Trends in the Baidu Index in Search Activity Related to Mpox at Geographical and Economic Levels and Associated Factors in China: National Longitudinal Analysis.

BACKGROUND: Research assessing trends in online search activity related to mpox in China is scarce. OBJECTIVE: We aimed to provide evidence for an overview of online information searching during an infectious disease outbreak by analyzing trends in online search activity related to mpox at geographical and economic levels in China and explore influencing factors. METHODS: We used the Baidu index to present online search activity related to mpox from May 19 to September 19, 2022. Segmented interrupted time-series analysis was used to estimate trends in online search activity. Factors influencing these trends were analyzed using a general linear regression (GLM) model. We calculated the concentration index to measure economic-related inequality in online search activity and related trends. RESULTS: Online search activity was highest on the day the first imported case of mpox appeared in Chongqing compared to 3 other cutoff time points. After the day of the first imported mpox case in Taiwan, the declaration of a public health emergency of international concern, the first imported mpox case in Hong Kong, and the first imported mpox case in Chongqing, national online search activity increased by 0.642%, 1.035%, 1.199%, and 2.023%, respectively. The eastern regions had higher increases than the central and western regions. Across 31 provinces, municipalities, and autonomous regions, the top 3 areas with higher increases were Beijing, Shanghai, and Tianjin at 3 time points, with the exception of the day of the first imported mpox case in Chongqing (Chongqing replaced Tianjin on that day). When AIDS incidence increased by 1 per 100,000 people, there was an increase after the day of the first imported mpox case in Chongqing of 36.22% (95% CI 3.29%-69.15%; P=.04) after controlling for other covariates. Online search activity (concentration index=0.18; P<.001) was more concentrated among populations with a higher economic status. Unlike the central area, the eastern (concentration index=0.234; P<.001) and western areas (concentration index=0.047; P=.04) had significant economic-related disparities (P for difference <.001) in online search activity. The overall concentration index of changes in online search activity became lower over time. CONCLUSIONS: Regions with a higher economic level showed more interest in mpox, especially Beijing and Shanghai. After the day of the first imported mpox case in Chongqing, changes in online search activity were affected by AIDS incidence rate. Economic-related disparities in changes in online search activity became lower over time. It would be desirable to construct a reliable information source in regions with a higher economic level and higher AIDS incidence rate and promote public knowledge in regions with a lower economic level in China, especially after important public events.

Association of Catastrophic Health Expenditure With the Risk of Depression in Chinese Adults: Population-Based Cohort Study.

BACKGROUND: Depression is one of the most common mental illnesses, and it may have a lasting effect on one's whole life. As a form of financial hardship, catastrophic health expenditure (CHE) may be associated with depression. However, current evidence about the relationship between CHE and the risk of depression is insufficient. OBJECTIVE: This study aimed to explore the relationship between CHE and the risk of depression among Chinese adults. METHODS: In this study, we used 3 waves of the China Family Panel Studies (CFPS) from 2012, 2016, and 2018. The CFPS are a nationally representative study covering 25 of 31 provinces in Chinese mainland and representing nearly 94.5% of the total population. We selected eligible household heads as participants, divided them into 2 groups by CHE events at baseline (exposed group: with CHE; unexposed group: without CHE), and followed them up. Households with CHE were defined as having out-of-pocket medical expenditures exceeding 40% of the total household nonfood expenditure, and people with depression were identified by the 8-item Centre for Epidemiological Studies Depression Scale (CES-D). We first described the baseline characteristics and used logistical regression to estimate their effects on CHE events. Then, we used Cox proportional hazard models to estimate adjusted hazard ratios and 95% CIs of depression among participants with CHE compared with those without CHE. Finally, we analyzed the subgroup difference in the association between CHE and depression. RESULTS: Of a total of 13,315 households, 9629 were eligible for analysis. Among them, 6824 (70.9%) were men. The mean age was 50.15 (SD 12.84) years. Only 987 (10.3%) participants had no medical insurance. The prevalence of CHE at baseline was 12.9% (1393/9629). Participants with a higher family economic level (adjusted odds ratio [aOR] 1.15, 95% CI 1.02-1.31) and with the highest socioeconomic development level (aOR 1.18, 95% CI 1.04-1.34) had a higher prevalence of CHE than reference groups. During a median of 71 (IQR 69-72) person-months of follow-up, the depression incidence of participants with CHE (1.41 per 1000 person-months) was higher than those without CHE (0.73 per 1000 person-months). Multivariable models revealed that the adjusted hazard ratio for the incidence of depression in participants with CHE was 1.33 (95% CI 1.08-1.64), and this association appeared to be greater in participants without outpatient services (for interaction, P=.048). CONCLUSIONS: CHE was significantly associated with increased risk of depression among Chinese adults. Concentrated work should be done to monitor CHE, and more efforts to ensure financial protection need to be made to prevent depression, especially for people with high health care needs.

