Workforce Participation and Mortality Risk Among Chinese Older Adults: A Nationwide Population-Based Prospective Study.

OBJECTIVES: This study examines the association between workforce participation and mortality among Chinese older adults. METHODS: 6,138 participants aged 60 and older from the 2011 to 2018 China Health and Retirement Longitudinal Study were studied and 79.5% of the sample were rural Hukou. Cox proportional hazard models were used to estimate hazard ratios (HRs) for the associations of work status, work types, and changes in work status with all-cause mortality. Cox models with penalized splines were performed to explore the dose-response relationship for hours worked per week and mortality. RESULTS: 37,235.3 person-years observed 1,165 deaths (19.0%). Working reduced the mortality risk in older adults by 41% compared with those who did not work (HR: 0.59, 95% confidence interval: 0.50-0.69). This effect was consistent across subgroups. The mortality risk was lowest among self-employed older adults, followed by nonagricultural employment and then agricultural work, with adjusted HRs of (0.38, 0.21-0.70), (0.58, 0.36-0.93), and (0.61, 0.51-0.72), respectively. The mortality risk decreased with increasing hours of work per week and appeared to reach a threshold of about 45 hr of work per week. Compared with the older adults who continuously did not work, those who started and kept working had 28% (0.72, 0.53-0.97) and 48% (0.52, 0.41-0.65) lower mortality risks, respectively. When older adults transitioned from working to not working, the mortality risk would no longer be significantly different from that of older adults who were continuously not working (0.86, 0.65-1.12, p = 0.3). DISCUSSION: Workforce participation was associated with survival benefits among older adults in China.

Trends in the availability of community-based home visiting services for oldest-old in China, 2005-2018.

OBJECTIVES: This study aims to examine trends in neighbourhood availability of community-based home visiting services (CHVS) (ie, coverage by local primary healthcare providers) over time and disparities in service availability according to individual characteristics using nationwide data of oldest-old individuals (age >80) in China. DESIGN: Repeated, cross-sectional study. SETTING: This study derived nationally representative data from the 2005-2018 Chinese Longitudinal Health Longevity Survey. PARTICIPANTS: A final analytical sample of 38 032 oldest-old individuals. PRIMARY OUTCOME MEASURES: Availability of CHVS was defined as having home visiting services in one's neighbourhood. Cochran-Armitage tests were used to test linear trends in the proportions of oldest-old with service availability. Weighted logistic regression models were used to examine variations in service availability across individual characteristics. RESULTS: Of 38 032 oldest-old individuals, availability of CHVS decreased from 9.7% in 2005 to 7.8% in 2008/2009, followed by continual increases to 33.7% in 2017/2018. These changes were similar between rural and urban oldest-old. After accounting for individual characteristics, in 2017/2018, compared with their counterparts, urban residents who had white-collar jobs before retirement and those residing in Western and Northeast China were less likely to have service availability. Oldest-old with disabilities, those living alone and those with low incomes did not report having greater availability of CHVS in either 2005 or 2017/2018. CONCLUSIONS: Despite the increasing service availability over the past 13 years, persistent geographical disparities in the availability of CHVS remain. As of 2017/2018, only one in three oldest-old in China reported having service availability, which raises concerns regarding continuity of care across different settings of services for those most in need, especially those living alone or with disabilities. National policies and targeting efforts are necessary to improve the availability of CHVS and reduce inequity in service availability for optimal long-term care to the oldest-old population in China.

Digital Inclusion, Cultural Capital, and Health Status of Urban and Rural Residents: An Empirical Study Based on 2017 CGSS Database.

China is committed to using digital technology to drive urban-rural integration in health care. This study aims to explore the effect of digital inclusion on health status with the mediating role of cultural capital and the digital health disparities between urban and rural residents in China. Using data from the 2017 Chinese General Social Survey (CGSS), the present study adopted an ordinary least squares (OLS) robust standard error regression model to investigate the impact of digital inclusion on health status. In addition, causal step regression (CSR) and bootstrapping methods were combined to test the mediating effect of cultural capital. The results showed that, first, digital inclusion was related to positive and significant effects on resident health status. Second, cultural capital played a mediating role in the relationship between digital inclusion and health status. Third, urban residents gained more health benefits from digital inclusion than rural residents. Additionally, common method variance (CMV) tests, endogenous tests, and a propensity score matching (PSM) analysis showed that the above conclusions remained robust. The government should therefore focus not only on promoting the population's health by utilizing digital inclusion but also on accelerating digital health equity between urban and rural areas by developing such strategies as a digital infrastructure expansion schedule and digital literacy education and training programs.

