Impact of Long COVID on Health-Related Quality of Life Among Patients After Acute COVID-19 Infection: A Cross-Sectional Study.

Concerns have been raised globally regarding the long-term effects of the novel coronavirus disease 2019 (COVID-19). This study aimed to investigate the impact of long COVID on the health of patients recovering from acute COVID-19 in China. We conducted a cross-sectional questionnaire survey from 1 February to 9 March 2023. Propensity score matching (PSM) was used to understand the differences in health utility values between individuals with and without long COVID. Factors associated with health-related quality of life (HRQoL) were determined using a multiple linear regression model. A chi-square test was used to compare differences between the 2 groups for each dimension of the EuroQoL-5 Dimension-5 Level (EQ-5D-5L) scale. In total, 307 participants were included in the analysis, of which 40.39% exhibited at least 1 persistent symptom. The common symptoms of long COVID were fatigue/weakness, coughing, memory decline, poor concentration, and phlegm in the throat. Most patients with long COVID reported mild effects from their symptoms. After propensity score matching, the long-COVID group had lower health utility scores than the non-long-COVID group (0.94 vs 0.97). In the multivariable linear regression analysis, persistent symptoms and low annual household income were associated with lower health utility values (P < .05). Anxiety/depression and pain/discomfort were the major problems experienced by the participants with long COVID. Long-COVID symptoms following acute COVID-19 infection have a serious impact on health-related quality of life. Therefore, it is necessary to implement interventions to improve patient health after the recovery from acute COVID-19.

Cost-Effectiveness of Pit and Fissure Sealing at Schools for Caries Prevention in China: A Markov Modeling Analysis.

The World Health Organization states that the application of pit and fissure sealants (PFSs) is an effective way to prevent dental caries. Estimates of potential health and economic impacts of PFS upon school-age children provide crucial evidence to support the extension of PFS coverage to all target populations. The China Children's Oral Disease Comprehensive Intervention Project was launched in 2009 to provide free oral health examinations, PFS application, and oral health education for children aged 7 to 9 years. However, the national-level health and economic impacts of the program are unclear. To provide higher quality evidence at the national level in China, we developed a multi-perspective, multistate Markov model to estimate the cost and effect of PFS application to prevent dental caries. The total cost of the PFS project was 2.087 billion CNY, which can prevent 16.06 million PFMs from caries lesions. Compared with no intervention, PFS application was cost-effective from payer and society perspectives (BCR = 1.22 from the payer's perspective, BCR = 1.91 from the societal perspective). The incremental cost-effectiveness ratio from both perspectives was negative (-61.46 CNY from the payer's perspective, and -125.75 CNY from the societal perspective), indicating that PFS was cost-effective and cost-saving. Expanding the coverage of PFS application in school can be a more cost-effective strategy for caries prevention in China.

Association Between Cancer Prevalence and Different Socioeconomic Strata in the US: The National Health and Nutrition Examination Survey, 1999-2018.

Background: Inequality in health outcomes in relation to Americans' socioeconomic status (SES) is rising. American Cancer Society depicts that the most common cancers are diagnosed in men and women in 2021. We aim to study socioeconomic inequalities in related cancers to investigate whether the cancer prevalence differs within the family income to poverty ratio (PIR). Methods: The study investigated data from adults aged 20-85 years participated in the 1999-2018 National Health and Nutrition Examination Survey (NHANES) who had complete data available on PIR and cancer or malignancy information (n = 49,720). Participants were stratified into 3 categories of PIR: high income (PIR ≥ 4), middle income (>1 and <4), or at or below the federal poverty level (≤1). Results: The prevalence of prostate cancer was higher in the middle-income (3.61% [n = 464]) and high-income groups (3.36% [n = 227]) than in the low-income group (1.83% [n = 84], all p < 0.001). The prevalence of breast cancer was higher in middle-income (2.86% [n = 390]) and high-income participants (3.48% [n = 218]) than in low-income participants (2.00% [n = 117], all p < 0.001). Compared with the low-income group in men (0.48% [n = 22]), a higher prevalence of colon and rectum cancer occurs in the middle-income (0.87% [n = 112], p = 0.012) and high-income groups (0.89% [n = 58], p = 0.018). The prevalence of lung cancer in women was lower in high-income participants than middle-income participants (0.10% [n = 6] vs. 0.29% [n = 39], p = 0.014). Conclusions: Increasing disparities in cancer prevalence were identified across all socioeconomic categories analyzed in this study. To ensure the sustainable development goals, it is a global health priority to understand inequalities in health and to target interventions accordingly.

