed: 05/22/2024]
Abstract
AIM Extending working life is considered as an important initiative to respond to the population aging and pension payment dilemma. This study aimed to investigate whether work after retirement is related to improved health-related quality of life. METHODS We used two waves of data from the China Health and Retirement Longitudinal Study in 2011 and 2018. Work after retirement was ascertained based on self-reported retirement and work status, and health-related quality of life (HRQOL) was measured with the three-level EuroQol five-dimensions. The impact of work after retirement on HRQOL was analyzed using the propensity score matching with difference-in-difference approach. RESULTS A total of 1043 retirees were included. The results showed that work after retirement was associated with significant improvement in HRQOL among retirees (β = 0.072, P < 0.001). Heterogeneity analyses did not show specificity on sex (P for sex interaction >0.05), but older-aged retirees seemed more sensitive to the benefits of work after retirement on HRQOL than their younger-aged counterparts (≥65 years: β = 0.167, P < 0.001 vs <65 years: β = -0.047, P > 0.05; P for age interaction = 0.010). CONCLUSIONS Work after retirement shows a positive impact on HRQOL among community-dwelling adults in China. Policy-makers should take the health of retirees into account when implementing policies related to delayed retirement, and reduce health inequity. Geriatr Gerontol Int 2024; 24: 722-729.
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Affiliation(s)
- Yiming Wang
- School of Public Health, Southeast University, Nanjing, China
| | - Yong Tian
- School of Public Health, Southeast University, Nanjing, China
- School of Law and Public Administration, Nanjing University of Information Science & Technology, Nanjing, China
| | - Wei Du
- School of Public Health, Southeast University, Nanjing, China
| | - Lijun Fan
- School of Public Health, Southeast University, Nanjing, China
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Jin W, Felix MS, Paek SC, Lamy FR. Social Activities and Depressive Symptoms Among Elderly Based on Rural and Urban Differences in China: a National Cross-Sectional Study. Psychol Res Behav Manag 2024; 17:2243-2254. [PMID: 38855479 PMCID: PMC11162184 DOI: 10.2147/prbm.s460453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/28/2024] [Indexed: 06/11/2024] Open
Abstract
Objective Depression has become an important global public health problem. Despite the government's efforts, the outlook regarding the health issue of elderly depression in China is still not optimistic. This study explored the association between social activities and depressive symptoms among Chinese urban and rural elderly. Methods Data were collected from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). The study sample included 5101 Chinese adults aged ≥ 65 years. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale. Binary logistic regression analyses were used to explore the relationship between social activities and depressive symptoms. Results The prevalence rate of depressive symptoms in rural elderly is 1.37 times higher than that in urban elderly. The proportion of elderly persons participating in a social activity less than once monthly, or never having participated in social activities is higher in rural areas than in urban areas. The results from the logistic regression model analysis show that among rural elderly, visiting others' homes or interacting with friends at least once a month or once a week is positively associated with depressive symptoms. Playing cards or mahjong at least once a week or almost daily is negatively associated with depressive symptoms. Participating in organized social activities once a month is negatively associated with depressive symptoms. None of these five activities significantly correlate with depressive symptoms among urban older adults. Conclusion This study explored the differences in depressive symptoms among elderly populations in urban and rural China, as well as the impact of social activity participation on depressive symptoms. This study underscores the necessity of targeted social interventions in rural areas to enhance social participation among the elderly and reduce depressive symptoms.
