RESUMO
Globally, the rollout of COVID-19 vaccine had been faced with a significant barrier in the form of vaccine hesitancy. This study adopts a multi-stage perspective to explore the prevalence and determinants of COVID-19 vaccine hesitancy, focusing on their dynamic evolutionary features. Guided by the integrated framework of the 3Cs model (complacency, confidence, and convenience) and the EAH model (environmental, agent, and host), this study conducted three repeated national cross-sectional surveys. These surveys carried out from July 2021 to February 2023 across mainland China, targeted individuals aged 18 and older. They were strategically timed to coincide with three critical vaccination phases: universal coverage (stage 1), partial coverage (stage 2), and key population coverage (stage 3). From 2021 to 2023, the surveys examined sample sizes of 29 925, 6659, and 5407, respectively. The COVID-19 vaccine hesitation rates increased from 8.39% in 2021 to 29.72% in 2023. Urban residency, chronic condition, and low trust in vaccine developer contributed to significant COVID-19 vaccine hesitancy across the pandemic. Negative correlations between the intensity of vaccination policies and vaccine hesitancy, and positive correlations between vaccine hesitancy and long COVID, were confirmed. This study provides insights for designing future effective vaccination programs for emerging vaccine-preventable infectious X diseases.
Assuntos
Vacinas contra COVID-19 , COVID-19 , Hesitação Vacinal , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , China/epidemiologia , COVID-19/prevenção & controle , COVID-19/epidemiologia , Vacinas contra COVID-19/administração & dosagem , Estudos Transversais , População do Leste Asiático , Inquéritos e Questionários , Vacinação/psicologia , Vacinação/estatística & dados numéricos , Hesitação Vacinal/estatística & dados numéricos , Hesitação Vacinal/psicologiaRESUMO
BACKGROUND: Healthy lifestyle behaviors (LBs) have been widely recommended for the prevention and management of cardiovascular disease (CVD). Despite a large number of studies exploring the association between combined LBs and CVD, a notable gap exists in integration of relevant literatures. We conducted a systematic review and meta-analysis of prospective cohort studies to analyze the correlation between combined LBs and the occurrence of CVD, as well as to estimate the risk of various health complications in individuals already diagnosed with CVD. METHODS: Articles published up to February 10, 2023 were sourced through PubMed, EMBASE and Web of Science. Eligible prospective cohort studies that reported the relations of combined LBs with pre-determined outcomes were included. Summary relative risks (RRs) and 95% confidence intervals (CIs) were estimated using either a fixed or random-effects model. Subgroup analysis, meta-regression, publication bias, and sensitivity analysis were as well performed. RESULTS: In the general population, individuals with the healthiest combination of LBs exhibited a significant risk reduction of 58% for CVD and 55% for CVD mortality. For individuals diagnosed with CVD, adherence to the healthiest combination of LBs corresponded to a significant risk reduction of 62% for CVD recurrence and 67% for all-cause mortality, when compared to those with the least-healthy combination of LBs. In the analysis of dose-response relationship, for each increment of 1 healthy LB, there was a corresponding decrease in risk of 17% for CVD and 19% for CVD mortality within the general population. Similarly, among individuals diagnosed with CVD, each additional healthy LB was associated with a risk reduction of 27% for CVD recurrence and 27% for all-cause mortality. CONCLUSIONS: Adopting healthy LBs is associated with substantial risk reduction in CVD, CVD mortality, and adverse outcomes among individuals diagnosed with CVD. Rather than focusing solely on individual healthy LB, it is advisable to advocate for the adoption of multiple LBs for the prevention and management of CVD. TRIAL REGISTRATION: PROSPERO: CRD42023431731.
Assuntos
Doenças Cardiovasculares , Estilo de Vida , Humanos , Estudos Prospectivos , Prognóstico , Estilo de Vida Saudável , Comportamentos Relacionados com a Saúde , Exercício Físico , Fatores de Risco , Comportamento de Redução do RiscoRESUMO
BACKGROUND: This study aimed to analyze the trends of Parkinson's disease (PD) mortality rates among Chinese residents from 2004 to 2021, provide evidence for the formulation of PD prevention and control strategies to improve the quality of life among PD residents. METHODS: Demographic and sociological data such as gender, urban or rural residency and age were obtained from the National Cause of Death Surveillance Dataset from 2004 to 2021. We then analyzed the trends of PD mortality rates by Joinpoint regression. RESULTS: The PD mortality and standardized mortality rates in China showed an overall increasing trend during 2004-2021 (average annual percentage change [AAPC] = 7.14%, AAPCASMR=3.21%, P < 0.001). The mortality and standardized mortality rate in male (AAPC = 7.65%, AAPCASMR=3.18%, P < 0.001) were higher than that of female (AAPC = 7.03%, AAPCASMR=3.09%, P < 0.001). The PD standardized mortality rates of urban (AAPC = 5.13%, AAPCASMR=1.76%, P < 0.001) and rural (AAPC = 8.40%, AAPCASMR=4.29%, P < 0.001) residents both increased gradually. In the age analysis, the mortality rate increased with age. And the mortality rates of those aged > 85 years was the highest. Considering gender, female aged > 85 years had the fastest mortality trend (annual percentage change [APC] = 5.69%, P < 0.001). Considering urban/rural, rural aged 80-84 years had the fastest mortality trend (APC = 6.68%, P < 0.001). CONCLUSIONS: The mortality rate of PD among Chinese residents increased from 2004 to 2021. Male sex, urban residence and age > 85 years were risk factors for PD-related death and should be the primary focus for PD prevention.
