Impact of the Essential Public Health Service program on financial protection and health outcomes among hypertensive patients: A quasi-experimental study in China.

BACKGROUND: The Chinese government launched the Essential Public Health Service (EPHS) program nationwide in 2009. However, prior studies have not provided clear and integrated evidence on whether the EPHS program improves health outcomes and prevents financial risks among individuals. Because hypertension is the chronic disease with the highest prevalence, this study evaluated the impact of the EPHS program among hypertensive patients to provide evidence for the progress of the program. METHODS: A cohort of hypertensive patients was identified from the 2011-2018 China Health and Retirement Longitudinal Study (CHARLS). The outcomes assessed included hospitalization expenditure, outpatient expenditure and cardiovascular disease (heart attack and stroke). The key independent variable was whether an individual received EPHS-covered blood pressure measurements in 2013-2015. Based on the International Health Partnership+ (IHP+) common monitoring and evaluation (M&E) framework, a difference-in-differences (DID) method with propensity score matching (PSM) was used to examine the impact of the EPHS program on hypertensive patients. RESULTS: The results showed that among hypertensive patients covered by the EPHS program, outpatient total costs/OOP costs were reduced by 29.8% and 30.8%, respectively, and hospitalization total costs/OOP costs were reduced by 34.9% and 35.6%, respectively. The EPHS program reduced the probability of heart attack and stroke among hypertensive patients by 3.5% and 2.7%, respectively. Mechanistic tests showed that the EPHS program improved health outcomes by reducing alcohol consumption and increasing physical activity, thereby further reducing health expenditure among hypertensive patients. The impacts of the EPHS program on hypertensive patients varied by age, educational attainment, residential region, and alcohol consumption status. CONCLUSION: The EPHS program in China significantly improved health outcomes and prevented financial risks for hypertensive patients. This evidence provides a valuable reference for low- and middle-income countries with their essential public health service programs.

Does college education reduce the risk of schizophrenia? Evidence from a college enrollment expansion policy in China.

BACKGROUND: Schizophrenia occurs worldwide, and the health, and economic burden is substantial. As one of the common proxies of socioeconomic status (SES), education was reported to be associated with the risk of developing schizophrenia. However, there is no causal evidence about the relationship. This paper explores the health benefits of college education for schizophrenia. METHOD: Based on exogenous variation in college enrollment across regions and cohorts induced by college enrollment expansion policy, we use instrument variable (IV) estimate strategy to estimate impacts of college education on the risk of schizophrenia with the data from Second National Sample Survey on Disability. RESULTS: We find that college education reduces the risk of developing schizophrenia by 4.2 percentage points. Some further analyses suggest the causal protective effect is only found among men, rural, and low-income individuals. CONCLUSIONS: These findings provide new evidence for the causal relationship between college education and schizophrenia, and add to the literature on the health benefits of education.

Discrepancy between objective and subjective cognition and its association with the trajectory of symptoms and functioning in depressive patients.

BACKGROUND: Discrepancy between objective and subjective cognitive deficit is common among patients with major depressive disorders (MDDs) and may play a key role in the mechanism linking cognition with recovery of symptom and psychosocial function. This study, therefore, explores the cognitive discrepancy, and its association with the trajectory of symptoms and functioning over a 6-month period. METHODS: We used data from the Prospective Research Observation to Assess Cognition in Treated patients with MDD (PROACT) study, from which 598 patients were included. Cognitive discrepancy scores were computed using a novel methodology, with positive values indicating more subjective than objective deficit (i.e. 'underestimation') and negative values indicating more objective than subjective difficulties (i.e. 'overestimation'). Linear growth curve models were employed to examine the association of the cognitive discrepancy with the trajectory of depressive symptoms, psychosocial function, and quality of life. RESULTS: About 68% of patients displayed disproportionately more objective than subjective cognitive deficit at baseline, and the mean cognitive discrepancy score was -1.4 (2.7). Overestimation was associated with a faster decrease of HDRS-17 (ß = -0.46, p = 0.002) and a faster decrease of psychosocial function in social life (ß = -0.13, p = 0.013) and family life (ß = -0.12, p = 0.026), and a greater improvement of EQ-5D utility score (ß = 0.01, p < 0.001). CONCLUSION: We found a lower sensitivity of cognitive deficit at baseline and its decrease was associated with better health outcomes. Our findings have clinical implications of the necessity to assess both subjective and objective cognition for identification and categorization and to incorporate cognitive and psychological therapies for optimized treatment outcomes.