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Affiliation(s)
- Weiyun Jin
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Thailand
- College of Humanities Education, Inner Mongolia Medical University, Hohhot, People’s Republic of China
| | - Mark Stephan Felix
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Thailand
| | - Seung Chun Paek
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Thailand
| | - François Rene Lamy
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Thailand
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Wang S, Cheng F, Xu J. The impact of family doctor contract services on the utilization of and satisfaction with primary health care among Chinese residents: A cross-sectional study. J Family Med Prim Care 2024; 13:1887-1893. [PMID: 38948628 PMCID: PMC11213444 DOI: 10.4103/jfmpc.jfmpc_1724_23] [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: 10/24/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 07/02/2024] Open
Abstract
Introduction Family doctor contract service (FDCS) is a vital part of China's primary health care system. This study aims to explore whether contracting with FDCS affects residents' utilization of and satisfaction with primary health care. Methods A structured questionnaire was employed to collect data in January 2022. The questionnaire mainly included the following three parts: the social-demographic characteristics, health-related information, and utilization of and satisfaction with primary health care. Propensity score matching (PSM) was used to adjust for social-demographic differences between participants who contracted with a family doctor and those who did not. For the matched population, we used the Chi-square test to examine the differences in the utilization of and satisfaction with primary health care between contracted and non-contracted participants. Moreover, multiple logistic regression and linear regression were used to explore the influencing factors of the utilization of and satisfaction with primary health care. Results A total of 10,850 people were investigated and 10,419 participants were incorporated into the data analysis. After matching, there were no significant differences in most of the matching variables between the contracted and non-contracted groups (P > 0.05). The utilization rate was significantly higher among the contracted population than of the non-contracted (96.3% vs 92.6%, P < 0.001). The quality of services (e.g., good service attitude, high medical level, and a trusted family doctor) was more likely to be cited as the main reasons for the contracted people to utilize primary health care than for the non-contracted. The contracted people were also significantly more satisfied than the non-contracted in all terms of satisfaction. Moreover, people who contracted with a family doctor were more likely to use primary health care with OR = 1.979 (95% CI, 1.511-2.593). Conclusion The contracted people were more likely to utilize and be satisfied with primary health care than the non-contracted. In addition, the contracted people tended to use primary health care because of the quality of services rather than because of the close distance or short waiting time. Therefore, it is important to further promote the high quality of FDCS to ensure residents' sense of gain and improve their satisfaction.
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Affiliation(s)
- Shuo Wang
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Feng Cheng
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Junfang Xu
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Zhang W, Su M, Li D, Zhang T, Li W. Catastrophic health expenditure and its inequality in rural China: based on longitudinal data from 2013 to 2018. BMC Public Health 2023; 23:1861. [PMID: 37752487 PMCID: PMC10521565 DOI: 10.1186/s12889-023-16692-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 09/04/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Catastrophic health expenditure (CHE) is an important indicator of measuring health inequality. Previous studies mainly focused on specific vulnerable populations rather than a wider range of vulnerable areas through panel data. Rural China is often associated with an underdeveloped economy and insufficient health resources. This study aims to update the information on the extent of and trends in the incidence and inequality of CHE among the households of rural China through longitudinal survey data. METHODS Data were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS): 2013, 2015, and 2018. In total, 2,575 households were included in the analysis. CHE was defined as household health expenditures exceeding 40% of non-food expenditures. Inequality in CHE was measured using the concentration curve and concentration index. The contribution to CHE inequality was decomposed using the concentration index decomposition method. RESULTS The incidence of CHE was 0.2341 (95% CI: 0.22, 0.25) in 2013, 0.2136 (95% CI: 0.20, 0.23) in 2015, and 0.2897 (95% CI: 0.27, 0.31) in 2018 in rural China. The concentration curve lay above the equality line, and the concentration index was negative: -0.1528 (95% CI: -0.1941, -0.1115) in 2013, -0.1010 (95% CI: -0.1442, -0. 0577) in 2015, and -0.0819 (95% CI: -0.1170, -0.0467) in 2018. Economic status, age, and chronic diseases were the main contributors to inequality in CHE. CONCLUSIONS The incidence of CHE in rural China displayed an upward trend from 2013 to 2018, although it was not continuous. Furthermore, a strong pro-low-economic inequality in CHE existed in rural China. Mainly economic status, age, and chronic diseases contributed to this pro-low-economic inequality. Health policies to allocate resources and services are needed to satisfy the needs of rural households and provide more accessible and affordable health services. More concern needs to be directed toward households with chronic diseases and older persons to reduce the incidence of CHE and promote health equality.
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Affiliation(s)
- Weile Zhang
- School of Public Administration, Inner Mongolia University, Zhaojun Road, Yuquan District, Hohhot, Inner Mongolia, 010070, China
| | - Min Su
- School of Public Administration, Inner Mongolia University, Zhaojun Road, Yuquan District, Hohhot, Inner Mongolia, 010070, China.
| | - Dongxu Li
- School of Public Administration, Inner Mongolia University, Zhaojun Road, Yuquan District, Hohhot, Inner Mongolia, 010070, China.
