Environmental health, economy, and amenities interactively drive migration patterns among China's older people.

The increasing number of older adult migrants is rapidly changing regional demographic and social structures in China. There is an urgent need to understand the spatial patterns and factors that influence older adults to migrate, especially the role of environmental health. However, this issue has been under-studied. This study focused on intra-provincial and inter-provincial older adult migrants as research subjects, estimated their spatial concentration index based on the iterative proportional fitting approach, and explored the factors influencing their migration using the GeoDetector Model. The results showed the following: (1) In 2015, more than 76% of inter-provincial older adult migrants were distributed in Eastern China, and most intra-provincial older adult migrants were scattered in sub-provincial cities. (2) Compared to factors relating to economy and amenities, environmental health by itself played a relatively weak role in the migration of older adults, but the interaction among environmental health, economy, and amenities was a key driving force of older adult migration. (3) There were significant differences in the dominant environmental health factors between inter-provincial migration and intra-provincial migration, which were temperature and altitude, respectively. Our findings can help policymakers focus on the composition of older adult migrants based on urban environmental health characteristics and rationally optimize older adult care facilities to promote supply-demand matching.

Can the household clean energy transition ameliorate health inequality? Evidence from China.

China is actively encouraging households to replace traditional solid fuels with clean energy. Based on the Chinese Families Panel Survey (CFPS) data, this paper uses propensity scores matching with the difference-in-differences model to examine the impact of clean energy in the household sector on residents' health status, and whether such an energy transition promotes health equity by favoring relatively disadvantaged social groups. The results show that: (1) The use of cleaner cooking fuels can significantly improve residents' health status; (2) The older adult and women have higher health returns from the clean energy transition, demonstrating that, from the perspective of age and gender, the energy transition contributes to the promotion of health equity; (3) The clean energy transition has a lower or insignificant health impact on residents who cannot easily obtain clean energy or replace non-clean energy at an affordable price. Most of these individuals live in low-income, energy-poor, or rural households. Thus, the energy transition exacerbates health inequalities. This paper suggests that to reduce the cost of using clean energy and help address key issues in health inequality, Chinese government efforts should focus on improving the affordability, accessibility, and reliability of clean energy.

The impact of COVID-19 pandemic on the world's major economies: based on a multi-country and multi-sector CGE model.

Objective: To quantitatively assess the impact of COVID-19 pandemic on public health, as well as its economic and social consequences in major economies, which is an international public health concern. The objective is to provide a scientific basis for policy interventions. Subject and methods: This study utilizes a multi-country, multi-sector CGE-COVID-19 model to analyze the repercussions of the pandemic in 2022. The re-search focuses on quantifying the effects of COVID-19 on the macroeconomy and various industry sectors within six economies: the United States, China, the EU, the United Kingdom, Japan, and South Korea. Results: The COVID-19 pandemic shock had the most significant impact on China and the EU, followed by notable effects observed in the United States and the United Kingdom. In contrast, South Korea and Japan experienced relatively minimal effects. The reduction in output caused by the pandemic has affected major economies in multiple sectors, including real industries such as forestry and fisheries, and the services such as hotels and restaurants. Conclusion: The overall negative macroeconomic impact of the epidemic on major economies has been significant. Strategic interventions encompassing initiatives like augmenting capital supply, diminishing corporate taxes and fees, offering individual subsidies, and nurturing international cooperation held the potential to mitigate the detrimental economic consequences and enhance the global-economic amid the pan-demic. Consequently, this study contributes to the advancement of global anti-epidemic policies targeting economic recovery. Moreover, using the CGE-COVID-19 model has enriched the exploration of general equilibrium models in PHEIC events.

Bioaccumulation, trophic transfer and risk assessment of polycyclic musk in marine food webs of the Bohai Sea.

