Effects of population aging on the mortality burden of related cancers in urban and rural areas of China, 2004-2017: a population-based study

OBJECTIVE

China is a developing country with urban-rural disparities and accelerating population aging. Therefore, quantifying the effects of population aging on the cancer mortality burden is urgently needed.

METHODS

Using data from China's death surveillance datasets (2004-2017), we decomposed and quantified the effects of population aging and factor variations on cancer mortality rates in urban and rural China during 2004-2017 through a decomposition method. R ratios were used to assess the extent of the mortality decreases attributable to factor variations offsetting the increases attributable to population aging for 4 aging-related cancers (lung, colorectal, esophageal, and stomach cancer).

RESULTS

Overall, population aging has led to continued increases in cancer mortality rates in China during 2004-2017 (mortality rates attributable to population aging: 8.63/100,000 for urban men, 4.21/100,000 for urban women, 11.95/100,000 for rural men, and 5.66/100,000 for rural women). The 4 cancers displayed 3 patterns. The mortality rates from lung cancer in rural China and from colorectal cancer nationwide increased because of both population aging and factor variations. Population aging was primarily responsible for the growing mortality due to lung cancer in urban areas. However, for esophageal and stomach cancer, the effect of population aging was not dominant, thus resulting in decreases in mortality rates.

CONCLUSIONS

Health resource allocation should prioritize areas or cancers more adversely affected by population aging. The burden of cancer will continue to increase in the future, because of rapid population aging, but can still be offset or even reversed with enhanced cancer control and prevention.

Urban-Rural Disparities in the Association Between Body Mass Index and Cognitive Impairment in Older Adults: A Cross-Sectional Study in Central China

BACKGROUND

Some studies have demonstrated an association between low and high body mass index (BMI) and an increased risk of dementia. However, only a few of these studies were performed in rural areas.

OBJECTIVE

This cross-sectional study investigated the associations between BMI and cognitive impairment among community-dwelling older adults from rural and urban areas.

METHODS

8,221 older persons enrolled in the Hubei Memory & Ageing Cohort Study (HMACS) were recruited. Sociodemographic and lifestyle data, comorbidities, physical measurements, and clinical diagnoses of cognitive impairment were analyzed. Logistic regression was performed to assess the associations of BMI categories with cognitive impairment. A series of sensitivity analyses were conducted to test whether reverse causality could influence our results.

RESULTS

Being underweight in the rural-dwelling participants increased the risk of cognitive impairment. Being overweight was a protective factor in rural-dwelling participants aged 65-69 years and 75-79 years, whereas being underweight was significantly associated with cognitive impairment (OR, 1.37; 95% CI: 1.03-1.83; p < 0.05). Sensitivity analyses support that underweight had an additive effect on the odds of cognitive impairment and was related to risk of dementia. Interaction test revealed that the differences between urban/rural in the relationship between BMI and cognitive impairment are statistically significant.

CONCLUSION

Associations between BMI and cognitive impairment differ among urban/rural groups. Older people with low BMI living in rural China are at a higher risk for dementia than those living in urban areas.

Epidemics, Convergence, and Common Prosperity: Evidence from China

This article investigates the impact of previous epidemics on rural development and convergence, and identifies the impact's mechanism based on convergence tests. Using a balanced panel of 31 provinces, the empirical results from 2002 to 2019 show that epidemics decelerated convergence in rural per capita income. The mechanism analysis shows that the accelerated divergence in wages and the decelerated convergence in business income were the major drivers, which also led to decelerated convergence in rural per capita consumption. Although epidemics have not threatened rural food consumption and the Engel coefficient of rural households, these two indicators of basic living needs have failed to achieve convergence across regions. The overall impact of an epidemic on convergence in rural–urban income disparity has also been insignificant, indicating that epidemics have affected rural and urban development simultaneously. Finally, COVID‐19 is likely to decelerate convergence in rural income, rural consumption, and urban income.

Rural Disparities in Hospital Patient Satisfaction: Multilevel Analysis of the Massachusetts AHA, SID, and HCAHPS Data

INTRODUCTION

Hospital patient satisfaction has been a salient policy concern. We examined rurality's impact on patient satisfaction measures.

METHODOLOGY

We examined patients (age 50 and up) from 65 rural and urban hospitals in Massachusetts, using the merged data from 2007 American Hospital Association Annual Survey, State Inpatient Database and Survey of Patients' Hospital Experiences, utilizing Hierarchical binary logistic regression analyses to examine the rural disparities in patient satisfaction measures.

