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He S, Bian Y. Older adults 's hospitalizational costs and burden study in China--analysis from CHARLS data 2018. Front Public Health 2024; 12:1418179. [PMID: 39118974 PMCID: PMC11306026 DOI: 10.3389/fpubh.2024.1418179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/19/2024] [Indexed: 08/10/2024] Open
Abstract
Objective The aging Chinese population is driving up health care costs, with hospitalizational accounting for a large portion of total health care costs. By 2012, hospitalization costs for people over 60 years of age exceeded outpatient costs, marking a change in the allocation of medical resources. Further research is needed on the factors influencing changes in hospitalizational costs and burden. This paper examines the costs and burden of hospitalization for older adults from a micro perspective, providing new evidence to explain how social, medical, family, personal, and geographic factors affect them. Methods Utilizing data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), a linear regression model was constructed to investigate the impact of various factors on the hospitalization costs and burden among the older adult in China. To ensure the heterogeneity of the results, the sample was divided into subgroups based on different regions for comparative analysis. Additionally, collinearity among the variables was examined. Results The average hospitalization costs for the older adult are $1,199.24, with a burden score of 0.5. Residence, type of chronic diseases, region, family size, type of health service facility, received distance, smoke and alcoholic significantly affect the out-of-pocket expenses for older adult hospitalizations. In terms of the burden of hospitalization for the older adult, Residence, health insurance, education, type of chronic diseases, region, family size, ethnic, type of health service facility, received distance, smoke, alcoholic and pension significantly impact the hospitalization burden for the older adult. Conclusion This paper provides a new perspective to explain the factors influencing hospitalizational costs and burden in China. The policy recommendations include expanding health insurance coverage and promoting commercial insurance to enhance the accessibility and financial security of healthcare services. Strengthening primary care is suggested to reduce the burden on hospitals and lower the overall cost of hospitalization. Policies aimed at addressing regional healthcare disparities are proposed, along with targeted support for vulnerable groups, including subsidies and culturally sensitive services.
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Affiliation(s)
- Shanheng He
- Institute of Chinese Medical Sciences, University of Macau, Macau, China
- State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Macau, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau, China
| | - Ying Bian
- Institute of Chinese Medical Sciences, University of Macau, Macau, China
- State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Macau, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau, China
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Wu Y, Liang Y, Cai Z, Li L, Sun C, Sylvia S, Zhou H, Feng J, Rozelle S. Process quality, diagnosis quality, and patient satisfaction of primary care in Rural Western China: A study using standardized patients. PATIENT EDUCATION AND COUNSELING 2024; 123:108208. [PMID: 38377708 DOI: 10.1016/j.pec.2024.108208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 12/26/2023] [Accepted: 02/12/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVES Patient satisfaction is an essential indicator of the doctor-patient relationship. This study aimed to investigate the relationship between primary care quality and patient satisfaction for non-communicable diseases (NCDs) in rural western China. METHODS The study utilized the standardized patients (SPs) approach to present typical symptoms of unstable angina and diabetes to rural healthcare providers. After the consultations, the SPs completed a satisfaction survey. Ordinary least squares and quantile regression were used to examine the association between quality of primary care and patient satisfaction. RESULTS We examined 178 anonymous SPs visits. The results showed that higher process quality for angina SPs was correlated with stronger satisfaction for provider ability at a low quantile of ability satisfaction. For diabetes SPs, higher process quality increased overall satisfaction at a low quantile of overall satisfaction, whereas a correct diagnosis significantly contributed to communication satisfaction at a high quantile of communication satisfaction. CONCLUSIONS The study found positive associations between process and diagnosis quality and SPs satisfaction. Notably, the influence of process quality was most significant among patients with lower satisfaction levels. PRACTICE IMPLICATIONS Provider's process quality could be a key area of improving the satisfaction levels, especially for patients with lower levels of satisfaction.
