Association between metabolic syndrome and incident chronic kidney disease among Chinese: A nation-wide cohort study and updated meta-analysis.

AIMS: We prospectively examined the relationship between metabolic syndrome (MetS) and incident chronic kidney disease (CKD) among middle-aged and elderly Chinese, and conducted a systematic review and meta-analysis of all cohort studies on this topic. MATERIALS AND METHODS: Our research data were derived from the China Health and Retirement Longitudinal Study. Participants (n=5752, age ≥45 years) without CKD (defined as estimated glomerular filtration rate <60 ml/min/1.73m2 ) at baseline were followed up for 4 years. We applied logistic regressions to examine the association of MetS with incident CKD. In addition, we pooled our effect estimates and those from previous cohort studies in the meta-analysis. RESULTS: In a 4-years follow-up, 61 (4.27%) developed CKD in participants with MetS versus 102 (2.36%) in participants without MetS. After adjustment for potential confounders, odds ratio for incident CKD was 1.82 [95% confidence interval (95% CI): 1.19-2.78] comparing participants with MetS with those without MetS. There was a linear positive association between the number of MetS components and incident CKD (p for trend <0.001). In the updated meta-analysis of 25 studies among 350,655 participants with 29,368 incident cases of CKD, the pooled relative risk of developing CKD in participants with MetS was 1.34 (95% CI: 1.28-1.39), compared with those without MetS. CONCLUSIONS: Individuals with MetS had higher risk of incident CKD in middle-aged and elderly Chinese adults, which was supported by a comprehensive review of cohort studies from multiple populations. It may be advisable to routinely monitor renal functions among individuals with MetS.

The relationship between urban and rural health insurance and the self-rated health of migrant workers in Southwest China.

BACKGROUND: Following health insurance reforms, China's health care system has made great progress. However, there are still huge differences between the urban and rural health insurance systems. For rural-to-urban migrant workers, there may be differences in the use of urban and rural health insurance to improve their health status. This study aimed to determine whether any disparities exist in the relationship between urban and rural health insurance and the self-rated health (SRH) of migrant workers in Southwest China from the perspective of urban and rural segmentation. METHODS: Using cross-sectional survey data on Southwest China in 2016, a representative data sample drawn from 8507 migrant workers was analysed. An ordinary least squares (OLS) model and instrumental variable (IV) estimation were used to analyse the relationship between urban and rural health insurance and the SRH of migrant workers. RESULTS: Using the IV method to control the endogeneity problems associated with health insurance, this study found that there are differences in the relationship between urban and rural health insurance and the SRH of migrant workers. Urban health insurance is associated with significant improvements in the SRH of migrant workers. Compared with the NRCMS, participating in urban health insurance, including urban employee basic medical insurance (UEBMI) and urban resident basic medical insurance (URBMI), increases the likelihood of migrant workers having better SRH. CONCLUSIONS: There are disparities in the relationship between urban and rural health insurance and the SRH of migrant workers in China. Compared to rural health insurance, urban health insurance has a more positive correlation with the health of migrant workers. Our study shows that it is necessary to integrate urban and rural health insurance to promote social equity.

[Influence of Social Capital on the Life Quality of Patients with Chronic Diseases-A Study Based on EQ-5D-5L Scale].

