Rapid detection of goose astrovirus genotypes 2 using real-time reverse transcription recombinase polymerase amplification.

BACKGROUND: Goose astrovirus (GoAstV) is an important pathogen that causes joint and visceral gout in goslings. It has been circulating in many provinces of China since 2017. Goose astrovirus genotypes 2 (GoAstV-2) is the main epidemic strain, and its high morbidity and mortality have caused huge economic losses to the goose industry. An accurate point-of-care detection for GoAstV-2 is of great significance. In this study, we developed a real-time reverse transcription recombinase polymerase amplification (RT-RPA) method for the on-site detection of GoAstV-2 infection. RESULTS: The real-time RT-RPA reaction was carried out at a constant temperature of 39 °C, and the entire detection time from nucleic acid preparation to the end of amplification was only 25 min using the portable device. The results of a specificity analysis showed that no cross-reaction was observed with other related pathogens. The detection limit of the assay was 100 RNA copies/µL. The low coefficient of variation value indicated excellent repeatability. We used 270 clinical samples to evaluate the performance of our established method, the positive concordance rates with RT-qPCR were 99.6%, and the linear regression analysis revealed a strong correlation. CONCLUSIONS: The established real-time RT-RPA assay showed high rapidity, specificity and sensitivity, which can be widely applied in the laboratory, field and especially in the resource-limited settings for GoAstV-2 point-of-care diagnosis.

Factors influencing the demands for home and community-based care services among older adults living alone in China.

The number of older adults living alone in China is rising sharply. This study aimed to explore the demand for home and community-based care services (HCBS) and related influencing factors of older adults living alone. The data were extracted from the 2018 Chinese Longitudinal Health Longevity Survey (CLHLS). Guided by the Andersen model, binary logistic regressions were used to analyze the influencing factors of HCBS demand from the aspect of predisposing, enabling and need variables. Results show that there were significant differences between urban and rural areas for provision of HCBS. HCBS demand of older adults living alone was influenced by distinct factors including age, residence, income source, economic status, availability of services, loneliness, physical function and number of chronic diseases. Implications for HCBS developments are discussed.

Prevalence and antimicrobial resistance profile of bacterial pathogens isolated from poultry in Jiangxi Province, China from 2020 to 2022.

Poultry is one of the most commonly farmed species and the most widespread meat industries. However, numerous poultry flocks have been long threatened by pathogenic bacterial infections, especially antimicrobial resistant pathogens. Here the prevalence and the antimicrobial resistance (AMR) profiles of bacterial pathogens isolated from poultry in Jiangxi Province, China were investigated. From 2020 to 2022, 283 tissue and liquid samples were collected from clinically diseased poultry, including duck, chicken, and goose, with an overall positive isolation rate of 62.90%. Among all the 219 bacterial isolates, 29 strains were gram-positive and 190 strains were gram-negative. Major bacteria species involved were avian pathogenic Escherichia coli (APEC; 57.53%; 126/219), followed by Salmonella spp. (11.87%, 26/219), Pasteurella multocida (6.39%, 14/219), and Staphylococcus spp. (1.22%, 11/219). Antimicrobial susceptibility testing showed the APEC isolates displayed considerably higher levels of AMR than the Salmonella and P. multocida isolates. The APEC isolates showed high resistance rate to amoxicillin (89.68%), ampicillin (89.68%), and florfenicol (83.33%), followed by streptomycin (75.40%), cefradine (65.87%), and enrofloxacin (64.29%). Multidrug-resistant isolates were observed in APEC (99.21%), Salmonella spp. (96.16%), and P. multocida (85.71%), and nearly 3 quarters of the APEC strains were resistant to 7 or more categories of antimicrobial drugs. Moreover, blaNDM genes associated with carbapenemase resistance and mcr-1 associated with colisitin resistance were detected in the APEC isolates. Our findings could provide evidence-based guidance for veterinarians to prevent and control bacterial diseases, and be helpful for monitoring the emerging and development of AMR in poultry bacterial pathogens.