Galaxolide (HHCB) and tonalide (AHTN) are dominant musks added to personal care products. However, the accumulate and trophic transfer of SMs through the marine food chain are unclear. In this study, organisms were collected from three bays in Bohai Sea to investigate the bioaccumulation, trophic transfer, and health risk of SMs. The HHCB and AHTN concentrations in the muscles range from 2.75 to 365.40 µg/g lw and 1.04-4.94 µg/g lw, respectively. The median HHCB concentrations in muscles were the highest in Bohai Bay, followed by Laizhou Bay and Liaodong Bay, consistent with the HHCB concentrations in sediments. The different fish tissues from Bohai Bay were analyzed, and the HHCB and AHTN concentrations followed the heart > liver > gill > muscles. The trophic magnification factors (TMF) were lower than 1 and the health risk assessment showed no adverse health effects. The results provide insights into the bioaccumulation and trophic transfer behavior of SMs in marine environments.

Current status of emergency medical service use in ST-segment elevation myocardial infarction in China: Findings from China Acute Myocardial Infarction (CAMI) Registry.

BACKGROUND: The mortality rate of myocardial infarction in China has increased dramatically in the past three decades. Although emergency medical service (EMS) played a pivotal role for the management of patients with ST-segment elevation myocardial infarction (STEMI), the corresponding data in China are limited. METHODS: An observational analysis was performed in 26,305 STEMI patients, who were documented in China acute myocardial infarction (CAMI) Registry and treated in 162 hospitals from January 1st, 2013 to January 31th, 2016. We compared the differences such as demographic factors, social factors, medical history, risk factors, socioeconomic distribution and treatment strategies between EMS transport group and self-transport group. RESULTS: Only 4336 patients (16.5%) were transported by EMS. Patients with symptom onset outside, out-of-hospital cardiac arrest and presented to province-level hospital were more likely to use EMS. Besides those factors, low systolic blood pressure, severe dyspnea or syncope, and high Killip class were also positively related to EMS activation. Notably, compared to self-transport, use of EMS was associated with a shorter prehospital delay (median, 180 vs. 245 min, P < 0.0001) but similar door-to-needle time (median, 45 min vs. 52 min, P = 0.1400) and door-to-balloon time (median, 105 min vs. 103 min, P = 0.1834). CONCLUSIONS: EMS care for STEMI is greatly underused in China. EMS transport is associated with shorter onset-to-door time and higher rate of reperfusion, but not substantial reduction in treatment delays or mortality rate. Targeted efforts are needed to promote EMS use when chest pain occurs and to set up a unique regionalized STEMI network focusing on integration of prehospital care procedures in China. TRIAL REGISTRATION: ClinicalTrials.gov (NCT01874691), retrospectively registered June 11, 2013.

Lagging pollution of polycyclic aromatic hydrocarbons in the rebuilt e-waste site: From the perspective of characteristics, sources, and risk assessment.

Little information is known regarding how the lagged pollution of polycyclic aromatic hydrocarbon (PAH) influenced the environment and human health after an e-waste dismantling site was rebuilt. This study investigated the characteristics, sources, and risk assessment of PAHs in a rebuilt e-waste site and its surrounding farmland by analyzing the samples of soil, dust, water, and vegetable. Concentrations of PAHs in soil, vegetable and water in the rebuilt site were relatively higher than in its surrounding farmland. The concentrations in surface soils, soil columns, dust, vegetables, and water varied from 55.4 to 3990 ng g-1, 1.65 to 5060 ng g-1, 2190 to 2420 ng g-1, 2670 to 10,300 ng g-1, and 46.8 to 110 µg L-1 in the e-waste site, respectively. On the farmland, PAH concentrations in surface soils, vegetables, and water ranged from 41.5 to 2760 ng g-1, 506 to 7640 ng g-1, and 56.6 to 89.2 µg L-1, respectively. A higher proportion of high-molecular-weight PAHs (HMW-PAHs) appeared in all multimedia compared with low-molecular-weight PAHs (LMW-PAHs). Diagnostic ratio together with positive matrix factorization (PMF) revealed that vehicle emission was the primary source in this area, and the activity of e-waste disposal was another important source in the rebuilt e-waste site. Based on the deterministic health risks, people working in the reconstructed e-waste site were exposed to low risks, whereas the residents living near the surrounding farmland were exposed to low risk. Sensitivity analyses indicated that exposure frequency and PAH concentrations were the main factors that influenced exposure risk. This study provides valuable insight into the comprehension of the lagging pollution effects of PAH on the environment and human health after the e-waste site was rebuilt.