Association between inequalities in human resources for health and all cause and cause specific mortality in 172 countries and territories, 1990-2019: observational study.

OBJECTIVE: To explore inequalities in human resources for health (HRH) in relation to all cause and cause specific mortality globally in 1990-2019. DESIGN: Observational study. SETTING: 172 countries and territories. DATA SOURCES: Databases of the Global Burden of Disease Study 2019, United Nations Statistics, and Our World in Data. MAIN OUTCOME MEASURES: The main outcome was age standardized all cause mortality per 100 000 population in relation to HRH density per 10 000 population, and secondary outcome was age standardized cause specific mortality. The Lorenz curve and the concentration index (CCI) were used to assess trends and inequalities in HRH. RESULTS: Globally, the total HRH density per 10 000 population increased, from 56.0 in 1990 to 142.5 in 2019, whereas age standardized all cause mortality per 100 000 population decreased, from 995.5 in 1990 to 743.8 in 2019. The Lorenz curve lay below the equality line and CCI was 0.43 (P<0.05), indicating that the health workforce was more concentrated among countries and territories ranked high on the human development index. The CCI for HRH was stable, at about 0.42-0.43 between 1990 and 2001 and continued to decline (narrowed inequality), from 0.43 in 2001 to 0.38 in 2019 (P<0.001). In the multivariable generalized estimating equation model, a negative association was found between total HRH level and all cause mortality, with the highest levels of HRH as reference (low: incidence risk ratio 1.15, 95% confidence interval 1.00 to 1.32; middle: 1.14, 1.01 to 1.29; high: 1.18, 1.08 to 1.28). A negative association between total HRH density and mortality rate was more pronounced for some types of cause specific mortality, including neglected tropical diseases and malaria, enteric infections, maternal and neonatal disorders, and diabetes and kidney diseases. The risk of death was more likely to be higher in people from countries and territories with a lower density of doctors, dentistry staff, pharmaceutical staff, aides and emergency medical workers, optometrists, psychologists, personal care workers, physiotherapists, and radiographers. CONCLUSIONS: Inequalities in HRH have been decreasing over the past 30 years globally but persist. All cause mortality and most types of cause specific mortality were relatively higher in countries and territories with a limited health workforce, especially for several specific HRH types among priority diseases. The findings highlight the importance of strengthening political commitment to develop equity oriented health workforce policies, expanding health financing, and implementing targeted measures to reduce deaths related to inadequate HRH to achieve universal health coverage by 2030.

The role of booster vaccination in decreasing COVID-19 age-adjusted case fatality rate: Evidence from 32 countries.

