Analysis of healthy life expectancy and related socioeconomic influencing factors among the middle-aged and elderly in China, the United States, and the European Union / 中华流行病学杂志

Objective: To calculate and compare the healthy life expectancy (HLE) of the middle-aged and elderly in China, the United States, and developing and developed countries in the European Union(EU) and analyze the impact of socioeconomic factors on HLE in different countries or regions. Methods: Four surveys from 2010 to 2019 were brought into the research. The data were collected from the China Health and Retirement Longitudinal Study, Health and Retirement Study, and the Survey of Health, Ageing and Retirement in Europe. Developed and developing countries in the EU were divided into two groups for calculation. Education level, total family wealth, and work retirement status were selected to measure socioeconomic status, and activities of daily living were used as health status indicators. We used the multi-state life cycle table method to calculate the transition probability between different health states and estimate life expectancy and HLE. Results: A total of 69 544 samples were included in the study. In terms of age, the middle-aged and elderly in the United States and developed countries of the EU have higher HLE in all age groups. In terms of gender, only Chinese women have lower HLE than men. Regarding socioeconomic factors, the middle-aged and elderly with higher education levels and total family wealth level have higher HLE. In China, working seniors have higher HLE, while for USA women and developed countries of the EU, retired or unemployed seniors have higher HLE. Conclusions: Demographic and socioeconomic factors impact HLE in different countries or regions. China should pay more attention to the health of women and the middle-aged and elderly retired with lower education and less total family wealth.

Joint association of sedentary behavior and physical activity on anxiety tendency among occupational population in China / 北京大学学报(医学版)

OBJECTIVE@#To investigate the status and influencing factors of anxiety tendency among occupational population in China and to examine the joint association between sedentary behavior and physical activity with anxiety tendency.@*METHODS@#The data were from the 2021 Asia Best Workplace (Chinese mainland) program. The Generalized Anxiety Tendency scale was used to assess employees' anxiety status, and Logistic regression was used to analyze the factors influencing anxiety tendency and calculate the odds ratio (OR) within different groups. The OR of sitting for each sitting-physical activity (PA) combination group and within PA strata were calculated to explore the joint association.@*RESULTS@#A total of 11 903 workers with an average age of 32.9 years were included in this study. Among them, 3 562 workers had anxiety tendency (29.9%) and the prevalence of those under 40 years old (30.6%) was significantly higher than the other age group (26.7%). 41.0% of the respondents had the moderated to vigorous physical activity. Their average daily sitting time was 9.4 h, and the percentage of those who exceeded 8 h sitting reached 73.9% in the past week. The analysis of Logistic regression showed that smoking (OR=1.24, 95%CI: 1.23-1.39), longer sedentary time and lower physical activity level were risk factors for anxiety tendency, and longer average daily sleep time (OR=0.56, 95%CI: 0.51-0.61) was a protective factor. The joint association analysis and stratified analysis of physical activity and sedentary behavior with anxiety tendency showed that increased sedentary time combined with decreased physical activity intensity was significantly associated with increased risk of anxiety tendency (range of OR: 1.64-3.14). The threshold for sedentary time in total as a risk factor for anxiety tendency gradually decreased as physical activity intensity increased.@*CONCLUSION@#The anxiety tendency and sedentary behavior among the occupational population should recieve more attention. Lack of physical activity and sedentary behavior are both risk factors for anxiety tendency, and strengthening the intensity of physical activity can attenuate the harmful effects of sedentary behavior on anxiety tendency.

Research progress on clinical quality disparity and effects for quality improvement in patients with acute coronary syndromes / 上海预防医学

The United Nations Sustainable Development Goal proposes to achieve universal health coverage by 2030， and the key element is that everyone can enjoy high-quality healthcare services. Cardiovascular diseases， predominantly acute coronary syndromes， have become the largest disease burden on global health. However， the quality of healthcare services for acute coronary syndromes varies significantly across the populations and regions. This study aimed to investigate the difference in the quality of acute coronary syndrome services in multiple countries， regions， hospitals， and patient populations， and then determine the impact of quality improvement initiatives on quality disparity， which may facilitate further improving the equity of clinical service quality for acute coronary syndromes and promoting health equity and universal health coverage.

