Epidemiological Characteristics and Economic Burden of Dengue in Zhejiang Province, China.

Dengue imposes a heavy economic burden on families and society. We used surveillance data reported in 2019 to characterize the dengue epidemic in Zhejiang Province, China, which provided guidance for dengue prevention and control. Dengue epidemics mostly occurred in July to October. People aged 30-44 years, males, and commercial service workers were more likely to suffer from dengue. The epidemic areas were mainly in Hangzhou and Wenzhou. Meanwhile, we assessed the economic cost of dengue in the province from both family and organizational perspectives. The direct economic burden of dengue patients was estimated to be USD 405,038.25, and the indirect economic burden was USD 140,364.90, for a total economic burden of USD 543,213.00. The direct economic burden of dengue patients should be reduced by increasing the coverage and reimbursement of health insurance. Additionally, the total annual cost of dengue prevention and control for the government and organizational sectors was estimated to be USD 7075,654.83. Quantifying the dengue burden is critical for developing disease control strategies, allocating public health resources, and setting health policy priorities.

Cold spells linked with respiratory disease hospitalization, length of hospital stay, and hospital expenses: Exploring cumulative and harvesting effects.

BACKGROUND: Previous studies have revealed the relationship between cold spells and morbidity and mortality due to respiratory diseases, while the detrimental effects of cold spells on the length of hospital stay and hospitalization expenses remain largely unknown. METHODS: We collected hospitalization data for respiratory diseases in 11 cities of Shanxi, China during 2017-2019. In each case, exposure to meteorological variables and air pollution was estimated by the bilinear interpolation approach and inverse distance weighting method, respectively, and then averaged at the city level. Cold spells were defined as the daily mean temperature below the 10th, 7.5th, or 5th percentiles for at least 2 to 5 consecutive days. We applied distributed lag non-linear models combined with generalized additive models to assess cumulative effects and harvesting effects. RESULTS: There were significant associations between cold spells and hospital admissions, length of hospital stay, and hospital expenses for respiratory diseases. Compared with the non-cold spell period, the overall (lag 0-21) cumulative risk of hospitalization for total respiratory diseases was 1.232 (95 % CI: 1.090, 1.394) on cold spell days, and the increased length of hospital stay and hospitalization expenses were 112.793 (95 % CI: 10.755, 214.830) days and 127.568 (95 % CI: 40.513, 214.624) thousand Chinese yuan. The overall cumulative risks of cold spells on total respiratory diseases and pneumonia were statistically significant. We further observed harvesting effects in the associations between cold spells and hospital admission, length of hospital stay, and hospitalization expenses for respiratory diseases. CONCLUSIONS: Cumulative cold-spell exposure for up to three weeks is associated with hospitalization, length of hospital stay, and hospital expenses for respiratory diseases. The observed harmful effects of cold spells on respiratory diseases can be partly attributable to harvesting effects.

Associations of Ambient NO2 with Daily Hospitalization, Hospitalization Expenditure and Length of Hospital Stay of Cause-Specific Respiratory Diseases - Shanxi, China, 2017-2019.

What is already known about this topic?: Numerous epidemiological studies have documented the association between ambient nitrogen dioxide (NO2) and mortality and morbidity of respiratory diseases, however, research on the effect of NO2 on the length of hospital stay (LOS) and hospitalization expenditure is limited. What is added by this report?: This study collected the respiratory hospitalization, hospital expenditure, and LOS for respiratory diseases from 2017-2019 in Shanxi, China, and comprehensively evaluated the association between ambient NO2 exposure and respiratory hospitalization, expenditure, and LOS. What are the implications for public health practice?: This study provides evidence on the association between ambient NO2 and respiratory burden, suggesting that continuously reducing the NO2 concentrations could prevent respiratory disease-associated hospital admissions and decrease the relative burden in Shanxi Province and other similar regions.

Economic burden of dengue fever in China: A retrospective research study.

BACKGROUND: Dengue fever has been a significant public health challenge in China. This will be particularly important in the context of global warming, frequent international travels, and urbanization with increasing city size and population movement. In order to design relevant prevention and control strategies and allocate health resources reasonably, this study evaluated the economic burden of dengue fever in China in 2019. METHODS: The economic burden of dengue fever patients was calculated from both family and the organisation perspectives. A survey was conducted among 1,027 dengue fever patients in Zhejiang, Chongqing, and Yunnan Provinces. Treatment expenses, lost working days, and insurance reimbursement expenses information were collected to estimate the total economic burden of dengue fever patients in 2019. The expenditures related to dengue fever prevention and control from government, Center for Disease Control and Prevention (CDC), communities and subdistrict offices of 30 counties (or districts) in Zhejiang Province and Chongqing City were also collected. RESULTS: The direct, indirect and total economic burden for dengue fever patients in 2019 in the three Provinces were about 36,927,380.00 Chinese Yuan (CNY), 10,579,572.00 CNY and 46,805,064.00 CNY, respectively. The costs for prevention and control of dengue fever for the counties (or districts) without cases, counties (or districts) with imported cases, and counties (or districts) with local cases are 205,800.00 CNY, 731,180.00 CNY and 6,934,378.00 CNY, respectively. The total investment of dengue fever prevention and control in the 30 counties in China in 2019 was approximately 3,166,660,240.00 CNY. CONCLUSION: The economic burden of dengue fever patients is relatively high, and medical insurance coverage should be increased to lighten patients' direct medical economic burden. At the same time, the results suggests that China should increase funding for primary health service institutions to prevent dengue fever transmission.