Assuntos
Doença de Parkinson , Humanos , Masculino , Feminino , Qualidade de Vida , População Urbana , China/epidemiologia , População Rural , MortalidadeRESUMO
BACKGROUND: The public health service capability of primary healthcare personnel directly affects the utilization and delivery of health services, and is influenced by various factors. This study aimed to examine the status, factors, and urban-rural differences of public health service capability among primary healthcare personnel, and provided suggestions for improvement. METHODS: We used cluster sampling to survey 11,925 primary healthcare personnel in 18 regions of Henan Province from 20th to March 31, 2023. Data encompassing demographics and public health service capabilities, including health lifestyle guidance, chronic disease management, health management of special populations, and vaccination services. Multivariable regression analysis was employed to investigate influencing factors. Propensity Score Matching (PSM) quantified urban-rural differences. RESULTS: The total score of public health service capability was 80.17 points. Chronic disease management capability scored the lowest, only 19.60. Gender, education level, average monthly salary, professional title, health status, employment form, work unit type, category of practicing (assistant) physician significantly influenced the public health service capability (all P < 0.05). PSM analysis revealed rural primary healthcare personnel had higher public health service capability scores than urban ones. CONCLUSIONS: The public health service capability of primary healthcare personnel in Henan Province was relatively high, but chronic disease management required improvement. Additionally, implementing effective training methods for different subgroups, and improving the service capability of primary medical and health institutions were positive measures.
Assuntos
Pessoal de Saúde , Atenção Primária à Saúde , Humanos , China , Masculino , Feminino , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Pessoal de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Inquéritos e Questionários , Serviços de Saúde Rural/estatística & dados numéricos , Serviços de Saúde Rural/organização & administraçãoRESUMO
AIMS AND OBJECTIVES: To investigate whether chronic diseases are associated with higher COVID-19 vaccine hesitancy and explore factors that influence COVID-19 vaccine hesitancy in patients with chronic diseases. BACKGROUND: Vaccine hesitancy has been acknowledged as one of the greatest hazards to public health. However, little information is available about COVID-19 vaccine hesitancy among patients with chronic diseases who may be more susceptible to COVID-19 infection, severe disease or death. METHODS: From 6 to 9 August 2021, we performed an internet-based cross-sectional survey with 22,954 participants (14.78% participants with chronic diseases). Propensity score matching with 1:1 nearest neighbourhood was used to reduce confounding factors between patients with chronic diseases and the general population. Using a multivariable logistic regression model, the factors impacting COVID-19 vaccine hesitancy were identified among patients with chronic diseases. RESULTS: Both before and after propensity score matching, patients with chronic diseases had higher COVID-19 vaccine hesitancy than the general population. In addition, self-reported poor health, multiple chronic diseases, lower sociodemographic backgrounds and lower trust in nurses and doctors were associated with COVID-19 vaccine hesitancy among patients with chronic diseases. CONCLUSIONS: Patients with chronic diseases were more hesitant about the COVID-19 vaccine. Nurses should focus on patients with chronic diseases with poor health conditions, low socioeconomic backgrounds and low trust in the healthcare system. RELEVANCE TO CLINICAL PRACTICE: Clinical nurses are recommended to not only pay more attention to the health status and sociodemographic characteristics of patients with chronic diseases but also build trust between nurses and patients by improving service levels and professional capabilities in clinical practice. PATIENT OR PUBLIC CONTRIBUTION: Patients or the public were not involved in setting the research question, the outcome measures, or the design or implementation of the study. However, all participants were invited to complete the digital informed consent and questionnaires.
Assuntos
Vacinas contra COVID-19 , COVID-19 , Pontuação de Propensão , Hesitação Vacinal , Humanos , Estudos Transversais , Masculino , Feminino , Vacinas contra COVID-19/administração & dosagem , Pessoa de Meia-Idade , COVID-19/prevenção & controle , COVID-19/psicologia , Doença Crônica/psicologia , Adulto , Hesitação Vacinal/psicologia , Hesitação Vacinal/estatística & dados numéricos , Idoso , Internet , Inquéritos e Questionários , SARS-CoV-2RESUMO
Combination vaccines can reduce the vaccination visit, simplify the vaccination schedule and efficiently improve management. This study was primarily designed to evaluate the economic impact of integrating the diphtheria-tetanus-acellular pertussis inactivated poliomyelitis and Haemophilus influenzae type B (DTaP-IPV-Hib) combination vaccine into the China National Immunization Program. A cost-minimization analysis (CMA) compared the costs associated with direct medical, direct nonmedical, and indirect social costs in four schemes was conducted. A budgetary impact analysis assessed the alternative schemes' financial impact on the healthcare budget. Direct medical costs were extracted using a costing questionnaire and an observational time and motion chart. Direct nonmedical (cost for transportation) and indirect costs (loss of productivity) were derived from parents' questionnaires. Replacement of the current vaccination scheme with DTaP-IPV-Hib combination vaccine, resulted in net increases in direct medical costs of 77.64% for alternative scheme 1, 146.54% for alternative scheme 2, and 294.67% for alternative scheme 3, respectively. However, the direct nonmedical and indirect costs and the cost of the alternative schemes were 18.18%, 36.36%, and 63.64% lower than the current scheme for alternative scheme 1, alternative scheme 2, and alternative scheme 3, respectively. From the societal perspective, when compared with the current scheme, the budgetary impact of the three alternative schemes were +66 million Chinese Yuan (CNY) (4.81%), +103 million CNY (7.53%), and +305million CNY (22.35%), respectively. The CMA considered a broader perspective of social costs and indicated that the alternative schemes would result in an overall saving of parents' transportation and work loss costs to bring their children for vaccination, translating into a total cost saving of 18.18%, 36.36%, 63.64%, comparing to the current scheme. Thus, fully or partly using the DTaP-IPV-Hib combination vaccine is cost-saving in the context of China.