Association of rurality, type of primary caregiver and place of death with end-of-life medical expenditures among the oldest-old population in China.

BACKGROUND: Understanding whether the type of primary caregiver and end-of-life (EOL) care location are associated with EOL medical expenditures is crucial to inform global debates on policies for efficient and effective EOL care. This study aims to assess trends in the type of primary caregiver and place of death stratified by rural‒urban status among the oldest-old population from 1998-2018 in China. A secondary objective is to determine the associations between rurality, the type of primary caregiver, place of death and EOL medical expenditures.  METHODS: A total of 20,149 deaths of people aged 80 years or older were derived from the Chinese Longitudinal Health Longevity Survey (CLHLS). Cochran-Armitage tests and Cuzick's tests were used to test trends in the type of primary caregiver and place of death over time, respectively. Tobit models were used to estimate the marginal associations of rurality, type of primary caregiver, and place of death with EOL medical expenditures because CLHLS sets 100,000 Chinese yuan (approximately US$15,286) as the upper limit of the outcome variable.  RESULTS: Of the 20,149 oldest-old people, the median age at death was 97 years old, 12,490 (weighted, 58.6%, hereafter) were female, and 8,235 lived in urban areas. From 1998-2018, the prevalence of informal caregivers significantly increased from 94.3% to 96.2%, and home death significantly increased from 86.0% to 89.5%. The proportion of people receiving help from informal caregivers significantly increased in urban decedents (16.5%) but decreased in rural decedents (-4.0%), while home death rates significantly increased among both urban (15.3%) and rural (1.8%) decedents. In the adjusted models, rural decedents spent less than urban decedents did (marginal difference [95% CI]: $-229 [$-378, $-80]). Those who died in hospitals spent more than those who died at home ($798 [$518, $1077]). No difference in medical expenditures by type of primary caregiver was observed. CONCLUSIONS: Over the past two decades, the increases in informal caregiver utilization and home deaths were unequal, leading to substantially higher EOL medical expenditures among urban decedents and deceased individuals who died at hospitals than among their counterparts who lived in rural areas and died at home.

Medical expenditure and its inequity for people with disabilities: Evidence from the CHARLS 2018 data.

Introduction: Disabilities may raise heavy medical expenses and rich-poor inequalities. However, data is lacking for the Chinese older populations. This study aimed to measure socioeconomic inequalities in medical expenses amongst the Chinese adult 45 years or older, and explored the main determinants among different disability categories. Method: Data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) were used. Disabilities were divided into five categories: physical disabilities, intellectual disability, vision problems, hearing problems, and multiple disabilities. The two-part model was employed to identify the factors that are associated with medical expenditures. Socioeconomic inequalities were measured by the concentration index (CI), and the horizontal inequity index (HI) which adjusts for health needs. Decomposition analysis was further applied to evaluate the contribution of each determinant. Results: Two thousand four hundred nineteen people were included in this study. The CIs and HIs of the expenditure were both positive. Amongst the varied types of medical expenses, the highest CIs were found for self-treatment expenses (0.0262). Amongst the five categories of disabilities, the group with vision problem disability reported the highest CIs and HIs for outpatient expenses (CI = 0.0843, HI = 0.0751), self-treatment expenses (CI = 0.0958, HI = 0.1119), and total expenses (CI = 0.0622, HI = 0.0541). The group of intellectual disability reported the highest CI and HI (CI = 0.0707, HI = 0.0625). The decomposition analysis showed that income (80.32%), education (25.14%) and living in the rural areas (13.96%) were the main determinants of medical expenses for HI amongst all types of disabilities. Conclusion: For five types of disabilities, our data shows that medical expenses concentrated in the richer groups in China. Income, education, and rural areas factors were the main contributors to the economic-related inequalities. Health policies to improve the affordability of medical care are needed to decrease inequity of medical expenditures for people with disabilities.