Background: The global COVID-19 pandemic is still ongoing, and cross-country and cross-period variation in COVID-19 age-adjusted case fatality rates (CFRs) has not been clarified. Here, we aimed to identify the country-specific effects of booster vaccination and other features that may affect heterogeneity in age-adjusted CFRs with a worldwide scope, and to predict the benefit of increasing booster vaccination rate on future CFR. Method: Cross-temporal and cross-country variations in CFR were identified in 32 countries using the latest available database, with multi-feature (vaccination coverage, demographic characteristics, disease burden, behavioral risks, environmental risks, health services and trust) using Extreme Gradient Boosting (XGBoost) algorithm and SHapley Additive exPlanations (SHAP). After that, country-specific risk features that affect age-adjusted CFRs were identified. The benefit of booster on age-adjusted CFR was simulated by increasing booster vaccination by 1-30% in each country. Results: Overall COVID-19 age-adjusted CFRs across 32 countries ranged from 110 deaths per 100,000 cases to 5,112 deaths per 100,000 cases from February 4, 2020 to Jan 31, 2022, which were divided into countries with age-adjusted CFRs higher than the crude CFRs and countries with age-adjusted CFRs lower than the crude CFRs (n = 9 and n = 23) when compared with the crude CFR. The effect of booster vaccination on age-adjusted CFRs becomes more important from Alpha to Omicron period (importance scores: 0.03-0.23). The Omicron period model showed that the key risk factors for countries with higher age-adjusted CFR than crude CFR are low GDP per capita and low booster vaccination rates, while the key risk factors for countries with higher age-adjusted CFR than crude CFR were high dietary risks and low physical activity. Increasing booster vaccination rates by 7% would reduce CFRs in all countries with age-adjusted CFRs higher than the crude CFRs. Conclusion: Booster vaccination still plays an important role in reducing age-adjusted CFRs, while there are multidimensional concurrent risk factors and precise joint intervention strategies and preparations based on country-specific risks are also essential.

Associations among socioeconomic status, multimorbidity of non-communicable diseases, and the risk of household catastrophic health expenditure in China: a population-based cohort study.

BACKGROUND: Multimorbidity of non-communicable diseases (NCDs) is increasingly prevalent among older adults around the world, leading a higher risk of household catastrophic health expenditure (CHE). As current powerful evidence was insufficient, we aimed to estimate the association between multimorbidity of NCDs and the risk of CHE in China. METHODS: We designed a cohort study using data investigated in 2011-2018 from the China Health and Retirement Longitudinal Study, which is a nationally-representative study covering 150 counties of 28 provinces in China. We used mean ± standard deviation (SD) and frequencies and percentages to describe baseline characteristics. Person χ2 test was employed to compare the differences of baseline characteristics between households with and without multimorbidity. Lorenz curve and concentration index were used to measure the socioeconomic inequalities of CHE incidence. Cox proportional hazards models were applied to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for the association between multimorbidity and CHE. RESULTS: Among 17,708 participants, 17,182 individuals were included for the descriptive analysis of the prevalence of multimorbidity in 2011, and 13,299 individuals (8029 households) met inclusion criteria and were included in the final analysis with a median of 83 (interquartile range: 25-84) person-months of follow-up. 45.1% (7752/17,182) individuals and 56.9% (4571/8029) households had multimorbidity at baseline. Participants with higher family economic level (aOR = 0.91, 95% CI: 0.86-0.97) had lower multimorbidity prevalence than those with lowest family economic level. 82.1% of participants with multimorbidity did not make use of outpatient care. The CHE incidence was more concentrated among participants with higher socioeconomic status (SES) with a concentration index of 0.059. The risk of CHE was 19% (aHR = 1.19, 95% CI: 1.16-1.22) higher for each additional NCD. CONCLUSIONS: Approximately half of middle-aged and older adults in China had multimorbidity, causing a 19% higher risk of CHE for each additional NCD. Early interventions for preventing multimorbidity among people with low SES could be intensified to protect older adults from financial hardship. In addition, concerted efforts are needed to increase patients' rational healthcare utilization and strengthen current medical security for people with high SES to reduce economic disparities in CHE.

Long-term impact of the COVID-19 pandemic on health services utilization in China: A nationwide longitudinal study.

Background: Long-term impact of the COVID-19 pandemic on health services utilization is unknown. We aim to assess the long-term effect of the COVID-19 pandemic on health services utilization in China. Methods: Between Jan 2017 and Dec 2021, we conducted a nationwide longitudinal study using routinely collected data on health services utilization in the National Health Information System of China. We extracted national and provincial data of demographic characteristics, socio-economic characteristics, and health resources. Interrupted time-series segmented negative binominal regression models were used. Results: A total of 34.2 billion health facilities visits and 1.1 billion inpatients discharged were included. The largest negative impact of COVID-19 pandemic on the health services utilization was during containment period, that health facility visits were observed 32% reduction in hospitals (adjusted incidence risk ratios [aRRs] 0.68, 95%CI: 0.50-0.92), 27% reduction in community health centers (aRR 0.73, 95%CI: 0.57-0.93), and 22% reduction township centers (aRR 0.78, 95%CI: 0.67-0.91), respectively. The impact on health facility visits and inpatients discharged were reduced and eliminated over time (all p>0.05). However, the negative impact on utilization rate of beds, average length of stay, average inpatient costs, and average outpatient costs in different level of health facilities still existed two years later (all p<0.05). Conclusions: The impact of the COVID-19 pandemic on health services utilization was largest during containment period and reduced over time, but it still existed two years later. There are disparities in the recovery of health services. Our findings highlighted the importance of maintaining primary healthcare services during the pandemic and strengthen resilient health system on the rapid recovery of medical services.