OBJECTIVE: To explore the influence of social capital on the quality of life of patients with chronic non-communicable diseases. METHODS: A multi-phase stratified cluster sampling method was adopted to select the survey respondents. Professionally trained surveyors made home visits in order to conduct face-to-face questionnaire surveys in person. European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) and a self-developed social capital scale were used to investigate the quality of life and social capital of the respondents. Factor analysis and Cronbach's α coefficient test were done to verify the reliability and validity of the self-developed social capital scale. The χ 2 test and robust Tobit regression model were used to analyze the impact of social capital on the quality of life of patients with chronic non-communicable diseases. RESULTS: The self-developed social capital scale showed excellent performance. The Cronbach's α coefficient was 0.728, the KMO value was 0.716, and the result of Bartlett's test of sphericity was statistically significant ( P<0.001), indicating that the data were well suited for factor analysis. The four common factors cumulatively explained 68.27% of the total variation. The health utility value of the survey respondents was 0.869±0.181. Those who could walk around, shower and dress themselves, and perform usual activities without any problem accounted for 75.70%, 80.10%, and 74.1% of the respondents, respectively. Those who had pain or discomfort and anxiety or depression, with no self-perceived problem were 43.40% and 58.90%, respectively. In the EQ-5D-5L scale, the self-rated health influencing factors of the physical health dimension were community safety and interpersonal network relationships. The influencing factors of social function health was community safety and mental health was affected by community safety, community trust and interpersonal network relationships. When community safety improved by one level, the health utility value of patients with chronic non-communicable diseases increased by 0.046, and when interpersonal network relationships improved by an additional level, their health utility value increased by 0.037. CONCLUSION: The main problem of the quality of life of patients with chronic non-communicable diseases was found in the mental health dimension. In the process of treating chronic non-communicable diseases, attention should also be given to psychological counseling. Community safety and interpersonal network relationships are the protective factors for self-rated health status. Providing a safe community environment and expanding interpersonal networks help improve the health of patients.

[Analysis of the Status of Depression and the Influencing Factors in Middle-Aged and Older Adults in China].

OBJECTIVE: To understand the status of depression and its influencing factors in the middle-aged and older adult populations aged 45 and above in China on the basis of data from the 2018 China Family Panel Studies (CFPS), and to provide empirical evidence for the improvement of the mental health of the middle-aged and older adults and the alleviation of their depressive symptoms. METHODS: The source of the research data was the 2018 CFPS. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess the prevalence of depression. A two-level two-category unconditional logistics regression method was used to analyze the influencing factors of the prevalence of depressive symptoms. RESULTS: The 80th percentile interval score of depression score was used as the critical value, and the detection rate of depressive symptoms was 23.61%. It was more likely for women to suffer from depressive symptoms than it was for men. Widowed individuals were at an even higher risk for having depression. The more education one had, the lower the possibility of developing depression. Middle-aged and older adults in rural areas were more likely to suffer from depression. Middle-aged and older adults with chronic diseases and self-rated poor health were at higher risk of depression. Sleep time is a protective factor that suppressed symptoms. After controlling the above-mentioned individual-level factors, middle-aged and older adults in coastal and economically developed areas were less likely to suffer from depression than those from inland and economically underdeveloped areas did. CONCLUSION: The health departments concerned should focus on the depressive symptoms of women, widowed individuals, and middle-aged and older adults with chronic diseases. In rural areas and underdeveloped inland regions, the state should invest more health resources in the prevention and improvement of depression among middle-aged and older adults.

Global prevalence of congenital heart disease in school-age children: a meta-analysis and systematic review.

BACKGROUND: Congenital heart disease (CHD) is the commonest birth defect. Studies estimating the prevalence of CHD in school-age children could therefore contribute to quantifying unmet health needs for diagnosis and treatment, particularly in lower-income countries. Data at school age are considerably sparser, and individual studies have generally been of small size. We conducted a literature-based meta-analysis to investigate global trends over a 40-year period. METHODS AND RESULTS: Studies reporting on CHD prevalence in school-age children (4-18 years old) from 1970 to 2017 were identified from PubMed, EMBASE, Web of Science and Google Scholar. According to the inclusion criteria, 42 studies including 2,638,475 children, reporting the prevalence of unrepaired CHDs (both pre-school diagnoses and first-time school-age diagnoses), and nine studies including 395,571 children, specifically reporting the prevalence of CHD first diagnosed at school ages, were included. Data were combined using random-effects models. The prevalence of unrepaired CHD in school children during the entire period of study was 3.809 (95% confidence intervals 3.075-4.621)/1000. A lower proportion of male than female school children had unrepaired CHD (OR = 0.84 [95% CI 0.74-0.95]; p = 0.001). Between 1970-1974 and 1995-1999, there was no significant change in the prevalence of unrepaired CHD at school age; subsequently there was an approximately 2.5-fold increase from 1.985 (95% CI 1.074-3.173)/1000 in 1995-1999 to 4.832 (95% CI 3.425-6.480)/1000 in 2010-2014, (p = 0.009). Among all CHD conditions, atrial septal defects and ventricular septal defects chiefly accounted for this increasing trend. The summarised prevalence (1970-2017) of CHD diagnoses first made in childhood was 1.384 (0.955, 1.891)/1000; during this time there was a fall from 2.050 [1.362, 2.877]/1000 pre-1995 to 0.848 [0.626, 1.104]/1000 in 1995-2014 (p = 0.04). CONCLUSIONS: Globally, these data show an increased prevalence of CHD (mainly mild CHD conditions) recognised at birth/infancy or early childhood, but remaining unrepaired at school-age. In parallel there has been a decrease of first-time CHD diagnoses in school-age children. These together imply a favourable shift of CHD recognition time to earlier in the life course. Despite this, substantial inequalities between higher and lower income countries remain. Increased healthcare resources for people born with CHD, particularly in poorer countries, are required.

