Sleep quality and health service utilization in Chinese general population: a cross-sectional study in Dongguan, China.

OBJECTIVES: The aims of this study were to explore the Pittsburgh Sleep Quality Index (PSQI) and health service utilization in Chinese general population, to investigate the association between PSQI and health service utilization and to identify the independent contributions of social demographic variables, health related factors and PSQI to health service utilization. METHODS: In a cross-sectional community-based health survey using a multi-instrument questionnaire, 4067 subjects (≥15 years old) were studied. The Chinese version of the PSQI was used to assess sleep quality. Health service utilization was measured by recent two-week physician visit and annual hospitalization rates. RESULTS: Higher PSQI scores were associated with more frequent health service utilization. Higher scores in subjective sleep quality were associated with higher rate of recent two-week physician visit (adjusted OR = 1.24 per SD increase, P = 0.015). Higher scores in habitual sleep efficiency (adjusted OR = 1.24 per SD increase, P = 0.038) and sleep disturbances (adjusted OR = 2.09 per SD increase, P < 0.001) were associated with more frequent annual hospitalization. The independent influence of PSQI on the risk of recent two-week physician visit was 0.7%, and that of annual hospitalization 31.4%. CONCLUSIONS: Poorer sleep quality predicted more frequent health service utilization. The independent contribution of PSQI on health service utilization was smaller than social demographic variables.

Relationships of multimorbidity and income with hospital admissions in 3 health care systems.

Associations of multimorbidity and income with hospital admission were investigated in population samples from 3 widely differing health care systems: Scotland (n = 36,921), China (n = 162,464), and Hong Kong (n = 29,187). Multimorbidity increased odds of admissions in all 3 settings. In Scotland, poorer people were more likely to be admitted (adjusted odds ratio [aOR] = 1.62; 95% CI, 1.41-1.86 for the lowest income group vs the highest), whereas China showed the opposite (aOR = 0.58; 95% CI, 0.56-0.60). In Hong Kong, poorer people were more likely to be admitted to public hospitals (aOR = 1.68; 95% CI, 1.36-2.07), but less likely to be admitted to private ones (aOR = 0.18; 95% CI, 0.13-0.25). Strategies to improve equitable health care should consider the impact of socioeconomic deprivation on the use of health care resources, particularly among populations with prevalent multimorbidity.

Health-related quality of life and health service utilization in Chinese rural-to-urban migrant workers.

OBJECTIVES: The number of rural-to-urban migrant workers has been increasing rapidly in China over recent decades, but there is a scarcity of data on health-related quality of life (HRQOL) and health service utilization among Chinese rural-to-urban migrant workers in comparison to local urban residents. We aimed to address this question. METHODS: This was a cross-sectional study of 2315 rural-to-urban migrant workers and 2347 local urban residents in the Shenzhen-Dongguan economic zone (China) in 2013. Outcomes included HRQOL (measured by Health Survey Short Form 36) and health service utilization (self-reported). RESULTS: Compared to local urban residents, rural-to-urban migrant workers had lower scores in all domains of HRQOL, and were more likely to report chronic illnesses (9.2% vs. 6.0%, adjusted OR = 1.62, 95% CI 1.28-2.04) and recent two-week morbidity (21.3% vs. 5.0%, adjusted OR = 5.41, 95% CI 4.26-6.88). Among individuals who reported sickness in the recent two weeks, migrant workers were much less likely to see a doctor (32.7% vs. 66.7%, adjusted OR = 0.21, 95% CI 0.13-0.36). CONCLUSIONS: Chinese rural-to-urban migrant workers have lower HRQOL, much more frequent morbidity, but are also much less likely to see a doctor in times of sickness as compared to local urban residents, indicating the existence of significant unmet medical care needs in this population.

Epidemiology of multimorbidity in China and implications for the healthcare system: cross-sectional survey among 162,464 community household residents in southern China.

BACKGROUND: China, like other countries, is facing a growing burden of chronic disease but the prevalence of multimorbidity and implications for the healthcare system have been little researched. We examined the epidemiology of multimorbidity in southern China in a large representative sample. The effects of multimorbidity and other factors on usual source of healthcare were also examined. METHODS: We conducted a large cross-sectional survey among approximately 5% (N = 162,464) of the resident population in three prefectures in Guangdong province, southern China in 2011. A multistage, stratified random sampling was adopted. The study population had many similar characteristics to the national census population. Interviewer-administered questionnaires were used to collect self-report data on demographics, socio-economics, lifestyles, healthcare use, and health characteristics from paper-based medical reports. RESULTS: More than one in ten of the total study population (11.1%, 95% confidence interval (CI) 10.6 to 11.6) had two or more chronic conditions from a selection of 40 morbidities. The prevalence of multimorbidity increased with age (adjusted odds ratio (aOR) = 1.36, 95% CI 1.35 to 1.38 per five years). Female gender (aOR = 1.70, 95% CI 1.64 to 1.76), low education (aOR = 1.26, 95% CI 1.23 to 1.29), lack of medical insurance (aOR = 1.79, 95% CI 1.71 to 1.89), and unhealthy lifestyle behaviours were independent predictors of multimorbidity. Multimorbidity was associated with the regular use of secondary outpatient care in preference to primary care. CONCLUSIONS: Multimorbidity is now common in China. The reported preferential use of secondary care over primary care by patients with multimorbidity has many major implications. There is an urgent need to further develop a strong and equitable primary care system.

[Assessment of the posttraumatic symptoms among survivors for three years following Wenchuan Earthquake].

OBJECTIVE: To investigate the incidence of posttraumatic stress disorder (PTSD) and its influencing factors for three years following the "5.12" Wenchuan Earthquake. METHODS: A systematic sampling of 870 subjects who came from Beichuan (605 persons) and Jiangyou (265 persons) areas were investigated by adopting subscale of PTSD Checklist-Civilian Version (PCL-C) and Social Demographic Questionnaire. RESULTS: The incidence rate of PTSD was 8.5% (74/870), the incidence rates of PTSD for the area of Beichuan and Jiangyou were 11.2% (68/605) and 2.3% (6/265) respectively. Subjects from Beichuan had higher PTSD incidence rate compared to Jiangyou (P < 0.05). The prevalence of PTSD for female and male were 11.8% (55/465) and 4.7% (19/405) respectively, female had higher prevalence of PTSD compared to male (P < 0.05). The incidence rates of PTSD for victims who suffered from major property lost and those who lost less were 13.3% (62/466) and 3.0% (12/404) respectively, victims suffered major property lost had higher incidence rate of PTSD(P < 0.05). The incidence rates of PTSD for victims who lost family members and those did not were 13.4% (45/336) and 5.4% (29/534) respectively, victims who lost family members had higher incidence rates of PTSD (P < 0.05). The posttraumatic symptoms for survivors who suffered from PTSD mainly focused on the symptoms of reexpericement and over vigilance, the prevalence rate was 100% (74/74). Exaggerated startle response, intense psychological distress and physiological reactivity were higher than others in total 17 symptoms, accounting for 96% (71/74), 94% (70/74) and 90% (67/74). The logistic regression showed that being female, victims who suffered from major property lost, lost family member in this earthquake were the risk factors of PTSD, and the values of OR (95%CI) were 2.746 (1.580 - 4.772), 3.616 (1.871 - 6.988) and 1.805(1.057 - 3.084), respectively. CONCLUSION: Posttraumatic symptoms were still common among survivors three years after "5.12" Wenchuan Earthquake. Survivors in Beichuan (heavy hit area), female victims, victims who suffered from major property lost, victims who lost family member need more social and economic support.