| | - Tianjiao Zhang
- School of Public Administration, Inner Mongolia University, Zhaojun Road, Yuquan District, Hohhot, Inner Mongolia, 010070, China
| | - Wenhui Li
- School of Public Administration, Inner Mongolia University, Zhaojun Road, Yuquan District, Hohhot, Inner Mongolia, 010070, China
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Xu J. Rethinking Performance Measurement of Primary Care in China Comment on "Quality and Performance Measurement in Primary Diabetes Care: A Qualitative Study in Urban China". Int J Health Policy Manag 2023; 12:7825. [PMID: 38618814 PMCID: PMC10590229 DOI: 10.34172/ijhpm.2023.7825] [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: 11/21/2022] [Accepted: 06/19/2023] [Indexed: 04/16/2024] Open
Abstract
Increased political commitment and financial input to primary care have led to a growing role of performance measurement. Rasooly et al studied the implementation of performance measurement for primary care for people with diabetes in China. This is an important topic that has received little attention from previous literature. In light of the findings from the article, this paper argues for rethinking the current use of performance measurement. It also suggests potential ways to improve primary care performance measurement, in order to avoid some of the pitfalls of top-down performance measurement and to create an enabling environment for primary care strengthening.
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Affiliation(s)
- Jin Xu
- China Center for Health Development Studies, Peking University, Beijing China
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Lv B, Zhang L, Meng K. Effect of multiple chronic conditions on family doctor contracting in the elderly in China: the moderating role of socioeconomic status. BMC Public Health 2023; 23:1540. [PMID: 37573398 PMCID: PMC10422842 DOI: 10.1186/s12889-023-16438-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/02/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND China's family doctor contracting service is an important part of deepening the reform of the healthcare systems, aiming to further develop chronic disease management services, enhance the capacity of primary health care services and improve the health of residents. The purpose of this study was to explore the influence of multiple chronic conditions in the elderly on family doctor contracting and whether socioeconomic status played a moderating role. METHODS A cross-sectional survey was conducted in Beijing, China. A total of 1814 elderly people over 60 years old were included in this study using a whole-group sampling method. The univariate analysis and logistic regression analysis was used to analyze the data. RESULTS 21.72% of the elderly signed up with family doctors. The multiple chronic conditions was a factor influencing the elderly to sign up with family doctors (OR = 1.44, 95%CI = 1.28-1.61), and the higher the degree of multiple chronic conditions, the stronger willingness to sign up. Socioeconomic status positively moderates the effect of multiple chronic conditions on signing. Also, physical activity intensity (OR = 1.25, 95%CI = 1.03-1.54) and willingness to first visit primary care facilities (OR = 1.38, 95%CI = 1.25-1.54) influenced the elderly to sign up with family doctors. CONCLUSIONS The elderly with a high degree of multiple chronic conditions, high activity intensity, and a strong willingness to first visit primary care facilities were more likely to sign up with family doctors. The health literacy of the elderly should be further improved, and publicity on the family doctor contracting service policies for the elderly with lower socioeconomic status should be strengthened to guide them to sign up with family doctors. At the same time, the service capacity of primary care facilities should be further improved to meet the health needs of the elderly.
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Affiliation(s)
- Bo Lv
- School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China
| | - Ling Zhang
- School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China.
| | - Kai Meng
- School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China.
- Beijing Tiantan Hospital, Capital Medical University, No.119 South of the Fourth Ring Road, Fengtai District, Beijing, 100070, China.
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Xu L, Chen M, Peng K, Hiligsmann M, Jan S, Si L. Socio-demographic disparities in health-related quality of life after hip fracture in China: evidence from the China Health and Retirement Longitudinal Study. Arch Osteoporos 2023; 18:29. [PMID: 36764986 DOI: 10.1007/s11657-023-01220-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023]
Abstract
This study analyzed the impact of hip fractures on people's health-related quality of life and its socio-demographic disparities in China. PURPOSE Hip fractures cause high mortality and worsened health-related quality of life (HRQoL). This study aimed to investigate whether socio-demographic-related inequities in post-hip fracture participants' HRQoL exist in China. METHODS Data from the China Health and Retirement Longitudinal Study (waves 2013, 2015, and 2018) were used. The measurement of HRQoL in this study focused on 5 health dimensions: depression, body pain, mobility, basic activities of daily living, and instrumental activities of daily living. A difference-in-differences (DID) analysis with multiple time periods was performed to gauge the impact of hip fracture on HRQoL. A multivariate regression approach was used to explore socio-demographic-related factors associated with inequities of HRQoL. RESULTS A total of 23,622 individuals were included, and 341 participants reported hip fracture events during the survey period. In participants with hip fracture, the presentation rate of body pain increased by 14% (p < 0.01) and the HRQoL of other health dimensions worsened (p ≤ 0.01) after hip fracture. The DID analysis showed that hip fracture had a negative impact on all HRQoL dimensions (p < 0.01). Socioeconomic-related factors of HRQoL inequities included school education level and location of residence. Study participants with hip fracture with greater educational attainment or living in urban areas had higher (p < 0.05) levels of HRQoL. In addition, comorbidities also correlated with a worse HRQoL (p < 0.05). CONCLUSION Hip fracture significantly affects people's HRQoL in China, and the impact is more profound for those with lower educational attainment or living in rural areas. Targeted interventions should be designed to narrow this inequity.