A Time-Series Analysis on the Association Between Fine Particulate Matter and Daily Mortality - Shijiazhuang City, Hebei Province, China, 2015-2020.

Introduction: Shijiazhuang is one of the most polluted cities in China, but few studies have investigated the acute impact of fine particulate matter (PM2.5) on mortality in this city. We assessed associations between PM2.5 and cause-specific mortality during 2015 to 2020. Methods: We obtained air quality data from Shijiazhuang Ecology and Environment Bureau, meteorological data from Shijiazhuang Meteorological Bureau, and mortality data from Shijiazhuang CDC's Cause of Death Reporting System for our analyses. We used a quasi-Poisson regression generalized additive model to assess excess risk of death for a single time-lag and for moving average time-lags of 0-7 days, stratifying by year, sex, age, and education. Results: There were 76,859 non-accidental deaths recorded in Shijiazhuang during the study period. The daily concentration of PM2.5 ranged from 6.3 µg/m3 to 625.3 µg/m3, and the annual mean concentration was 77.6 µg/m3. Regression analysis showed that an increment of PM2.5 of 10 µg/m3 in a two-day average concentration (lag01) was associated with 0.47% [95% Confidence Interval (CI): 0.24%, 0.70%], 0.49% (95% CI: 0.19%, 0.79%), and 0.72% (95% CI: 0.22%, 1.23%) increases in non-accidental deaths, cardiovascular disease deaths, and respiratory disease deaths, respectively. With reduction of PM2.5 concentration, impact of PM2.5 on respiratory disease deaths decreased, but the impact of PM2.5 on total non-accidental deaths and circulatory disease deaths did not change significantly. Conclusion: Although PM2.5 has been greatly reduced in recent years, PM2.5 pollution is still serious in Shijiazhuang. PM2.5 was significantly associated with non-accidental death, cardiovascular disease death, and respiratory disease death. As PM2.5 concentrations decreased, risk of death from respiratory diseases also decreased.

Catastrophic health expenditure and its determinants in households with lung cancer patients in China: a retrospective cohort study.

BACKGROUND: Numerous studies have examined catastrophic health expenditures (CHE) worldwide, mostly focusing on general or common chronic populations, rather than particularly vulnerable groups. This study assessed the medical expenditure and compensation of lung cancer, and explored the extent and influencing factors of CHE among households with lung cancer patients in China. METHODS: During 2018-2019, a hospital-based multicenter retrospective survey was conducted in seven provinces/municipalities across China as a part of the Cancer Screening Program of Urban China. CHE was measured according to the proportion of out-of-pocket (OOP) health payments of households on non-food expenditures. Chi-square tests and logistic regression analysis was adjusted to determine the factors that significantly influenced the likelihood of a household with lung cancer patient to incur in CHE. RESULTS: In total, 470 households with lung cancer patients were included in the analysis. Health insurance was shown to protect some households from the impact of CHE. Nonetheless, CHE incidence (78.1%) and intensity (14.02% for average distance and 22.56% for relative distance) were still relatively high among households with lung cancer patients. The incidence was lower in households covered by the Urban Employee Basic Medical Insurance (UEMBI) insurance, with higher income level and shorter disease course. CONCLUSION: More attention is needed for CHE incidence among vulnerable populations in China. Households with lung cancer patients were shown to be more likely to develop CHE. Therefore, policy makers should focus on improving the financial protection and reducing the economic burden of this disease.

Comparison of EuroQol-5D-3L and Short Form-6D Utility Scores in Family Caregivers of Colorectal Cancer Patients: A Cross-Sectional Survey in China.

