[Urban-rural differentials in the relationship between personality traits and changes in depressive symptoms].

OBJECTIVE: The prevalence of depressive symptoms has become a significant public health issue in China. Research on the relationship between personality traits and changes in depressive symptoms, as well as further exploration of urban-rural differences, not only benefits for the understanding of the prevalence trend of depression in China, but also provides a useful reference for the government to develop personalized mental health prevention strategies. METHODS: Based on the data from the China Family Panel Studies in 2018 and 2020, a univariate analysis was conducted on 16 198 Chinese residents aged 18 years and above. Five dimensions of personality traits were conscientiousness, extraversion, agreeableness, neuroticism and openness. In the study, 16 198 residents were divided into "keep good group", "better group", "worse group" and "keep bad group" according to the changes in depressive symptoms in 2018 and 2020. After controlling for factors, such as gender and education, multinomial Logistic regression analysis was used to examine whether personality traits were associated with changes in depressive symptoms. In addition, we evaluated whether urban-rural and personality traits interacted to influence depressive symptoms. RESULTS: The five dimensions of personality traits were significantly correlated with changes in depressive symptoms. Conscientiousness, extroversion, and agreeableness were negatively associated with depressive symptoms, while neuroticism and openness were positively related. Urban and rural differences moderated the relationship between personality traits and depressive symptoms. Compared with urban residents, rural residents showed stronger correlations between neuroticism (OR=1.14; 95%CI: 1.00-1.30) and the group of depression-recovery, as well as conscientiousness (OR=0.79;95%CI: 0.68-0.93) and the group of persistent-depression. CONCLUSION: The study finds that personality traits have a significant correlation with changes in depressive symptoms, with certain traits showing a negative or positive relationship. Specifically, higher levels of conscientiousness, extraversion, and agreeableness are associated with lower levels of depressive symptoms, while higher levels of neuroticism and openness are associated with higher levels of depressive symptoms. In addition, the study finds that rural residents have a stronger association between their personality traits and persistent or improved depressive symptoms, which highlights the need for tailoring mental health intervention and prevention programs that should take into account personality traits and urban-rural differences in China. By developing targeted strategies that are sensitive to personality differences and geographic disparities, policymakers and mental health professionals can help prevent and reduce the incidence of depressive symptoms, ultimately improving the overall well-being of Chinese adults. Meanwhile, additional studies in independent populations are needed to corroborate the findings of this study.

[Analysis on the relationship between urbanization and health behavior in China: An empirical research based on China Health and Retirement Longitudinal Study (CHARLS)].

OBJECTIVE: To explore the relationship between urbanization and residents ' health behaviors in China, and to clarify the impact of urbanization on health behaviors. METHODS: Based on China Health and Retirement Longitudinal Study (CHARLS), we established a panel data fixed effect model tracked in 2011, 2013 and 2015 to analyze the effect of urbanization level on smoking cessation, drinking, sleep quality and physical exercise behavior. The ratio of population density, gross domestic product (GDP) per capita and output value of secondary and tertiary industries to GDP were used to represent the levels of urbanization. RESULTS: From 2011 to 2015, China ' s urbanization levels showed an increasing trend, which showed that the ratio of population density, GDP per capita and output value of secondary and tertiary industries in GDP increased year by year. Smoking cessation increased with the increase of GDP per capita and the proportion of the output value of secondary and tertiary industries. Compared with the low-level, the drinking rate in the regions with per capita GDP of more than 45 000 yuan increased by 2.49%, and the drinking rate in the regions with secondary and tertiary industries for 80%-85% decreased by 2.48%. However, there was no significant difference with population density. The sleep quality decreased with the increase of per capita GDP. In regions where per capita GDP was more than 93%, the sleep quality decreased by 3.71% compared with the low-level which was not significantly different from the ratio of population density and the output value of secondary and tertiary industries. For low contrast, the exercise rate in regions with the population density of 400-600 people/km2 and over 800 people/km2 was reduced by 5.2% and 7.7% respectively. The exercise rate in regions with per capita GDP of 25 000-35 000 yuan and over 45 000 yuan was reduced by 3.26% and 3.73% respectively. The exercise rate in regions with secondary and tertiary industries accounting for more than 93% of GDP was 10.68% lower than that of the low-level regions. CONCLUSION: Different dimensions of urbanization have different impacts on different health behaviors. The smoking cessation rate increases with the increase of urbanization level, which is related to the proportion of per capita GDP and the output value of secondary and tertiary industries. The exercise rate, related to the three dimensions, decreases with the increase of urbanization. Sleep quality is more closely related to per capita GDP, and the probability of good sleep quality decreases with the increase of urbanization level. However, there is no obvious trend between drinking rate and urbanization level, which needs further study.

[Analysis of variation trend in health workforce equity allocation in China].