Tracking gaze position from EEG: Exploring the possibility of an EEG-based virtual eye-tracker.

INTRODUCTION: Ocular artifact has long been viewed as an impediment to the interpretation of electroencephalogram (EEG) signals in basic and applied research. Today, the use of blind source separation (BSS) methods, including independent component analysis (ICA) and second-order blind identification (SOBI), is considered an essential step in improving the quality of neural signals. Recently, we introduced a method consisting of SOBI and a discriminant and similarity (DANS)-based identification method, capable of identifying and extracting eye movement-related components. These recovered components can be localized within ocular structures with a high goodness of fit (>95%). This raised the possibility that such EEG-derived SOBI components may be used to build predictive models for tracking gaze position. METHODS: As proof of this new concept, we designed an EEG-based virtual eye-tracker (EEG-VET) for tracking eye movement from EEG alone. The EEG-VET is composed of a SOBI algorithm for separating EEG signals into different components, a DANS algorithm for automatically identifying ocular components, and a linear model to transfer ocular components into gaze positions. RESULTS: The prototype of EEG-VET achieved an accuracy of 0.920° and precision of 1.510° of a visual angle in the best participant, whereas an average accuracy of 1.008° ± 0.357° and a precision of 2.348° ± 0.580° of a visual angle across all participants (N = 18). CONCLUSION: This work offers a novel approach that readily co-registers eye movement and neural signals from a single-EEG recording, thus increasing the ease of studying neural mechanisms underlying natural cognition in the context of free eye movement.

Community-based integrated care for patients with diabetes and depression (CIC-PDD): study protocol for a cluster randomized controlled trial.

BACKGROUND: Managing the multimorbidity of diabetes and depression remains a clinical challenge for patients and healthcare professionals due to the fragmented healthcare delivery system. To effectively cope with multimorbidity, there is an urgent need for the health system to transform into people-centered integrated care (PCIC) system globally. Therefore, this paper describes the protocol of community-based integrated care for patients with diabetes and depression (CIC-PDD) project, an integrated and shared-care intervention project. METHODS/DESIGN: CIC-PDD project is conducted in two phases, namely "care model development" and "implementation and evaluation." In the first phase, CIC-PDD model was designed and developed based on the four criteria of collaborative care model (CCM) and was subsequently adjusted to align with the context of China. The second phase entails a pragmatic, two-arm, cluster randomized controlled implementation trial, accompanied by parallel mixed-methods process evaluation and cost-effectiveness analysis. DISCUSSION: We anticipate CIC-PDD project will facilitate the development and innovation of PCIC model and related theories worldwide, particularly in low- and middle-income countries (LMICs). In addition, CIC-PDD project will contribute to the exploration of primary health care (PHC) in addressing the multimorbidity of physical and mental health issues. TRIAL REGISTRATION: ClinicalTrials.gov registration ChiCTR2200065608 (China Clinical Trials Registry https://www.chictr.org.cn ). Registered on November 9, 2022.

Knowledge about schizophrenia test: the Chinese Mandarin version and its sociodemographic and clinical factors.

BACKGROUND: Schizophrenia is a chronic, complex, and severe mental disorder and caregivers having knowledge about it can help improve patient adherence to treatment. This study aims to translate the Knowledge About Schizophrenia Test (KAST) into a Chinese Mandarin version and test it among caregivers to validate its reliability and reproducibility, as well as to determine its associated sociodemographic factors and clinical factors. METHODS: The project surveyed 160 patients with schizophrenia and their caregivers at four community health facilities in Beijing, China, from January 2022 to February 2022. All patients and caregivers completed the sociodemographic questionnaire, and caregivers also completed the Chinese-version KAST, and 143 of these caregivers completed the Chinese-version KAST again 2-4 weeks later. RESULTS: The mean (SD) of the caregiver score was 11.49 (± 3.13). After item analysis, there was acceptable internal consistency among the 17 items in the Chinese version (KR-20 coefficient 0.702). The intraclass correlation coefficient in the retest (0.686) was statistically significant. Gender, educational attainment, marital status, relationship with the patient, and occupational status were associated with the KAST score. CONCLUSION: The findings demonstrate that the Chinese-version KAST is a reliable and reproducible instrument that can measure knowledge about schizophrenia and is valid to be applied in schizophrenia research.