Ambient sulfur dioxide and hospital expenditures and length of hospital stay for respiratory diseases: A multicity study in China.

BACKGROUND: Ambient sulfur dioxide (SO2) has been associated with morbidity and mortality of respiratory diseases, however, its effect on length of hospital stays (LOS) and cost for these diagnoses remain unclear. METHODS: We collected hospital admission information for respiratory diseases from all 11 cities in the Shanxi Province of China during 2017-2019. We assessed individual-level exposure by using an inverse distance weighting approach based on geocoded residential addresses. A generalized additive model was built to delineate city-specific effects of SO2 on hospitalization, hospital expenditure, and length of hospital stay for respiratory diseases. The overall effects were obtained by random-effects meta-analysis. We further estimated the respiratory burden attributable to SO2 by comparing different reference concentrations. RESULTS: We observed significant effects of SO2 exposure on respiratory diseases. At the provincial level, each 10 µg/m3 increase in SO2 on lag03 was associated with a 0.63% (95% CI: 0.14-0.11) increase in hospital admission, an increase of 4.56 days (95% CI: 1.16-7.95) of hospital stay, and 3647.97 renminbi (RMB, Chinese money) (95% CI: 1091.05-6204.90) in hospital cost. We estimated about 6.13 (95% CI: 1.33-11.10) thousand hospital admissions, 65.77 million RMB (95% CI: 19.67-111.87) in hospital expenditure, and 82.13 (95% CI: 20.87-143.40) thousand days of hospital stay could have potentially been avoided had the daily SO2 concentrations been reduced to WHO's reference concentration (40 µg/m3). Variable values in correspondence with this reference concentration could reduce the hospital cost and LOS of each case by 52.67 RMB (95% CI: 15.75-89.59) and 0.07 days (95% CI: 0.02-0.117). CONCLUSION: This study provides evidence that short-term ambient SO2 exposure is an important risk factor of respiratory diseases, indicating that continually tightening policies to reduce SO2 levels could effectively reduce respiratory disease burden in Shanxi Province.

Ambient PM2.5 exposure and hospital cost and length of hospital stay for respiratory diseases in 11 cities in Shanxi Province, China.

BACKGROUND: Few studies have examined the effects of ambient particulate matter with an aerodynamic diameter less than or equal to 2.5 µm (PM2.5) on hospital cost and length of hospital stay for respiratory diseases in China. METHODS: We estimated ambient air pollution exposure for respiratory cases through inverse distance-weighted averages of air monitoring stations based on their residential address and averaged at the city level. We used generalised additive models to quantify city-specific associations in 11 cities in Shanxi and a meta-analysis to estimate the overall effects. We further estimated respiratory burden attributable to PM2.5 using the standards of WHO (25 µg/m3) and China (75 µg/m3) as reference. RESULTS: Each 10 µg/m3 increase in lag03 PM2.5 corresponded to 0.53% (95% CI: 0.33% to 0.73%) increase in respiratory hospitalisation, an increment of 3.75 thousand RMB (95% CI: 1.84 to 5.670) in hospital cost and 4.13 days (95% CI: 2.51 to 5.75) in length of hospital stay. About 9.7 thousand respiratory hospitalisations, 132 million RMB in hospital cost and 145 thousand days of hospital stay could be attributable to PM2.5 exposures using WHO's guideline as reference. We estimated that 193 RMB (95% CI: 95 to 292) in hospital cost and 0.21 days (95% CI: 0.13 to 0.30) in hospital stay could be potentially avoidable for an average respiratory case. CONCLUSION: Significant respiratory burden could be attributable to PM2.5 exposures in Shanxi Province, China. The results need to be factored into impact assessment of air pollution policies to provide a more complete indication of the burden addressed by the policies.

Heatwave and mortality in 31 major Chinese cities: Definition, vulnerability and implications.