Assuntos
Haemophilus influenzae tipo b , Criança , Humanos , Lactente , Estudos Transversais , Vacinas Combinadas , Custos e Análise de Custo , ChinaRESUMO
BACKGROUND: This study aimed to determine long-term variations in mortality trends and identify the leading causes of death among older adults in China from 2009 to 2019 so as to propose interventions to further stabilise the mortality rate among older adults and facilitate healthy ageing. METHODS: We extracted data from the China Death Surveillance database from 2009 to 2019 for all-cause mortality and cause-specific death among individuals aged ≥ 65 years. A joinpoint regression model was used to estimate mortality trends by calculating the annual percentage change (APC). A trend chi-square test was used to estimate sex differences in mortality, and descriptive analysis was used to estimate the leading causes of death. Semi-structured expert interviews were conducted to examine health interventions for older adults. RESULTS: We observed an overall declining trend in age-adjusted mortality rates among older adults aged ≥ 65 years in China from 2009 to 2019 (APC, -2.44; P < 0.05). In this population, the male mortality rate was higher than the female mortality rate during this period (P < 0.05). However, the mortality rate among older adults aged ≥ 85 years increased since 2014, particularly among females. Cardiovascular disease (CVD) was the leading cause of death among older adults aged 65-84 years, whereas ischaemic heart disease was the leading cause of death among individuals aged ≥ 85 years, especially among females. The majority of injuries resulting in death were caused by falls, showing an increasing trend. CONCLUSIONS: CVD is a major cause of death among older adults aged ≥ 65 years in China, and relevant health intervention strategies should be implemented from the perspectives of physiology, psychology, and living environment. The change in the mortality trend and the distribution of cause of death among older adults aged ≥ 85 years is noteworthy; a diagnostic and management model centred around females aged ≥ 85 years should be implemented. Additionally, a multidimensional fall prevention strategy involving primary medical institutions and care services needs to be implemented to reduce the risk of falls among older adults.
Assuntos
Doenças Cardiovasculares , Humanos , Masculino , Feminino , Idoso , Causas de Morte , Causalidade , China/epidemiologia , MortalidadeRESUMO
BACKGROUND: COVID-19 is still prevalent in most countries around the world at the low level. Residents' lifestyle behaviors and emotions are critical to prevent COVID-19 and keep healthy, but there is lacking of confirmative evidence on how residents' lifestyle behaviors and emotional expressivity affected COVID-19 infection. METHODS: Baseline study was conducted in August 2022 and follow-up study was conducted in February 2023. Baseline survey collected information on residents' basic information, as well as their lifestyle behaviors and emotions. Follow-up study was carried out to gather data on COVID-19 infection condition. Binary logistic regression was utilized to identify factors that may influence COVID-19 infection. Attributable risk (AR) was computed to determine the proportion of unhealthy lifestyle behaviors and emotional factors that could be attributed to COVID-19 infection. Sensitivity analysis was performed to test the robustness of the results. RESULTS: A total of 5776 participants (46.57% males) were included in this study, yielding an overall COVID-19 infection rate of 54.8% (95%CI: 53.5 - 56.0%). The findings revealed that higher stress levels [aOR = 1.027 (95%CI; 1.005-1.050)] and lower frequency in wearing masks, washing hands, and keeping distance [aOR = 1.615 (95%CI; 1.087-2.401)], were positively associated with an increased likelihood of COVID-19 infection (all P < 0.05). If these associations were causal, 8.1% of COVID-19 infection would have been prevented if all participants had normal stress levels [Attributable Risk Percentage: 8.1% (95%CI: 5.9-10.3%)]. A significant interaction effect between stress and the frequency in wearing masks, washing hands, and keeping distance on COVID-19 infection was observed (ß = 0.006, P < 0.001), which also was independent factor of COVID-19 infection. CONCLUSIONS: The overall COVID-19 infection rate among residents is at a medium level. Residents' increasing stress and decreasing frequency in wearing masks and washing hands and keeping distance contribute to increasing risk of infection, residents should increase the frequency of mask-wearing, practice hand hygiene, keep safe distance from others, ensure stable emotional state, minimize psychological stress, providing evidence support for future responses to emerging infectious diseases.