Heavy metals in water and sediment of Cikijing River, Rancaekek District, West Java: Contamination distribution and ecological risk assessment.

The Cikijing River is one of the rivers of the Citarik River Basin, which empties into the Citarum River and crosses Bandung Regency and Sumedang Regency, Indonesia. One of the uses of the Cikijing River is as a source of irrigation for rice fields in the Rancaekek area, but the current condition of the water quality of the Cikijing river has decreased, mainly due to the disposal of wastewater from the Rancaekek industrial area which is dominated by industry in the textile and textile products sector. This study aims to determine the potential ecological risks and water quality of the Cikijing River based on the content of heavy metals (Cr, Cu, Pb, and Zn). Sampling was carried out twice, during the dry and rainy seasons at ten different locations. The selection of locations took into account the ease of sampling and distribution of land use. Based on the results of this study, it was found that the water quality of the Cikijing River was classified as good based on the content of heavy metals (Cr, Cu, Pb, and Zn) with a Pollution Index 0.272 (rainy season) and 0.196 (dry season), while for the sediment compartment of the Cikijing River, according to the geoaccumulation index (Igeo) were categorized as unpolluted for heavy metals in rainy and dry seasons Cr (-3.16 and -6.97) < Cu (-0.59 and -1.05), and Pb (-1.68 and -1.91), heavily to very heavily polluted for heavy metals Zn (4.7 and 4.1) . The pollution load index (PLI) shows that the Cikijing River is classified as polluted by several heavy metals with the largest pollution being Zn> Cu > Pb > Cr. Furthermore, the results of the analysis using the Potential Ecological Risk Index (PERI) concluded that the Cikijing River has a mild ecological risk potential in rainy season (93.94) and dry season (96.49). The correlation test results concluded that there was a strong and significant relationship between the concentrations of heavy metals Pb and Zn and total dissolved solids, salinity, and electrical conductivity in the water compartment.

Green finance improves enterprises' environmental, social and governance performance: A two-dimensional perspective based on external financing capability and internal technological innovation.

This paper takes the establishment of the Green Financial Reform and Innovation Pilot Zone (GFPZ) in 2017 as a natural experiment, adopts the data of a-share industrial listed enterprises in Shanghai and Shenzhen from 2010 to 2020, and utilizes the difference-in-differences (DID) method to carry out empirical tests. The results show that (1) GFPZ policy significantly improves the environmental, social, and governance (ESG) performance of enterprises, and the positive effect is mainly realized by improving the external financing ability and green-technology innovation level of enterprises. (2) There is heterogeneity in the impact of GFPZ policy on the ESG performance of firms with different equity natures and internal control levels. (3) Green finance promotes active corporate social responsibility, and it can further improve environmental governance in the regions where it operates. This paper provides a useful supplement to the comprehensive understanding of green-finance policy effects and ESG impact factors, and it is of great significance in mitigating the negative environmental and social externalities caused by the excessive pursuit of economic benefits by enterprises.

Soil pollution indices and health risk assessment of metal(loid)s in the agricultural soil of pistachio orchards.