Association between obesity status and successful aging among older people in China: evidence from CHARLS.

BACKGROUND: The paper aimed to examine the association between obesity status and successful aging among elderly adults in China and further find gender differences in the effect of components of successful aging on obesity status. METHODS: The data came from the follow-up survey(2015) of China Health and Retirement Longitudinal Study (CHARLS) and 4019 dwellers age 60 and over are included. Obesity status were defined by the body mass index (BMI) according to Chinese criteria. Successful aging was defined following Rowe and Kahn's multidimensional model. Multivariable logistic regression was used to estimate the relationship between obesity status and successful aging. RESULTS: The rate of successful aging in men and women was 18.87 and 9.48% respectively. For BMI, the proportion of population with underweight, overweight and obesity in men was 10.29, 23.04 and 29.63% respectively and that in women was 1.40, 11.69 and 9.47%. Men with obesity (OR = 1.587 95% CI 1.087 ~ 2.316) has an positive relationship with successful aging than normal weight men; Women with underweight (OR = 0.197 95% CI 0.058 ~ 0.824) has an negative relationship with successful aging than normal weight women; Meanwhile, no matter men and women, the relationship between obesity status and successful aging were not significant among oldest adults(≥75 years). CONCLUSION: Obesity status was significantly association with successful aging in young older adults (60-74 years), and the components of successful aging differently were related with the obesity status of male and female.

The influence of job satisfaction, resilience and work engagement on turnover intention among village doctors in China: a cross-sectional study.

BACKGROUND: As the gatekeepers of rural residents' health, teams of village doctors play a vital role in improving rural residents' health. However, the high turnover of village doctors, both individually and collectively, threaten the stability of village medical teams. This research evaluated the influence of job satisfaction, resilience, and work engagement on the village doctors' turnover intention, and explored the mediating role of work engagement and resilience between job satisfaction and the turnover intention of village doctors in China. METHODS: A quantitative study using a self-administered questionnaire containing mostly structured items was conducted among village doctors with a sample size of 2693 from 1345 rural clinics in Shandong province, China, during May and June 2019. All variables including demographic characteristics, job satisfaction, resilience, work engagement and turnover intention were based on available literature, and measured on a 5- or 6-point Likert scale. Such statistical methods as one-way ANOVA, bivariate correlation, exploratory factor analysis (EFA), and Structural Equation Modelling (SEM) were used. RESULTS: Up to 46.9% of the subjects had a higher turnover intention and more than 26.3% of them had a medium turnover intention. The job satisfaction of village doctors could not only have a direct negative effect on turnover intention (ß = - 0.37, p < 0.001), but also have an indirect effect through work engagement (ß = - 0.04,=< 0.001). Meanwhile, work engagement also had a direct negative impact on turnover intention (ß = - 0.13, p < 0.001), and resilience had an indirect negative impact on turnover intention through work engagement (ß = - 0.09, p < 0.001). The above results of this study strongly confirmed that job satisfaction, resilience, and work engagement were early, powerful predicators of village doctors' turnover intention. CONCLUSION: According to the results, the following should be taken seriously to improve job satisfaction: reasonable and fair income, effective promotion mechanism, fair social old-age security, reasonable workload, and strong psychological coping mechanisms for work stress. The turnover intention of village doctors could be reduced through improving job satisfaction, resilience and work engagement.