Global, regional, and national disease burden of autism spectrum disorder among children under 5 years from 1990 to 2019: An analysis for the Global Burden of Disease 2019 Study.

AIM: To estimate the trend in burden of autism spectrum disorder (ASD) at global, regional, and national levels from 1990 to 2019. METHODS: Annual incident cases, incidence rates, prevalent cases, prevalence rates, disability-adjusted life years (DALYs), and DALY rates of ASD among children under 5 years from 1990 to 2019 were collected from the Global Burden of Diseases Study 2019. The percentage of relative changes in cases and the estimated annual percentage changes (EAPCs) of rates were calculated to reflect the temporal trends of ASD burden. Pearson correlation analysis was used to explore the influential factors for EAPC. RESULTS: Globally, the incidence rate, prevalence rate, and DALY rate of ASD among children under 5 years were 91.09 per 100,000, 439.39 per 100,000, and 68.67 per 100,000 in 2019, respectively. From 1990-2019, the incidence rate decreased (EAPC = -0.09, 95% confidence interval [CI] -0.12 to -0.06), whereas the prevalence rate (EAPC=0.08, 95%CI 0.06-0.09) and DALY rate (EAPC=0.08, 95%CI 0.07-0.10) increased. The largest increases in prevalent cases (80.26%) and DALYs (81.24%) were found in low SDI regions, while High-income North America experienced the fastest increase in incidence rate, prevalence rate, and DALY rate. Moreover, the burden of ASD among male children under 5 years was approximately three times that among female children, despite the slight narrowing of gender disparity. The EAPC of incidence rate was positively correlated with SDI and UHCI in 2019 (P < 0.001). CONCLUSION: ASD is a noticeable child neurodevelopmental syndrome. More attention should be given to early screening, diagnosis, and intervention, particularly in resource-limited areas.

Countdown to 2030: eliminating hepatitis B disease, China.

Hepatitis B virus (HBV) infection is a major public health problem worldwide. China has the world's largest burden of HBV infection and will be a major contributor towards the global elimination of hepatitis B disease by 2030. The country has made good progress in reducing incidence of HBV infection in the past three decades. The achievements are mainly due to high vaccination coverages among children and high coverage of timely birth-dose vaccine for prevention of mother-to-child transmission of HBV (both > 95%). However, China still faces challenges in achieving its target of 65% reduction in mortality from hepatitis B by 2030. Based on targets of the World Health Organization's Global health sector strategy on viral hepatitis 2016-2021, we highlight further priorities for action towards HBV elimination in China. To achieve the impact target of reduced mortality we suggest that the service coverage targets of diagnosis and treatment should be prioritized. First, improvements are needed in the diagnostic and treatment abilities of medical institutions and health workers. Second, the government needs to reduce the financial burden of health care on patients. Third, better coordination is needed across existing national programmes and resources to establish an integrated prevention and control system that covers prevention, screening, diagnosis and treatment of HBV infection across the life cycle. In this way, progress can be made towards achieving the target of eliminating hepatitis B in China by 2030.