Elevated levels of metal(loid)s in soil may pose potential threats to the ecosystem and can be harmful for human health. The concentrations of As, Cd, Pb, Cr and Ni were determined in agricultural soil collected from 45 pistachio orchards around Feizabad city, Khorasan Razavi province, Iran using ICP-OES. Also, soil pollution indices including contamination factor (CF), pollution load index (PLI) and geo-accumulation index (Igeo) were evaluated. In addition, non-carcinogenic and carcinogenic risk indices were estimated. The mean concentrations of metal(loid)s were in the order of Ni = 466.256 > Cr = 120.848 > Pb = 12.009 > As = 5.486 > Cd = 0.394 mg/kg. Concentrations of As, Cd and Pb in the soil samples were within their respective permissible limits set by World Health Organization (WHO). But concentrations of Cr and Ni in 84.4 and 100% of the samples, respectively exceeded the WHO allowable limits. The CF, PLI and Igeo showed that soil of some of the pistachio orchards was contaminated with some metals. The possible sources of the metals in the soil are application of pesticides, chemical fertilizers, manures as well as irrigation water. Hazard quotient (HQ) ad Hazard index (HI) values from soil of all the orchards were found to be well below the respective threshold limit (1), suggesting that there is no immediate non-cancer threat arising from the contamination at all the orchards with metal(loid)s for children and adults. The highest cancer risk values (1.13E-02 for children and 1.25E-03 for adults) were estimated for Ni in the soil. Collectively, this study provides valuable information to improve the soil in the pistachio orchards to reduce metal(loid)s contamination and minimize the associated health risks to the population in the area.

Assessment of urban ecosystem health and its influencing factors: a case study of Zibo City, China.

Urban ecosystem health is the foundation of sustainable urban development. It is important to know the health status of urban ecosystem and its influencing factors for formulating scientific urban development planning. Taking Zibo city as the study area, the indicators were selected from five aspects: ecosystem vigor, structure, resilience, service function and population health to establish an assessment index system of urban ecosystem health. The health level of urban ecosystem was assessed, and its changing trend was analyzed from 2006 to 2018 in Zibo. Furthermore, obstacle degree analysis and sensitivity analysis were used to quantitatively analyze the main obstacle factors and sensitivity factors affecting urban ecosystem health, so as to provide references for improving urban ecosystem health. The results showed that the health level of urban ecosystem in Zibo showed an upward trend from 2006 to 2018. The poor structure and ecological environment quality were the main obstacle factors to urban ecosystem health. The impact of changes in a single indicator on urban ecosystem health gradually decreased, but the sensitivity index of indicators had obvious differences. Urban ecosystem health was sensitive to changes in ecosystem structure and resilience. In the future, Zibo should strengthen ecological construction, optimize the industrial structure, and develop green economy to promote urban ecosystem healthy.

Evaluation of China's long-term care insurance policies.

Introduction: In response to the increasing demand for long-term care services for older people, the Chinese government has launched a pilot program for long-term care insurance (LTCI) since 2016. The objective of this study is to evaluate the performance and effectiveness of this program in China and provide recommendations for the future development and expansion of the LTCI system. Methods: We developed a comprehensive evaluation framework to assess these LTCI policies implemented in all 49 pilot cities in China. Results: Based on our evaluation, the average assessment score for the LTCI program across all pilot cities was 71.8 points, with scores ranging from 57.5 to 92.5 points in these cities. Furthermore, most of the pilot cities achieved higher scores in the fact-based assessment compared to the value-based assessment. Discussion: The results suggested that the overall pilot effect regarding LTCI was favorable, but there were significant regional disparities. Moreover, in most of pilot cities, current LTCI policies were designed to alleviate both the financial burden and the burden of caring for people with disabilities that families faced. However, some challenges still remained, such as the lack of community and home-based care services, the need to expand the coverage of insurance, and the importance of diversifying funding sources.

Impact path of digital economy on carbon emission efficiency: Mediating effect based on technological innovation.

The digital economy (DIE), a new economic form with digitalization at its core, has become an important driving force for promoting regional economy development. In the context of the COVID-19 pandemic, exploring the impact path of the DIE on carbon emission efficiency (CEE) is conducive to giving full play to the "carbon-reduction-and-efficiency-enhancement" role of the DIE, and to promoting the realization the "dual carbon" goal of carbon peak and carbon neutrality. In this paper, the Yellow River Basin (YRB) and the Yangtze River Economic Belt (YREB) are taken as study areas, the panel Tobit model is used to explore the impact of the DIE on CEE, and the intermediary-effect model and threshold-effect model are constructed to test the intermediary and threshold effects of technological innovation, respectively. The results show that the DIE has a U-shaped nonlinear impact on CEE in both the YRB and the YREB and that the impact has regional heterogeneity. Technological innovation can play a mediating effect between the DIE and CEE, whereas the mediating effect in the YRB is stronger than that in the YREB. Technological innovation has a threshold effect on the DIE to improve CEE, while the threshold value in the YREB is higher than that in the YRB. Furthermore, this paper proposes some suggestions to guide regional low-carbon and sustainable development.