[The Study of the Relationship Between Community Social Capital and Quality of Life among the Middle-aged and Elderly Rural-to-Urban Residents].

OBJECTIVE: To analyze the relationship between community social capital and quality of life among the middle-aged and elderly rural-to-urban residents, and to provide the policy reference for improving the health status. METHODS: A multi-stage random sampling method was used to select the research objects. Univariate analysis and logistic regression model were used to explore the effect of social capital on quality of life among the middle-aged and elderly rural-to-urban urbanized residents. RESULTS: The scores of self-rated physical health and mental health in the rural-to-urban residents were lower than those of urban residents ( P<0.05). The total score of community social capital, community participation and community cohesion in the rural-to-urban residents were lower than those of urban residents ( P<0.05). The result of multivariate analysis showed that community attachment and community cohesion were the protective factors of physical health ( P<0.05), and community cohesion was the protective factor of mental health ( P<0.05). CONCLUSION: There is a correlation between community belonging, community cohesion and quality of life among the elderly rural-to-urban residents. Attention should be paid to the promotion of community social capital so as to improve the health status of middle-aged and elderly rural-to-urban residents.

[Evaluation of Reliability and Validity of EQ-5D-5L Based on Residents in Southwest China].

OBJECTIVE: To explore the reliability and validity of the EQ-5D-5L scale in the population of southwest China. METHODS: The internal consistency reliability is measured by Cronbach's α coefficient and the structural validity is measured by factor analysis. The difference in health utility value of different characteristic populations is compared by t test and analysis of variance. RESULTS: Cronbach's α coefficient was 0.857. Exploratory factor analysis extracts two common factors whose cumulative contribution rate is 77.311%. The first common factor represents mobility, self-care and uaual activities. The second common factor represents pain/discomfort and anxiety/depression. The results of confirmatory factor analysis showed that the correlation of the two common factors was 0.659, the average variance of the first common factor was 0.862 and the combination reliability was 0.949, and the average variance extracted of the second common factor was 0.587 and the composite reliability was 0.739. The factor loadings for mobility, self-care and uaual activities on the first common factor were 0.871, 0.945 and 0.967, respectively. The loadings for pain/discomfort and anxiety/depression on the second common factor were 0.708 and 0.820, respectively. CONCLUSION: EQ-5D-5L has good reliability and validity when it is applied to the measurement of healthy life quality of residents in Southwest China.

[The Effects of Social Capital on Depressive Symptoms of Elderly Patients with Chronic Diseases in Urbanized Communities].

OBJECTIVE: To understand the effects of social capital on depressive symptoms of elderly patients with chronic diseases in urbanized communities, and to explore preventive measures to promote their mental health. METHODS: A multi-stage stratified cluster sampling method was used to extract 740 elderly patients with chronic diseases in the urbanized communities in Chengdu and Kunming. The questionnaire survey was conducted by using the center of depression rating scale (CES-D) and the self-made social capital scale. Multivariate unconditional logistic regression was used to analyze the impact of urbanized residents' social capital on depressive symptoms. RESULTS: The self-made social capital scale has good reliability and validity. The incidence of depressive symptoms in this study was 24.9%. The incidence of depressive symptoms in elderly females with chronic diseases was higher (P < 0.05); the residents with high "sense of social trust and security" had lower risk of incidence of depressive symptoms 〔odds ratio (OR)=0.489〕; the residents with higher "community belonging" had a lower risk of incidence of depressive symptoms (OR=0.570), and the residents with higher "social support" scores had a lower risk of incidence of depressive symptoms (OR=0.233). CONCLUSION: Targeted measures should be taken to intervene in the social capital factors affecting the depressive symptoms of elderly patients with chronic diseases in urbanized communities to improve their mental health.