Rapid diagnosis of different goose astrovirus genotypes with Taqman-based duplex real-time quantitative PCR.

The epidemic of goose astrovirus (GoAstV) caused huge losses to the poultry industry. Epidemiological studies in China revealed 2 circulating genotypes of GoAstV, but there is a lack of differential diagnosis tools. By analyzing all published genomes of GoAstV, this study designed specific PCR primers and Taqman probes to recognize different genotypes of GoAstV. After optimization and verification, this study developed a Taqman-based real-time quantitative PCR method that is capable of differential diagnosis. The established qPCR exhibited detection limitations of 100 copies/µL or 10 copies/µL, respectively, for GoAstV genotype 1 and genotype 2, and showed no false positive for other common avian viruses. This method was then used to analyze 72 samples collected from different regions in Jiangxi, and the results were verified by genome sequencing and phylogenetic analysis. These results revealed a complex coinfection of GoAstV different genotypes in China, highlighting the importance of long-term focus on the prevalence and genome evolution of GoAstV.

Rapid diagnosis of duck Tembusu virus and goose astrovirus with TaqMan-based duplex real-time PCR.

The mixed infection of duck Tembusu virus (DTMUV) and goose astrovirus (GoAstV) is an important problem that endangers the goose industry. Although quantitative PCR has been widely used in monitoring these two viruses, there is no reliable method to detect them at the same time. In this study, by analyzing the published genomes of DTMUV and goose astrovirus genotype 2 (GoAstV-2) isolated in China, we found that both viruses have high conservation, showing 96.5 to 99.5% identities within different strains of DTMUV and GoAstV, respectively. Subsequently, PCR primers and TaqMan probes were designed to identify DTMUV and GoAstV-2, and different fluorescent reporters were given to two probes for differential diagnosis. Through the optimization and verification, this study finally developed a duplex TaqMan qPCR method that can simultaneously detect the above two viruses. The lower limits of detection were 100 copies/µL and 10 copies/µL for DTMUV and GoAstV-2 under optimal condition. The assay was also highly specific in detecting one or two viruses in various combinations in specimens, and provide tool for clinical diagnosis of mixed infections of viruses in goose.

How long can Chinese women work after retirement based on health level: Evidence from the CHARLS.

Objective: To further enhance the understanding of factors impacting female participation in the workforce based on health levels and to measure the excess work capacity of middle-aged and older female groups by residence and educational level. Methods: Data of women aged 45-74 were accessed from the China Health and Retirement Longitudinal Study (CHARLS) from 2011, 2013, 2015, to 2018. The health status of women was comprehensively evaluated by single health variables and frailty index. A Probit model was used to measure the excess working capacity of women by region (rural/urban) and educational level, taking all women aged 45-49, rural women aged 45-49, and rural (illiterate) women in all age groups as the benchmark, respectively. Results: The excess capacity of all Chinese women aged 50-64 is 1.9 years, and that of women aged 50-74 is 5.1 years. The excess work capacity of women in urban and rural areas and with different educational levels is heterogeneous. The excess working capacity of urban women aged 50-64 is 6.1-7.8 years, and that of urban women aged 50-74 is 9.8-14.9 years. The excess working capacity of urban women aged 50-64 is about 6 times that of rural women. The excess work capacity of highly educated women was 3 times higher than that of illiterate women. Conclusion: The potential work capacity of Chinese women remains to be exploited, especially for urban and highly educated middle-aged and older women with better conditions of health, whose potential is more significant. A rational retirement policy for women and the progressive implementation of an equal retirement age for men and women will contribute to further advancement of gender equality and healthy aging in the workplace in China.

Using machine learning algorithms for predicting cognitive impairment and identifying modifiable factors among Chinese elderly people.