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Affiliation(s)
- Lizheng Xu
- The George Institute for Global Health, Sydney, NSW, Australia
- UNSW Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Mingsheng Chen
- School of Health Policy and Management, Nanjing Medical University, No. 101, Longmian Avenue, Nanjing, 211166, China.
- Creative Health Policy Research Group, Nanjing Medical University, Nanjing, China.
- Center for Global Health, Nanjing Medical University, Nanjing, China.
| | - Ke Peng
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Stephen Jan
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Lei Si
- School of Health Sciences, Western Sydney University, Campbelltown, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
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Hu L, Zhu W, Yu J, Chen Y, Yan J, Liao Q, Zhang T. Family-based improvement for health literacy among the Yi nationality (FAMILY) in Liangshan: protocol of an open cohort stepped wedge cluster randomized controlled trial. BMC Public Health 2022; 22:1543. [PMID: 35964063 PMCID: PMC9375317 DOI: 10.1186/s12889-022-13782-w] [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: 07/03/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improvement of health literacy constitutes a cornerstone to improving public health. However, the overall health literacy of Liangshan Yi Autonomous Prefecture (Liangshan Prefecture) in the southwest Sichuan Province of China has kept extremely low for a long time. How to improve health literacy of the Yi nationality residents is key to be urgently solved. Notably, Family Branch System is a distinctive patrilineal bloodline organization of Yi nationality, which plays an important role in the daily life of Yi nationality. Meanwhile, Contracted Family Doctor Services is conducted in Liangshan Prefecture. Therefore, this study proposes an intervention model of health education based on Family Branch System and Contracted Family Doctor Services, which is a Family-based Improvement for Health Literacy among the Yi nationality (FAMILY) in Liangshan, when improving traditional Innovative Care for Chronic Conditions Framework (ICCC) framework. METHODS An open cohort stepped wedge cluster randomized trial design is used to implement health literacy education interventions including project preparation, core group building, promotion within family branch and competition between family branches while using Contracted Family Doctor Services as control measure. The study will be conducted among Yi nationality residents in Meigu County and Yanyuan County, with health literacy level of residents as the primary outcome. Finally, mixed-effects model and causal inference method will be used to evaluate intervention effect. DISCUSSION This study highlights family, using the unique Family Branch System and Contracted Family Doctor Services in Liangshan Prefecture to design intervention among improved ICCC framework, and combines the mixed-effects model with complier average causal effects (CACE) to estimate the intervention effect under non-compliance for the first time. Besides, other key technologies to be adopted include construction of electronic questionnaire quality control system, with quality control based on artificial intelligence. This trial contributes to exploring an effective way to improve health literacy of Yi nationality residents in Liangshan Prefecture, which will provide reference for other areas, especially poor areas, to improve residents' health literacy. TRIAL REGISTRATION ISRCTN11299863 on June 1, 2022; https://www.isrctn.com/ .
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Affiliation(s)
- Lin Hu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Renmin South Road 3rd Section NO.16, Chengdu, 610041, Sichuan Province, China
| | - Wenhui Zhu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Renmin South Road 3rd Section NO.16, Chengdu, 610041, Sichuan Province, China
| | - Jie Yu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Renmin South Road 3rd Section NO.16, Chengdu, 610041, Sichuan Province, China
| | - Ying Chen
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Renmin South Road 3rd Section NO.16, Chengdu, 610041, Sichuan Province, China
| | - Jingmin Yan
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Renmin South Road 3rd Section NO.16, Chengdu, 610041, Sichuan Province, China
| | - Qiang Liao
- Liangshan Prefecture Center for Disease Control and Prevention, Xichang, 615000, Sichuan Province, China
| | - Tao Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Renmin South Road 3rd Section NO.16, Chengdu, 610041, Sichuan Province, China.
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