[Multilevel Modelling on the Prevalence and Determinants of Depressive Symptoms in Middle and Old-aged Rural-to-urban Immigrants in Chengdu].

OBJECTIVE: To determine the prevalence and determinants of depressive symptoms in middle and old-aged rural-to-urban immigrants in Chengdu. METHODS: A total of 1 645 middle and old-aged rural-to-urban immigrants aged over 45 yr. were selected to participate in a questionnaire survey through a multi-stage random sampling method in Chengdu. Multilevel (households and individuals) models were established to identify predictors of depressive symptoms. RESULTS: About 14.5% of respondents reported depressive symptoms. The multilevel model indicated that family clustering of depressive symptoms existed. Household income and length of urban life at the household level, and age, chronic diseases, smoking, and social support at the individual level were significant predictors of depressive symptoms. CONCLUSION: The prevalence of depressive symptoms in middle and old-aged rural-to-urban immigrants deserves increasing policy attention for the purpose of promoting mental health in the population.

Study on the equity of medical services utilization for elderly enrolled in different basic social medical insurance systems in an underdeveloped city of Southwest China.

BACKGROUND: The equity of medical services utilization for elderly individuals enrolled in different basic social medical insurance systems holds significant meaning for social harmony against a background of demographic aging and a growing wealth gap in China. This study is to explore the equity of the three medical insurance systems in southwest China with the aim of providing recommendations for relevant policy. METHODS: A total of 9600 elderly people insured through basic social medical insurance were selected and interviewed with a questionnaire. This study used a binary logistic regression model to investigate the effect of household income for medical services utilization and adopted a concentration index to measure the inequity of medical services utilization among elderly participants enrolled in different medical insurance categories. RESULTS: Outpatient services utilization was almost identical in the different insurance systems (78.5%, 77.7% and 78.6%). There were no statistically significant differences according to income level in the Urban Employee Basic Medical Insurance (UEBMI) and Urban Resident Basic Medical Insurance (URBMI) programs, but in the New Cooperative Medical Scheme (NCMS), higher-income groups tended to utilize more services. The corresponding concentration index (CI) values were 0.0162, 0.0173 and 0.0179 respectively. The NCMS showed a lower hospitalization rate than UEBMI and URBMI (17.7% vs 24.2% and 24.9%). The higher income group utilized hospitalization more, regardless of the insurance system. The corresponding CI values were 0.0817, 0.0605 and 0.0319 respectively. CONCLUSION: The equity of medical services utilization for elderly exist in all three health insurance systems, in particular, the inequities in utilization of hospitalization were more severe than outpatient services. UEBMI and URBMI were better than NCMS in the equity of outpatient services. Although NCMS was more equitable than URBMI and UEBMI in terms of hospitalization, this was based on "overall low utilization of hospitalization regardless of income levels" in NCMS compared with URBMI and UEBMI. The disparities of the three basic social medical insurance systems should be eliminated. For low-income residents, specific insurance policies including reducing deductible, covering more medical service and increasing reimbursement ratio could be considered.

[Prevalence and Determinants of Depressive Symptoms in Middle and Senior Aged Populations with Visual Impairment].

OBJECTIVE: To determine the prevalence and determinants of depressive symptoms in visually impaired mid- and old-aged populations. METHODS: Data were extracted from the 2013 China Health and Retirement Longitudinal Study database. A total of 1 462 mid- and old-aged respondents reported visual problems. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression (CES-D) scale. Chi-square tests and binary logistic regression analyses were performed to identify factors associated with the prevalence of depressive symptoms. RESULTS: The study participants had an average age of (65±10) years. About 45.6% reported depression symptoms,with an average CES-D score of 10±7. The respondents aged between 55 and 64 years [odds ratio (OR)=1.679)],women (OR=1.310),and those who had shorter sleeping (OR=1.570) were more likely to have depressive symptoms than others ( P<0.05). Lower prevalence of depressive symptoms ( P<0.05) was found in the respondents who resided in urban areas (OR=0.480),had no chronic disease (OR=0.534),had no other disabilities (OR=0.570),perceived better general health (OR=0.324),reported better memory (OR=0.380),and expressed better life satisfaction (OR=0.126). CONCLUSION: Visually impaired mid- and old-aged people have high prevalence of depressive symptoms. Age,gender,residency,chronic conditions,self-rated general health,other disabilities,sleeping deprivation,memory,and life satisfaction are determinants of the prevalence of depressive symptoms.