Polycyclic aromatic hydrocarbons and their halogenated derivatives in soil from Yellow River Delta: Distribution, source apportionment, and risk assessment.

The distribution of polycyclic aromatic hydrocarbons (PAHs) and halogenated PAHs (HPAHs) in surface soils from the petroleum industrial area of the Yellow River Delta (YRD) in China were investigated. The total concentrations of 16 PAHs ranged from 19.6 to 1560 ng/g, while 22 HPAHs ranged from 2.44 to 14.9 ng/g. Moreover, a high degree of spatial distribution heterogeneity was observed for both PAHs and HPAHs, which is likely attributed to the distinct industrial activities in studied area. The combustion of biomass and petroleum were identified as primary sources of soil PAHs and HPAHs in the YRD. Furthermore, benzo[b]fluoranthene, benzo[k]fluoranthene, and benzo[g,h,i]perylene exhibited high ecological risks (with risk quotients of 1.47, 1.44, and 1.02, respectively) in specific sites within the YRD. Considering the high toxicity of HPAHs and their potential joint environmental effects with PAHs, continuous attention should be directed towards the environmental risks associated with both PAHs and HPAHs.

Assessment and management of constipation in post-operative patients in the spinal surgery ward: a best practice implementation project.

INTRODUCTION AND OBJECTIVE: Constipation is a common complication following spinal surgery that can result in distension, abdominal pain, infection, and even intestinal perforation. This study reports on an evidence-based implementation project to reduce the incidence of constipation in spinal surgery wards. METHODS: The project was conducted in the spinal surgery ward of a general tertiary hospital in Changsha City, China, from March to August 2022. We used the JBI Implementation Framework and the JBI Model of Evidence-Based Healthcare for audits and feedback. Data were collected and analyzed using JBI's Practical Application of Clinical Evidence System (PACES) software. Seven audit criteria were developed based on the best practice recommendations summarized by JBI. A baseline audit was conducted with 20 nurses and 50 patients in the spinal surgery ward, and a follow-up audit was conducted using the same sample size and setting. RESULTS: The baseline audit revealed compliance below 46% for five of the seven criteria. Strategies developed to address poor compliance included educating nurses and patients, developing a post-operative constipation risk assessment sheet, organizing stakeholder focus group meetings, establishing a constipation management routine, and effective empowerment of nurses. The follow-up audit showed positive compliance results, with the highest rate for Criterion 7 (100%) and the greatest increase for Criterion 2 (from 0% to 78%). Furthermore, the incidence of post-operative constipation decreased from 48% to 16%. CONCLUSION: The project improved compliance with audit criteria, reduced the incidence of constipation, and enhanced the efficiency of quality management in the spinal surgery ward. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A186.

A cost-effective, machine learning-driven approach for screening arterial functional aging in a large-scale Chinese population.

Introduction: An easily accessible and cost-free machine learning model based on prior probabilities of vascular aging enables an application to pinpoint high-risk populations before physical checks and optimize healthcare investment. Methods: A dataset containing questionnaire responses and physical measurement parameters from 77,134 adults was extracted from the electronic records of the Health Management Center at the Third Xiangya Hospital. The least absolute shrinkage and selection operator and recursive feature elimination-Lightweight Gradient Elevator were employed to select features from a pool of potential covariates. The participants were randomly divided into training (70%) and test cohorts (30%). Four machine learning algorithms were applied to build the screening models for elevated arterial stiffness (EAS), and the performance of models was evaluated by calculating the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy. Results: Fourteen easily accessible features were selected to construct the model, including "systolic blood pressure" (SBP), "age," "waist circumference," "history of hypertension," "sex," "exercise," "awareness of normal blood pressure," "eat fruit," "work intensity," "drink milk," "eat bean products," "smoking," "alcohol consumption," and "Irritableness." The extreme gradient boosting (XGBoost) model outperformed the other three models, achieving AUC values of 0.8722 and 0.8710 in the training and test sets, respectively. The most important five features are SBP, age, waist, history of hypertension, and sex. Conclusion: The XGBoost model ideally assesses the prior probability of the current EAS in the general population. The integration of the model into primary care facilities has the potential to lower medical expenses and enhance the management of arterial aging.

