Association of sensory impairment with healthcare use and costs among middle-aged and older adults in China.

OBJECTIVES: This study aimed to explore the association of visual, hearing, or dual sensory impairment with healthcare use and costs. STUDY DESIGN: This is a cohort study. METHODS: These research data were from the China Health and Retirement Longitudinal Study spanning 2011-2018 and included 8982 community-dwelling middle-aged and older adults (aged ≥45 years at baseline). Sensory impairment was measured according to self-reported assessment of visual and hearing functions, and healthcare use and costs were ascertained via self-report. The associations of sensory impairment with healthcare use and costs were estimated using the mixed-effects regression models. RESULTS: Of the 8982 respondents, 4346 (48.39%) were females and their mean (standard deviation) age at baseline was 57.03 (8.26) years. Individuals with hearing impairment (HI) only, visual impairment (VI) only, and dual sensory impairment (DSI) were all at significantly higher risks of healthcare use and catastrophic health expenditure than those without sensory impairment (all P < 0.05), except that VI only non-significantly prolonged inpatient days. Compared with no impairment, DSI was associated with increases in outpatient (ß = 50.67, 95% confidence interval [CI] = 17.47-83.86) and inpatient out-of-pocket costs (ß = 40.35, 95% CI = 5.94-74.76), while VI only or HI only did not show significant effects. Further stratification analyses indicated that the associations between sensory impairment and outpatient use were more pronounced among males than among females but that age group did not moderate the associations with any healthcare outcomes. CONCLUSIONS: HI and VI were independently and together associated with higher risks of healthcare use and catastrophic health expenditure. Dual sensory impairment was the only category consistently associated with increased outpatient and inpatient costs.

An evolutionary analysis of low-carbon technology investment strategies based on the manufacturer-supplier matching game under government regulations.

Developing a low-carbon economy is the only way for countries to achieve sustainable development. Carbon emission reduction policies and low-carbon technology (LCT) innovation play key roles in developing low-carbon economy. Under government reward and punishment regulations, based on the bilateral matching and evolutionary theories, this paper constructs an evolution model consisting of a manufacturer investing LCT and a supplier offering LCT to analyze multi-phase LCT investment strategies. Firstly, the profit optimization model of a green supply chain is constructed from the perspectives of centralized-matching (CM), decentralized-matching (DM), and mismatching (MM), and the spatial information internal evolution law of multi-phase LCT investment is described by the Markov chain. Then, a bilateral matching algorithm is proposed to solve the equilibrium solutions, and the evolution process of the three modes is analyzed by numerical simulation. Finally, based on the product green degree, we analyze the impact of subsidies and taxes on investment-production decisions. Analytical results show that the matching mechanism proposed in this paper can help supply chain firms to obtain stable matching and has a significant effect on the realization of "triple wins" of society, economy, and environment. The investment utility of CM is higher than that of DM and MM. Manufacturers are inclined to adopt LCT, and the investment level tends to be stable over time. Government reward and punishment regulations are helpful to motivate supply chain firms to invest in LCT, and the synergistic effect of subsidies and taxes is better than that of a single policy.

Catastrophic Health Expenditure Associated With Frailty in Community-Dwelling Chinese Older Adults: A Prospective Cohort Analysis.

Background: Catastrophic health expenditure (CHE) represents a key indicator for excessive financial burden due to out-of-pocket (OOP) healthcare costs, which could push the household into poverty and is highly pronounced in households with members at an advanced age. Previous studies have been devoted to understanding the determinants for CHE, yet little evidence exists on its association with frailty, an important geriatric syndrome attracting growing recognition. We thus aim to examine the relationship between frailty and CHE and to explore whether this effect is moderated by socioeconomic-related factors. Methods: A total of 3,277 older adults were drawn from two waves (2011 and 2013) of the China Health and Retirement Longitudinal Study (CHARLS). CHE was defined when OOP healthcare expenditure exceeded a specific proportion of the capacity of the household to pay. Frailty was measured following the Fried Phenotype (FP) scale. Mixed-effects logistic regression models were employed to assess the longitudinal relationship between frailty and CHE, and stratification analyses were conducted to explore the moderation effect. Results: The incidence of CHE among Chinese community-dwelling older adults was 21.76% in 2011 and increased to 26.46% in 2013. Compared with non-frail individuals, prefrail or frail adults were associated with higher odds for CHE after controlling for age, gender, residence, education, marriage, income, health insurance, smoking, drinking, and comorbidity (prefrail: odds ratio (OR) = 1.32, 95%CI = 1.14-1.52; frail: OR = 1.67, 95%CI = 1.13-2.47). Three frailty components including weakness, exhaustion, and shrinking contributed to a significantly increased likelihood of CHE (all p < 0.05), while the other two components including slowness and inactivity showed a non-significant effect (all p > 0.05). Similar effects from frailty on CHE were observed across socioeconomic-related subgroups differentiated by gender, residence, education, household income, and social health insurance. Conclusions: Frailty is a significant predictor for CHE in China. Developing and implementing cost-effective strategies for the prevention and management of frailty is imperative to protect households from financial catastrophe.

Self-efficacy difference among patients with cancer with different socioeconomic status: application of latent class analysis and standardization and decomposition analysis.

INTRODUCTION: Although the relationship between partial socioeconomic status (SES) and self-efficacy has been studied in previous studies, few research have examined self-efficacy difference among patients with cancer with different SES. METHODS: A cross-sectional survey involving 764 patients with cancer was completed. Latent class analysis (LCA) was applied to identify distinct groups of patients with cancer using four SES indicators (education, income, employment status and health insurance status). Standardization and decomposition analysis (SDA) was then used to examine differences in patients' self-efficacy among SES groups and the components of the differences attributed to confounding factors, such as gender, age, anxiety, depression and social support. RESULTS: Participants were classified into four distinctive SES groups via using LCA method, and the observed self-efficacy level significantly varied by SES groups; as theorized, higher self-efficacy was associated with higher SES. The self-efficacy differences by SES groups were decomposed into "real" group differences and factor component effects that are attributed to group differences in confounding factor compositions. CONCLUSION: Self-efficacy significantly varies by SES. Social support significantly confounded the observed differences in self-efficacy between different SES groups among Chinese patients with cancer.