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Affiliation(s)
- Yuju Wu
- Department of Health Behavior and Social Science,West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yizhi Liang
- Department of Global Health and Population, Harvard Chan School of Public Health, 677 Huntington Ave, Boston 02115, MA, USA
| | - Zhengjie Cai
- Department of Health Behavior and Social Science,West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Linhua Li
- Department of Health Behavior and Social Science,West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chang Sun
- Department of Health Behavior and Social Science,West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Huan Zhou
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, South Renmin Road, Chengdu 610041, Sichuan, China.
| | - Jieyuan Feng
- Stanford Center on China's Economy and Institutions, Stanford University, Stanford, CA, USA
| | - Scott Rozelle
- Stanford Center on China's Economy and Institutions, Stanford University, Stanford, CA, USA
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Fu W, Shi J, Liu C, Chen W, Liu G, He J. Health insurance and inequalities in catastrophic health spending in cancer patients. A cross-sectional study in China. GACETA SANITARIA 2024; 38:102397. [PMID: 38772059 DOI: 10.1016/j.gaceta.2024.102397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 01/23/2024] [Accepted: 03/19/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVE To determine the role of social health insurance programs in reducing inequality in the incidence and intensity of catastrophic health expenditure (CHE) of cancer patients in China. METHOD A convenient sample of 2534 cancer patients treated in nine hospitals in 2015 and 2016 were followed up through face-to-face interviews in March-December 2018. The incidence and intensity (mean positive overshoot) of CHE (≥ 40% household consumption) were calculated. RESULTS About 72% of cancer patients experienced CHE events after insurance compensation, with the catastrophic mean positive overshoot amounting to 28.27% (SD: 15.83%) of the household consumption. Overall, social insurance contributed to a small percentage of drop in CHE events. Income-related inequality in CHE persisted before and after insurance compensation. Richer patients benefit more than poorer ones. CONCLUSIONS Cancer treatment is associated with high incidence of CHE events in China. The alleviating effect of social health insurance on CHE events is limited.
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Affiliation(s)
- Wenqi Fu
- School of Health Management, Public Health, Harbin Medical University, Harbin, China
| | - Jufang Shi
- Office of Cancer Screening, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Wanqing Chen
- Office of Cancer Screening, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guoxiang Liu
- School of Health Management, Public Health, Harbin Medical University, Harbin, China.
| | - Jie He
- Office of Cancer Screening, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Xie Z, Chen S, He C, Cao Y, Du Y, Yi L, Wu X, Wang Z, Yang Z, Wang P. Trends and age-period-cohort effect on the incidence of falls from 1990 to 2019 in BRICS. Heliyon 2024; 10:e26771. [PMID: 38434415 PMCID: PMC10907765 DOI: 10.1016/j.heliyon.2024.e26771] [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: 10/05/2023] [Revised: 02/15/2024] [Accepted: 02/20/2024] [Indexed: 03/05/2024] Open
Abstract
Background The increasing burden of falls in BRICS countries warrants a comprehensive investigation to understand the dynamics and trends. This study utilized data from the Global Burden of Disease Study (GBD) 2019 to assess fall incidence rates in Brazil, Russia, India, China, and South Africa (BRICS) to provide valuable insights for the development of targeted prevention and management strategies. Methods Data from the GBD 2019 were employed to estimate fall incidence rates. The study utilized age-period-cohort (APC) model analysis, implemented using R 4.3.0 software and the R package apc, to examine fall incidence trends from 1990 to 2019. Results In 2019, the BRICS nations collectively reported 32.32 million fall cases. The overall fall incidence rate increased from 2681.7 per 100,000 people in 1990-2896.3 per 100,000 people in 2019. China and India exhibited escalating trends, with China experiencing the highest growth rate at 21%, followed by India at 5.8%. South Africa displayed a comparatively lower overall incidence rate increase. Notably, the 90-94 age group in China exhibited the most significant deterioration, with men and women experiencing annual increases of 4.23% and 1.77%, respectively. Age effects indicated a higher susceptibility to falls among preschool children and the elderly. Period effects revealed no improvement in the fall state for India (2005-2019) and China (2015-2019). Cohort effects adversely impacted the incidence rate for individuals born earlier in South Africa. Conclusion The present study highlights a consistent upward trend in fall incidence rates across BRICS countries from 1990 to 2019. With an aging population, the burden of fall-related diseases is on the rise in these nations. Our results underscore the necessity of formulating evidence-based disease prevention and management approaches tailored to the distinctive demographic attributes of each nation. Addressing these trends is crucial for mitigating the growing impact of falls on public health in BRICS countries.