Medical service utilization and costs of autism spectrum disorder: Evidence from hospital records in Beijing, China.

As more and more people are diagnosed with autism spectrum disorder (ASD), it is necessary to better understand their costs. Detailed information on medical service utilization and costs could aid in designing equitable, effective policies to support individuals with ASD and their families. In this retrospective analysis, individuals with a hospital encounter (outpatient visit or inpatient admission) were collected from Beijing Municipal Health Big Data and Policy Research Center (BMHBD), from January 1, 2017 to December 31, 2021. We analyzed the costs, hospital visits/admissions and their changing trends over 5 years. Poisson regression and logit regression were conducted to analyze the influencing factors of visits, admissions and costs. The study population consisted of 26,826 users of medical services (26,583 outpatients and 243 inpatients; mean age: 4.82 ± 3.47 years for outpatients; 11.62 ± 6.74 years for inpatients). 99.1% were outpatients (mean ± standard deviation (SD) costs per year: $422.06 ± $11.89), while 0.9% were inpatients (mean ± SD costs per year: $4411.71 ± $925.81). More than 50% of outpatients received medication and diagnostic testing services. Among those with an inpatient admission, 91% received treatment services. Medication costs were the major contributor to medical costs for adults. Diagnostic test and treatment costs were the major contributors for children and adolescents. The findings demonstrated a significant economic burden for those diagnosed with ASD and highlighted opportunities for improving the care of this vulnerable group. This study adds to the literature by focusing on age differences among health-care utilization in individuals with ASD.

Effectiveness of Community-Based Rehabilitation Interventions on Symptoms and Functioning for People with Schizophrenia: A Systematic Review and Meta-Analysis.

Schizophrenia is a serious mental illness that imposes huge burden of illness on the society. We aimed to conduct a meta-analytic and systematic review of literature on the effectiveness of community-based rehabilitation interventions on symptoms and functioning for people with schizophrenia. The PubMed, Embase, the Cochrane Library, Web of Science, and CINAHL databases were searched through April 16 and 17, 2021, including clinical trial registries and previous Cochrane reviews. We included 24 randomized controlled trials in this review. The content of interventions varied from single-faceted rehabilitation intervention or cognitive retraining, to multi-component rehabilitation interventions or case management. Among 20 studies that reported effects of community-based rehabilitation interventions on symptoms, the pooled SMDs across all interventions was 0.94 (95% CI = 0.11, 1.76; P < 0.001; I2 = 99.1%; n = 3694), representing a strong effect. 21 included studies showed that community-based rehabilitation interventions also had beneficial impacts on functioning (SMD = 1.65; 95% CI = 0.88, 2.43; P < 0.001; I2 = 98.9%; n = 3734). Overall quality of evidence was moderate with a high level of heterogeneity. Community-based rehabilitation interventions have positive effectiveness in improving patients' symptoms and functioning. Community-based rehabilitation interventions should therefore be provided as an adjuvant service in addition to facility-based care for people with schizophrenia.

Community-based rehabilitation interventions on quality of care for people with schizophrenia in China (CRISC): study protocol for a cluster-randomized controlled trial.