The influencing factors of discrimination against recovered Coronavirus disease 2019 (COVID-19) patients in China: a national study.

BACKGROUND: Over 26 million recovered COVID-19 patients will suffer from discrimination in work, education and social interactions. We analyzed the determinants of discrimination against recovered COVID-19 patients and suggest policy recommendations to reduce such discrimination. METHODS: Twenty-seven Chinese cities were selected randomly based on their geographical location and GDP rank. One hundred adults were interviewed in each city with an equal number of men and women and three urban residents for every two rural residents. A multiple ordered logistic regression model was used to assess the associations between potential determinants and the COVID-19 discrimination level. RESULTS: Of 2377 participants, 79.76% displayed discrimination toward recovered COVID-19 patients. The female discrimination level was 1.25 times that of males; the discrimination level increased with age; and was occupation-specific, with physicians' (OR = 0.352) and students' (OR = 0.553) discrimination level lower than that of farmers. The discrimination level of participants from the central regions was 1.828 times, and the eastern region 1.504 times, that of participants from western region. The participants' discrimination level was lower when they scored higher in transmission knowledge, prevention knowledge and other COVID-19 knowledge, treatment methods and quarantine time. CONCLUSION: Sex, age, occupation, infections of relatives and friends, regions and scores on COVID-19 knowledge were determinants of discrimination level against recovered COVID-19 patients. In contrast with qualitative studies, our quantitative study recommends targeted education campaigns, focusing on physicians, women, older people and certain occupations. Only the COVID-19 vaccination program for the whole population will resolve the COVID-19 discrimination problem.

Corrigendum: Influence of lecithin cholesterol acyltransferase alteration during different pathophysiologic conditions: A 45 years bibliometrics analysis.

[This corrects the article DOI: 10.3389/fphar.2022.1062249.].

Influence of lecithin cholesterol acyltransferase alteration during different pathophysiologic conditions: A 45 years bibliometrics analysis.

Background: Lecithin cholesterol acyltransferase (LCAT) is an important enzyme responsible for free cholesterol (FC) esterification, which is critical for high density lipoprotein (HDL) maturation and the completion of the reverse cholesterol transport (RCT) process. Plasma LCAT activity and concentration showed various patterns under different physiological and pathological conditions. Research on LCAT has grown rapidly over the past 50 years, but there are no bibliometric studies summarizing this field as a whole. This study aimed to use the bibliometric analysis to demonstrate the trends in LCAT publications, thus offering a brief perspective with regard to future developments in this field. Methods: We used the Web of Science Core Collection to retrieve LCAT-related studies published from 1975 to 2020. The data were further analyzed in the number of studies, the journal which published the most LCAT-related studies, co-authorship network, co-country network, co-institute network, co-reference and the keywords burst by CiteSpace V 5.7. Results: 2584 publications contained 55,311 references were used to analyzed. The number of included articles fluctuated in each year. We found that Journal of lipid research published the most LCAT-related studies. Among all the authors who work on LCAT, they tend to collaborate with a relatively stable group of collaborators to generate several major authors clusters which Albers, J. published the most studies (n = 53). The United States of America contributed the greatest proportion (n = 1036) of LCAT-related studies. The LCAT-related studies have been focused on the vascular disease, lecithin-cholesterol acyltransferase reaction, phospholipid, cholesterol efflux, chronic kidney disease, milk fever, nephrotic syndrome, platelet-activating factor acetylhydrolase, reconstituted lpa-i, reverse cholesterol transport. Four main research frontiers in terms of burst strength for LCAT-related studies including "transgenic mice", "oxidative stress", "risk", and "cholesterol metabolism "need more attention. Conclusion: This is the first study that demonstrated the trends and future development in LCAT publications. Further studies should focus on the accurate metabolic process of LCAT dependent or independent of RCT using metabolic marker tracking techniques. It was also well worth to further studying the possibility that LCAT may qualify as a biomarker for risk prediction and clinical treatment.

Evaluation of the quality of contracted family doctor services based on patient perceptions and expectations: a follow-up analysis from the elderly with chronic diseases in rural Jiangsu, China.