OBJECTIVE: To analyze the long-term trends of the changes in the equity of China's health workforce allocation to provide a reference for the more balanced and orderly development of China's health system. METHODS: The Gini coefficient was used to evaluate the degree of equity in the allocation of health workforce between regions, and the Gini coefficients for the allocation of doctors and nurses based on population and regional gross domestic product (GDP) distribution were calculated respectively. RESULTS: In 2019, the number of licensed (assistant) physicians per 1 000 population in China was 2.77, and the number of registered nurses per 1 000 population was 3.18. The Gini coefficient for the distribution of licensed (assistant) physicians by population was 0.141 in 2002, decreasing to 0.081 by 2014 and then remained stable. The Gini coefficient for the distribution of registered nurses by population was 0.164 in 2002 and decreased to 0.066 in 2018. The Gini coefficient for the distribution of licensed (assistant) physicians by GDP was 0.236 in 2002, decreased to 0.169 in 2013, then increased to 0.183 and remained stable. The Gini coefficient for the distribution of registered nurses by GDP was 0.206 in 2002, decreased to 0.150 in 2013, and then increased each year to 0.180 in 2019. The equity of the allocation of registered nurses by population was worse than the equity of the allocation of licensed (assistant) physicians in 2002, and in 2016, for the first time, exceeded that of licensed (assistant) physicians. CONCLUSION: Equity in the allocation of health workforce across China has improved, but the improvement in equity between regions has hit a bottleneck, with health workforce allocation in the western regions still relatively scarce. Although nursing workforce allocation equity caught up with licensed (assistant) physicians, the number of licensed (assistant) physicians is close to that of developed western countries, while there is a large gap in registered nurses. It is recommended that the relevant authorities make good long-term planning for health workforce, further increase the policy for the introduction of health workforce in the western region, and increase the supply of healthcare services in the western region with the help of digital transformation of healthcare and internet healthcare. At the same time, they should further increase investment in resources for higher nursing education and actively plan to cope with the ageing population.

[Economic burden and factors associated with Crohn's disease].

OBJECTIVE: To study the economic burden of Crohn's disease and its related factors, and to provide opinions for reducing personal burden and improving reimbursement policy. METHODS: Using a cross-sectional method, a self-created questionnaire based on the basic principles of health services research was used to survey Crohn's disease patients served by the Shanghai volunteer service foundation platform. Information collected included basic characteristics, therapy, and medical costs related to Crohn's disease in the past 12 months. Descriptive statistics were used to analyse the composition of inpatient and outpatient costs of Crohn's disease for treatment of the disease in the past year. Further, a logarithm-linear model was constructed to analyse the factors associated with the financial burden of Crohn's disease. RESULTS: In the study, 820 questionnaires were distributed and 799 questionnaires were returned, of which 797 were valid. There were 528 (66.25%) males and 269 (33.75%) females. The mean age of the patients was (34.02±11.49) years, with a concentration between 18-39 years (510 cases, 63.99%) and a mean disease duration of (5.58±5.13) years. 10.7% of the patients did not receive continuous treatment, and the average annual treatment cost for the patients with continuous treatment was 54 246 Yuan, of which 30 279 Yuan (55.8%) was paid by the individuals and 23 966 Yuan (44.2%) was paid by the insurance. The personal financial burden was close to the national per capita disposable income in 2020, which was 32 189 Yuan (94.1%), exceeding the annual cost for type 2 diabetes in China in 2016, 8 245 Yuan. In terms of the distribution of outpatient and inpatient services, the average annual cost of inpatient services was 31 092 Yuan, of which 14 673 Yuan (48.5%) was paid out of pocket by the individuals and 16 418 Yuan (51.5%) was paid by the insurance; the average annual cost of outpatient services was 23 154 Yuan, of which 15 606 Yuan (65.1%) was paid out of po-cket by the individuals and 7 548 Yuan (34.9%) was paid by the insurance. The personal burden of outpatient care was higher than of inpatient care. The regression results of the logarithm-linear model showed that the total annual treatment cost was related to the duration of illness (ß=0.03, P < 0.01), having complications (ß=-0.68, P < 0.01), receiving surgical treatment (ß=0.52, P < 0.01), using immunosuppressive drugs (ß=0.51, P < 0.01), annual outpatient visits (ß=0.02, P < 0.05), and number of hospitalizations per year (ß=0.08, P < 0.01). CONCLUSION: The annual financial burden for patients with Crohn's disease is heavy and rises significantly with the duration of illness, exceeding that of chronic diseases such as diabetes. The personal financial burden is close to the national per capita disposable income, and the medical security department should develop policies to reduce the financial burden. The inclusion of Crohn's disease as a special outpatient disease is a possible measure that could be considered in response to the fact that the outpatient personal financial burden is heavier than the inpatient's.

[Analysis of substitutional effect of outpatient expenditure on inpatient expenditure in hypertensive patients with rural new cooperative medical scheme].