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Affiliation(s)
- Zhiqin Xie
- Jiangxi Medical Center for Critical Public Health Events, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330052, China
| | - Shihan Chen
- Department of Nursing, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
- School of Nursing, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Chaozhu He
- School of Nursing, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Ying Cao
- Department of Nursing, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Yunyu Du
- Department of Thoracic Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330052, China
| | - Linxia Yi
- Department of Nursing, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Xiuqiang Wu
- Department of Nursing, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Zequan Wang
- Department of Nursing, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Zhen Yang
- Department of Nursing, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Pinghong Wang
- Department of Nursing, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
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Li X, Mohanty I, Chai P, Niyonsenga T. Healthcare utilization and its association with socioeconomic status in China: Evidence from the 2011-2018 China Health and Retirement Longitudinal Study. PLoS One 2024; 19:e0297025. [PMID: 38483924 PMCID: PMC10939203 DOI: 10.1371/journal.pone.0297025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 12/26/2023] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Healthcare utilization often favors the higher-socioeconomic status (SES) and having chronic diseases may exacerbate this inequality. This study aims to examine the trends in health service use over time, the effect of SES on healthcare utilization, and the role of chronic diseases in this association. METHODS Data used in this study were from the China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013, 2015, and 2018, which is the first nationally representative survey of the middle-aged and older. The sample included people aged 45 years and older who responded to all the waves. A total of 10,922 adults were included in this study. Healthcare utilization was categorized into outpatient and inpatient service use and SES was measured by per-capita household expenditure. A multilevel zero-inflated negative binomial regression model was performed to analyze outpatient and inpatient service use, separately. RESULTS The rates of outpatient service use in 2011, 2013, 2015, and 2018 were 19.11%, 21.45%, 20.12%, and 16.32%, respectively, while the rates of inpatient service use were 8.40%, 13.04%, 14.17%, and 18.79%, respectively. Compared to individuals in the lowest quintile of per-capita household expenditure, those in higher quintiles had higher odds of outpatient service use (Q2: odds ratio = 1.233, p < 0.0001; Q3: 1.416, p < 0.0001; Q4: 1.408, p < 0.0001; or Q5: 1.439, p < 0.0001) and higher rates of inpatient service use (Q2: incidence rate ratio = 1.273, p < 0.0001; Q3: 1.773, p < 0.0001; Q4: 2.071, p < 0.0001; or Q5: 1.992, p < 0.0001). Additionally, having morbidity generally increased healthcare utilization, but did not play a significant role in moderating the relationship between SES and healthcare utilization. CONCLUSIONS Healthcare utilization rates were overall low in China, but relatively high for people in higher quintiles of per-capita household expenditure or those with morbidity, compared to their counterparts. Policy actions are required to provide more health education to the public, to further optimize health insurance schemes targeting outpatient services, especially for the low-SES, and to establish new health delivery models for NCD management in the primary health care setting.
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Affiliation(s)
- Xi Li
- Health Research Institute (HRI), Faculty of Health, University of Canberra, Canberra, Australia
| | - Itismita Mohanty
- Health Research Institute (HRI), Faculty of Health, University of Canberra, Canberra, Australia
| | - Peipei Chai
- Department of Health Economics and National Health Accounts Research, China National Health Development Research Center, Beijing, China
| | - Theo Niyonsenga
- Health Research Institute (HRI), Faculty of Health, University of Canberra, Canberra, Australia
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Zhang T, Su M, Li D, Zhang W, Yang F, Li W. Equity in health service utilisation among middle-aged and elderly people with multiple chronic conditions in China: evidence from longitudinal data of 2011-2018 CHARLS. BMJ Open 2023; 13:e072320. [PMID: 37816559 PMCID: PMC10565265 DOI: 10.1136/bmjopen-2023-072320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/04/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVES Equity in health service utilisation is a central objective for health systems. Middle-aged and elderly patients with multiple chronic conditions (MCCs) are particularly vulnerable to healthcare inequity. This study aimed to update the information on the trends in the incidence and equity of outpatient health service utilisation (OHSU) and inpatient health service utilisation (IHSU) for middle-aged and elderly MCCs patients in China, identify socioeconomic determinants that may contribute to inequity, and suggest optimisation strategies to mitigate this disparity. METHODS Panel data obtained from four waves of the China Health and Retirement Longitudinal Study (CHARLS) were used to determine the trends in OHSU and IHSU. The inequity in OHSU and IHSU was measured by the Concentration Index (CI) and Horizontal Inequity Index (HI), which is a valid measure of health service utilisation equity. The decomposition model of the CI was set up to explore the contribution of various determinants of overall equity. RESULTS The annual rate of OHSU gradually decreased from 29.32% in 2011 to 27.27% in 2018. The HI remained positive and decreased from 0.0803 in 2011 to 0.0662 in 2018, indicating the existence of pro-rich inequity. The annual rate of IHSU gradually increased from 13.31% in 2011 to 19.89% in 2018. The HI remained positive and showed a declining trend from 0.2363 in 2011 to 0.0574 in 2018, evidencing pro-rich inequity; however, a trend towards the easing of inequity was observed. CONCLUSIONS Pro-rich inequity was present in both OHSU and IHSU among middle-aged and elderly MCCs patients in China. Economic status, area, education and age were the main contributors to pro-rich inequity. Concerted efforts are needed to allocate resources for mitigating health service utilisation inequity in middle-aged and elderly people with MCCs.
