Direct medical costs of hospitalizations for cardiovascular diseases in Shanghai, China: trends and projections.

Few studies in China have focused on direct expenditures for cardiovascular diseases (CVDs), making cost trends for CVDs uncertain. Epidemic modeling and forecasting may be essential for health workers and policy makers to reduce the cost burden of CVDs.To develop a time series model using Box-Jenkins methodology for a 15-year forecasting of CVD hospitalization costs in Shanghai.Daily visits and medical expenditures for CVD hospitalizations between January 1, 2008 and December 31, 2012 were analyzed. Data from 2012 were used for further analyses, including yearly total health expenditures and expenditures per visit for each disease, as well as per-visit-per-year medical costs of each service for CVD hospitalizations. Time series analyses were performed to determine the long-time trend of total direct medical expenditures for CVDs and specific expenditures for each disease, which were used to forecast expenditures until December 31, 2030.From 2008 to 2012, there were increased yearly trends for both hospitalizations (from 250,354 to 322,676) and total costs (from US $ 388.52 to 721.58 million per year in 2014 currency) in Shanghai. Cost per CVD hospitalization in 2012 averaged US $ 2236.29, with the highest being for chronic rheumatic heart diseases (US $ 4710.78). Most direct medical costs were spent on medication. By the end of 2030, the average cost per visit per month for all CVDs was estimated to be US $ 4042.68 (95% CI: US $ 3795.04-4290.31) for all CVDs, and the total health expenditure for CVDs would reach over US $1.12 billion (95% CI: US $ 1.05-1.19 billion) without additional government interventions.Total health expenditures for CVDs in Shanghai are estimated to be higher in the future. These results should be a valuable future resource for both researchers on the economic effects of CVDs and for policy makers.

Effect of ambient temperature on emergency department visits in Shanghai, China: a time series study.

BACKGROUND: Many studies have examined the association between ambient temperature and mortality. However, less evidence is available on the temperature effects on gender- and age-specific emergency department visits, especially in developing countries. In this study, we examined the short-term effects of daily ambient temperature on emergency department visits (ED visits) in Shanghai. METHODS: Daily ED visits and daily ambient temperatures between January 2006 and December 2011 were analyzed. After controlling for secular and seasonal trends, weather, air pollution and other confounding factors, a Poisson generalized additive model (GAM) was used to examine the associations between ambient temperature and gender- and age-specific ED visits. A moving average lag model was used to evaluate the lag effects of temperature on ED visits. RESULTS: Low temperature was associated with an overall 2.76% (95% confidence interval (CI): 1.73 to 3.80) increase in ED visits per 1°C decrease in temperature at Lag1 day, 2.03% (95% CI: 1.04 to 3.03) and 2.45% (95% CI: 1.40 to 3.52) for males and females. High temperature resulted in an overall 1.78% (95% CI: 1.05 to 2.51) increase in ED visits per 1°C increase in temperature on the same day, 1.81% (95% CI: 1.08 to 2.54) among males and 1.75% (95% CI: 1.03 to 2.49) among females. The cold effect appeared to be more acute among younger people aged <45 years, whereas the effects were consistent on individuals aged ≥65 years. In contrast, the effects of high temperature were relatively consistent over all age groups. CONCLUSIONS: These findings suggest a significant association between ambient temperature and ED visits in Shanghai. Both cold and hot temperatures increased the relative risk of ED visits. This knowledge has the potential to advance prevention efforts targeting weather-sensitive conditions.

Ambient air pollution and hospital admission in Shanghai, China.

No prior studies exist in Mainland China examining the association of outdoor air pollution with hospital admissions. In this study, we conducted a time-series analysis to examine the association of outdoor air pollutants (PM(10), SO(2), and NO(2)) with both total and cause-specific hospital admission in Shanghai, using three years of daily data (2005-2007). Hospital admission and air pollution data were collected from the Shanghai Health Insurance Bureau and Shanghai Environmental Monitoring Center. Natural spline model was used to analyze the data. We found outdoor air pollution was associated with increased risk of total and cardiovascular hospital admission in Shanghai. The effect estimates of air pollutants varied by lag (L) structures of pollutants' concentrations. For lag 5, a 10 microg/m(3) increase in concentration of PM(10), SO(2) and NO(2) corresponded to 0.18% (95% CI: -0.15%, 0.52%), 0.63% (95% CI: 0.03%, 1.23%), and 0.99% (95% CI: 0.10%, 1.88%) increase of total hospital admission; and 0.23% (95% CI: -0.03%, 0.48%), 0.65% (95% CI: 0.19%, 1.12%), and 0.80% (95% CI: 0.10%, 1.49%) increase of cardiovascular hospital admission. The associations appeared to be more evident in the cool season (from November to April) than in the warm season (from May to October). We found significant effects of gaseous pollutants (SO(2) and NO(2)) after adjustment for PM(10). Our analyses provide the first evidence in China that the current air pollution level has an effect on hospital admission and strengthen the rationale for further limiting air pollution levels in Shanghai.

Association of ambient air pollution with hospital outpatient and emergency room visits in Shanghai, China.

Few studies exist in China examining the association of ambient air pollution with morbidity outcomes. We conducted a time-series analysis to examine the association of outdoor air pollutants (PM(10), SO(2), and NO(2)) with hospital outpatient and emergency room visits in Shanghai, China, using 3 years of daily data (2005-2007). Hospital and air pollution data were collected from the Shanghai Health Insurance Bureau and Shanghai Environmental Monitoring Center. Using a natural spline model, we examined effect of air pollutants with different lag structures including both single-day lag and multi-day lag. We examined effects of air pollution for the warm season (from April to September) and cool season (from October to March) separately. We found outdoor air pollution (SO(2) and NO(2)) was associated with increased risk of hospital outpatient and emergency room visits in Shanghai. The effect estimates varied for different lag structures of pollutants' concentrations. For lag 3, a 10 microg/m(3) increase in concentration of PM(10), SO(2) and NO(2) corresponded to 0.11% (95%CI: -0.03%, 0.26%), 0.34% (95%CI: 0.06%, 0.61%) and 0.55% (95%CI: 0.14%, 0.97%) increase of outpatient visit; and 0.01% (95%CI: -0.09%, 0.10%), 0.17% (95%CI: 0.00%, 0.35%) and 0.08% (95%CI: -0.18%, 0.33%) increase of emergency room visit. The associations appeared to be more evident in the cool season than in the warm season. In conclusion, short-term exposure to outdoor air pollution was associated with increased risk of hospital outpatient and emergency room visits in Shanghai. Our analyses provide evidence that the current air pollution level has an adverse health effect and strengthen the rationale for further limiting air pollution levels in the city.