Soil quality assessment in low human activity disturbance zones: a study on the Qinghai-Tibet Plateau.

The Qinghai-Tibet Plateau, located at the Third Pole and known as the "Asian water tower," serves as a crucial ecological barrier for China. Grasping the soil quality on the Qinghai-Tibet Plateau holds paramount importance for the rational and scientific exploitation of soil resources within the region and is essential for vegetation restoration and ecological reconstruction. This study, conducted in Maqin County, Qinghai Province, collected 1647 soil samples (0-20 cm) within a study area of 6300 km2. Sixteen soil indicators were selected that were split into beneficial (N, P, S, and B), harmful (Cr, Hg, As, Pb, Ni, and Cd), and essential (Cu, Zn, Se, Ga, K, and Ca) elements. The Soil Quality Index (SQI) was computed to assess soil quality across diverse geological contexts, land cover classifications, and soil profiles. The results indicate that the overall SQI in the study area was comparatively high, with most regions having an SQI between 0.4 and 0.6, categorized as moderately to highly satisfactory. Among the different geological backgrounds, the highest SQI was found in the Quaternary alluvium (0.555) and the lowest in the Precambrian Jinshuikou Formation (0.481). Regarding different land-use types, the highest SQI was observed in glacier- and snow-covered areas (0.582) and the lowest in other types of grassland (0.461). The highest SQI was recorded in typical alpine meadow soil (0.521) and the lowest in leached brown soil (0.460). The evaluation results have significant reference value for the sustainable utilization and management of soil in Maqin County, Qinghai Province, China.

Cost-Utility Analysis of Vericiguat in Heart Failure with Reduced Ejection Fraction After Worsening Heart Failure Events in China.

OBJECTIVE: Vericiguat is a new medication to demonstrate clinical efficacy in heart failure with reduced ejection fraction (HFrEF) after worsening heart failure (WHF) events, but its cost-utility was unknown. We aimed to assess the cost-utility of combining the application of vericiguat with standard treatment in HFrEF patients who had WHF events. METHODS: A multistate Markov model was implemented to mimic the economic results of HFrEF patients who had WHF events in China after receiving vericiguat or placebo. An analysis of cost-utility was conducted; most parameters were set according to the published studies and related databases. All the utilities and costs were decreased at a rate of 5% annually. The incremental cost-effectiveness ratios (ICERs) were the primary outcome measure. We also conducted sensitivity analyses. RESULTS: Over a 20 year lifetime horizon, additional use of vericiguat led to an elevated cost from US$9725.03 to US$20,660.76 at the current vericiguat costs. This was related to increased quality-adjusted life years (QALYs) from 2.50 to 2.66, along with an ICER of US$65,057.24 per QALY, which was over the willingness-to-pay (WTP) threshold of US$36,096.30 per QALY. If the vericiguat costs were discounted at 80%, it contributed to an ICER of US$12,226.77 per QALY. Additional use of vericiguat for patients with plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) of ≤ 5314 pg per ml produced an ICER of US$23,688.46 per QALY. The outcomes of the one-way sensitivity analysis showed the risk of death from cardiovascular disease in both groups was variable with the highest sensitivity. The probabilistic sensitivity analysis showed that 41.6% of the mimicked population receiving vericiguat combined with standard therapy was cost-effective at the WTP threshold of US$36,096.30 per QALY. CONCLUSIONS: From the perspective of Chinese public healthcare system, the combined use of vericiguat and standard treatment in patients with HFrEF following WHF events did not generate advantages in cost-utility in China but was a cost-effective therapeutic strategy for those who with plasma NT-proBNP of ≤ 5314 pg per ml.