Assuntos
COVID-19 , Comportamentos Relacionados com a Saúde , Feminino , Humanos , Masculino , COVID-19/epidemiologia , COVID-19/prevenção & controle , População do Leste Asiático , Seguimentos , Estilo de Vida Saudável , Máscaras , SARS-CoV-2RESUMO
BACKGROUND: Primary medical and health care facilities are the first lines of defense for the health of population. This study aims to evaluate the current state and trend of equity and coupling coordination degree (CCD) of staff in primary medical and health care institutions (SPMHCI) based on the quantity and living standards of citizens in China 2013-2019. The research findings are expected to serve as a guideline for the allocation of SPMHCI. METHODS: The data used in this study including the quantity and living standards of citizens, as well as the number of SPMHCI in 31 provincial administrative regions of China, were obtained from the China Statistical Yearbook and the China Health Statistics Yearbook. The equity and CCD for SPMHCI were analyzed by using the Gini coefficient and the CCD model, and the Grey forecasting model GM (1, 1) (GM) was used to predict the equity and CCD from 2020 to 2022. RESULTS: Between 2013 and 2019, the number of SPMHCI increased from 3.17 million to 3.50 million, and the population-based Gini coefficient declined from 0.0704 to 0.0513. In urban and rural areas, the Gini coefficients decreased from 0.1185 and 0.0737 to 0.1025 and 0.0611, respectively. The CCD between SPMHCI and citizens' living standards (CLS) changed from 0.5691, 0.5813, 0.5818 to 0.5650, 0.5634, 0.6088 at national, urban, and rural levels, respectively. The forecasting results of GM revealed that at the national, urban and rural levels from 2020 to 2022, the Gini coefficient would rise at a rate of - 13.53, - 5.77%, and - 6.10%, respectively, while the CCD would grow at a rate of - 0.89, 1.06, and 0.87%, respectively. CONCLUSIONS: In China, the number of SPMHCI has increased significantly, with an equitable allocation based on the population. The interaction between SPMHCI and CLS is sufficient, but the degree of mutual promotion is moderate. The government could optimize SPMHCI and improve the chronic disease management services to improve CLS and to ensure the continued operation of primary medical and health care institutions in urban areas.
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Equidade em Saúde , Atenção Primária à Saúde , China , Atenção à Saúde , Humanos , População Rural , Fatores SocioeconômicosRESUMO
BACKGROUND: Building an equitable health care system involves both the promotion of social justice in health and people's subjective perception of the promotion. This study aimed to analyze the overall status and associated factors of the perceived equity of the Chinese health care system, and then to offer policy recommendations for health care reform. METHODS: Information on the perceived equity score (scale 0 to 10) of 10,243 valid cases in total were derived from the data set of Chinese Social Survey 2015. Univariate analysis methods were applied to present respondents' overall perceived equity of the Chinese health care system. Multivariate linear regression method was used to explore the associated factors of the perceived equity and examine their independent effect. RESULTS: The respondents gave positive but relatively low marks (6.7 ± 2.6, 95% CI: = 6.64~6.74) of the equity of the Chinese health care system. Younger respondents reported a higher score of perceived equity than their elder counterparts (ß = - 0.132, 95% CI: - 0.203~ - 0.062, P < 0.001). Respondents with lower education level were significantly more likely to consider the Chinese health care system equitable (ß = - 0.104, 95% CI: - 0.153~ - 0.056, P < 0.001). Respondents satisfied with the Social Health Insurance reimbursement ratio tended to score the system higher in the survey (ß = 0.044, 95% CI: 0.024~0.063, P < 0.001). Respondents residing in eastern China and rural areas were significantly more likely to consider the Chinese health care system equitable (ß = - 0.268, 95% CI: - 0.338~ - 0.199, P < 0.001). Meanwhile, rural respondents reported higher scores of the perceived equity than urban respondents did (ß = 0.348, 95% CI: 0.237~0.458, P < 0.001). Respondents from regions with adequate GPs scored the system higher in this survey (ß = 0.087, 95% CI: 0.008~0.165, P < 0.001). The present study found no influence of gender, economic status, Social Health Insurance coverage, or satisfaction with the latest treatment on perceived equity. CONCLUSIONS: Eliminating the sense of inequity among a range of populations should be prioritized in health care reform. A national-level investigation system to rate residents' perceived equity was necessary for global health care reform.