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Affiliation(s)
- Tianjiao Zhang
- School of Public Administration, Inner Mongolia University, Hohhot, China
| | - Min Su
- School of Public Administration, Inner Mongolia University, Hohhot, China
| | - Dongxu Li
- School of Public Administration, Inner Mongolia University, Hohhot, China
| | - Weile Zhang
- School of Public Administration, Inner Mongolia University, Hohhot, China
| | - Fan Yang
- School of Public Administration, Inner Mongolia University, Hohhot, China
| | - Wenhui Li
- School of Public Administration, Inner Mongolia University, Hohhot, 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 Y, Liu Z, Qi J, Wang L, Zhou M, Yin P. Pulmonary Heart Disease Associated Mortality - China, 2014-2021. China CDC Wkly 2023; 5:779-784. [PMID: 37745265 PMCID: PMC10515646 DOI: 10.46234/ccdcw2023.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Over the latter half of the previous century, pulmonary heart disease (PHD) emerged as a significant public health issue in China. However, the current mortality rate is unknown. Utilizing the Multiple Cause of Death database, the present study aims to investigate the current state and progression of PHD-associated death in China. Methods Data from the China National Mortality Surveillance System were used to analyze progression in mortality rates attributable to PHD from 2014 to 2021. To standardize population structure for each year during the investigation period, demographic information from the 2020 census was employed as the reference population. Age-standardized mortality rates (ASMR) were determined based on sex, urban-rural area, and region. To identify trends in ASMR, a joinpoint regression analysis was executed. Results The ASMR of PHD exhibited a marked decrease, falling from 61.68 per 100,000 in 2014 to 28.53 per 100,000 in 2021. This downward trend was observable in both genders, all regions, and both urban and rural settings. The greatest ASMR values were documented in the western region. Comparative observations revealed a higher ASMR in rural areas versus urban ones and in males versus females. PHD-associated deaths predominantly occurred among older individuals, particularly those aged 80 and above. Chronic obstructive pulmonary disease (COPD) emerged as the principal underlying cause of death PHD-associated mortalities, accounting for between 87.41% and 93.42% of cases throughout the period 2014-2021. Conclusions There was a declining trend in PHD mortality in China from 2014 to 2021, with COPD accounting for a significant proportion of these deaths. Given the high prevalence of COPD and the escalating population aging in China, PHD remains a significant health concern that warrants further attention.
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Affiliation(s)
- Yangyang Xu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhe Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jinlei Qi
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lijun Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Nie C, Feng Y. The impact of national comprehensive medical reform on residents' medical expenses: Evidence from China. Front Public Health 2023; 10:1038543. [PMID: 36684899 PMCID: PMC9850085 DOI: 10.3389/fpubh.2022.1038543] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/15/2022] [Indexed: 01/07/2023] Open
Abstract
Residents' high medical expenses is the core challenge that needs to be solved urgently in China's medical reform for a long time. Based on the panel data of 30 provinces in Chinese Mainland during 2011-2019, we evaluate the impact of China's national comprehensive medical reform pilot policy on residents' medical expenses by using the difference-in-differences model. The results show that the pilot policy was generally conducive to reducing residents' medical expenses, resulting in a reduction of 2.13% in per capita medical expenses for inpatients, but the effect on per capita medical expenses for outpatients was insignificant. Mechanism analysis shows that hospital competition and institutional environment played a moderating role in the effect of the pilot policy on residents' medical expenses reduction. The more intense the hospital competition and the better the institutional environment, the more significant of the reduction effect. In addition, the reduction effect of the pilot policy was greater in the central provinces, the provinces with poor medical infrastructure, and the provinces with strong financial strength. This study provides useful policy insights for deepening medical reform and reducing residents' medical expenses.