Long-term variations of urban-Rural disparities in infectious disease burden of over 8.44 million children, adolescents, and youth in China from 2013 to 2021: An observational study.

BACKGROUND: An accelerated epidemiological transition, spurred by economic development and urbanization, has led to a rapid transformation of the disease spectrum. However, this transition has resulted in a divergent change in the burden of infectious diseases between urban and rural areas. The objective of our study was to evaluate the long-term urban-rural disparities in infectious diseases among children, adolescents, and youths in China, while also examining the specific diseases driving these disparities. METHODS AND FINDINGS: This observational study examined data on 43 notifiable infectious diseases from 8,442,956 cases from individuals aged 4 to 24 years, with 4,487,043 cases in urban areas and 3,955,913 in rural areas. The data from 2013 to 2021 were obtained from China's Notifiable Infectious Disease Surveillance System. The 43 infectious diseases were categorized into 7 categories: vaccine-preventable, bacterial, gastrointestinal and enterovirus, sexually transmitted and bloodborne, vectorborne, zoonotic, and quarantinable diseases. The calculation of infectious disease incidence was stratified by urban and rural areas. We used the index of incidence rate ratio (IRR), calculated by dividing the urban incidence rate by the rural incidence rate for each disease category, to assess the urban-rural disparity. During the nine-year study period, most notifiable infectious diseases in both urban and rural areas exhibited either a decreased or stable pattern. However, a significant and progressively widening urban-rural disparity in notifiable infectious diseases was observed. Children, adolescents, and youths in urban areas experienced a higher average yearly incidence compared to their rural counterparts, with rates of 439 per 100,000 compared to 211 per 100,000, respectively (IRR: 2.078, 95% CI [2.075, 2.081]; p < 0.001). From 2013 to 2021, this disparity was primarily driven by higher incidences of pertussis (IRR: 1.782, 95% CI [1.705, 1.862]; p < 0.001) and seasonal influenza (IRR: 3.213, 95% CI [3.205, 3.220]; p < 0.001) among vaccine-preventable diseases, tuberculosis (IRR: 1.011, 95% CI [1.006, 1.015]; p < 0.001), and scarlet fever (IRR: 2.942, 95% CI [2.918, 2.966]; p < 0.001) among bacterial diseases, infectious diarrhea (IRR: 1.932, 95% CI [1.924, 1.939]; p < 0.001), and hand, foot, and mouth disease (IRR: 2.501, 95% CI [2.491, 2.510]; p < 0.001) among gastrointestinal and enterovirus diseases, dengue (IRR: 11.952, 95% CI [11.313, 12.628]; p < 0.001) among vectorborne diseases, and 4 sexually transmitted and bloodborne diseases (syphilis: IRR 1.743, 95% CI [1.731, 1.755], p < 0.001; gonorrhea: IRR 2.658, 95% CI [2.635, 2.682], p < 0.001; HIV/AIDS: IRR 2.269, 95% CI [2.239, 2.299], p < 0.001; hepatitis C: IRR 1.540, 95% CI [1.506, 1.575], p < 0.001), but was partially offset by lower incidences of most zoonotic and quarantinable diseases in urban areas (for example, brucellosis among zoonotic: IRR 0.516, 95% CI [0.498, 0.534], p < 0.001; hemorrhagic fever among quarantinable: IRR 0.930, 95% CI [0.881, 0.981], p = 0.008). Additionally, the overall urban-rural disparity was particularly pronounced in the middle (IRR: 1.704, 95% CI [1.699, 1.708]; p < 0.001) and northeastern regions (IRR: 1.713, 95% CI [1.700, 1.726]; p < 0.001) of China. A primary limitation of our study is that the incidence was calculated based on annual average population data without accounting for population mobility. CONCLUSIONS: A significant urban-rural disparity in notifiable infectious diseases among children, adolescents, and youths was evident from our study. The burden in urban areas exceeded that in rural areas by more than 2-fold, and this gap appears to be widening, particularly influenced by tuberculosis, scarlet fever, infectious diarrhea, and typhus. These findings underscore the urgent need for interventions to mitigate infectious diseases and address the growing urban-rural disparity.