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Atenção à Saúde/organização & administração , Reforma dos Serviços de Saúde , Equidade em Saúde/organização & administração , Adolescente , Adulto , China , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: China has set up a universal coverage social health insurance system since the 2009 healthcare reform. Due to the inadequate funds, the social health insurance system reimbursed the inpatient expenditures with much higher ratio than outpatient expenditure. The gap in reimbursement ratios resulted in a rapid rising hospitalization rate but poor health outcomes among the Chinese population. A redistribution of social health insurance funds has become one of the main challenges for the performance of Social Health Insurance. METHODS: Two comparable counties, Dangyang County and Zhijiang County, in Hubei Province of China, were sampled as the intervention group and the control group, respectively. The Social Health Insurance Management Department of the intervention group budgeted 600 yuan per capita per year to the patients with 3rd stage hypertension to cover their outpatient expenditures. The outpatient spending in the control group were paid out-of-pocket. The inpatient expenditures reimbursement policies in both groups were not changed. Besides, the Social Health Insurance Management Department of the intervention group budgeted 100 yuan per patient per year to township physicians and hospitals to provide health management services for the patients. While, the health management services in the control group were still provided by health workers. A Propensity Score Matching model and Difference-in-differences model were used to estimate the net effects of the intervention in dimensions of medical services utilization, medical expenditures, SHI reimbursement, and health outcomes. RESULTS: One thousand, six hundred and seventy three pairs of patients were taken as valid subjects to conduct Difference-in-differences estimation after the Propensity Score Matching. The net intervention effect is to increase outpatient frequency by 3.3 (81.0%) times (P < 0.05), to decrease hospitalization frequency by 0.075 (- 60.0%) times (P < 0.05), and to increase the per capita total medical service utilization frequency by 3.225 (76.8%) times (P < 0.05). The per capita total medical expenditure decreased 394.2 (- 27.7%) yuan. The SHI reimbursed 90.3 yuan more per capita for the outpatient spending, but the per capita inpatient expenditure reimbursement and per capita total medical expenditure reimbursement decreased significantly by 282.6 (- 44.0%) yuan and 192.3 (- 28.5%) yuan, respectively (P < 0.05). The intervention reduced the per capita inpatient out-of-pocket expenditure and the per capita total out-of-pocket expenditure by 192.8 (- 36.7%) yuan and 201.9 (- 29.9%) yuan, respectively (P < 0.05). The intervention significantly decreased the diastolic blood pressure of the intervention group by 2.9 mmHg (P < 0.05) but had no significant impact on the systolic blood pressure (- 7.9 mmHg, P > 0.05). CONCLUSION: For China and countries attempting to establish a universal coverage SHI with inadequate funds, inpatient services were expensive but might not produce good health outcomes. Outpatient care for patients with chronic diseases should be fundamental, and outpatient expenditures should be reimbursed with a higher ratio.
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Gastos em Saúde/tendências , Assistência Médica/organização & administração , Pacientes Ambulatoriais , População Rural , China/epidemiologia , Feminino , Programas Governamentais , Reforma dos Serviços de Saúde , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Masculino , Assistência Médica/economia , Previdência Social/organização & administraçãoRESUMO
BACKGROUND: Integrative strategy of health services delivery has been proven to be effective in economically developed countries, where the healthcare systems have enough qualified primary care providers. However rural China lacks such providers to act as gatekeeper, besides, Chinese rural hypertensive patients are usually of old age, more likely to be exposed to health risk factors and they experience a greater socio-economic burden. All these Chinese rural setting specific features make the effectiveness of integrative strategy of health services in improving health related quality of life among Chinese rural hypertensive patients uncertain. METHODS: In order to assess the impact of integrative strategy of health services delivery on health related quality of life among Chinese rural hypertensive patients, a two-year quasi-experimental trial was conducted in Chongqing, China. At baseline the sample enrolled 1006 hypertensive patients into intervention group and 420 hypertensive patients into control group. Physicians from village clinics, town hospitals and county hospitals worked collaboratively to deliver multidisciplinary health services for the intervention group, while physicians in the control group provided services without cooperation. The quality of life was studied by SF-36 Scale. Blood pressures were reported by town hospitals. The Difference-in-Differences model was used to estimate the differences in SF-36 score and blood pressure of both groups to assess the impact. RESULTS: The study showed that at baseline there was no statistical difference in SF-36 scores between both groups. While at follow-up the intervention group scored higher in overall SF-36, Role Physical, Body Pain, Social Functioning and Role Emotional than the control group. The Difference-in-Differences result demonstrated that there were statistical differences in SF-36 total score (p = 0.011), Role Physical (p = 0.027), Social Functioning (p = 0.000), Role Emotional (p = 0.002) between both groups. Integrative services delivery improved the score of SF-36 by 4.591 ± 1.794, and also improved the score in domains of Role Physical, Social Functioning and Role Emotional by 8.289 ± 3.753, 9.762 ± 2.019 and 12.534 ± 4.083, respectively. CONCLUSION: Patients in the intervention group obtained lower systolic blood pressure and diastolic blood pressure. Integrative strategy of health services delivery improved health related quality of life and blood pressure control among rural Chinese hypertensive patients. TRIAL REGISTRATION: The Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology, ChiCTR-OOR-14005563, Registered on 7 June 2011.