[Overweight and Obesity among New Urban Migrants in Chengdu and Kunming].

OBJECTIVE: To determine the prevalence of overweight and obesity in new urban migrants. METHODS: A questionnaire survey was conducted on 21 651 urban residents in the downtown and surrounding urban areas of Kunming and Chengdu selected through a multi-stage stratified cluster sampling method. Factors associated with overweight and obesity were identified using Chi-square tests and multivariate logistic regression models. RESULTS: 11 626 people were enrolled. The new urban migrants (n=7 555) had 31.2% overweight and 6.7% obesity, compared with 24.9% and 4.3%, respectively, in the urban residents(n=4 071). Gender, age, educational, marital status and alcohol consumption were associated with overweight and obesity in the new urban migrants. Gender, age, education and alcohol consumption were predictors of overweight and obesity of the urban residents. CONCLUSIONS: Urban new immigrants are more likely to be overweight and obese than urban residents, although predictors for overweight and obesity remain similar.

[Equivalence of SF-12v2 and SF-36v2 in Assessing Health Related Quality of Life in a General Population in Chengdu].

OBJECTIVE: To determine the equivalence of SF-12v2 and SF-36v2 for assessing health related quality of life in a general population in Chengdu. METHODS: The equivalence between SF-12v2 and SF-36v2 was assessed using reliability,validity and responsiveness. RESULTS: The eight sub-scales of SF-36v2 had a score ranging from 64.13 to 89.15,compared with a range between 47.45 and 87.92 for SF-12v2. The SF-12v2 had larger standard deviations than the SF-36v2. No floor effects were detected; but ceiling effects were significant in the subscales of physical functioning (PF) ,role-physical (RP),bodily pain (BP),social functioning (SF) and role emotion (RE). The SF-12v2 had higher ceiling effects (56.66%-68.32%) than the SF-36v2 (50.14%-63.87%). The exploratory factor analyses extracted two factors in both cases,representing physical (PCS) and mental health (MCS),respectively. The total variances explained by the common factors reached 64.05% for the SF-36v2 and 55.79% for the SF-12v2. The SF-12v2 PCS and MCS scores explained 91.0% and 80.3% of the total variances of those of the SF-36v2,respectively. The effect size of PCSs ranges from 0.78 to 2.77 in the subpopulations with different health conditions,compared with 0.00-0.57 for MSCs. The relative validity (RV) of PCS-12 to PCS-36 ranged from 0.89 to 0.94,compared with a MCS-12 to MCS-36 range of 0.60-0.75. CONCLUSION: SF-12v2 is reliable and valid as a brief substitute version of SF-36v2 with acceptable responsiveness and equitable structure for assessing health related quality of life in the general population of Chengdu. But sub-scale scores were not recommended when using the SF-12v2 due to reduced precision.

[Health Determinants of Rural Elderly Populations with Different Living Arrangements: a Multilevel Model].

OBJECTIVE: To determine the health and its determinants of rural elderly populations in a city in Sichuan province. METHODS: Data were extracted from a 2015 household survey, containing 7 280 rural participants aged over 60 years. The prevalence of two-week morbidity and chronic conditions were compared among those with different living arrangements. Multilevel models were established to determine the family and individual factors associated with the health status of the respondents. RESULTS: Most respondents (57.0%) lived with a spouse, compared with 15.4% who lived alone. Those who lived alone had higher prevalence of two-week morbidity (48.0%) and chronic conditions (70.0%). The multilevel model indicated a familial clustering effect. Living arrangements and household income were associated with the prevalence of two-week morbidity and chronic conditions, after controlling for variations in age, depression, smoking, drinking, and exercise at the individual level. CONCLUSIONS: The rural elderly people who live alone have poor health status. Household income, age, depression, smoking, drinking and physical exercise are associated with two-week morbidity and chronic conditions.