The regional disparities in liver disease comorbidity among elderly Chinese based on a health ecological model: the China Health and Retirement Longitudinal Study.

PURPOSE: This study aimed to investigate the risk factors for liver disease comorbidity among older adults in eastern, central, and western China, and explored binary, ternary and quaternary co-morbid co-causal patterns of liver disease within a health ecological model. METHOD: Basic information from 9,763 older adults was analyzed using data from the China Health and Retirement Longitudinal Study (CHARLS). LASSO regression was employed to identify significant predictors in eastern, central, and western China. Patterns of liver disease comorbidity were studied using association rules, and spatial distribution was analyzed using a geographic information system. Furthermore, binary, ternary, and quaternary network diagrams were constructed to illustrate the relationships between liver disease comorbidity and co-causes. RESULTS: Among the 9,763 elderly adults studied, 536 were found to have liver disease comorbidity, with binary or ternary comorbidity being the most prevalent. Provinces with a high prevalence of liver disease comorbidity were primarily concentrated in Inner Mongolia, Sichuan, and Henan. The most common comorbidity patterns identified were "liver-heart-metabolic", "liver-kidney", "liver-lung", and "liver-stomach-arthritic". In the eastern region, important combination patterns included "liver disease-metabolic disease", "liver disease-stomach disease", and "liver disease-arthritis", with the main influencing factors being sleep duration of less than 6 h, frequent drinking, female, and daily activity capability. In the central region, common combination patterns included "liver disease-heart disease", "liver disease-metabolic disease", and "liver disease-kidney disease", with the main influencing factors being an education level of primary school or below, marriage, having medical insurance, exercise, and no disabilities. In the western region, the main comorbidity patterns were "liver disease-chronic lung disease", "liver disease-stomach disease", "liver disease-heart disease", and "liver disease-arthritis", with the main influencing factors being general or poor health satisfaction, general or poor health condition, severe pain, and no disabilities. CONCLUSION: The comorbidities associated with liver disease exhibit specific clustering patterns at both the overall and local levels. By analyzing the comorbidity patterns of liver diseases in different regions and establishing co-morbid co-causal patterns, this study offers a new perspective and scientific basis for the prevention and treatment of liver diseases.

Enhancing pooling levels strengthens the risk resilience of healthcare insurance: a case study of basic medical insurance fund operations data in Gansu, China.

BACKGROUND: In China, enhancing the pooling levels of basic health insurance has consistently been regarded as a pivotal measure to promote the refinement of the healthcare insurance system. From 2020 to 2022, the widespread outbreak of COVID-19 posed new challenges to China's basic health insurance. METHODS: The research utilizes Data Envelopment Analysis (DEA), Malmquist index assessment, and fixed-effects panel Tobit models to analyze panel data from 2020 to 2022, assessing the efficiency of basic health insurance in Gansu Province. RESULTS: From 2020 to 2022, the average overall efficiency of the municipal pooling of Basic Medical Insurance for Urban and Rural Residents was 0.941, demonstrating a stable trend with a modest increase. The efficiency frontier regions have expanded from 5 (35.71%) to 7 (50%). Operational efficiency exhibited a negative correlation with per capita hospitalization expenses and per capita fund balance but a positive correlation with per capita accumulated fund balance and reimbursement rates for hospitalized patients. In 2021, compared to 2020, the county-pooling Basic Medical Insurance for Urban Employees saw a decline of 0.126 in overall efficiency, reducing the efficiency frontier regions from 8 to 3. However, from 2021 to 2022, the municipal-coordinated Basic Medical Insurance for Urban Employees experienced a 0.069 increase in overall efficiency, with the efficiency frontier regions expanding from 3 to 5. Throughout 2020 to 2022, the operational efficiency of the Urban Employee Basic Medical Insurance showed a consistent negative correlation with per capita fund balance. CONCLUSION: From 2020 to 2022, the overall operational performance of basic health insurance in Gansu Province was satisfactory, and enhancing the pooling level is beneficial in addressing the impact of unforeseen events on the health insurance system.