INTRODUCTION: The policy focus of contracted family doctor services (CFDS) has been shifting to improve quality and efficiency in China. The study's objective was to establish a quality evaluation scale for CFDS based on the perceived service quality model and to assess the service quality from the perspective of patient perceptions and expectations. METHODS: Data were obtained from a 2-year follow-up survey of CFDS in Jiangsu, China. A total of 1264 elderly people with chronic diseases were tracked. The self-developed scale was designed based on the perceived service quality model. The product scale method was used to assign weighted values, the Wilcoxon signed-rank test was used to compare the differences over the 2 years, and pooled cross-sectional regression was conducted to evaluate the associated factors with the gap scores of service quality. RESULTS: There were significant differences between perceptions and expectations in each dimension in the 2 years (p<0.05), and the service quality gaps existed. Over the 2 years, Accessibility and Horizontal continuity were the first-ranked and second-ranked in expectations; the top three scores in perception were Horizontal continuity, Comprehensive service and Accessibility dimensions. The service quality gap in 2020 was smaller than that in 2019 (p<0.05). There were differences in the perception scores in the Vertical continuity, Technical and Economic dimensions and in the expectation scores in the Horizontal continuity, Vertical continuity and Technical dimensions between the 2 years (p<0.05). The factors that were significantly associated with each dimension score included the Jiangsu region, gender, age and education levels (p<0.05). CONCLUSION: The quality evaluation scale of CFDS has good reliability and validity. Policy efforts should be focused on accelerating the development of medical alliances, optimising medical insurance policies and improving the capacity of family doctor services to meet the needs of the elderly with chronic diseases.

Two-year impact of an educational intervention in primary care on blood glucose control and diabetes knowledge among patients with type 2 diabetes mellitus: a study in rural China.

Background: Type 2 diabetes mellitus is increasing in rural China and should be managed in primary health care, but knowledge is lacking. Educational interventions have been implemented but not followed up long-term.Objective: The study aimed to assess the long-term impact of an educational intervention on patients' diabetes knowledge and fasting blood glucose (FBG) level, and whether these outcomes differed between two rural counties.Methods: The study was nested in an educational intervention project in primary health care in Jiangsu province. Patients with type 2 diabetes mellitus from Huaiyin county and Gaochun county were randomly divided into an intervention group receiving an educational intervention and follow-up visits, and a control group with standard care. Questionnaires and medical records, including FBG level and diabetes knowledge score, were compared, at baseline in 2015 and two follow-ups, in 2016, and 2017, respectively. A paired t-test and two mixed-effects linear regression models were used.Results: The diabetes knowledge score increased in the intervention group in 2016 and in 2017, compared with 2015. The FBG level decreased in 2016 compared with 2015 in the intervention and control groups. Comparing data in 2015 and 2017, there was no significant change in FBG level in the intervention or control group, but the diabetes knowledge score increased in the intervention group both in 2016 and 2017. A significant association between FBG level and the interaction of time and group, suggesting a long-term effect, was only found in Gaochun county in 2017.Conclusion: The educational intervention improved the diabetes knowledge score in the intervention group, while no significant improvement was found in the control group in both year 2016 and 2017. Meanwhile, the intervention had a positive impact on FBG level in the intervention group in 2017. Patients in Gaochun county had better improvement in both diabetes knowledge and controlling FBG level, compared with Huaiyin county.

Prevalence and coprevalence of modifiable risk factors for upper digestive tract cancer among residents aged 40-69 years in Yangzhong city, China: a cross-sectional study.