BACKGROUND: International consensus shows that community-based rehabilitation (CBR) service is an effective way to improve functioning and negative symptoms and address the treatment gap for schizophrenia. Rigorous trials are needed in China to demonstrate effective and scalable CBR interventions to significantly improve outcomes for people with schizophrenia and to provide evidence of the economic benefits. The objectives of this trial are to examine the effectiveness of CBR as an adjunct to test the usual facility-cased care (FBC) in comparison to FBC alone in improving a range of outcomes in people with schizophrenia and their caregivers. METHODS: This trial is a cluster randomized controlled trial design in China. The trial will be conducted at three districts of Weifang city, Shandong province. Eligible participants will be identified from the psychiatric management system where community-dwelling patients with schizophrenia have been registered. Participants will be recruited after providing informed consent. 18 sub-districts will be randomly allocated in a 1:1 ratio to facility-based care (FBC) plus CBR (intervention arm) or FBC alone (control arm). The structured CBR intervention will be delivered by trained psychiatric nurses or community health workers. We aim to recruit 264 participants. The primary outcomes include symptoms of schizophrenia, personal and social function, quality of life, family burden of caring, etc. The study will be conducted according to good ethical practice, data analysis and reporting guidelines. DISCUSSION: If the hypothesized clinical benefit and cost-effectiveness of CBR intervention are confirmed, this trial will provide significant implications for policy makers and practitioners to scale up rehabilitation services, as well as for people with schizophrenia and their family to promote recovery and social inclusion, and to alleviate the burden of care. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2200066945). Registered December 22, 2022.

Association between oral health behavior and chronic diseases among middle-aged and older adults in Beijing, China.

OBJECTIVES: To evaluate the association between oral health behavior and multiple chronic diseases among middle-aged and older adults. METHODS: We obtained data of the Beijing Health Service Survey and used multivariate logistic models to estimate the association between oral hygiene behavior and the risk of chronic diseases. RESULTS: The risk of any chronic diseases (OR = 1.27, 95% CI: 1.18-1.37), cardiovascular diseases (CVD, OR = 1.30, 95% CI: 1.21-1.39), and endocrine or nutritional metabolic disorders (OR = 1.11, 95% CI: 1.01-1.22) was higher in those who with poor oral health behavior. There was no significant correlation between oral health behavior and the risk of diseases of the musculoskeletal, respiratory, digestive, and genitourinary systems. CONCLUSIONS: Poor oral hygiene practices were associated with higher risk of chronic diseases, CVD and diabetes mellitus (DM) among middle-aged and older adults. These findings motivate further studies to evaluate whether improved oral health behavior may prevent the incidence of chronic diseases.

The dynamic relationship between subjective social status and health: Evidence from a Chinese cohort study.

PURPOSE: Using nationally representative longitudinal data from 2010 to 2018 in China, this study systematically investigates the relationship between Subjective Social Status (SSS) and health (physical health and mental health) in the Chinese adult population. METHODS: By applying between-within model, we disentangle the relationship between health outcomes and: (1) between-individual differences in SSS and (2) within-individual variations of SSS across time. In addition, to explore SSS mobility and trajectory, we further decomposed SSS into lagged SSS and the change between the current and lagged SSS (mobility). RESULTS: We find that there is significantly positive and unique relationship (independent of Objective Social Status (OSS)) between SSS and physical and mental health. However, for physical health, we observed an Inverse-U effect of average SSS, after some point (SSS = 3.93), higher average SSS is associated with a score decrease. Through heterogeneity analysis, we find that for physical health, within- and between-effects decreases with age and for mental health, the within effect is only significant among the urban population. Individuals with high expected mobility are also found to have significantly better health. CONCLUSIONS: These findings show that the personal relative deprivation has negative, particularly salient and unique effects on the health of the Chinese population, and it is important to consider the dynamic nature of SSS.

Is it just a cure? Re-evaluating the effects of prenatal exposure to the Great Chinese Famine on the risk of infectious diseases in adulthood.