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Affiliation(s)
- Changfei Nie
- School of Economics and Management, Nanchang University, Nanchang, China
| | - Yuan Feng
- College of City Construction, Jiangxi Normal University, Nanchang, China
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Yang M, Zhang Z, Wang Z. Does Internet use connect smallholder farmers to a healthy diet? Evidence from rural China. Front Nutr 2023; 10:1122677. [PMID: 37153910 PMCID: PMC10157090 DOI: 10.3389/fnut.2023.1122677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/30/2023] [Indexed: 05/10/2023] Open
Abstract
Introduction Undernutrition and micronutrient malnutrition remain problems of significant magnitude among small-scale subsistence farmers, posing a serious threat to their health and well-being. Developing a healthy diet can effectively reduce this threat. Fortunately, the Internet can speed up the process. Methods Based on survey data from 5,114 farm households in nine provinces in China, this study quantitatively assesses the impact of Internet use on the dietary quality of smallholder farmers using OLS regression models and PSM models. Results/Discussion (1) Internet use can significantly contribute to dietary diversity and dietary rationality among smallholder farmers, thus optimizing their dietary structure. (2) Internet use significantly increased the average consumption amounts of milk and its products (2.9 g), fruits (21.5 g), eggs (7.5 g), and vegetables (27.1 g), while also decreasing the intake of salts (1.5 g) and oil (3.8 g). (3) The pull of internet use to improve diet quality is more significant for smallholder households with lower levels of education, older heads of households, and higher household incomes. (4) A possible mechanism is that Internet use increases household income and information access skills of rural residents, thus improving their dietary quality. In summary, governments should further promote Internet penetration in rural areas for health purposes.
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Affiliation(s)
- Mingwei Yang
- Research Center for Economy of Upper Reaches of the Yangtse River, Chongqing Technology and Business University, Chongqing, China
- Qinghai University Library, Qinghai University, Xining, Qinghai, China
- *Correspondence: Mingwei Yang,
| | - Zhiyong Zhang
- Research Center for Economy of Upper Reaches of the Yangtse River, Chongqing Technology and Business University, Chongqing, China
| | - Zheng Wang
- Research Center for Economy of Upper Reaches of the Yangtse River, Chongqing Technology and Business University, Chongqing, China
- School of Economics and Management, Taiyuan Normal University, Taiyuan, China
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Li C, Han Q, Hu J, Han Z, Yang H. Impact of intergenerational support and medical expenditures on depression: Evidence from rural older adults in China. Front Public Health 2022; 10:840864. [PMID: 35937247 PMCID: PMC9354659 DOI: 10.3389/fpubh.2022.840864] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Globally, depression has become a major health issue among older adults, who experience poor physical health and high medical expenditures. In Asian countries, older adults are greatly dependent on their children. This study assessed the impact of different types of intergenerational support and medical expenditures on depression among older adults in rural China. Method A three-phase balanced panel was constructed based on data from 1,838 rural older adults with comparable scores on the Center for Epidemiologic Studies Depression Scale (CES-D) from the China Family Panel Studies in 2012, 2016, and 2018. A fixed-effects model was used to analyze the impact of intergenerational support and medical expenditures on CES-D score and of intergenerational support on medical expenditures. The propensity score-matching model was used to test the regression results' robustness. Results The findings were as follows. First, different types of intergenerational support had a heterogeneous impact on depression among rural older adults. Emotional support had a significantly negative impact on CES-D score, although too much care-based support had a positive impact on CES-D score. Low-level economic support had no significant effect on CES-D score. Second, medical expenditures impacted depression; among these, non-inpatient medical expenditure had a significant and positive impact on CES-D score. Third, CES-D scores among rural older adults were associated with chronic diseases and per capita family income. Fourth, care-based support was associated with reduced non-inpatient medical expenditures, and the sub-sample regression results indicated that the impact was significant for older adults with no chronic diseases and those younger than 75 years. Conclusion Intergenerational emotional support and non-inpatient medical expenditures directly affected rural older adults' CES-D scores. The mediating role of medical expenditures between intergenerational support and CES-D score was not significant. Measures should be taken to encourage intergenerational emotional support and reduce the pressure on children's economic and care-based support. Further, the medical insurance reimbursement policy, as formal support, should be improved to alleviate depression among rural older adults when children's support is limited.