Sleep Patterns, Sleep Disturbances, and Associated Factors Among Chinese Urban Kindergarten Children.

This study aimed to characterize sleep patterns and disturbances among Chinese urban kindergarten children and examine potentially associated factors. Caregivers of 513 children (47.96% male) aged 3-6 years (mean age = 4.46, SD = 0.9) completed the Children's Sleep Habits Questionnaire (CSHQ) and the Strengths and Difficulties Questionnaire (SDQ). Almost 80% (78.8%) of the children scored above the original CSHQ cutoff point for global sleep disturbance. Regression analysis indicated that child's age, and the presence of emotional problems, hyperactivity and peer problems, cosleeping, and interparental inconsistency of attitudes toward child rearing accounted for significant variance in the CSHQ total score (R(2) = 22%). These findings indicate that there is an apparently high prevalence of sleep disturbances in Chinese urban kindergarten children; and sleep disturbances are associated with both child-related and parenting practice variables.

Correlates of unequal access to preventive care in China: a multilevel analysis of national data from the 2011 China Health and Nutrition Survey.

BACKGROUND: Preventive care has an essential role in reducing income-related health inequalities. Despite a general consensus of the need of shifting focus from disease treatment to wellness and prevention, little is known about inequalities in access to preventive care in China. Our study aimed to explore the inequalities in preventive care usage and factors that were associated with such inequalities among Chinese adults. METHODS: Multilevel logistic regression analyses were performed using national data from the 2011 Chinese Health and Nutrition Survey. The study sample comprised 13,483 adults who were covered by Basic Social Medical Insurance (BSMI). We analyzed individual socioeconomic status (marital status, education attainment, annual household income per capita, and medical insurance) and contextual factors for their influence on preventive care usage (region of residence and type of community) after controlling for health needs (age, sex, and health condition). RESULTS: Out of the participants, 6.9 % received preventive care services over the past four weeks and 3.9 % went for a general physical examination prior to the survey. We noted regional disparities in the overall use of preventive care and specific use of general physical examination, with residents from central and northeastern regions less likely to use preventive care including general physical examination than in the more affluent eastern region. Lower levels of education and income were associated with reduced use of preventive care. Subscriptions to less generous social medical insurance programs such as Urban Resident-based Medical Insurance Scheme or New Rural Cooperative Medical Scheme were associated with decreased specific use of general physical examinations, but not overall use of preventive care. CONCLUSIONS: Inequalities in preventive care usage were evident in China, and were associated with health needs and socioeconomic characteristics. Current health insurance arrangements may fail to reduce inequalities relating to preventive care. A fair and more coherent policy across all BSMI schemes is needed.

[Survey on the applicability of SF-36 version-2 (SF-36v2) in assessment quality of life among urban residents in Chengdu city].