Objectives: This study firstly aimed to explore predicting cognitive impairment at an early stage using a large population-based longitudinal survey of elderly Chinese people. The second aim was to identify reversible factors which may help slow the rate of decline in cognitive function over 3 years in the community. Methods: We included 12,280 elderly people from four waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), followed from 2002 to 2014. The Chinese version of the Mini-Mental State Examination (MMSE) was used to examine cognitive function. Six machine learning algorithms (including a neural network model) and an ensemble method were trained on data split 2/3 for training and 1/3 testing. Parameters were explored in training data using 3-fold cross-validation and models were evaluated in test data. The model performance was measured by area-under-curve (AUC), sensitivity, and specificity. In addition, due to its better interpretability, logistic regression (LR) was used to assess the association of life behavior and its change with cognitive impairment after 3 years. Results: Support vector machine and multi-layer perceptron were found to be the best performing algorithms with AUC of 0.8267 and 0.8256, respectively. Fusing the results of all six single models further improves the AUC to 0.8269. Playing more Mahjong or cards (OR = 0.49,95% CI: 0.38-0.64), doing more garden works (OR = 0.54,95% CI: 0.43-0.68), watching TV or listening to the radio more (OR = 0.67,95% CI: 0.59-0.77) were associated with decreased risk of cognitive impairment after 3 years. Conclusions: Machine learning algorithms especially the SVM, and the ensemble model can be leveraged to identify the elderly at risk of cognitive impairment. Doing more leisure activities, doing more gardening work, and engaging in more activities combined were associated with decreased risk of cognitive impairment.

Effects of social participation patterns and living arrangement on mental health of Chinese older adults: A latent class analysis.

Objectives: The purpose of this study was to discover patterns of social participation among Chinese older individuals, investigate the links between these patterns and their living arrangements and mental health, and connect these patterns to their background characteristics. Methods: Data were drawn from the 2014 and 2018 waves of Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2537 Chinese elders aged 60 years and over at the baseline. Latent class analysis was used to determine the patterns of social participation. Multinomial logistic regression was used to explore the relationship between patterns of social participation and the sociodemographic and health characteristics of older adults. Binary logistic regression was used to explore the differences and associations between these categories and living arrangement on mental health status, represented by positive and negative emotions. Results: Three patterns of social participation were identified: Low activity (17.5%, n = 443); Moderate activity (36.2%, n = 1,176); and High activity (46.3%, n = 918). At baseline, these patterns were significantly associated with mental health status. Positive and negative emotions were much better in the High activity group than in the other two groups (OR = 1.36, 95% CI = 1.05-1.76 and OR = 1.50, 95% CI = 1.16-1.93). Living arrangement only significantly affected negative emotions (OR=1.25, 95% CI = 1.02-1.53). Age, gender, education, marital status, self-rated health, and activities of daily living limitations all affected social participation patterns. Conclusions: The patterns of social participation and living arrangement of Chinese older adults are significantly associated with mental health. Population-tailored interventions may help liberate older adults from domestic labor and improve social participation. Moreover, family support can decrease negative emotions' damage in old age thus promoting health.

What factors are associated with utilisation of health services for the poor elderly? Evidence from a nationally representative longitudinal survey in China.

OBJECTIVES: To investigate the status and factors of healthcare service utilisation among the poor elderly in China. METHODS: We selected the poor elderly from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015. The main outcome measures include utilisation indicators for the probability and costs of outpatient/inpatient services. Based on modified Andersen behaviour model, a two-part model is designed to analyse the factors of the health service utilisation of the poor elderly. RESULTS: The visit rate of outpatient services increased from 15.05% in 2011 to 21.26% in 2015, and the hospitalisation rate increased from 7.26% to 14.32%. The median cost of outpatient and inpatient services in 2015 for the poor elderly were 350 RMB and 10 000 RMB, respectively, and the out-of-pocket ratios were 85.2% and 53.3%, respectively. 78.44% of the people who actually needed healthcare did not use health services, and the main reason was financial difficulties (42.32%). The poor elderly who are higher educated, have children, live in central regions and have social security and a poor health status and who do not smoke or drink are more likely to use health services. The need factor plays a crucial role in determining health service utilisation. CONCLUSIONS: The poor elderly tends to have a worse health status and a heavier medical burden but had a lower utilisation of health services. Predisposing, enabling, need and health behaviour variables should be considered to improve the health service utilisation and the health of the poor elderly.