BACKGROUND: Very limited studies focused on the early-life adversities on infectious diseases. Taking the Great Chinese famine as a natural experiment, this study re-evaluated the long-term effect of prenatal famine exposure on infectious diseases by using nationally representative data. METHODS: Using difference-in-difference (DID) models, we analyzed 215,216 adults who participated in the Second National Sample Survey on Disability in 2006 across 734 counties of China to detect the effects of prenatal exposure to the Great Chinese Famine on the risk of infectious diseases in adulthood. Infectious diseases were ascertained by using the combination of self-reports or family members' reports and on-site medical diagnosis by experienced specialists, and the severity of famine was measured by the cohort size shrinkage index (CSSI) at the county level. RESULTS: All DID estimates of the effects of famine on the probability of infectious diseases were insignificant, with a coefficient of 0.0007 (-0.0024, 0.0026) for all participants and coefficients of 0.0001 (-0.0041, 0.0043) and -0.0002 (-0.0036, 0.0033) for males and females, respectively. That is, the famine cohort dwelling in regions with a greater intensity of famine had similar levels of infectious disease risks than the cohorts with post-famine prenatal exposure experience in less affected famine regions. Furthermore, there were no significant famine and post-famine cohort differences in the DID estimates by examining the variations in subgroups with different types of infectious diseases (trachoma, poliomyelitis, tuberculosis, maternal infections and other infectious diseases). CONCLUSION: No significant impact of prenatal exposure to the Chinese famine was observed on the risk of infectious diseases in adulthood. Famine survivors may be "cured" by the famine and were resilient to adverse environments in their life course because selective mortality may weaken the association between adverse prenatal exposure and later health.

Medical service utilisation and direct medical cost of depression: a cross-sectional analysis of urban medical claims data from China.

OBJECTIVES: Depression is becoming a growing cause of disability, suicides and disease burden. It incurred substantial costs to societies all over the world. Estimating the medical costs of depression will provide implications for related policies and interventions. However, there is scarce of evidence on the economic costs of depression in China. The aim of this study is to assess depression-related medical service utilisation, the direct medical costs of depression and potential associated factors. SETTINGS: This study used data that comprised 5% random sample of claims data from China's Urban Basic Medical Insurance between January 2013 and December 2016. Beneficiaries' demographic information, diagnoses and cost of outpatient and inpatient services were recorded in the data set. PARTICIPANTS: 26 123 patients with depression were identified as the study population in this study. PRIMARY AND SECONDARY OUTCOME MEASURES: The information on health service utilisation and cost was extracted based on the condition that depression was claimed as the index disease. RESULTS: From 2013 to 2016, weighted average annual total medical cost of depression in urban China was RMB2706.92, and the annual out-of-pocket cost was RMB786.4. The annual total medical cost of depression among urban residents in China was estimated to be 4.4 billion RMB (95% CI 4.15 to 4.67) (US$ 0.70, 95% CI 0.66 to 0.74). Nearly 65% of medical costs (RMB 1795.7 or US$ 285.0) were accounted by inpatient expenditure, and tertiary hospitals were the main provider of depression treatment. Depression-related medical care utilisation and direct costs were associated with gender, age, insurance status, severity of depression and diagnosis. Medication costs and medical service contributed to 41.7% and 56.6% of the average depression-related medical costs. CONCLUSION: Depression poses a considerable burden on both the health system and the individual in urban China. Specific policies to strengthen the mental health resources in primary and secondary hospitals are in urgent need, and effective treatment strategies are important to prevent a progression and recurrence of depression, as well as an increase in medical cost.

Socioeconomic inequality in rehabilitation service utilization for schizophrenia in China: Findings from a 7-year nationwide longitudinal study.

Aims: Few studies have focused on the utilization of rehabilitation services among people with schizophrenia. In this study, we aimed to examine the trend of pharmacological and psychotherapy service utilization among adults with schizophrenia and to identify the associated socioeconomic factors. Methods: Data were obtained from the Second National Sample Survey on Disability in 2006 and from the follow-up investigation in 2007-2013. Individuals with schizophrenia were ascertained by the combination of self-reports and on-site diagnosis by psychiatrists. Random effect logistic regression models were applied to examine the socioeconomic disparity in service utilization and the time trend in the association. Results: Overall, the percentage of individuals using pharmacological treatment services increased from 23.7 in 2007 to 55.0% in 2013, and the percentage of individuals using psychotherapy services increased from 11.4 to 39.4%. Living in rural areas, being illiterate, living in families with lower income and being uninsured were less likely to receive pharmacological treatment and psychotherapy. The pace of growth in service utilization was higher among individuals with rural residence, illiteracy or low-income status than among their counterparts with advantaged backgrounds. Conclusions: This study demonstrated an upward trend in pharmacological treatment and psychotherapy service utilization and a downward trend in socioeconomic disparity among Chinese adults with schizophrenia. Future studies to explore the reasons for the observed changes and to identify policies for improving the health service access of this vulnerable group are warranted.