State fragility and the coronavirus disease 2019 (COVID-19) pandemic: an ecologic analysis of data from 146 countries / 《全球健康杂志（英文）》

Background: Global spread and impact of the coronavirus disease 2019 (COVID-19) pandemic are determined to a large extent,by resistance to the pandemic and public response of all countries in the world;while a country's resistance and response are in turn determined by its political and socio economic conditions.To inform future disease prevention and control,we analyzed global data to exam the relationship between state vulnerabilities and COVID-19 incidences and deaths.Methods: Vulnerability was measured using the Fragile States Index (FSI).FSI is created by the Fund for Peace to assess levels of fragility for individual countries.Total FSI score and scores for 12 specific indicators were used as the predictor variables.Outcome variables were national cumulative COVID-19 cases and deaths up to September 16,2020,derived from the World Health Organization.Cumulative incidence rates were computed using 2019 National population derived from the World Bank,and case fatality rates were computed as the ratio of deaths/COVID-19 cases.Countries with incomplete data were excluded,yielding a final sample of 146 countries.Multivariate regression was used to examine the association between the predictor and the outcome measures.Results: There were dramatic cross-country variations in both FSI and COVID-19 epidemiological measurements.FSI total scores were negatively associated with both COVID-19 cumulative incidence rates (β =-0.0135,P ＜ 0.001) and case fatality rates (β =-0.0147,P ＜ 0.05).Of the 12 FSI indicators,three negatively associated with COVID-19 incidences were E1(Economic Decline and Poverty),E3 (Human Flight and Brain Drain),and S2 (Refugees and Internally Displaced Persons);two positively associated were P1 (State Legitimacy) and X1 (External Intervention).With regard to association with case fatality rates,C1 (Security Apparatus) was positive,and P3 (Human Rights and Rule of Law) and X1 was negative.Conclusion: With FSI measures by the Fund of Peace,overall,more fragile countries are less likely to be affected by the COVID-19 pandemic,and even if affected,death rates were lower.However,poor in state legitimacy and lack of external intervention are risk for COVID-19 infection and lack of security apparatus is risky for COVID-19 death.Implications of the study findings are discussed and additional studies are needed to examine the mechanisms underpinning these relationships.

Research on equity and influencing factors of disability among Chinese middle-aged and old people / 北京大学学报(医学版)

OBJECTIVE@#To evaluate disability status and equity of the middle-aged and old population in China, and to explore the influencing factors contributing to the inequity of disability.@*METHODS@#This study was based on data collected from the first wave survey (2007-2010) of World Health Organization Study on Global Ageing and Adult Health (SAGE). Concentration index (CI) and concentration curve were calculated to measure the economic-related inequity of disability among the Chinese middle-aged and old people. The CI was further decomposed in which the attributions of social and individual determinants were calculated.@*RESULTS@#The mean score of the World Health Organization Disability Assessment Sche-dule (WHODAS) was 7.32 among the Chinese middle-aged and old people, 6.37 for males and 8.21 for females. The CI for the whole participants was -0.190 9, compared with -0.184 4 for the middle-aged and old men and -0.196 1 for the women. After decomposition of the CI, socioeconomic status contributed most to disability inequity among the Chinese middle-aged and old population. Financial status, educational level and work type contributed 66.41%, 16.45% and 13.10% respectively to inequity of disability. Individual lifestyle factors, including tobacco use, alcohol consumption and physical activities, contributed less to inequity of disability compared with social structural determinants.@*CONCLUSION@#There was inequity of disability among Chinese middle-aged and old population, and those with better financial status were less likely to suffer from functional disability. Middle-aged and old males were less disabled than females, and had less inequity of disability. Financial status, educational level and work type took the highest contribution to inequity of disability among Chinese middle-aged and old population, suggesting that promoting healthy lifestyles alone cannot effectively reduce the inequity of disability. The government needs to continually strengthen and improve appropriate social and medical protection measures on the basis of the importance it attaches to the health of the middle-aged and old population, and makes reducing health inequities a policy priority. The government should pay attention to the provision of healthcare and other resources in areas where development is relatively lagging and where there is a relative concentration of middle-aged and old population. Meanwhile, there should be more significant support for research on health status and equity among the middle-aged and old population to obtain more evidence for proactive responses to rapid population aging in China and policy development.

