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Geulayov G, Casey D, Bale L, Brand F, Clements C, Kapur N, Ness J, Waters K, White S, Hawton K. Variation in the clinical management of self-harm by area-level socio-economic deprivation: findings from the multicenter study of self-harm in England. Psychol Med 2024; 54:1004-1015. [PMID: 37905705 DOI: 10.1017/s0033291723002799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND We investigated disparities in the clinical management of self-harm following hospital presentation with self-harm according to level of socio-economic deprivation (SED) in England. METHODS 108 092 presentations to hospitals (by 57 306 individuals) after self-harm in the Multicenter Study of Self-harm spanning 17 years. Area-level SED was based on the English Index of Multiple Deprivation. Information about indicators of clinical care was obtained from each hospital's self-harm monitoring systems. We assessed the associations of SED with indicators of care using mixed effect models. RESULTS Controlling for confounders, psychosocial assessment and admission to a general medical ward were less likely for presentations by patients living in more deprived areas relative to presentations by patients from the least deprived areas. Referral for outpatient mental health care was less likely for presentations by patients from the two most deprived localities (most deprived: adjusted odd ratio [aOR] 0.77, 95% CI 0.71-0.83, p < 0.0001; 2nd most deprived: aOR 0.80, 95% CI 0.74-0.87, p < 0.0001). Referral to substance use services and 'other' services increased with increased SED. Overall, referral for aftercare was less likely following presentations by patients living in the two most deprived areas (most deprived: aOR 0.85, 95% CI 0.78-0.92, p < 0.0001; 2nd most deprived: aOR 0.86, 95% CI 0.79-0.94, p = 0.001). CONCLUSIONS SED is associated with differential care for patients who self-harm in England. Inequalities in care may exacerbate the risk of adverse outcomes in this disadvantaged population. Further work is needed to understand the reasons for these differences and ways of providing more equitable care.
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Affiliation(s)
- G Geulayov
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - D Casey
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - L Bale
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - F Brand
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - C Clements
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - N Kapur
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - J Ness
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - K Waters
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - S White
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - K Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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Abusaada H, Elshater A. Revisiting Urban Street Planning and Design Factors to Promote Walking as a Physical Activity for Middle-Class Individuals with Metabolic Syndrome in Cairo, Egypt. Int J Environ Res Public Health 2024; 21:402. [PMID: 38673315 PMCID: PMC11050667 DOI: 10.3390/ijerph21040402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/13/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
This paper revisits the planning and design factors of "pedestrianized" and "walkable" urban streets to encourage physical activity, focusing on their prioritization according to public health and smart growth. The aim is to create a conceptual framework for urban planners and designers to encourage walking and reduce metabolic syndrome (MetS) risks. Through a scoping review, the study found that while pedestrianized and walkable streets share many planning and design factors, they have different objectives. The study explores how urban planning and design can reduce MetS risk among middle-class individuals using online video storytelling for 30 participants in three districts of Cairo, Egypt: El Zamalek, Old Cairo, and Heliopolis. It identifies three factors to address MetS symptoms for middle-class individuals: strategic, design-oriented, and technical. Practitioners and policymakers can use this framework to evaluate the impact of their work. This study is particularly relevant for cities in the Global South that are facing similar challenges.
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Affiliation(s)
- Hisham Abusaada
- Housing and Building National Research Center, Giza 1770, Egypt;
| | - Abeer Elshater
- Faculty of Engineering, Ain Shams University, Cairo 11517, Egypt
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Prahbhjot M, Singhi P. Age at diagnosis for autism spectrum disorders: Does it differ by place of residence? Indian J Public Health 2022; 66:166-170. [PMID: 35859499 DOI: 10.4103/ijph.ijph_1801_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Despite steady decline in the age of diagnosis (AOD) at the global level, it has not declined uniformly, and marked disparities are documented by income, education, race, and access to health care. OBJECTIVES The objectives of the study are to examine the urban/rural disparities in the initial age of autism diagnosis and to understand the interplay of the underlying demographic and social factors. METHODS A retrospective case record review of all children who received their initial diagnosis of autism at the Pediatric Psychology Clinic (1997-2018) of a tertiary advanced pediatric center at Chandigarh was conducted. A structured abstraction data form was used to extract demographic, socioeconomic, and clinical information from the files maintained at the clinic. RESULTS A total of 1321 case records were examined. The mean AOD was 4.62 years (standard deviation = 2.38) and children from rural communities were diagnosed at 4.87 years, nearly 0.35 years later than urban children (t = 2.47, P = 0.013). Results indicated that 31.1% of the variance in the AOD for children from rural areas was predicted by two variables, namely the number of children in the family and total Childhood Autism Rating Scale (CARS) score (F = 13.62, P = 0.001). For the urban sample, three variables emerged as significant predictors including the number of children in the family, total CARS score, and maternal education and these together explained 20.2% of the variance in the AOD (F = 19.60, P = 0.001). CONCLUSION The public health system must be sensitized to the unmet needs of the marginalized socioeconomic groups to access diagnostic and management services in a timely manner.