OBJECTIVES: To describe the prevalence of modifiable risk factors for upper digestive tract cancer (UDTC) and its coprevalence, and investigate relevant influencing factors of modifiable UDTC risk factors coprevalence among residents aged 40-69 years in Yangzhong city, China. DESIGN: Cross-sectional study. PARTICIPANTS: A total of 21 175 participants aged 40-69 years were enrolled in the study. 1962 subjects were excluded due to missing age, marital status or some other selected information. Eventually, 19 213 participants were available for the present analysis. MAIN OUTCOMES MEASURES: Prevalence and coprevalence of eight modifiable UDTC risk factors (overweight or obesity, current smoking, excessive alcohol consumption, insufficient vegetables intake, insufficient fruit intake and the consumption of pickled, fried and hot food) were analysed. RESULTS: The prevalence of overweight/obesity, current smoking, excessive alcohol consumption, insufficient vegetables intake, insufficient fruit intake and the consumption of pickled, fried and hot food in this study was 45.3%, 24.1%, 16.2%, 66.1%, 94.5%, 68.1%, 36.0% and 88.4%, respectively. Nearly all (99.9%) participants showed one or more UDTC risk factors, 98.6% of the participants showed at least two risk factors, 92.2% of the participants had at least three risk factors and 69.7% of the participants had four or more risk factors. Multivariate logistic regression analysis revealed that men, younger age, single, higher education, higher annual family income and smaller household size were more likely to present modifiable UDTC risk factors coprevalence. CONCLUSIONS: The prevalence and coprevalence of modifiable UDTC risk factors are high among participants in Yangzhong city. Extra attention must be paid to these groups who are susceptible to risk factors coprevalence during screening progress. Relative departments also need to make significant public health programmes that aim to decrease modifiable UDTC risk factors coprevalence among residents aged 40-69 years from high-risk areas of UDTC.

A cohort study on risk factors of high-density lipoprotein cholesterol hypolipidemia among urban Chinese adults.

BACKGROUND: High-density lipoprotein cholesterol (HDL-C) hypolipidemia, a major type of dyslipidemia, has been associated with many kinds of diseases, such as stroke, coronary heart disease, obesity and diabetes, and has displayed an increasing prevalence in China. This study explores the risk factors of HDL-C hypolipidemia and makes recommendations for controlling and preventing HDL-C hypolipidemia and the diseases caused by it. METHODS: Using a retrospective cohort study design, 26,863 urban adults without dyslipidemia, diabetes, cardiovascular and cerebrovascular diseases, hepatosis, renal insufficiency and thyroid diseases were enrolled in the study between 2010 and 2015. Data on each individual were collected at the 2010 baseline year and at a follow-up medical check. A Cox regression model was constructed to evaluate the influence of potential risk factors on the outcome event- HDL-C hypolipidemia. RESULTS: The incidence of HDL-C hypolipidemia was 5.7% (1531/26863). Sex, age, body mass index (BMI), HDL-C, triglyceride (TG) and urea nitrogen (UN) were significant risk factors of HDL-C hypolipidemia. Men were more likely to develop HDL-C hypolipidemia than women during follow-up medical checks (HR = 1.258, P = 0.014). The incidence of HDL-C hypolipidemia in the over 65 years old group was higher than that of the ≤65 age group (HR = 1.276, P = 0.009). The incidence of HDL-C hypolipidemia increased with increasing BMI (HR = 1.030, P = 0.002), TG (HR = 1.321, P = 0.001) and UN (HR = 1.054, P = 0.019), while falling with increasing HDL-C in the baseline year (HR = 0.002, P < 0.001). CONCLUSIONS: Men, aged over 65, with high BMI were at the highest risk of developing HDL-C hypolipidemia. Measures should be taken to prevent HDL-C hypolipidemia even for healthy urban adults whose blood biochemical indicators were in the normal range when their level of TG, UN and HDL-C are closed to the border of the normal value range.

Impact of an educational intervention in primary care on fasting blood glucose levels and diabetes knowledge among patients with type 2 diabetes mellitus in rural China.

OBJECTIVE: To assess the impact of an educational intervention for type 2 diabetes mellitus (T2DM) in primary care in rural China, on fasting blood glucose (FBG) level and diabetes knowledge. METHODS: Patients with T2DM (n = 1,589) in 18 township health centres in three counties in Jiangsu Province were randomly divided into an intervention group receiving educational intervention and follow-up visits, and a control group with standard care. Questionnaires and medical records, including FBG level and diabetes knowledge score, were compared, at baseline and follow-up. Propensity score matching and Difference-in-Difference analysis were used. RESULTS: The FBG level decreased significantly in the intervention group compared to the control group, DID=-0.53 mmol/l, (CI95 % -0.90 to -0.16). The diabetes knowledge score increased significantly in the intervention group compared to the control group, DID = 0.91, (CI95 % 0.64-1.18). The FBG level and diabetes knowledge score improved significantly in the intervention group in all counties. CONCLUSIONS: The educational intervention and increased collaboration between hospitals and primary care improved the FBG level and diabetes knowledge score in the intervention group compared to the control group after one year. PRACTICE IMPLICATIONS: Educational intervention and increased collaboration between hospitals and primary care may improve diabetes care in rural China.