Hospitals' responsibility in response to the threat of infectious disease outbreak in the context of the coronavirus disease 2019 (COVID-19) pandemic: implications for low- and middle-income countries / 《全球健康杂志（英文）》

The WHO declared the coronavirus disease 2019 (COVID-19) outbreak as a public health emergency of international concern on January 30, 2020, and then a pandemic on March 11, 2020. COVID-19 affected over 200 countries and territories worldwide, with 25,541,380 confirmed cases and 852,000 deaths associated with COVID-19 globally, as of September 1, 2020. 1While facing such a public health emergency, hospitals were on the front line to deliver health care and psychological services. The early detection, diagnosis, reporting, isolation, and clinical management of patients during a public health emergency required the extensive involvement of hospitals in all aspects. The response capacity of hospitals directly determined the outcomes of the prevention and control of an outbreak. The COVID-19 pandemic has affected almost all nations and territories regardless of their development level or geographic location, although suitable risk mitigation measures differ between developing and developed countries. In low- and middle-income countries (LMICs), the consequences of the pandemic could be more complicated because incidence and mortality might be associated more with a fragile health care system and shortage of related resources. 2-3 As evidenced by the situation in Bangladesh, India, Kenya, South Africa, and other LMICs, socioeconomic status (SES) disparity was a major factor in the spread of disease, potentially leading to alarmingly insufficient preparedness and responses in dealing with the COVID-19 pandemic. 4 Conversely, the pandemic might also bring more unpredictable socioeconomic and long-term impacts in LMICs, and those with lower SES fare worse in these situations. This review aimed to summarize the responsibilities of and measures taken by hospitals in combatting the COVID-19 outbreak. Our findings are hoped to provide experiences, as well as lessons and potential implications for LMICs.

Leveraging the Public Health Emergency Operation Center (PHEOC) for pandemic response: opportunities and challenges / 《全球健康杂志（英文）》

Public Health Emergency Operation Center (PHEOC) was conceptualized and established for coordinating information and resources towards goal-oriented response in large scale public health emergency. Yet, the activities undertaken by PHEOCs and their intended goals have not been fully optimized in current scenario. This paper revisited the collective efforts invested in PHEOC conceptualization and development, identified the opportunities and challenges in compliance with standards and framework, demonstrated the accountability of PHEOC network, thereby promoted best practice guidance for global public health emergency preparedness and response. This review will help navigate emergency response complexities leveraging PHEOC partnerships and advance the ability to detect and respond to public health emergencies in low resource settings. The review shows that the information on how to adapt best practice guidance to local circumstances could incentivize the full implementation of prevention, early detection and response to outbreaks. Identifying and correcting deficiencies in effectiveness evaluation will provide the basis for continuous PHEOC improvement. With the gradually reopening economies and public services in some countries, there is an urgent need to emphasize and validate the collective efforts undertaken by PHEOCs for tackling the COVID-19 pandemic.

Public health preparedness and responses to the coronavirus disease 2019 (COVID-19) pandemic in South Asia: a situation and policy analysis / 《全球健康杂志（英文）》

Like rest of the world, the South Asian region is facing enormous challenges with the coronavirus disease 2019 (COVID-19) pandemic. The socio-economic context of the eight South Asian countries is averse to any long-term lockdown program, but the region still observed stringent lockdown close to two months. This paper analyzed major measures in public health preparedness and responses in those countries in the pandemic. The research was based on a situation analysis to discuss appropriate plan for epidemic preparedness, strategies for prevention and control measures, and adequate response management mechanism. Based on the data from March 21 to June 26, 2020, it appeared lockdown program along with other control measures were not as effective to arrest the exponential growth of fortnightly COVID-19 cases in Afghanistan, Bangladesh, India, Nepal and Pakistan. However, Bhutan, Maldives and Sri Lanka have been successfully limiting the spread of the disease. The in-depth analysis of prevention and control measures espoused densely populated context of South Asia needs community-led intervention strategy, such as case containment, in order to reverse the growing trend, and adopt the policy of mitigation instead of suppression to formulate COVID-19 action plan. On the other hand, mechanism for response management encompassed a four-tier approach of governance to weave community-led local bodies with state, national and international governance actors for enhancing the countries' emergency operation system. It is concluded resource-crunch countries in South Asia are unable to cope with the disproportionate demand of capital and skilled health care workforce at the time of the pandemic. Hence, response management needs an approach of governance maximization instead of resource maximization. The epidemiologic management of population coupled with suitable public health prevention and control measures may be a more appropriate strategy to strike a balance between economy and population health during the time of pandemic.