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Affiliation(s)
- Malhi Prahbhjot
- Professor, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pratibha Singhi
- Retired Professor, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Wemrell M, Lenander C, Hansson K, Perez RV, Hedin K, Merlo J. Socio-economic disparities in the dispensation of antibiotics in Sweden 2016-2017: An intersectional analysis of individual heterogeneity and discriminatory accuracy. Scand J Public Health 2021; 50:347-354. [PMID: 33461415 PMCID: PMC9096578 DOI: 10.1177/1403494820981496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Aims: Antimicrobial resistance presents an increasingly serious
threat to global public health, which is directly related to how antibiotic
medication is used in society. Actions aimed towards the optimised use of
antibiotics should be implemented on equal terms and according to the needs of
the population. Previous research results on differences in antibiotic use
between socio-economic and demographic groups in Sweden are not entirely
coherent, and have typically focused on the effects of singular socio-economic
variables. Using an intersectional approach, this study provides a more precise
analysis of how the dispensation of antibiotic medication was distributed across
socio-economic and demographic groups in Sweden in 2016–2017.
Methods: Using register data from a nationwide cohort and
adopting an intersectional analysis of individual heterogeneity and
discriminatory accuracy, we map the dispensation of antibiotics according to
age, sex, country of birth and income. Results: While women and
high-income earners had the highest antibiotic dispensation prevalence, no large
differences in the dispensation of antibiotics were identified between
socio-economic groups. Conclusions: Public-health
interventions aiming to support the reduced and optimised use of antibiotics
should be directed towards the whole Swedish population rather than towards
specific groups. Correspondingly, an increased focus on socio-economic or
demographic factors is not warranted in interventions aimed at improving
antibiotic prescription patterns among medical practitioners.
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Affiliation(s)
- Maria Wemrell
- Unit for Social Epidemiology, Department of Clinical Sciences in Malmö, Lund University, Sweden.,Department of Gender Studies, Lund University, Sweden
| | - Cecilia Lenander
- Family Medicine, Department of Clinical Sciences in Malmö, Lund University, Sweden
| | | | - Raquel Vicente Perez
- Unit for Social Epidemiology, Department of Clinical Sciences in Malmö, Lund University, Sweden
| | - Katarina Hedin
- Family Medicine, Department of Clinical Sciences in Malmö, Lund University, Sweden.,Futurum, Region Jönköping County, and Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Juan Merlo
- Unit for Social Epidemiology, Department of Clinical Sciences in Malmö, Lund University, Sweden.,Center for Primary Health Care Research, Region Skåne, Sweden
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Poulsen G, Andersen AMN, Jaddoe VWV, Magnus P, Raat H, Stoltenberg C, Osler M, Mortensen LH. Does smoking during pregnancy mediate educational disparities in preterm delivery? Findings from three large birth cohorts. Paediatr Perinat Epidemiol 2019; 33:164-171. [PMID: 30920006 DOI: 10.1111/ppe.12544] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/14/2018] [Accepted: 01/06/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Socio-economic disparities in preterm delivery have often been attributed to socially patterned smoking habits. However, most existing studies have used methods that potentially give biased estimates of the mediating effect of smoking. We used a contemporary mediation approach to study to which extent smoking during pregnancy mediates educational disparities in preterm delivery. METHODS We performed a comparative analysis of data from three large birth cohort studies: the Danish National Birth Cohort (DNBC), the Dutch Generation R Study, and the Norwegian Mother and Child Cohort Study (MoBa). Risk of preterm delivery by maternal education is reported as risk differences and decomposed into a part explained by smoking and a part explained by other pathways. RESULTS Proportions of preterm singleton deliveries were 4.8%-4.9% in all three cohorts. Total effects of maternal education were 2.0 (95% confidence interval [CI] 1.4, 2.5), 3.2 (95% CI 0.8, 5.2) and 2.0 (95% CI 0.9, 3.0) excess preterm deliveries per 100 singleton deliveries in DNBC, Generation R and MoBa when comparing primary/lower secondary education to an academic degree or equivalent. Smoking mediated, respectively, 22%, 10% and 19% of the excess risk in the DNBC, Generation R and MoBa cohorts. Adjustment for potential misclassification of smoking only increased mediated proportions slightly. CONCLUSIONS Smoking during pregnancy explains part of educational disparities in preterm delivery, but the mediated proportion depends on the educational gradient in smoking, emphasising that educational disparities in preterm birth may be mediated by different risk factors in different countries.
