Global Chronic obstructive pulmonary disease burden attributable to air pollution from 1990 to 2019.

BACKGROUND: The disease burden attributable to chronic obstructive pulmonary disease (COPD) is significant worldwide. Some studies have linked exposure to air pollution to COPD, but there has been little research on this. METHODS: We aimed to assess the COPD-related disease burden attributable to air pollution from multiple epidemiological perspectives. This study conducted a three-stage analysis. Firstly, we reported on the burden of disease worldwide in 2019 by different subgroups including sex, age, region, and country. Secondly, we studied the trends in disease burden from 1990 to 2019. Finally, we explored the association of some national indicators with disease burden to look for risk factors. RESULTS: In 2019, the death number of COPD associated with air pollution accounted for 2.32% of the total global death, and the number of DALY accounted for 1.12% of the global DALY. From 1990 to 2019, the death number of COPD associated with air pollution increased peaked at 1.41 million in 1993, fluctuated, and then declined. We found the same temporal pattern of DALY. The corresponding age-standardized rates had been falling. At the same time, the burden of COPD associated with air pollution was also affected by some national indicators. CONCLUSIONS: This study indicated that air pollution-related COPD contributed to a significant global disease burden. We called for health policymakers to take action and interventions targeting vulnerable countries and susceptible populations.

Strong policies control the spread of COVID-19 in China.

The coronavirus disease 2019 (COVID-19) outbroke in Wuhan, Hubei Province, China, affecting more than 200 countries and regions. This study aimed to predict the development of the epidemic with specific interventional policies applied in China and evaluate their effectiveness. COVID-19 data of Hubei Province and the next five most affected provinces were collected from daily case reports of COVID-19 on the Health Committee official website of these provinces. The number of current cases, defined as the number of confirmed cases minus the number of cured cases and those who have died, were examined in this study. A modified susceptible-exposed-infectious-removed (SEIR) model was used to assess the effects of interventional policies on the epidemic. In this study, 28 January was day 0 of the model. The results of the modified SEIR model showed that the number of current cases in Hubei and Zhejiang provinces tended to be stabilized after 70 days and after 60 days in the four other provinces. The predicted number of current cases without policy intervention was shown to far exceed that with policy intervention. The estimated number of COVID-19 cases in Hubei Province with policy intervention was predicted to peak at 51 222, whereas that without policy intervention was predicted to reach 157 721. Based on the results of the model, strong interventional policies were found to be vital components of epidemic control. Applying such policies is likely to shorten the duration of the epidemic and reduce the number of new cases.

Who benefited from the New Rural Cooperative Medical System in China? A case study on Anhui Province.

BACKGROUND: The goal of the New Rural Cooperative Medical System (NCMS) is to decrease the financial burden and improve the health of rural areas. The purpose of the present study is to determine how government subsidies vary between poorer and wealthier groups, especially in low-income regions in rural China. METHODS: The distribution, amount, and equity of government subsidies delivered via NCMS to rural residents at different economic levels were assessed using benefit-incidence analysis, concentration index, Kakwani index, Gini index, Lorenz curve, and concentration curve. Household and health institution surveys were conducted in 2010, covering 9701 residents. Household socio-economic status, healthcare costs, out-of-pocket payments, and utilization information were collected in household interviews, and reimbursement policy was provided by institutional survey. RESULTS: The government subsidy concentration index was -0.055 for outpatients and 0.505 for inpatients; and the outpatient and inpatient subsidy Kakwani indexes were -0.376 and 0.184, respectively. The poorest 20 % of populations received 3.4 % of the total subsidy output; while the wealthiest 20 % received 54.3 %. The results showed that the distribution of outpatient subsidies was equitable, but the hospital subsidies disproportionally benefited wealthier people. CONCLUSIONS: Wealthier people benefited more than poorer people from the NCMS in terms of inpatient and total subsidies. For outpatients, the subsidies were unrelated to ability to pay. This contradicts the common belief that the NCMS does not exacerbate benefit inequity. Long-term policy is required to tackle this problem, specifically of redesign the NCMS reimbursement system.

An Empirical Analysis of Rural-Urban Differences in Out-Of-Pocket Health Expenditures in a Low-Income Society of China.

OBJECTIVE: The paper examines whether out-of-pocket health care expenditure also has regional discrepancies, comparing to the equity between urban and rural areas, and across households. METHOD: Sampled data were derived from Urban Household Survey and Rural Household Survey data for 2011/2012 for Anhui Province, and 11049 households were included in this study. The study compared differences in out-of-pocket expenditure on health care between regions (urban vs. rural areas) and years (2011 vs. 2012) using two-sample t-test, and also investigated the degree of inequality using Lorenz and concentration curves. RESULT: Approximately 5% and 8% of total household consumption expenditure was spent on health care for urban and rural populations, respectively. In 2012, the wealthiest 20% of urban and rural population contributed 49.7% and 55.8% of urban and rural total health expenditure respectively, while the poorest 20% took only 4.7% and 4.4%. The concentration curve for out-of-pocket expenditure in 2012 fell below the corresponding concentration curve for 2011 for both urban and rural areas, and the difference between curves for rural areas was greater than that for urban areas. CONCLUSION: A substantial and increasing gap in health care expenditures existed between urban and rural areas in Anhui. The health care financing inequality merits ample attention, with need for policymaking to focus on improving the accessibility to essential health care services, particularly for rural and poor residents. This study may provide useful information on low income areas of China.