Objective: To compare the EuroQol-5D-3L (EQ-5D-3L) and the Short Form-6D (SF-6D) utility scores in family caregivers (FCs) of colorectal cancer (CRC) patients. Method: This study was performed on FCs of CRC patients from three primary cancer centers in the capital city of the Heilongjiang province. The participants (FCs) who were enrolled, filled the EQ-5D-3L, along with the SF-6D questionnaire. Two tools were compared for their distribution, discriminant validity, agreement, and convergent validity along with known-groups validity. Result: Two hundred ninety-two FCs of CRC patients were enrolled. The score distribution of the SF-6D along with the EQ-5D-3L were not normal. A ceiling impact was seen in 31.8% of the FCs for EQ-5D-3L; however, none for the SF-6D. Good associations (Spearman's rho = 0.622, p < 0.01) and intraclass correlation coefficient (ICC 0.637 and average ICC 0.778) between the two scores were observed. The EQ-5D-3L yielded higher utility scores in contrast with the SF-6D in the better health subclass. The SF-6D distinguished better between excellent and good health statuses, with better effect size and relative efficiency statistics. Both tools showed good known-groups validity. Conclusion: The utility scores of SF-6D were remarkably lower relative to that of the EQ-5D-3L, but the difference may be clinically insignificant. However, the SF-6D may be superior because of the lack of ceiling impact. SF-6D exhibited a better convergent validity along with discrimination validity of excellent health condition and improved known-groups validity efficiency.

Determining cost-effectiveness of lung cancer screening in urban Chinese populations using a state-transition Markov model.

OBJECTIVES: This study analyses the cost-effectiveness of annual low-dose CT (LDCT) screening of high-risk cancer populations in Chinese urban areas. DESIGN: We used a Markov model to evaluate LDCT screening from a sociological perspective. SETTING: The data from two large lung cancer screening programmes in China were used. PARTICIPANTS: The sample consisted of 100 000 smokers who underwent annual LDCT screening until age 76. INTERVENTION: The study comprises five screening strategies, with the initial screening ages in both the screening strategies and their corresponding non-screening strategies being 40, 45, 50, 55 and 60 years, respectively. PRIMARY AND SECONDARY OUTCOME MEASURES: The incremental cost-effectiveness ratio (ICER) between screening and non-screening strategies at the same initial age was evaluated. RESULTS: In the baseline scenario, compared with those who were not screened, the specific mortality from lung cancer decreased by 18.52%-23.13% among those who underwent screening. The ICER of LDCT screening ranges from US$13 056.82 to US$15 736.06 per quality-adjusted life year, which is greater than one but less than three times the gross domestic product per capita in China. An initial screening age of 55 years is the most cost-effective strategy. CONCLUSIONS: Baseline analysis shows that annual LDCT screening of heavy smokers in Chinese urban areas is likely to be cost-effective. The sensitivity analysis reveals that sensitivity, specificity and the overdiagnosis rate influence the cost-effectiveness of LDCT screening. All scenarios tested demonstrate cost-effectiveness, except for the combination of worst values of sensitivity, specificity and overdiagnosis. Therefore, the cost-effectiveness of a screening strategy depends on the performance of LDCT screenings.

Effects of cancer treatment on household impoverishment: a multicentre cross-sectional study in China.