Few data are available on the health impacts of heatwaves in China, and in particular, the heatwave definition and vulnerable populations remain to be identified. We collected data on daily maximum temperature and mortality from 31 Chinese capital cities during 2007-2013. A Poisson regression model allowing for over-dispersion was applied to estimate the short-term effects of heatwaves on mortality in hot season (May-September). 15 heatwave definitions combining five heat thresholds (90.0th, 92.5th, 95th, 97.5th and 99th percentiles of daily maximum temperature) and three durations (≥2, ≥3 and ≥4 days) were compared. The pooled effects were then computed using random effect meta-analysis based on the residual maximum likelihood estimation. Effect modification of heatwave-mortality association by individual-level characteristics was tested using a stratified analysis. Potential effect modification by city-level characteristics was examined by meta-regression analysis. Totally, 259 million permanent residents were covered and 4,481,090 non-accidental deaths occurred during the study period. Generally, the magnitude of heatwave impacts increased by intensities and durations of the heatwaves. Heatwave definition using daily maximum temperature ≥ 92.5th percentile with duration ≥3 days produced the best model fit. The pooled relative risks of heatwaves on non-accidental mortality at lag 0, lag 0-2 and lag 0-10 days were 1.06 (95%CI: 1.03-1.09), 1.09 (1.05-1.13) and 1.10 (1.05-1.15), respectively. Compared with non-accidental mortality, higher effect estimates of heatwaves were observed among deaths from ischemic heart diseases, stroke and respiratory diseases, although the differences were not statistically significant. Females, those ≥75 years old and the illiterates were more vulnerable to heatwaves. Cities with higher concentrations of PM2.5, higher latitudes, and lower numbers of hospital beds per 10,000 populations had higher mortality risks during heatwaves. These findings may have important implications for developing heat alert systems and early response actions on protecting the vulnerable populations from adverse health effects of heatwave in China.

Spatial analysis of dengue fever and exploration of its environmental and socio-economic risk factors using ordinary least squares: A case study in five districts of Guangzhou City, China, 2014.

OBJECTIVE: Spatial patterns and environmental and socio-economic risk factors of dengue fever have been studied widely on a coarse scale; however, there are few such quantitative studies on a fine scale. There is a need to investigate these factors on a fine scale for dengue fever. METHODS: In this study, a dataset of dengue fever cases and environmental and socio-economic factors was constructed at 1-km spatial resolution, in particular 'land types' (LT), obtained from the first high resolution remote sensing satellite launched from China (GF-1 satellite), and 'land surface temperature', obtained from moderate resolution imaging spectroradiometer (MODIS) images. Spatial analysis methods, including point density, average nearest neighbor, spatial autocorrelation, and hot spot analysis, were used to analyze spatial patterns of dengue fever. Spearman rank correlation and ordinary least squares (OLS) were used to explore associated environmental and socio-economic risk factors of dengue fever in five districts of Guangzhou City, China in 2014. RESULTS: A total of 30553 dengue fever cases were reported in the districts of Baiyun, Haizhu, Yuexiu, Liwan, and Tianhe of Guangzhou, China in 2014. Dengue fever cases showed strong seasonal variation. The cases from August to October accounted for 96.3% of the total cases in 2014. The top three districts for dengue fever morbidity were Baiyun (1.32%), Liwan (0.62%), and Haizhu (0.60%). Strong spatial clusters of dengue fever cases were observed. Areas of high density for dengue fever were located at the district junctions. The dengue fever outbreak was significantly correlated with LT, normalized difference water index (NDWI), land surface temperature of daytime (LSTD), land surface temperature of nighttime (LSTN), population density (PD), and gross domestic product (GDP) (correlation coefficients of 0.483, 0.456, 0.612, 0.699, 0.705, and 0.205, respectively). The OLS equation was built with dengue fever cases as the dependent variable and LT, LSTN, and PD as explanatory variables. The residuals were not spatially autocorrelated. The adjusted R-squared was 0.320. CONCLUSIONS: The findings of spatio-temporal patterns and risk factors of dengue fever can provide scientific information for public health practitioners to formulate targeted, strategic plans and implement effective public health prevention and control measures.

Spatiotemporal patterns of severe fever with thrombocytopenia syndrome in China, 2011-2016.

Severe fever with thrombocytopenia syndrome (SFTS) is emerging and the number of SFTS cases have increased year by year in China. However, spatiotemporal patterns and trends of SFTS are less clear up to date. In order to explore spatiotemporal patterns and predict SFTS incidences, we analyzed temporal trends of SFTS using autoregressive integrated moving average (ARIMA) model, spatial patterns, and spatiotemporal clusters of SFTS cases at the county level based on SFTS data in China during 2011-2016. We determined the optimal time series model was ARIMA (2, 0, 1) × (0, 0, 1)12 which fitted the SFTS cases reasonably well during the training process and forecast process. In the spatial clustering analysis, the global autocorrelation suggested that SFTS cases were not of random distribution. Local spatial autocorrelation analysis of SFTS identified foci mainly concentrated in Hubei Province, Henan Province, Anhui Province, Shandong Province, Liaoning Province, and Zhejiang Province. A most likely cluster including 21 counties in Henan Province and Hubei Province was observed in the central region of China from April 2015 to August 2016. Our results will provide a sound evidence base for future prevention and control programs of SFTS such as allocation of the health resources, surveillance in high-risk regions, health education, improvement of diagnosis and so on.

Zagreb regimen, an abbreviated intramuscular schedule for rabies vaccination.

The Zagreb regimen, an abbreviated intramuscular schedule for rabies vaccination, was developed by I. Vodopija and colleagues of the Zagreb Institute of Public Health in Croatia in the 1980s. It was recommended by WHO as one of the intramuscular (IM) schedules for rabies vaccination in 2010. We reviewed the literature on the immunogenicity, safety, economic burden, and compliance of the Zagreb 2-1-1 regimen. Compared to Essen, another IM schedule recommended by WHO, Zagreb has higher compliance, lower medical cost, and better immunogenicity at an early stage.