Normal reference values for serum lipid levels in Chinese adolescents between 12 and 18 years of age.

The purpose of this study was to develop representative gender- and age-specific percentile reference data for serum lipids for Chinese adolescents between 12 and 18 years of age. Blood samples were obtained from 2998 boys and 3225 girls in nine provinces from the mainland of China, including rural and urban areas. The data for serum lipid levels, including TC, TG, HDL-C and LDL-C, were calculated and measured between March and June 2008. Gender- and age-specific percentiles of serum lipid levels were calculated. Gender- and age-specific percentile-based reference data for serum lipids is presented for Chinese adolescents for the first time. The 95th percentile for the TC, TG and LDL-C levels was 5.07, 1.90 and 3.32 mmol/l, and the 5th percentile for the HDL-C level was 0.92 mmol/l among all the students. These reference values can be used to plan and implement preventive policies, and to study temporal trends.

Risk of sexual HIV transmission among wives left behind and wives of nonmigrant men in rural areas of China.

In rural areas of China where commercial plasma donation used to be common, little is known about sexual behaviors and condom use among wives left behind by migrating husbands and wives of nonmigrant men. This study investigated sexual behaviors and condom use among married women in rural areas of China. A cross-sectional survey was conducted with 1,873 participants recruited by a cluster-sampling method. Study results showed that wives left behind had a significantly lower mean frequency of sexual intercourse with their husbands in the previous month, a higher rate of multiple sexual partners, a higher rate of self-reported HIV infection, and a lower rate of condom use when compared with wives of nonmigrant men. Also, HIV-infected wives left behind who were infected by their husbands had multiple sex partners and did not use condoms consistently. This research provides additional insight that may be used to develop effective HIV prevention strategies in rural areas of China.

Self-concept and mental health status of 'stay-at-home' children in rural China.

AIM: To describe the self-concept and mental health status of 'stay-at-home' children and to explore the differences between stay-at-home children and non-stay-at-home children. METHODS: A cross-sectional survey was conducted in Changfeng County to collect information on self-concept and mental health status. Children were classified as 'stay-at-home' or 'non-stay-at-home' for data analysis. RESULTS: Stay-at-home children accounted for 55.1% of children. The two groups of children differed significantly on the total scores of self-concept (stay-at-home, 52.48 +/- 14.29; non-stay-at-home, 55.24 +/- 15.10). The mental health status of stay-at-home children was poor, with significant difference between them (stay-at-home, 41.17 +/- 12.25; non-stay-at-home, 40.14 +/- 13.11). Using multivariate linear regression analysis, we found that the total P-H score, gender, low family economic status, stay-at-home status and being cared for by an uncle/aunt or an older sibling were independent variables for mental health of the children. CONCLUSION: This study suggests that stay-at-home children have a greater risk of mental health problems than their counterparts in rural Anhui province, China. In addition, this study provides useful baseline information on childhood mental health and has identified important risk factors that would be important in planning strategies for prevention of mental health problems for stay-at-home children.

[Study on the equity of rural health service in the experimental region of new rural cooperative medical scheme, Yuexi county, Anhui province].

OBJECTIVE: To explore the situation of equity in health service delivery in the experimental region of new rural cooperative medical scheme (NRCMS). METHODS: A household questionnaire survey was conducted to 2112 residents in the experimental county of NRCMS in Yuexi county with a stratified-cluster sampling on the situation of health service delivery, from July 1-15,2005. Data was analyzed with Epi Info 6.04 and SPSS 11.0 software and indices as rate, ratio, Gini coefficient, concentration index (CI) and chi-square test etc. RESULTS: There was no significante difference of the treatment-seeking rate during two weeks among five groups economic condition residents (chi2 = 5.52, P > 0.05) and the rates were 48.14 per thousand, 82.90 per thousand, 65.88 per thousand, 48.72 per thousand and 50.66 per thousand respectively with CI = -0.026. Similarly, the hospitalization rates were 59.08 per thousand, 67.36 per thousand, 51.76 per thousand, 58.97 per thousand and 52.86 per thousand respectively in the last year and the CI = - 0.017. But there was a significante difference of rates on chronic disease among the five groups of residents with different economic conditions in the last six months (chi2 = 18.42, P < 0.01) and the rates were 295.40 per thousand, 243.52 per thousand, 230.59 per thousand, 225.64 per thousand and 176.21 per thousand and the CI = -0.055. When income reduced, the prevalence had been increasing among residents. Meanwhile, the collection funds showed unfair in residents with various income and the compensating fund of new rural cooperative medical scheme had not reduced the gap between rich and poor. CONCLUSION: There was an unequity of medicine expenditure and compensating fund in residents with various income in the experimental region. The low income residents had a high health service need and the government should improve NRCMS greatly to change the situation.