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Prestação Integrada de Cuidados de Saúde/organização & administração , Promoção da Saúde/métodos , Hipertensão/terapia , População Rural/estatística & dados numéricos , Adulto , Idoso , Pressão Sanguínea , China , Feminino , Nível de Saúde , Humanos , Hipertensão/psicologia , Masculino , Pessoa de Meia-Idade , Qualidade de VidaRESUMO
BACKGROUND: Continuity of care is widely considered a principle of primary care that decreases healthcare utilization and mortality. However, the effect of continuity of care on health-related quality of life (HRQoL) for adult patients with hypertension remains unclear. METHODS: To further evaluate the effect of continuity of care, we implemented a cohort study among hypertensive patients aged over 35 years (n = 1200) in six townships in Qianjiang District, Chongqing, China, between 2012 and 2014. The study ultimately included 1079 participants. The continuity of care index was calculated using claim-based longitudinal data obtained from hypertension follow-up service records. The baseline and endline survey-based data, tested by the SF-36 scale, were used to assess HRQoL. To control selection bias and examine the effect of continuity of care, a kernel-based propensity score matching difference-in-differences (DID) method was used. Additionally, descriptive statistics, chi-squared test, and Mann-Whitney nonparametric test were used to summarize characteristics, evaluate proportional differences, and analyze statistical differences, respectively. RESULTS: Our results showed that patients in the high continuity of care group presented greater improvement in both Physical Component Summary (PCS, DID = 5.192 ± 1.970, p < 0.001) and Mental Component Summary (MCS, DID = 7.900 ± 1.815, p = 0.008) than those in the low continuity of care group. Moreover, patients in the high continuity of care group showed significant improvement in physical functioning, role-physical, general health, role-emotional, and mental health. CONCLUSIONS: Our findings indicate that a long-term physician-patient relationship may improve HRQoL in patients with hypertension. However, more unified measurement tools are needed to evaluate continuity of care. Further studies should include more study settings.
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Continuidade da Assistência ao Paciente , Hipertensão/terapia , Qualidade de Vida , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Estudos de Coortes , Feminino , Nível de Saúde , Humanos , Hipertensão/psicologia , Masculino , Saúde Mental , Pessoa de Meia-Idade , Relações Médico-Paciente , Estatísticas não Paramétricas , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Vaccination plays an important role in preventing COVID-19 infection and reducing the severity of the disease. There are usually differences in vaccination rates between urban and rural areas. Measuring these differences can aid in developing more coordinated and sustainable solutions. This information also serves as a reference for the prevention and control of emerging infectious diseases in the future. OBJECTIVE: This study aims to assess the current coverage rate and influencing factors of COVID-19 (second booster) vaccination among Chinese residents, as well as the disparities between urban and rural areas in China. METHODS: This cross-sectional study used a stratified random sampling approach to select representative samples from 11 communities and 10 villages in eastern (Changzhou), central (Zhengzhou), western (Xining), and northeast (Mudanjiang) Mainland China from February 1 to February 18, 2023. The questionnaires were developed by experienced epidemiologists and contained the following: sociodemographic information, health conditions, vaccine-related information, information related to the Protective Motivation Theory (PMT), and the level of trust in the health care system. Vaccination rates among the participants were evaluated based on self-reported information provided. Binary logistic regression models were performed to explore influencing factors of vaccination among urban and rural participants. Urban-rural disparities in the vaccination rate were assessed using propensity score matching (PSM). RESULTS: A total of 5780 participants were included, with 53.04% (3066/5780) being female. The vaccination rate was 12.18% (704/5780; 95% CI 11.34-13.02) in the total sample, 13.76% (341/2478; 95% CI 12.40-15.12) among the rural participants, and 10.99% (363/3302; 95% CI 9.93-12.06) among the urban participants. For rural participants, self-reported health condition, self-efficacy, educational level, vaccine knowledge, susceptibility, benefits, and trust in the health care system were independent factors associated with vaccination (all Pï¼.05). For urban participants, chronic conditions, COVID-19 infection, subjective community level, vaccine knowledge, self-efficacy, and trust in the health care system were independent factors associated with vaccination (all Pï¼.05). PSM analysis uncovered a 3.42% difference in vaccination rates between urban and rural participants. CONCLUSIONS: The fourth COVID-19 vaccination coverage rate (second booster) among the Chinese population was extremely low, significantly lower than the previous vaccine coverage rate. Given that COVID-19 infection is still prevalent at low levels, efforts should focus on enhancing self-efficacy to expand the vaccine coverage rate among the Chinese population. For rural residents, building awareness of the vaccine's benefits and improving their overall health status should be prioritized. In urban areas, a larger proportion of people with COVID-19 and patients with chronic illness should be vaccinated.