Les infections par le virus de l'hépatite B (VHB) constituent un problème de santé publique majeur à l'échelle mondiale. La Chine est le pays le plus lourdement touché par les infections par le VHB et sa contribution sera donc essentielle pour atteindre l'objectif d'élimination de l'hépatite B dans le monde à l'horizon 2030. Au cours des trente dernières années, le pays a fait des progrès notables en matière de réduction de l'incidence des infections par le VHB. Ces avancées sont principalement dues aux forts niveaux de couverture vaccinale des enfants et d'administration de la dose vaccinale à la naissance visant à prévenir la transmission du VHB de la mère à l'enfant (>95% dans les deux cas). Néanmoins, la Chine doit encore relever des défis de taille pour atteindre l'objectif de réduction de 65% de la mortalité due à l'hépatite B d'ici à 2030. À partir des cibles définies dans la Stratégie mondiale du secteur de la santé contre l'hépatite virale, 2016-2021 de l'Organisation mondiale de la Santé, nous avons identifié les actions à mener prioritairement en vue de l'élimination du VHB en Chine. Pour atteindre l'objectif de réduction de la mortalité, nous suggérons d'orienter en priorité les efforts sur l'amplification de la couverture des services de diagnostic et de traitement. Premièrement, des améliorations sont requises au niveau des capacités diagnostiques et de traitement des institutions médicales et des agents de santé. Deuxièmement, le gouvernement doit réduire la charge financière des soins de santé qui pèse sur les patients. Troisièmement, une meilleure coordination est nécessaire entre les ressources et les programmes nationaux existants, en vue d'établir un système intégré de prévention et de lutte englobant la prévention, le dépistage, le diagnostic et le traitement des infections par le VHB à tous les âges de la vie. De nouveaux progrès pourraient ainsi être faits en vue d'atteindre l'objectif d'élimination de l'hépatite B en Chine à l'horizon 2030.

La infección por el virus de la hepatitis B (VHB) es un gran problema de sanidad pública en todo el mundo. China tiene la mayor carga de infección por VHB en el mundo y será uno de los principales contribuyentes a la eliminación mundial de la enfermedad de la hepatitis B para 2030. En las últimas tres décadas, el país ha hecho grandes progresos en la reducción de la incidencia de la infección por el VHB. Los logros se deben principalmente a la alta cobertura de vacunación entre los niños y a la alta cobertura de la vacuna de dosis oportuna al nacer para la prevención de la transmisión maternoinfantil del VHB (ambas > 95 %). Sin embargo, China sigue teniendo dificultades para alcanzar su objetivo de reducir en un 65 % la mortalidad por hepatitis B para 2030. Basados en los objetivos de la Organización Mundial de la Salud sobre la Estrategia global del sector sanitario para la hepatitis viral 2016-2021, destacamos otras prioridades de acción para la eliminación del VHB en China. Para lograr el objetivo de impacto de la reducción de la mortalidad, sugerimos que se prioricen los objetivos de cobertura de los servicios de diagnóstico y tratamiento. En primer lugar, es necesario mejorar la capacidad de diagnóstico y tratamiento de las instituciones médicas y los trabajadores sanitarios. En segundo lugar, el gobierno debe reducir la carga financiera de la atención sanitaria para los pacientes. En tercer lugar, se necesita una mejor coordinación entre los programas y recursos nacionales existentes para establecer un sistema integrado de prevención y control que abarque la prevención, el cribado, el diagnóstico y el tratamiento de la infección por VHB a lo largo de todo el ciclo de vida. De esta manera, se puede avanzar hacia el objetivo de eliminar la hepatitis B en China para 2030.

Factors associated with health-seeking behavior among migrant workers in Beijing, China.

BACKGROUND: Migrant workers are a unique phenomenon in the process of China's economic transformation. The household registration system classifies them as temporary residents in cities, putting them in a vulnerable state with an unfair share of urban infrastructure and social public welfare. The amount of pressure inflicted by migrant workers in Beijing, as one of the major migration destinations, is currently at a threshold. This study was designed to assess the factors associated with health-seeking behavior and to explore feasible solutions to the obstacles migrant workers in China faced with when accessing health-care. METHODS: A sample of 2,478 migrant workers in Beijing was chosen by the multi-stage stratified cluster sampling method. A structured questionnaire survey was conducted via face-to-face interviews between investigators and subjects. The multilevel methodology (MLM) was used to demonstrate the independent effects of the explanatory variables on health seeking behavior in migrant workers. RESULTS: The medical visitation rate of migrant workers within the past two weeks was 4.8%, which only accounted for 36.4% of those who were ill. Nearly one-third of the migrant workers chose self-medication (33.3%) or no measures (30.3%) while ill within the past two weeks. 19.7% of the sick migrants who should have been hospitalized failed to receive medical treatment within the past year. According to self-reported reasons, the high cost of health service was a significant obstacle to health-care access for 40.5% of the migrant workers who became sick. However, 94.0% of the migrant workers didn't have any insurance coverage in Beijing. The multilevel model analysis indicates that health-seeking behavior among migrants is significantly associated with their insurance coverage. Meanwhile, such factors as household monthly income per capita and working hours per day also affect the medical visitation rate of the migrant workers in Beijing. CONCLUSION: This study assesses the influence of socio-demographic characteristics on the migrant workers' decision to seek health care services when they fall ill, and it also indicates that the current health service system discourages migrant workers from seeking appropriate care of good quality. Relevant policies of public medical insurance and assistance program should be vigorously implemented for providing affordable health care services to the migrants. Feasible measures need to be taken to reduce the health risks associated with current hygiene practices and equity should be assured in access to health care services among migrant workers.

