Impact of long-term care insurance on the health status of middle-aged and older adults.

With the increase of aging population, long-term care insurance (LTCI) systems have become important for improving individuals' health. However, the effect of LTCI on health is unclear, especially in developing countries, owing to the lack of random policy shocks and comprehensive databases. This study investigates the Chinese LTCI pilot program, using four waves of the China Health and Retirement Longitudinal Study database (sample aged ≥45 years) from 2011 to 2018. The recent difference-in-differences approaches for staggered design, which are capable of dealing with the negative weights issue, are used to investigate changes in health status, measured by self-rated health (SRH), (instrumental) activities of daily living, self-rated depression, and cognition, in pilot and non-pilot cities before and after LTCI implementation. Long-term care insurance has a significant average effect on SRH improvement and a long-term positive effect on cognition for middle-aged and older populations. This study provides the first evaluation of LTCI policy on health outcomes using the recent difference-in-differences approaches. It provides evidence for the overall health improvement achieved through the LTCI and offers positive reinforcement and potential areas for improvement in establishing LTCI worldwide.

The impact of public health education on people's demand for commercial health insurance: Empirical evidence from China.

Public health education is gaining significance globally, and it is important for managing health risks. This study empirically analyzed the effect of public health education on people's demand for commercial health insurance. And we used the fixed effects and the mediating effect models, and instrumental variables regression in our research based on panel data of 31 provinces (including municipalities and autonomous regions) in China from year 2009 to 2019. The findings show that public health education significantly increases people's demand for commercial health insurance, and this effect remains significant when considering endogeneity and robustness. We further analyzed and found that the increased demand for commercial health insurance is caused by health literacy, health risk perceptions and health risk attitudes. Through heterogeneity analysis, we found that there were significant differences in the effects of public health education in regions with different demographic and socioeconomic characteristics. We found that the effect of health education on promoting people's demand for commercial health insurance is more obvious in regions with high levels of urbanization, proportion of men, education, economic development, medical resources, and social medical insurance coverage. Governments are supposed to take further measures to enhance the effectiveness of public health education, develop high-quality commercial health insurance, and continuously improve health risk coverage.

Loneliness, hopelessness and suicide in later life: a case-control psychological autopsy study in rural China.

AIMS: Loneliness is increasingly recognised as a serious public health issue worldwide. However, there is scarce research addressing the association between loneliness and suicide in older adults in rural China. We set out to examine loneliness and other psychosocial factors in elderly suicide cases and explore their interaction effects. METHODS: Using a 1 : 1 matched case-control design, data were collected from 242 elderly suicide cases and 242 living community controls by psychological autopsy method in rural China, including demographic characteristics, loneliness, depression, hopelessness and social support. The chi-square automatic interaction detection (CHAID) tree model and multivariable logistic regression analysis were used to explore the relationships of these factors and suicide. RESULTS: The CHAID tree model showed that loneliness, hopelessness and depressive symptoms were closely associated with completed suicide and that loneliness and hopelessness interacted with each other. The result of multivariable logistic regression showed that individuals who were unemployed [odds ratio (OR) = 2.344; 95% confidence interval (CI): 1.233-4.457], living alone (OR = 2.176; 95% CI: 1.113-4.254), had lower levels of subjective social support (OR = 2.185; 95% CI: 1.243-3.843), experienced depressive symptoms (OR = 6.700; 95% CI: 3.405-13.182), showed higher levels of hopelessness (OR = 7.253; 95% CI: 3.764-13.974) and felt higher levels of hopelessness × higher levels of loneliness (OR = 2.446; 95% CI: 1.089-5.492) were significantly associated with an elevated suicide risk in older people in rural China. CONCLUSIONS: Regular evaluation of loneliness, hopelessness and depression can help detect older adults who are at risk of committing suicide. Interventions should target social support systems, particularly among people living alone, to alleviate feelings of loneliness and hopelessness. Treating depression is also key to preventing suicide among elderly people in rural China.

The impact of suicidal death of rural older people to their relatives: Results from a national psychological autopsy study in China.

OBJECTIVE: The suicide pattern in China is changing to a predominance of older people. However, little is known about the impact of suicide on the family members of elderly decedents. The aim of this study was to evaluate whether the suicidal death of rural older adults in China increases the odds of depression or suicidal ideation among their relatives and to explore the associated risk factors. METHODS: In a national psychological autopsy study in China, consecutive samples of suicide decedents aged 60 or above and matched living controls were enrolled in rural areas of three provinces. Univariate and multivariate analyses were performed to explore the occurrence and correlates of depression and suicidal ideation among relatives of elderly suicide decedents. RESULTS: A total of 242 suicide decedents and 242 living controls were identified. We enrolled 245 relatives of suicide decedents and 205 relatives of living controls. No significant differences in depression or suicide ideation were found between the relatives of suicide decedents and living comparisons after controlling for socio-demographic characteristics (depression: 26.5% vs. 21.5%; suicide ideation: 5.7% vs. 2.9%). A mood disorder diagnosis in the suicide decedent (OR = 1.93, 95% CI 1.12-3.52) and a spouse relationship (OR = 3.62, 95% CI 1.40-9.34) were independent risk factors for depression among relatives of suicide decedents. Spouses (OR = 5.91, 95% CI 1.49-23.38) were more likely to have suicidal ideation than other relatives. LIMITATIONS: there are methodological limitations in psychological autopsy studies. CONCLUSIONS: It seems that the suicide of an older adult 2-6 months ago has no significant impact on depressive symptoms and suicidal ideation in their relatives. Proactive support should be provided for spouses of suicide decedents and those whose relatives have a mood disorder diagnosis.

Efficacy and Safety of Tapentadol Immediate Release Assessment in Treatment of Moderate to Severe Pain: A Systematic Review and Meta-Analysis.

Objective: To assess the efficacy and safety of tapentadol IR for moderate to severe pain compared to oxycodone IR. Methods: A search was carried out up to July 2015 for randomized controlled trials (RCTs) of tapentadol IR compared to placebo or oxycodone HCL IR 10 mg for moderate to severe pain. Studies were pooled by risk ratio (RR) and weighted mean differences (WMD) with 95% confidence interval (CI). Results: Nine RCTs (n = 3,961) were analyzed. In this meta-analysis, tapentadol IR (50-, 75-, and 100-mg doses) showed significant improvements in moderate to severe pain relief on the sum of pain intensity difference over 48 hours (SPID 48 ) scores ( P < 0.00001 or P = 0.01). No statistically significant difference among all three doses of tapentadol IR and oxycodone HCL IR 10 mg on both SPID 48 and total pain relief over 48 hours (TOTPAR 48 ) scores (all P > 0.05) was found. Compared with tapentadol IR 50 mg, tapentadol IR 75 mg demonstrated significant improvement in moderate to severe pain relief based on both SPID 48 and TOTPAR 48 scores (all P < 0.05). For total adverse events (AEs) incidence, tapentadol IR 50 and 75 mg were significantly lower than oxycodone HCL IR 10 mg. Incidence of nausea and constipation were significantly lower with either tapentadol IR 50 or 75 mg compared with oxycodone HCL IR 10 mg (all P < 0.05). Conclusions: Tapentadol IR 75 mg might be an optimal dose for moderate to severe pain control with fewer side effects. All three doses of tapentadol IR could provide comparable efficacy to oxycodone HCL IR 10 mg.