Assuntos
Vacinas contra COVID-19 , COVID-19 , População Rural , População Urbana , Humanos , Estudos Transversais , População Rural/estatística & dados numéricos , Feminino , China/epidemiologia , População Urbana/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Adulto , COVID-19/prevenção & controle , COVID-19/epidemiologia , Vacinas contra COVID-19/administração & dosagem , Disparidades em Assistência à Saúde/estatística & dados numéricos , Idoso , Vacinação/estatística & dados numéricos , Adulto Jovem , AdolescenteRESUMO
BACKGROUND: Socioeconomic status (SES) plays a crucial role in blood pressure (BP) control. SES may influence BP control through obesity indices, such as body mass index (BMI) and waist circumference (WC). This study aimed to understand the relationships between SES and BP control in the elderly hypertensive population, and to determine whether BMI and WC mediate the relationship between SES and BP control. METHODS: The study was conducted in Jia County, Henan Province, China, from 1 July to 31 August 2023. The 18,963 hypertensive people over 65 years old who were included in the National Basic Public Health Service Program were investigated. The study utilized questionnaire surveys to collect data on participants' demographic characteristics, disease history, lifestyle behaviors, antihypertensive medication, and measured height, weight, and blood pressure. SES was indexed by participants' self-reported educational level, family income, and occupation, and categorized into low, medium, and high groups by using latent category analysis (LCA). Logistic regression models were used to analyze the associations between SES and BP control. Obesity indicators, represented by BMI and WC, were included in mediation models to examine the indirect effects of BMI/WC on the association between SES and BP control. RESULTS: The mean age of 17,234 participants was 73.4 years and 9888 (57.4%) of the participants were female. The LCA results indicated the number of participants in low SES, middle SES, and high SES groups were 7760, 8347, and 1127, respectively. Compared with the low SES group, the odds ratios (ORs) and 95% confidence intervals (CIs) for the association of BP control with middle SES and high SES were 1.101 (1.031, 1.175), and 1.492 (1.312, 1.696). This association was similarly found in the subsequent subgroup analyses (p < 0.05). Compared with low SES, our findings further suggested that BMI (indirect effects: 95% CIs: -0.004--0.001; p < 0.001) and WC (indirect effects: 95% CIs: -0.003--0.001; p = 0.020) play a suppressing role in the association between high SES and BP control. CONCLUSIONS: Our study indicated that the elderly hypertensive population with high SES may have a better result for BP control. However, we found that BMI/WC plays a suppressing role in this association. This indicated that despite the better BP control observed in elderly hypertensive populations with high SES, BMI and WC might undermine this beneficial relationship. Therefore, implementing strategies for obesity prevention is an efficient way to maintain this beneficial association between high SES and BP control.
Assuntos
Pressão Sanguínea , Índice de Massa Corporal , Hipertensão , Obesidade , Classe Social , Circunferência da Cintura , Humanos , Feminino , Hipertensão/epidemiologia , Masculino , Idoso , Obesidade/epidemiologia , China/epidemiologia , Idoso de 80 Anos ou mais , Fatores de Risco , Anti-Hipertensivos/uso terapêuticoRESUMO
Background: COVID-19 vaccine hesitancy has been cited as one of the main obstacles impacting vaccine coverage. However, factors that affect hesitancy may change over time. Understanding these evolving concerns and adapting strategies accordingly are crucial for effectively addressing vaccine hesitancy effectively and promoting public health. We aimed to explore the temporal changes in factors associated with COVID-19 VH during the COVID-19 pandemic and assess the dynamic evolution of VH. Methods: In August 2022 and February 2023, repeated online surveys were undertaken to collect information from 5378 adults across four regions of China. Multiple linear regression models assessed the influencing factors of COVID-19 VH. The association between protective motive theory (PMT) (perceived severity, susceptibility, benefits, barriers, and self-efficacy) and VH was evaluated by structural equation modeling (SEM). Results: Repeated measures showed that 573 (10.7%) and 1598 (29.7%) of the 5378 participants reported COVID-19 VH in the baseline and follow-up surveys, respectively. Educational levels, chronic disease, history of allergy, COVID-19 infection, and trust in medical staff and vaccine developers were positively associated with COVID-19 VH (Pï¼0.05). The application of SEM revealed that perceived severity, susceptibility, vaccination barriers, and self-efficacy in the PMT directly impacted on VH (Pï¼0.05). In addition, severity, susceptibility, benefits, and barriers had a significant direct effect on self-efficacy as ß = 0.113, ß = 0.070, ß = 0.722, ß = -0.516 respectively with P < 0.001. Conclusion: The prevalence of COVID-19 VH was relatively low in the baseline survey and much higher in the follow-up survey, with a significant increase in hesitancy rates among mainland Chinese residents. Acknowledging the substantial impact on the shaping of COVID-19 VH, one must consider factors including perceived severity, susceptibility, vaccination barriers, and self-efficacy.
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During the COVID-19 pandemic, the vaccine hesitancy has significantly affected the vaccination. To evaluate the booster vaccine hesitancy and its influencing factors among urban and rural residents, as well as to estimate the net difference of booster vaccine hesitancy between urban and rural residents. We conducted a nationwide, cross-sectional Internet survey on 1-8 February 2023, and employed stratified random sampling technique to select participants (≥18 years old) from urban and rural areas. Multivariate logistic regression was used to determine the factors impacting booster vaccine hesitancy. Propensity Score Matching was used to estimate the net difference of COVID-19 booster vaccine hesitancy between urban and rural residents. The overall COVID-19 booster vaccine hesitancy rate of residents was 28.43%. The COVID-19 booster vaccine hesitancy rate among urban residents was found to be 34.70%, among rural residents was 20.25%. Chronic diseases, infection status, vaccination benefits, and trust in vaccine developers were associated with booster vaccine hesitancy among urban residents. Barriers of vaccination were associated with booster vaccine hesitancy among rural residents. PSM analysis showed that the urban residents have a higher booster vaccine hesitancy rate than rural residents, with a net difference of 6.20%. The vaccine hesitancy rate increased significantly, and the urban residents have a higher COVID-19 booster vaccine hesitancy than rural residents. It becomes crucial to enhance the dissemination of information regarding the advantages of vaccination and foster greater trust among urban residents toward the healthcare system.