Stronger Increases in Cognitive Functions among Socio-Economically Disadvantaged Older Adults in China: A Longitudinal Analysis with Multiple Birth Cohorts.

Highly variable changes in cognitive functions occur as people get older, and socio-economically disadvantaged older adults are more likely to suffer from cognitive decline. This study aims to identify the longitudinal trend in cognitive functions among different socio-economic groups of older adults. The Chinese Longitudinal Healthy Longevity Survey (CLHLS) followed up 32,323 individuals aged 65 years and older over a 12-year period. A series of mixed-effects models was used to explicitly assess cohort trend and its socio-economic disparity in the cognitive functions of older adults. Scores for significant increase in cognitive functions by birth cohort were smaller by 0.49, 0.28, and 0.64 among older adults with more educational experience, a lower household income, or economic dependence relative to their counterparts. Scores for differences in cognitive function between older adults with higher and lower incomes were smaller by 0.46 among those living in urban areas than among those living in rural areas. Although there were larger cohort growth trends in cognitive functions among older adults with lower educational attainment, lower household income, and who were economically dependent, effective public intervention targeting these socio-economically disadvantaged populations is still necessary.

Shifting the Care of Type 2 Diabetes Mellitus from Hospital to Primary Health Care Institutions through an Educational Intervention for Health Care Professionals: An Example from Rural China.

This study assessed the impact of an educational intervention on the knowledge, attitudes, and practice regarding Type 2 Diabetes Mellitus (T2DM) of Primary Health Care (PHC) professionals, as well as on the types of T2DM care services which they were able to provide. The intervention was carried out in collaboration with county hospitals. The study was conducted from 2015 to 2016 among 241 health care professionals in 18 township health centers and 55 village clinics in three counties in Jiangsu Province, randomly divided into an intervention group and a control group. Participants in the intervention group received professional skills training sessions and team communication and were involved in regular meetings. The control group followed the routine work plan. At one-year follow up, the diabetes knowledge score, practice score, and attitudes score were significantly higher in the intervention group than in the control group. A significantly higher proportion of health care professionals in the intervention group was able to provide services compared with the control group, for all types of services, except T2DM emergency treatment. The intervention among health care professionals in PHC had a positive impact on their professional diabetes skills, knowledge, attitudes, practices, and types of services they were able to provide, at one-year follow-up.

Socioeconomic disparities in leisure activities over the life course of the oldest-old in China.

OBJECTIVE: To identify the socioeconomic factors leading to disparities in participation in leisure activities over the life course among Chinese oldest-old people. METHODS: Data are from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a sample of adults aged 80 years or older in the period 1998-2012, featuring 38 312 individuals (58 945 observations). RESULTS: The younger birth cohorts were found to have significantly higher levels of participation in leisure activities, with a non-linear decrease in age observed for oldest-old men and women. Higher participation levels were significantly related to higher education levels, economic independence and non-manual occupations before retirement among the Chinese oldest-old. CONCLUSIONS: Leisure activity participation has increased substantially in recent cohorts of Chinese oldest-olds. Those with lower socioeconomic status may represent a disadvantaged population in terms of participation in leisure activities over their life course.

Differential Impact of an Education-Based Intervention for Patients with Type 2 Diabetes Mellitus in Rural China.

The study aimed to assess the impact of an education-based intervention to improve vertical integration and management of type 2 diabetes mellitus in primary care in rural China. Patients with type 2 diabetes mellitus in three townships in Jingjiang county, Jiangsu Province were randomly divided into intervention and control groups. Participants in the intervention group received an education-based intervention. Patients' data including the fasting blood glucose (FBG) level, health-related quality of life (HRQoL), and sociodemographic characteristics were collected at baseline (2015) and follow-up (2016). The FBG levels decreased significantly in the intervention group compared to the control group in the overall analysis. In the stratified analysis, FBG levels and some aspects of HRQoL improved in the intervention group more for females, married persons, those with low education, and those in farming or house working. Participants in the control group deteriorated in FBG levels but improved in some aspects of HRQoL. The intervention improved in FBG levels and some aspects of HRQoL among participants. Furthermore, the intervention seemed to differentially benefit females, married persons, lowly educated persons, and those in farming or house working more than other groups. (Trial registration: ISRCTN, ISRCTN13319989. Retrospectively registered 4 April 2017).