Effectiveness of Collaborative Care for Depression and HbA1c in Patients with Depression and Diabetes: A Systematic Review and Meta-Analysis.

Background and Aim: The collaborative care (CC) is emerging as an effective method in treating patients with multimorbidity, but evidence whether this model is effective for people with comorbid depression and diabetes is unclear. This study aimed to investigate whether CC could improve depression outcomes and HbA1c in patients with depressive symptoms and diabetes, and assess its effects on Quality of Life (QoL). Method: The author searched Embase, Scopus, PubMed, Cochrane, PsycINFO and CINAHL to identify randomized controlled trials (RCTs) and cluster RCTs published up to October 21, 2020. Studies were required to assess CC in patients with depressive symptoms and diabetes. The primary outcomes were depression treatment response rate and HbA1c and secondary outcome was Quality of Life (QoL). Available individual patient data was collected from all eligible studies. Studies were independently screened by two reviewers and critically appraised using the Cochrane Risk of Bias tool. This study conducted a systematic review and meta-analysis, and the fixed effects and random effects model were used to pool Relative Risks (RRs) and Standard Mean Differences (SMDs). Results: Our research identified 7906 articles, and finally 12 RCTs were included. Study sample sizes ranged from 58 to 417. The total follow-up period ranged from 12 weeks to 24 months. At follow-up, depression treatment response rate had a significant increase (RR = 1·31, 95% CI 1·23 to 1·39, I2 = 0%) in CC patients compared to controls. There was no statistically significant difference in HbA1c between CC group and the control group (SMD = 0·15, 95% CI -0·35 to 0·65, I2 = 97·6%). Overall QoL at follow-up was greater (SMD = 0·12, 95% CI 0·03 to 0·21, I2 = 54·2%) in CC patients compared to controls but the difference was minor. Conclusion: This systematic review and meta-analysis supported the effectiveness of CC in reducing depression and improving QoL in people with comorbid depression and diabetes.

Towards Sustainable Development Goals: Study on the Consequences of Food Insecurity Among Global Population - Worldwide, 2022.

What is already known about this topic?: The global population is predicted to reach 8 billion by the end of 2022, which can delay the progress and exacerbate the challenges of achieving the Sustainable Development Goals (SDGs), especially the goal of "Zero Hunger." What is added by this report?: During the next 15 years, it is predicted that the world's population will increase from 8 billion to 9 billion people. Although food insecurity is anticipated to decrease over the next three decades for most of the world, food insecurity is anticipated to increase in Africa. Accelerating population growth is projected to lead to larger percentages of infants with low birth weight and of children under 5 years old with stunted growth. What are the implications for public health practice?: Rapid population growth will make it more difficult to achieve the SDGs for ending hunger and ensuring good health and well-being. It is important to develop foresight and adopt proactive planning that is guided by careful demographic analysis.

Parenting styles and health in mid- and late life: evidence from the China health and retirement longitudinal study.

BACKGROUNDS: The impact of relationships in early childhood may be long-lasting and reaching to mid to late life. Limited studies have investigated the associations between parenting style and different aspects of well-being beyond adolescence. The current study aims to examine the association between parenting styles and multiple dimensions of functioning in mid-and later-life adults. METHODS: We used data from China Health and Retirement Longitudinal Study (CHARLS). Generalized Estimating Equation (GEE) was applied to examine the association between retrospective parenting styles/behaviors in childhood and health outcome. RESULTS: Compared with authoritative style, authoritarian style predicted worse self-rated health (coefficient = - 0.13, P < 0.001), cognitive function (- 0.23, P < 0.05) and depressive symptom (0.87, P < 0.001). Paternal affection was associated with more health outcome in mid- and late life than maternal affection. Only paternal affection was a significant predictor of mid- and late life health among male adults, while both paternal and maternal affection were strong predictors among female adults. Authoritative style was associated more positive health outcomes in mid- and late life among adults with literate parents than those with illiterate parents. CONCLUSION: This study provides evidence for the link between parenting behaviors in early life stage and physical and psychological functioning in mid- to late adulthood. Authoritative style, and the memory of parental affection, particularly from father and educated parents, could have long-lasting positive influence on children's physical and mental well-being, which further support the life-course perspective on human development.