Isolation and phylogenetic analysis of goose astrovirus type 1 from goslings with gout in Jiangxi province, China.

Goose astrovirus (GoAstV) is a new Avastrovirus of the genus astrovirus causing gout, hemorrhage, and swellings of kidneys that have affected goslings around the major goose-producing regions in China. The GoAstV is divided into goose astrovirus type 1 (GoAstV-1) and goose astrovirus type 2 (GoAstV-2). Although GoAstV-2 is known to be the causative agent of goose gout, little published information about the relationship between GoAstV-1 and goose gout is unknown. In this study, we investigated the presence of GoAstV-1 in 293 visceral tissue/dead embryos samples with gout on different farms in Jiangxi province, China. A survey result indicated that the mono-infection of GoAstV-1 (32.08%) and co-infection of GoAstV-1 (12.28%) with GoAstV-2 in gout goslings in Jiangxi, China. JXGZ, a GoAstV-1 strain, was effectively isolated from the visceral tissue of gosling gout and serially propagated for more than 25 passages in a goose embryo. The JXGZ strain's whole genome was sequenced and investigated. Phylogenetic analysis of complete genome and capsid protein sequences of JXGZ strain show that it was more closely related to GoAstV-1 strain than GoAstV-2 strain and was grouped within the GoAstV-1 cluster. These findings will aid in the development of efficient diagnostic reagents and possible vaccinations by providing insight into the prevalence and genetic evolution of GoAstV-1 in China.

Whole-genome analysis reveals possible sources of ALV-J infection in an anyi tile-like gray chicken flock.

Avian leukosis virus (ALV) induces multiple tumors in chicken and is still prevalent in a lot of local flocks in China. In this study, we analyzed the ALV infection status in an Anyi tile-like gray chicken flock by DF1-cells isolation, virus identification, and genome sequencing. Results showed a 29% (29/100) ALV positive rate in this flock. Homology analysis based on env genes illustrated that all these stains belong to subgroup J (92-100% identities) and can be further divided into 5 batches, suggesting a higher diversity of ALV-J within the same flock. The whole-genome analysis of representative stains from each batch confirmed the close relationship between these isolated strains with previously reported strains from different regions (Guangxi, Shandong, and Heilongjiang), revealing the enrichment of different strains in Anyi tile-like grey chickens. This study provides the epidemiological data of ALV-J in a special chicken flock and a reference for the further eradication of ALV in China.

The Expected Demand for Elderly Care Services and Anticipated Living Arrangements Among the Oldest Old in China Based on the Andersen Model.

Objective: The first aim of this study was to explore expected demands of the oldest old and their determinants for different types of elderly care services. The second aim was to investigate preferred choices of living arrangements among the oldest old and the influencing factors. Methods: Data of 4,738 participants aged ≥80 years were extracted from the Chinese Longitudinal Health Longevity Survey carried out in 2014. Using the Andersen model as the analysis framework, a multiple logistic regression analysis was performed to analyze the relationship between the expected elderly care services and living arrangements and other influencing factors. The odds ratios were calculated to indicate the relationship between the influencing factors and the dependent variables. Results: From the descriptive analysis results, we found that the oldest old showed high anticipated needs for home visits (83.5%) and health education (76.4%). Further, there existed a huge imbalance between the supply and demand of care services for the aged. Living with children is still the most important way of providing for the oldest old. The regression results showed that the expected demands for elderly care services and anticipated living arrangements among the oldest old in China are influenced by age, residence, housing property rights, economic status, loneliness, and activities of daily living (ADLs). The oldest old who are older without housing property rights, childless, and have restricted ADLs were more frequently observed to live in long-term care institutions. Conclusions: There is an inequality of the supply and expected demand for elderly care services, and living with children is still a preferred choice of the Chinese oldest old. Our findings indicate that when planning how to promote elderly care services among the oldest old, it is important to consider their expectations, especially for the subgroup that is relatively disadvantaged. Related policies should be developed to offer incentives to family caregivers when they live with the oldest old.