Vertical integrated service model: an educational intervention for chronic disease management and its effects in rural China - a study protocol.

BACKGROUND: Chronic diseases are becoming a huge threat to the Chinese health system. Although the New Round of Medical Reform aims to improve this, the chronic disease management in rural China is still worrying as it relies highly on hospital care instead of primary care. The vertical integrated care model has proven to be effective for chronic disease patients in many high-income countries, while few studies have been conducted in China. In this project, vertical integrated care will be applied to optimize the care of patients with type 2 diabetes mellitus (T2DM) and primary hypertension in rural China, and to shift the care from hospital to primary care. METHODS: An educational intervention was conducted in three pilot counties in Jiangsu province, a high-income province in southeast China. The intervention was based on the model of vertical integrated care between the three-levels of healthcare institutions. In the pilot counties, 22 townships were included (11 in the intervention and control groups, respectively). Service teams assembled by the local health bureaus implemented the intervention which provides services for both patients and healthcare professionals. Questionnaire interviews (n = 4259) and medical records were used to collect patient data (physiological measures, health-related quality of life, satisfaction with care). Data from healthcare professionals (n = 282) was gathered through questionnaires and in-depth interviews (knowledge about chronic diseases, general procedure of diagnosing and registering, chronic disease management situation, perceptions of chronic disease treatment and prevention). Baseline data were collected before the start of the intervention in Nov 2015, follow-up data in Oct-Nov 2016, and final data completed in Jul-Aug 2017. DISCUSSION: The intervention has been conducted smoothly and gotten support from patients, healthcare institutions and local health authorities. The research team anticipates that the vertical integrated model will improve patients' health, satisfaction with care, and their understanding of their chronic disease. We also anticipate that healthcare professionals can acquire more information about chronic diseases and improve their strategy for providing good quality care for patients. TRIAL REGISTRATION: ISRCTN13319989 Registration date: 4th April, 2017.

Socioeconomic disparities in abdominal obesity over the life course in China.

BACKGROUND: Abdominal obesity has become an important public health issue in China. Socioeconomic disparities are thought to be closely related to the prevalence of abdominal obesity. Exploring socioeconomic disparities in abdominal obesity over the life course in China could inform the design of new interventions to prevent and control abdominal obesity. METHODS: The China Health and Nutrition Survey (CHNS) was a prospective household-based study involving seven rounds of surveys between 1993 and 2011. Twenty three thousand, two hundred and forty-three individuals were followed up over an 18-year period. The mixed effects models with random intercepts were used to assess the effects on abdominal obesity. Six key socioeconomic indicators, with age and age-squared added to the models, were used to identify socioeconomic disparities in abdominal obesity over the adult life course. RESULTS: Prevalence of abdominal obesity increased non-linearly with age over the adult life course. Abdominal obesity was more prevalent in younger than older birth cohorts. Positive period effects on the prevalence of abdominal obesity were substantial from 1993 to 2011, and were stronger among males than females. Prevalence of abdominal obesity was higher among ethnic Han Chinese and among the married [coefficient (95% confidence intervals): 0.03(0.003, 0.057) and 0.035(0.022, 0.047), respectively], and was lower among males [coefficient (95% confidence intervals): - 0.065(- 0.075,-0.055)]. A higher-level of urbanization and higher household income increased the probability of abdominal obesity [coefficient (95% confidence intervals): 0.160(0.130, 0.191), 3.47E- 4 (2.23E- 4, 4.70E- 4), respectively], while individuals with more education were less likely to experience abdominal obesity [coefficient (95% confidence intervals): - 0.222 (- 0.289, - 0.155)] across adulthood. CONCLUSIONS: In China, abdominal obesity increased substantially in more recent cohorts. And people with lower educational attainment, with higher household income, or living in more urbanized communities may be the disadvantaged population of abdominal obesity over the adult life course. Effective interventions targeting the vulnerable population need to be developed.