OBJECTIVE: To explore the psychometric performances and applicability of SF-36v2 in assessment quality of life among urban residents in Chengdu. METHODS: During Oct. to Dec., 2012, 2 186 adult urban residents with clear mind and well self-express were recruited in the study by multistage stratified cluster sampling method in Chengdu urban area. The survey questionnaires included general health condition and quality of life, which was adopted the SF-36v2. Internal consistency reliability, test-retest reliability and construct validity were all analyzed as indicators of the psychometric performance. RESULTS: The survey released 2 186 questionnaires, with 2 182 ones returned and 2 178(99.8%) met the data standard. The scores of 8 scales in SF-36v2, including physical function (PF), role-physical (RP), bodily pain (BP), general health (GH), vitality (VT), social function (SF), role-emotion (RE) and mental health (MH), were 89.15 ± 17.56, 85.18 ± 22.52, 76.64 ± 17.80, 64.13 ± 19.56, 70.39 ± 17.31, 86.43 ± 17.35, 87.79 ± 19.24 and 80.61 ± 13.49, respectively; the floor effects were 0.28%, 0.41%, 0.23%, 0.28%, 0.09%, 0.05%, 0.14% and 0.23%, respectively; and the ceiling effects were 51.38%, 60.60%, 58.08%, 0.83%, 2.94%, 50.32%, 64.00% and 3.95%, respectively. The item-convergent validities were all achieved the standard (r = 0.40) except the item MH5 (Have you been happy?), and the total scaling success rate of item-convergent validity was 97.14%. The scales' success rates of item-discriminant validities for the SF, VT and MH scales were 93.75%, 56.25% and 97.50% respectively, while the rates of others were 100.00% and the total success rate was 96.43%. The internal reliability ranged from 0.724 to 0.974 across all the scales, except for SF (r = 0.603) and VT (r = 0.697). The two-week test-retest reliability ranged from 0.610 to 0.845. Within factor analysis, two common factors were confirmed, separately representing physical health and mental health, altogether contributing 64.4% of the total variance. CONCLUSION: As a revised version of SF-36v1, the SF-36v2 seemed to be more preferable in layout for questions and answers and could reduce the ceiling and floor effect. Additionally, it also showed comparatively well reliability and validity. And thereby we believed the SF-36v2 could be applied to assess the life quality among urban residents in Chengdu.

Depressive symptoms and all-cause mortality among middle-aged and older people in China and associations with chronic diseases.

Introduction: It remains unclear whether depressive symptoms are associated with increased all-cause mortality and to what extent depressive symptoms are associated with chronic disease and all-cause mortality. The study aims to explore the relationship between depressive symptoms and all-cause mortality, and how depressive symptoms may, in turn, affect all-cause mortality among Chinese middle-aged and older people through chronic diseases. Methods: Data were collected from the China Health and Retirement Longitudinal Study (CHARLS). This cohort study involved 13,855 individuals from Wave 1 (2011) to Wave 6 (2020) of the CHARLS, which is a nationally representative survey that collects information from Chinese residents ages 45 and older to explore intrinsic mechanisms between depressive symptoms and all-cause mortality. The Center for Epidemiological Studies Depression Scale (CES-D-10) was validated through the CHARLS. Covariates included socioeconomic variables, living habits, and self-reported history of chronic diseases. Kaplan-Meier curves depicted mortality rates by depressive symptom levels, with Cox proportional hazards regression models estimating the hazard ratios (HRs) of all-cause mortality. Results: Out of the total 13,855 participants included, the median (Q1, Q3) age was 58.00 (51.00, 63.00) years. Adjusted for all covariates, middle-aged and older adults with depressive symptoms had a higher all-cause mortality rate (HR = 1.20 [95% CI, 1.09-1.33]). An increased rate was observed for 55-64 years old (HR = 1.23 [95% CI, 1.03-1.47]) and more than 65 years old (HR = 1.32 [95% CI, 1.18-1.49]), agricultural Hukou (HR = 1.44, [95% CI, 1.30-1.59]), and nonagricultural workload (HR = 1.81 [95% CI, 1.61-2.03]). Depressive symptoms increased the risks of all-cause mortality among patients with hypertension (HR = 1.19 [95% CI, 1.00-1.40]), diabetes (HR = 1.41[95% CI, 1.02-1.95]), and arthritis (HR = 1.29 [95% CI, 1.09-1.51]). Conclusion: Depressive symptoms raise all-cause mortality risk, particularly in those aged 55 and above, rural household registration (agricultural Hukou), nonagricultural workers, and middle-aged and older people with hypertension, diabetes, and arthritis. Our findings through the longitudinal data collected in this study offer valuable insights for interventions targeting depression, such as early detection, integrated chronic disease care management, and healthy lifestyles; and community support for depressive symptoms may help to reduce mortality in middle-aged and older people.