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Affiliation(s)
- Congrong Li
- School of Public Administration, Xi'an University of Architecture and Technology, Xi'an, China
- *Correspondence: Congrong Li
| | - Qing Han
- School of Public Administration, Xi'an University of Architecture and Technology, Xi'an, China
| | - Jinrong Hu
- School of Public Administration, Xi'an University of Architecture and Technology, Xi'an, China
| | - Zeyu Han
- School of Public Administration, Xi'an University of Architecture and Technology, Xi'an, China
| | - Hongjuan Yang
- Institute of Sociology, Shaanxi Academy of Social Sciences, Xi'an, China
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The Comparison of Various Types of Health Insurance in the Healthcare Utilization, Costs and Catastrophic Health Expenditures among Middle-Aged and Older Chinese Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105956. [PMID: 35627490 PMCID: PMC9141905 DOI: 10.3390/ijerph19105956] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 02/04/2023]
Abstract
Rapid aging in China is increasing the number of older people who tend to require health services for their poor perceived health. Drawing on the China Health and Retirement Longitudinal Study (CHARLS) 2018 data, we used two-part model and binary logistic regression to compare various types of health insurance in the healthcare utilization, costs and catastrophic health expenditures (CHE) among the middle-aged and older adults in China. Compared with uninsured, all types of health insurance promoted hospital utilization rate (ranged from 8.6% to 12.2%) and reduced out-of-pocket (OOP) costs (ranged from 64.9% to 123.6%), but had no significant association with total costs. In contrast, the association of health insurance and outpatient care was less significant. When Urban Employee Medical Insurance (UEMI) as reference, other types of insurance did not show a significant difference. Health insurance could not reduce the risk of CHE. The equity in healthcare utilization improved and healthcare costs had been effectively controlled among the elderly, but health insurance did not protect against CHE risks. Policy efforts should further focus on optimizing healthcare resource allocation and inclining toward the lower socio-economic and poor-health groups.
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Wang X, Wang P, Wang P, Cao M, Xu X. Relationships among mental health, social capital and life satisfaction in rural senior older adults: a structural equation model. BMC Geriatr 2022; 22:73. [PMID: 35073854 PMCID: PMC8785491 DOI: 10.1186/s12877-022-02761-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/11/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Literature about life satisfaction in rural senior older adults is scarce. The aim of this research was to examine the relationships among mental health, social capital and life satisfaction in rural senior older adults. METHODS This was a cross-sectional study. From July to October 2017, 245 senior older adults from 14 villages of Jinhua City in China were recruited. The Satisfaction with Life Scale (SWLS), the Chinese Version of the 12-item General Health Questionnaire (GHQ-12), the Social Capital Questionnaire (SCQ) and a self-designed questionnaire was administered to the participants. Structural equation modelling was implemented to analyse the relationships between mental health, social capital and life satisfaction in rural senior older adults. RESULTS The structural equation model was fitting adequately (χ2/df = 1.785, P < 0.001; RMSEA = 0.059; CFI = 0.963). Life satisfaction was positively affected by income (β = 0.243, P = 0.01). Likewise, community canteen services improved life satisfaction (β = 0.288, P = 0.001). Social capital had direct positive prediction on life satisfaction (β = 0.342, P = 0.003) and indirectly improved life satisfaction through mental health (β =0.183, P = 0.007). Life satisfaction was impaired by poor mental health among senior older adults (β = - 0.395, P < 0.026). CONCLUSIONS Life satisfaction among rural senior older adults is a multifaceted well-being construct affected by income, community canteen services, social capital and mental health. The presented model highlights the positive effect of income, community canteen services, social capital and mental health. Appropriate home-based aged care, programs and policies are needed.
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Affiliation(s)
- Xiaolei Wang
- School of Nursing, Department of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Panpan Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan Province, China.
| | - Peng Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Meijuan Cao
- School of Nursing, Department of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Xianrong Xu
- Department of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang Province, China
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