Assuntos
COVID-19 , População Rural , Humanos , Adolescente , COVID-19/epidemiologia , COVID-19/prevenção & controle , Estudos Transversais , Pandemias , Pontuação de Propensão , Hesitação Vacinal , VacinaçãoRESUMO
This study aimed to evaluate how the duration of travel affects the behavior of urban and rural residents regarding free COVID-19 vaccination, and provide scientific evidence for promoting free vaccination and building an immune barrier to cope with future epidemics. From August 3, 2022 to February,18,2023, A follow-up survey was conducted in urban and rural adults in four cities in China to collect information on socio-demographic factors, vaccination status and travel time for vaccination. Propensity score matching (PSM) analysis was deployed to measure the net difference of the enhanced vaccination rate between urban and rural residents in different traffic time distribution. A total of 5780 samples were included in the study. The vaccination rate of the booster dose of COVID-19 vaccine among rural residents was higher than that of urban residents with a significant P-value (69.36% VS 64.49%,p < .001). The traffic time had a significant negative impact on the COVID-19 booster vaccination behavior of urban and rural residents. There was a significant interaction between the travel time to the vaccination point and the level of trust in doctors. Travel time had a negative impact on the free vaccination behavior of both urban and rural residents. The government should optimize and expand the number of vaccination sites and enhance residents' trust in the medical system. This is crucial for promoting free vaccination and effective epidemic management in the future.
Assuntos
Vacinas contra COVID-19 , COVID-19 , Imunização Secundária , População Rural , Viagem , População Urbana , Humanos , Masculino , China , COVID-19/prevenção & controle , Feminino , Viagem/estatística & dados numéricos , População Urbana/estatística & dados numéricos , População Rural/estatística & dados numéricos , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/imunologia , Pessoa de Meia-Idade , Adulto , Imunização Secundária/estatística & dados numéricos , SARS-CoV-2/imunologia , Vacinação/estatística & dados numéricos , Vacinação/psicologia , Fatores de Tempo , Idoso , Adulto Jovem , Inquéritos e Questionários , População do Leste AsiáticoRESUMO
Objective: To evaluate the prevalence and influencing factors of long COVID, and measure the difference in health status between long COVID and non-long COVID cases. Methods: A cross-sectional survey was conducted from February 1 to 8, 2023, using a stratified random sampling method in four regions (eastern [Changzhou], central [Zhengzhou], western [Xining] and northeastern [Mudanjiang]) of China. The survey collected COVID-19 patients' socio-demographic characteristics and lifestyles information. The scores of lifestyles and health status range from 5 to 21 and 0 to 100 points, respectively. The criteria of "persistent health problems after 4 weeks of COVID-19 infection" issued by the US Centers for Disease Control and Prevention was used to assess long COVID. Multiple linear regression was used to analyze the influencing factors of the health. The bootstrap method was used to analyze the lifestyles' mediating effect. Propensity score matching (PSM) was used to evaluate the net difference in health scores between long COVID and non-long COVID cases. Results: The study included 3165 COVID-19 patients, with 308 (9.73%) long COVID cases. The health score of the long COVID cases (74.79) was lower than that of the non-long COVID cases (81.06). After adjusting for potential confounding variables, we found that never focused on mental decompression was a common risk factor for the health of both groups. Lifestyles was the mediating factor on individuals' health. After PSM, the non-long COVID cases' health scores remained higher than that of long COVID cases. Conclusion: The proportion of long COVID cases was low, but they were worse off in health. Given the positive moderating effect of healthy lifestyles on improving the health of long COVID cases, healthy lifestyles including mental decompression should be considered as the core strategy of primary prevention when the epidemic of COVID-19 is still at a low level.
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BACKGROUND: Optimal Corona Virus Disease 2019 (COVID-19) vaccination coverage is necessary to achieve community protection, and self-efficacy independently predict vaccination behavior. The current study examined the effect of self-perception on COVID-19 vaccination self-efficacy as well as potential mechanisms among Chinese adults. METHODS: A cross-sectional survey was conducted from four cities in China (n = 6781). Models 4 and 8 in Hayes' PROCESS macro were used to test models. RESULTS: Self-perception (ß = 0.128, 95 % CI: 0.093, 0.163) and self-perception ∗ mental health (ß = 0.009, 95 % CI: 0.003, 0.014) were positively associated with trust in doctors and vaccine developers, while mental health was negatively related to trust in doctors and vaccine developers (ß = -0.483, 95 % CI: -0.629, -0.337). Self-perception (ß = 0.149, 95 % CI: 0.138, 0.161), trust in doctors and vaccine developers (ß = 0.185, 95 % CI: 0.177, 0.194) and self-perception ∗ mental health (ß = 0.003, 95 % CI: 0.002, 0.005) were positively associated with COVID-19 vaccination self-efficacy. Mental health was negatively related to COVID-19 vaccination self-efficacy (ß = -0.101, 95 % CI: -0.151, -0.051). LIMITATIONS: This cross-sectional study collected data through online questionnaires. CONCLUSIONS: Our results demonstrated that the relationship between self-perception and COVID-19 vaccination self-efficacy was partially mediated by trust in doctors and vaccine developers. Both the correlation between self-perception and COVID-19 vaccination self-efficacy, and the relationship between self-perception and trust in doctors and vaccine developers were moderated by mental health. Findings confirm that increasing COVID-19 vaccination self-efficacy would be facilitated by improvements in self-perception, mental health, and trust in doctors and vaccine developers.