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Affiliation(s)
- Gry Poulsen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Vincent W V Jaddoe
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Per Magnus
- Norwegian Institute of Public Health, Oslo, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Hein Raat
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Camilla Stoltenberg
- Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Community Care, University of Bergen, Bergen, Norway
| | - Merete Osler
- Research Center for Prevention and Health, Glostrup Hospital, Glostrup, Denmark
| | - Laust Hvas Mortensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Karriker-Jaffe KJ, Ji J, Sundquist J, Kendler KS, Sundquist K. Disparities in pharmacotherapy for alcohol use disorder in the context of universal health care: a Swedish register study. Addiction 2017; 112:1386-1394. [PMID: 28406579 PMCID: PMC5503767 DOI: 10.1111/add.13834] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/31/2016] [Accepted: 03/29/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Pharmacotherapy can be an important part of the continuum of care for alcohol use disorder (AUD). The Swedish universal health-care system emphasizes provision of care to marginalized groups. The primary aim was to test associations of neighborhood deprivation and disadvantaged social status with receipt of AUD pharmacotherapy in this context. DESIGN Data from linked population registers were used to follow an open cohort over 7 years. SETTING Sweden. PARTICIPANTS Alcohol-related ICD-10 codes reported for all hospitalizations in the Swedish Hospital Discharge Register and all clinic/office visits in the Outpatient Care Register between 2005 and 2012 were used to identify 62 549 cases with AUD. MEASUREMENTS The primary outcome was any AUD pharmacotherapy (naltrexone, disulfiram, acamprosate, nalmefene) picked up by patients between 2005 and 2012 (versus none), based on the Swedish Prescribed Drug Register. Neighborhood deprivation was defined using aggregated data from the Total Population Register; indicators of disadvantaged social status (income, education, country of origin) also came from this source. FINDINGS Approximately half the cases (53.7%) picked up one or more AUD pharmacotherapy prescriptions. In adjusted models, people living in neighborhoods with moderate [odds ratio (OR) = 0.90, 95% confidence interval (CI) = 0.86, 0.95] or high levels of deprivation (OR = 0.75, 95% CI = 0.70, 0.79) compared with low deprivation, those with lower incomes (for example, lowest quartile: OR = 0.70, 95% CI = 0.66, 0.73 compared with highest) and less education (for example, < 10 years: OR = 0.82, 95% CI = 0.78, 0.85 compared with 12+ years) and people born outside Sweden (OR = 0.74, 95% CI = 0.71, 0.78 compared with Swedish-born) were significantly less likely to pick up a prescription for AUD pharmacotherapy during the study period. CONCLUSIONS There appear to be socio-economic disparities in the receipt of pharmacotherapy for alcohol use disorder in Sweden.
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Affiliation(s)
| | - Jianguang Ji
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Kenneth S. Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA,Department of Psychiatry, Virginia Commonwealth University, Richmond VA, USA,Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
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Harris K, Burley H, McLachlan R, Bowman M, Macaldowie A, Taylor K, Chapman M, Chambers GM. Socio-economic disparities in access to assisted reproductive technologies in Australia. Reprod Biomed Online 2016; 33:575-584. [PMID: 27595434 DOI: 10.1016/j.rbmo.2016.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/16/2016] [Accepted: 07/28/2016] [Indexed: 11/30/2022]
Abstract
Women from disadvantaged socio-economic groups access assisted reproductive technology treatment less than women from more advantaged groups. However, women from disadvantaged groups tend to start families younger, making them less likely to suffer from age-related subfertility and potentially have less need for fertility treatment. Whether socio-economic disparities in access to assisted reproductive technology treatment persist after controlling for the need for treatment, has not been previously explored. This population based study demonstrates that socio-economic disparities in access to assisted reproductive technology treatment persist after adjusting for several confounding factors, including age at first birth (used as a measure of delayed childbearing, hence a proxy for need for fertility treatment), geographic remoteness and Australian jurisdiction. Assisted reproductive technology access progressively decreased as socio-economic quintiles became more disadvantaged, with a 15.8% decrease in access in the most disadvantaged quintile compared with the most advantaged quintile after controlling for confounding factors. The adjusted rate of access to assisted reproductive technology treatment also decreased by 12.3% for women living in regional and remote areas compared with those in major cities. These findings indicate that financial and sociocultural barriers to assisted reproductive technology treatment remain in disadvantaged groups after adjusting for need.