OBJECTIVE: To study direct medical cost of hypertensive patients without complicated diseases, to analyze substitution impacts of outpatient expenditure on inpatient expenditure, and then to make recommendations to health policy makers and hypertensive patients for managing hypertension. METHODS: The claims data of hypertensive patients insured by the rural new cooperative medical scheme in a city in northern China from 2008 to 2013 were analyzed, descriptive statistics employed to analyze direct medical cost of hypertensive patients and hypertensive patients without complicated diseases which was one of the three groups divided by medical treatment conditions (hypertension without complicated diseases, hypertension with complicated diseases, and other diseases), and the differences between groups compared by t test. The fixed effect two-part model was employed to analyze the substitution effect of outpatient services on inpatient services, and specific effects of outpatient times and reimbursement expenses on the inpatient expenditure were calculated by Logistic regression analysis. RESULTS: For the hypertensive patients, the average cost of outpatients was 283.49 Yuan in 2008 and rose to 370.93 Yuan in 2013. After being divided into three groups, for hypertensive patients without complicated diseases, the average cost of outpatient was 449.79 Yuan in 2008 and rose to 582.53 Yuan in 2013. In the total cost of the outpatient, 45.73% was for the hypertensive patients without complicated diseases; in the total cost of the inpatient, only 9.29% was for the hypertensive patients without complicated diseases. By calculating the marginal effect of parameter estimation through the fixed effect two-part model, the inpatient cost could be significantly reduced by increasing the visit times of outpatient utilization or the cost of outpatient reimbursement. For example, in 2013, a 1% rise of outpatient visit times increased outpatient expenditures by 6.48 million Yuan, which could reduce inpatient expenditures by 39.86 million Yuan. The substituted ratio of outpatient cost on inpatient cost had been around 5 in 2010 and later. CONCLUSION: The health policy-makers and hypertensive patients should pay more attentions to the substitution of outpatient cost for inpatient cost, especially for the hypertensive patients without complicated diseases whose direct medical cost was mainly due to outpatient rather than inpatient costs.

[Association analysis between urbanization and non-communicable diseases and health-related behavior].

OBJECTIVE: To explore the association between different urbanization levels and non-communicable diseases (NCDs) in China and provide suggestions on designing relevant health policies in the urbanization process. METHODS: We obtained health-related data from China Health and Retirement Longitudinal Study (CHARLS) 2011. This study used multistage sampling in design stage and covered 150 districts/counties, representative at the levels of the country. Geo-information system (GIS) method was used to get district areas data, and in combination with the Sixth National Census population data, we computed the population density which was regarded as the proxy variable of urbanization level in every city. The Logistic model was used to explore the effect of urbanization level on hypertension, diabetes, smoking, drinking, overweight and obesity. RESULTS: Compared with other cities in China, Shanghai and Shenzhen, with the population density of more than 3 000 people per km(2), were the cities with highest urbanization level. From the map of urbanization distribution across China, it was found that the urbanization levels of the northwestern districts were lower than those of the southeastern and coastal districts. The hypertension rate increased with the development of urbanization but there was no statistical significance. The proportion of patients with diabetes went up first and then saw a decrease trend in the process of urbanization. Drinking rate, overweight rate and obesity rate had similar trends, falling to their lowest point when urbanization level equaled 737,1 186 and 1 353 people per km(2) respectively and then experienced upward trends. By contrast, smoking rate declined first and then went up (the turning point was 1 029 people per km(2)). CONCLUSION: Different urbanization levels have different effects on NCDs, health-related behavior, overweight and obesity. Low urbanization level may create negative impact on health while high level can pose positive effect and increase people's health condition possibly due to the improvement of health care accessibility and the quality of living environment. Policy-makers should specially focus on different residents'health problems in different periods of urbanization, such as the impact of environmental pollution, health resources' allocation and accessibility of health services. It is necessary to reduce or avoid the negative effect of urbanization on NCDs during the local development process to face the NCDs' threat.

[Effect of air pollution on health service demand of the elderly and middle-age patients with hypertension, cardiovascular and cerebrovascular diseases: based on analysis of data from CHARLS].

OBJECTIVE: To study the association of air pollution with health service demand of the elderly and middle-age patients with cardiovascular and cerebrovascular diseases, and to provide a scientific basis for development of environmental protection policy and health service policy of the Chinese government. METHODS: This study included survey data on self-evaluated health, outpatient service demand and inpatient service demand of the patients with hypertension, heart disease and stroke in 62 cities of 17 provinces from China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 2013, and combined it with the data on the annual concentrations of inhalable particulate matter (PM(10)), sulfur dioxide(SO(2)) and nitrogen dioxide (NO(2)) of those provinces and cities. Conditional Logistic regression was carried out to assess the possible effects of air pollutants on self-evaluated health and health service utilization. RESULTS: The results showed that turning points existed in the effects of concentrations of NO(2) and SO(2) on the health service demand of the patients with hypertension, heart disease and stroke. The inpatient service demand of the hypertension patients increased with NO(2) concentration when it was lower than 35.1 µg/m(3) and decreased with NO(2) concentration for higher value. Self-evaluated health of the patients with heart disease and stroke decreased with SO(2) concentration when it was lower than 63.8 µg/m(3) and increased with SO(2) concentration for higher value. In addition, no evidence was found for the association between PM(10) and health service demand. CONCLUSION: Air pollution may have effects on health service demand of the patients with hypertension,cardiovascular and cerebrovascular diseases, and different air pollutants at high or low concentration may have different health effects.