Association of life-course socioeconomic status with allostatic load in Chinese middle-aged and older adults.

AIM: To examine the association of life-course socioeconomic status (SES) and mobility with allostatic load (AL) in a large cohort of Chinese middle-aged and older adults. METHODS: Drawing on data from 17 552 middle-aged and older adults from three waves of a longitudinal study conducted in China in 2011-2015, generalized estimating equation (GEE) models were used for the overall sample and subsample to examine the association between life-course SES and AL. RESULTS: On the whole, those who were literate had lower AL (ß = -0.034, 95% CI = -0.065, -0.004), while those with a non-agricultural occupation (ß = 0.093, 95% CI = 0.065, 0.120) and better financial status in childhood (ß = 0.037, 95% CI = 0.012, 0.063) or adulthood (ß = 0.033, 95% CI = 0.009, 0.058) had higher AL. In terms of SES mobility, a stable high education was associated with lower AL (ß = -0.041, 95% CI = -0.078, -0.004). Upward (ß = 0.090, 95% CI = 0.061, 0.120) or stable high (ß = 0.075, 95% CI = 0.025, 0.125) occupation was related to higher AL. Downward (ß = 0.034, 95% CI = 0.003, 0.064) or stable high (ß = 0.072, 95% CI = 0.037, 0.107) financial status was associated with higher AL. Education manifested no associations with AL for the rural and men samples. Financial status showed no relationship with AL for the urban sample. CONCLUSIONS: Our findings demonstrate the importance of applying life-course models for gaining an understanding of SES and AL. Efforts to lower AL among Chinese middle-aged and older adults should consider childhood and current SES status, as well as different subgroups. Geriatr Gerontol Int 2022; 22: 425-432.

Medical Service Utilization and Direct Medical Cost of Stroke in Urban China.

BACKGROUND: Understanding the treatment costs of stroke can guide health policies and interventions. However, few studies have analyzed the treatment costs of stroke in China. The aim of this study is to assess stroke-related medical service utilization, direct costs of stroke and associated stroke predictors, and, second, to understand the structure of medical resource use. METHODS: This study used a 5% random sample of claim data from China's Urban Basic Medical Insurance between January 2013 to December 2016. The sampling design assigned a sample weight to each beneficiary. Weighted descriptive analyses, Poisson regression and generalized linear model were used to analyze the medical service utilization, costs and their associations with patient characteristics. RESULTS: In urban China, the annual prevalence of stroke was 730.43 (95% CI = 730.10-730.76) cases per 100 000 people, and nearly 2% of total health expenditures of urban residents was spent on stroke-related medical costs. Weighted average annual total medical cost of stroke was RMB10 637 [95% CI = 10 435-10 840] (US$1682, 95% CI = 1650-1714), with annual out-of-pocket (OOP) cost of RMB3093 [95% CI = 3026-3161] (US$489, 95% CI = 478-500). The average yearly number of stroke-related outpatient visit was 1.67 [SD = 3.39] and inpatient admission was 0.79 [SD = 0.83], with an average cost of RMB440 [SD = 739] (US$70, SD = 117) for outpatients and RMB12 702 [SD = 21 424] (US$2008, SD = 3387) for inpatients. Inpatient costs accounted for 94% (RMB10 034 or US$ 1586) of medical costs, and tertiary hospitals were the main provider of stroke care. Stroke-related medical care utilization and direct costs were associated with gender, age, pathological stroke types and insurance status. Medication costs contributed to 50.6% (RMB5382 or US$ 851) of the average stroke-related medical costs. CONCLUSION: China's health system bares a large economic burden from stroke. Specific policies are needed to strengthen the capacity of secondary hospitals, alter the structure of medical resource allocation, and target specific sections of the stroke population.