RESULTS

Relative to the urban location, rurality reduced the likelihood of cleanliness of environment (odds ratio = 0.66, 95% confidence interval: [0.63-0.70]); but increased the likelihood of staff responsiveness and quietness. Compared to Caucasian counterparts, Hispanic patients were less likely to reside in a quiet hospital. Compared to other payments, Medicare or Medicaid coverage each reduced the likelihood of staff responsiveness and cleanliness. Compared to other diagnoses, depressive or psychosis disorders predicted smaller odds in responsiveness and cleanliness. Anxiety diagnosis reduced the likelihood of cleanness and quietness. At the facility level, higher registered nurse full-time equivalent (FTE)s or being a teaching hospital increased the likelihood of all measures.

CONCLUSION

Relative to the urban counterparts, rural patients experienced lower likelihood of staff responsiveness after adjusting for other factors. Compared to Caucasian patients, Hispanic patients were less likely to reside in quiet hospital environment. Research is needed to further explore the basis of these disparities. Mental health diagnoses in depressive and psychosis disorders also called upon further studies in special care needs.

Measuring Health Vulnerability: An Interdisciplinary Indicator Applied to Mainland Portugal

Health promotion and inequality reduction are specific goals of the United Nations 2030 Agenda, which are interconnected with several dimensions of life. This work proposes a composite index SEHVI-socioeconomic health vulnerability index-to address Portuguese population socioeconomic determinants that affect health outcomes. Variables composing SEHVI are aligned with the sustainable development goals considering data and times series availability to enable progress monitoring, and variables adequacy to translate populations' life conditions affecting health outcomes. Data for 35 variables and three periods were collected from official national databases. All variables are part of one of the groups: Health determinants (social, economic, cultural, and environmental factors) and health outcomes (mortality indicators). Variables were standardized and normalized by "Distance to a reference" method and then aggregated into the SEHVI formula. Several statistical procedures for validation of SEHVI revealed the internal consistency of the index. For all municipalities, SEHVI was calculated and cartographically represented. Results were analyzed by statistical tests and compared for three years and territory typologies. SEHVI differences were found as a function of population density, suggesting inequalities of communities' life conditions and in vulnerability to health.

Rural-urban disparities in caesarean section rates in minority areas in China: evidence from electronic health records

OBJECTIVE

To assess the rural-urban disparity in caesarean section rates using electronic health records from hospitals located in the Province of Inner Mongolia, which is a minority area in Northeastern China.

METHODS

The study examined the electronic health records of women that gave birth in three major public hospitals between January 2012 and December 2016. Multinomial regression analyses were used to estimate rural-urban disparities in caesarean section rates.

RESULTS

Data from 61 903 women were examined. Caesarean section rates increased slightly over the study period and the rate was significantly higher in rural compared with urban hospitals (48% versus 38%). This disparity consistently increased over time. Multinomial regression analyses showed that maternal age, ethnicity, health insurance type, employment status, reproductive history and the newborn's sex were significant risk factors associated with caesarean section rate. Furthermore, stratified analysis of first-time pregnancies, minorities and different age groups showed that the odds of undergoing an emergency caesarean section was lower in the rural hospital, but the odds of undergoing a planned caesarean section was higher in the rural hospital.

CONCLUSIONS

Caesarean section rates have increased in rural areas and the disparity in rural-urban areas has increased substantially over the years.

Household Registration System, Migration, and Inequity in Healthcare Access

This study investigates the influence of the household registration system on rural–urban disparity in healthcare access (including healthcare quality, blood pressure check, blood test, vision test, dental examination, and breast exam), using data from a large-scale nationwide life history survey that covered 150 counties across 28 provinces and municipalities in China. In contrast to the findings of many previous studies that emphasize the disparity in the residence place as the cause of rural–urban disparity in healthcare access, this study finds that the residence place just has a very limited influence on healthcare access in China, and what really matters is the household registration type. Our empirical results show that people with a non-rural household registration type generally have better healthcare access than those with a rural one. For rural residents, changing the registration type of their household (from rural to non-rural) can improve their healthcare access, whereas changing the residence place or migrating from rural to urban areas have no effect. Therefore, mere rural-to-urban migration may not be a valid measure to eliminate the rural–urban disparity in healthcare access, unless the institution of healthcare resource allocation is reformed.