Human resource staffing and service functions of community health services organizations in China.

PURPOSE: We report a study on the developmental status of human resource staffing and service functions of community health services (CHS) in China and offer recommendations for improving the CHS in the future. METHODS: A study questionnaire was completed by 712 CHS organizations distributed in 52 cities and districts in all areas of China using a multilevel stratified randomized sampling method. Data were collected on the backgrounds, human resources, and service functions of CHS organizations. RESULTS: We found that 68.2% of doctors and 86.5% of nurses employed in CHS centers have low-level medical training. The doctor-nurse ratio in CHS centers is 1.2 to 1 and in CHS stations is 1.3 to 1. More than 50% of CHS organizations have developed on-the-job training programs, causing cost trends for staff training to increase. Although the delivery of basic clinical services and public health services is steadily increasing, 58.6% of stations are open less than 12 hours per day. Health records are established in a high proportion of CHS organizations. Two kinds of health education--general public health education, and personal education for specific problems--have been adopted by more than 92% of CHS centers and 90% of CHS stations. CONCLUSIONS: Desired functions for CHS organizations have been partially achieved. Training for doctors and nurses engaged in CHS should be promoted and improved as quickly as possible. Training in basic clinical services and management of noncommunicable chronic diseases should be strongly promoted. Changes in government policies should be pursued to promote effective support for the development of CHS.

Assessment of impacts of public health interventions on the SARS epidemic in Beijing in terms of the intervals between its symptom onset, hospital admission, and notification.

OBJECTIVES: To assess the impacts of public health interventions on the outbreak of SARS in Beijing by analyzing the intervals between symptom onset, hospital admission and notification of its cases. METHODS: Data of SARS cases reported from the Beijing Municipal Centers for Disease Prevention and Control (BCDC) were collected and analyzed by descriptive epidemiology. RESULTS: In the early epidemic period, the intervals between the disease onset and the hospital admission seemed irregular, so was the intervals between the hospital admission and the notification. After the middle ten days of April, the intervals turned out to be more regular, and the disordered situation in terms of the hospital admission and the case notification was gradually brought under control. CONCLUSIONS: Public health interventions against SARS has revealed positive impacts on SARS control program in Beijing. The timing and sensitivity of epidemic information reporting systems has been greatly improved in Beijing as a result of successful fight against this disease.

[Studies on direct and indirect economic burden of disease and related factor in countryside of Qingdao city in 2001].

OBJECTIVE: To study the condition of economic burden of disease in the countryside and to explore the related factors. METHODS: Human capital method and two-step method were used in the calculation of economic burden of disease. RESULTS: The total economic burden of disease among 3359 persons was 3072 225 Yuan. Noncommunicable conditions were accounted for 62.95%, while communicable disease, maternal and perinatal conditions accounted for 24.25%, and injury accounted for 9.83% respectively. The direct economic burden of disease was 1,559,619 Yuan and the indirect economic burden of disease was 1,472,606 Yuan. The economic burden of disease for each person was 914 Yuan. The equal burden of disease among patients with disability and without disability were 3070 Yuan and 680 Yuan respectively (P < 0.001). There was significant difference among different age groups. The influencing factors were found to include having noncommunicable disease, age, disability and the condition of marriage. CONCLUSION: Corresponding policy to cope with conditions of different age groups needs to be developed to reduce the economic burden of disease in the countryside.