OBJECTIVES: To determine the incidence and intensity of household impoverishment induced by cancer treatment in China. DESIGN: Average income and daily consumption per capita of the households and out-of-pocket payments for cancer care were estimated. Household impoverishment was determined by comparing per capita daily consumption against the Chinese poverty line (CPL, US$1.2) and the World Bank poverty line (WBPL, US$1.9) for 2015. Both pre-treatment and post-treatment consumptions were calculated assuming that the households would divert daily consumption money to pay for cancer treatment. PARTICIPANTS: Cancer patients diagnosed initially from 1 January 2015 to 31 December 2016 who had received cancer treatment subsequently. Those with multiple cancer diagnoses were excluded. DATA SOURCES: A household questionnaire survey was conducted on 2534 cancer patients selected from nine hospitals in seven provinces through two-stage cluster/convenience sampling. FINDINGS: 5.89% (CPL) to 12.94% (WBPL) households were impoverished after paying for cancer treatment. The adjusted OR (AOR) of post-treatment impoverishment was higher for older patients (AOR=2.666-4.187 for ≥50 years vs <50 years, p<0.001), those resided in central region (AOR=2.619 vs eastern, p<0.01) and those with lower income (AOR=0.024-0.187 in higher income households vs the lowest 20%, p<0.001). The patients without coverage from social health insurance had higher OR (AOR=1.880, p=0.040) of experiencing post-treatment household impoverishment than those enrolled with the insurance for urban employees. Cancer treatment is associated with an increase of 5.79% (CPL) and 12.45% (WBPL) in incidence of household impoverishment. The median annual consumption gap per capita underneath the poverty line accumulated by the impoverished households reached US$128 (CPL) or US$212 (WBPL). US$31 170 395 (CPL) or US$115 238 459 (WBPL) were needed to avoid household impoverishment induced by cancer treatment in China. CONCLUSIONS: The financial burden of cancer treatment imposes a significant risk of household impoverishment despite wide coverage of social health insurance in China.

Catastrophic Health Expenditure and Its Determinants Among Households With Breast Cancer Patients in China: A Multicentre, Cross-Sectional Survey.

Background: Although numerous studies have examined catastrophic health expenditures (CHE) worldwide, most focus on the general population, not on specific vulnerable groups. We aimed to analyse the extent and the influencing factors of CHE in households with breast cancer patients in China, and explore the ability of different insurances to protect these households from CHE. Methods: A multicentre, cross-sectional interview surveys was conducted in households with breast cancer patients across seven provinces/municipalities in China. CHE were defined as out-of-pocket expenditures ≥ 40% of households' non-food expenditures. Chi-square tests and logistic regression analysis were performed to identify the determinants of CHE in household with breast cancer patients. Results: In the 639 participating households with breast cancer patients, the mean out-of-pocket (OOP) expenditure accounted for ~55.20% of the mean households' non-food expenditures. The overall incidence of CHE was 87.95 and 66.28% before and after insurance compensation, respectively. The logistic regression model revealed that education, disease course, health insurance, treatment method, and income were significant predictors of CHE. Conclusions: The results indicated that medical insurance protects some households with breast cancer patients from the impact of CHE. However, their reimbursement rates were relatively low. Therefore, breast cancer still had a significant catastrophic effect on the economy of households. Policy efforts should focus on improving insurance compensation rates and relieving the economic burden of critical illnesses such as breast cancer.

A systematic review of the budget impact analyses for antitumor drugs of lung cancer.

BACKGROUND: Budget impact analyses (BIAs) are used for reimbursement decisions and drug access medical insurance, as a supplement to cost-effectiveness analyses (CEAs). OBJECTIVES: We systematically reviewed BIAs for antitumor drugs of lung cancer to provide reference for high-value drug budget impact analyses and decision making. METHODS: We conducted a literature search on PubMed, EMbase, The Cochrane Library, China National Knowledge Infrastructure and Wanfang Data Knowledge Service Platform from 2010 to 2019. The methodological indicators and result information of the budget impact analyses were extracted and evaluated for quality. RESULTS: A total of 14 studies on the budget impact for antitumor drugs of lung cancer were included, and the overall quality was good. Half of studies were from developed countries. Nine of the studies were designed using the BIA cost calculation model, and two were simulated using the Markov model Monte Carlo model. From all studies, only 14.3% reported model validation. The budget impact results of the same drug in different countries were inconsistent. CONCLUSIONS: Included studies evaluating budget impact analyses for anti-tumor drugs of lung cancer showed variability in the methodological framework for BIAs. The budget impact analyses of high-value drugs need to be more stringent to ensure the accuracy of the parameters, and should provide reliable results based on real data to decision-making departments, which should carefully consider access to lung cancer drugs.