Global health governance for travel health: lessons learned from the coronavirus disease 2019 (COVID-19) outbreaks in large cruise ships / 《全球健康杂志（英文）》

Background: The outbreak and global pandemic of coronavirus disease 2019 (COVID-19) attracts a great deal of attentions to the problem of travel health. Cruise tourism is increasingly popular, with an estimated 30 million passengers transported on cruise ships worldwide each year. Safeguarding the health of cruise travelers during the entire travel is of ultimate importance for both the industry and global public health.Objective: This study aimed to explore the challenges and opportunities in travel health from the perspective of global health governance. Methods: The global governance framework including problems, values, tools or regulations, and actors related to travel health were used to analyze the issues involved. Results: Up to April 2020, nearly thirty cruise ship voyages reported COVID-19 cases. The Diamond Princess, Grand Princess and Ruby Princess cruise ship had over 1,400 total reported COVID-19 cases, and more than 30 deaths. A community with a common future in travel health is the core value of global health governance for travel health. The travel-related international regulations, including the International Health Regulation (IHR [2005]), United Nations Convention on the Law of the Sea (UNCLOS) and the International Maritime Organization (IMO) conventions should be further updated to deal with the travel health problems. The roles and responsibilities and the cooperation mechanisms of different actors are not clear in relation to the public health emergencies during the travel. Conclusion: Travel health transcends national borders and involves multilevel actors, thus needs global cooperation and governance. Regulations and legislation at global and country level are required to prevent large-scale humanitarian crisis on travel health. Multilateral coordination, cooperation and collaboration mechanisms between governments, intergovernmental organizations, non-governmental organizations and industry are needed to build a better community of common destiny for travel health.

Coronavirus disease 2019 (COVID-19) pandemic: how countries should build more resilient health systems for preparedness and response / 《全球健康杂志（英文）》

Objective: A resilient health system plays a crucial role in pandemic preparedness and response. Although the World Health Organization (WHO) has required all states parties to strengthen core capacities to respond to public health emergencies under the International Health Regulations (2005), the actions of most countries to combating coronavirus disease 2019 (COVID-19) has showed that they are not well-prepared. This cross-sectional study aimed to examine the health system resilience of selected countries and analyze their strategies and measures in response to the COVID-19 pandemic.Methods: This study selected five countries including the Iran, Japan, Republic of Korea (South Korea), the U.K., and the U.S., based on the severity of the national epidemic, the geographical location, and the development level. Cumulative number of death cases derived from WHO COVID-19 dashboard was used to measure the severity of the impact of the pandemic in each country; WHO State Parties Self-Assessment Annual Reporting (SPAR) Scores and Global Health Security (GHS) Index were applied to measure the national health system resilience; and research articles and press materials were summarized to identify the strategies and measures adopted by countries during response to COVID-19. This study applied the resilient health systems framework to analyze health system resilience in the selected countries from five dimensions, including awareness, diversity, self-regulation, integration and adaptation. Results: The SPAR Scores and GHS Index of the four developed countries, Japan, South Korea, the U.K. and the U.S. were above the global and regional averages; the SPAR Scores of Iran were above the global average while the GHI Index lain below the global average. In terms of response strategies, Japan, the U.K. and the U.S. invested more health resources in the treatment of severe patients, while South Korea and Iran had adopted a strategy of extensive testing and identification of suspected patients. In terms of specific measures, all the five countries adopted measures such as restrictions on entry and international travel, closure of schools and industries, lockdown and quarantine. Nevertheless, the effectiveness of implementing these measures varied across countries, based on the response strategies. Conclusion: Although SPAR Scores and GHS Index have evaluated the national core capacities for preparedness and response, the actions to cope with the COVID-19 pandemic has revealed the fact that most countries still do not build resilient health systems in response to public health emergencies. Health system strengthening and health security efforts should be pursued in tandem, as part of the same mutually reinforcing approach to developing resilient health systems.