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Affiliation(s)
- Katie Harris
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health UNSW, University of New South Wales, Sydney, Australia.
| | - Hugh Burley
- School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, Australia; Commonwealth Scientific and Industrial Research Organisation (CSIRO), CSIRO Land and Water, Canberra, ACT, Australia
| | - Robert McLachlan
- Hudson Institute of Medical Research, Australia; Department of Endocrinology, Monash Medical Centre, Clayton, Australia; Andrology Australia, Alfred Hospital, Monash University School of Public Health, Prahran, Australia
| | - Mark Bowman
- Genea, Sydney, NSW, Australia; Department of Obstetrics and Gynaecology, University of Sydney, Australia
| | - Alan Macaldowie
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health UNSW, University of New South Wales, Sydney, Australia
| | - Kate Taylor
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia; Australian Fertility Medicine Foundation, Sydney, New South Wales, Australia
| | - Michael Chapman
- School of Women's and Children's Health UNSW, University of New South Wales, Sydney, Australia; St George Private Hospital, IVF Australia, Pty Ltd, Sydney, Australia
| | - Georgina Mary Chambers
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health UNSW, University of New South Wales, Sydney, Australia
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Feng XL, Guo S, Yang Q, Xu L, Zhu J, Guo Y. Regional disparities in child mortality within China 1996-2004: epidemiological profile and health care coverage. Environ Health Prev Med 2011; 16:209-16. [PMID: 21431818 PMCID: PMC3117208 DOI: 10.1007/s12199-010-0187-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 10/11/2010] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE China was one of the 68 "countdown" countries prioritized to attain Millennium Development Goals (MDG 4). The aim of this study was to analyze data on child survival and health care coverage of proven cost-effective interventions in China, with a focus on national disparities. METHODS National maternal and child mortality surveillance data were used to estimate child mortality. Coverage for proven interventions was analyzed based on data from the National Health Services Survey, National Nutrition and Health Survey, and National Immunization Survey. Consultations and qualitative field observations by experts were used to complement the Survey data. RESULTS Analysis of the data revealed a significant reduction in the overall under-5 (U5) child mortality rate in China from 1996 to 2007, but also great regional disparities, with the risk of child mortality in rural areas II-IV being two- to sixfold higher than that in urban areas. Rural areas II-IV also accounted for approximately 80% of the mortality burden. More than 60% of child mortality occurred during the neonatal period, with 70% of this occurring during the first week of life. The leading causes of neonatal mortality were asphyxia at birth and premature birth; during the post-neonatal period, these were diarrhea and pneumonia, especially in less developed rural areas. Utilization of health care services in terms of both quantity and quality was positively correlated with the region's development level. A large proportion of children were affected by inadequate feeding, and the lack of safe water and essential sanitary facilities are vital indirect factors contributing to the increase in child mortality. The simulation analysis revealed that increasing access to and the quality of the most effective interventions combined with relatively low costs in the context of a comprehensive approach has the potential to reduce U5 deaths by 34%. CONCLUSIONS China is on track to meet MDG 4; however, great disparities in health care do exist within the country. It is therefore necessary to specifically target rural areas II-IV. Many causes of child mortality can be prevented or averted through the provision of basic health care. However, the leading predisposing factor contributing to child mortality in China is the insufficient coverage and poor quality of maternal and child health care services. Based on these data, we recommend that the government put more effort to ensure the health of the Chinese people, particularly in terms of providing the most vulnerable populations, i.e., children from the poorest areas and households, with access to good quality essential health care services.
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Affiliation(s)
- Xing Lin Feng
- Department of Health Policy and Administration, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191 China
| | - Sufang Guo
- Office for China, United Nations Children’s Fund, Beijing, China
| | - Qing Yang
- Department of Maternal & Child Health and Community Health, Ministry of Health, China, Beijing, China
| | - Ling Xu
- Center for Health Statistics and Information, Ministry of Health, China, Beijing, China
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance of China, West China Second Hospital of Sichuan University, Chengdu, 610041 China
| | - Yan Guo
- Department of Health Policy and Administration, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191 China
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