Healthcare-Seeking Behavior among Chinese Older Adults: Patterns and Predictive Factors.

This study aimed to investigate the patterns and predictive factors of healthcare-seeking behavior among older Chinese adults. A sample of 10,914 participants aged ≥60 years from the 2011, 2013 and 2015 China Health and Retirement Longitudinal Study (CHARLS) was included. The bivariate analyses and Heckman selection model was used to identify predictors of healthcare-seeking behavior. Results shows that the utilization rate of outpatient services increased from 21.61% in 2011 to 32.41% in 2015, and that of inpatient services increased from 12.44% to 17.68%. In 2015, 71.93% and 92.18% chose public medical institutions for outpatient and inpatient services, 57.63% and 17.00% chose primary medical institutions. The individuals who were female, were younger, lived in urban, central or western regions, had medical insurance, had poor self-rated health and exhibited activity of daily living (ADL) impairment were more inclined to outpatient and inpatient services. Transportation, medical expenses, the out-of-pocket ratio and the urgency of the disease were associated with provider selection. The universal medical insurance schemes improved health service utilization for the elderly population but had little impact on the choice of medical institutions. The older adults preferred public institutions to private institutions, preferred primary institutions for outpatient care, and higher-level hospitals for hospitalization.

Diversity of Avian leukosis virus subgroup J in local chickens, Jiangxi, China.

Avian leukosis caused by avian leukosis virus (ALV) is one of the most severe diseases endangering the poultry industry. When the eradication measures performed in commercial broilers and layers have achieved excellent results, ALV in some local chickens has gradually attracted attention. Since late 2018, following the re-outbreak of ALV-J in white feather broilers in China, AL-like symptoms also suddenly broke out in some local flocks, leading to great economic losses. In this study, a systematic epidemiological survey was carried out in eight local chicken flocks in Jiangxi Province, China, and 71 strains were finally isolated from 560 samples, with the env sequences of them being successfully sequenced. All of those new isolates belong to subgroup J but they have different molecular features and were very different from the strains that emerged in white feature broilers recently, with some strains being highly consistent with those previously isolated from commercial broilers, layers and other flocks or even isolated from USA and Russian, suggesting these local chickens have been acted as reservoirs to accumulate various ALV-J strains for a long time. More seriously, phylogenetic analysis shows that there were also many novel strains emerging and in a separate evolutionary branch, indicating several new mutated ALVs are being bred in local chickens. Besides, ALV-J strains isolated in this study can be further divided into ten groups, while there were more or fewer groups in different chickens, revealing that ALV may cross propagate in those flocks. The above analyses explain the complex background and future evolution trend of ALV-J in Chinese local chickens, providing theoretical support for the establishment of corresponding prevention and control measures.

Research Note: A putative novel subtype of the avian hepatitis E virus of genotype 3, Jiangxi province, China.

In recent years, the avian hepatitis E virus (HEV) has been widely spread in China, causing huge economic losses. Several studies have carried out detailed epidemiologic investigations of the avian HEV, but no data were from Jiangxi province. Since early April 2020, diseases similar to hepatic rupture hemorrhage syndrome caused by the avian HEV occurred in a Roman Brown layer farm in Jiangxi province, indicating this virus may also be epidemic there. To make this assumption clear, 20 liver samples were collected from the sick flock and then analyzed by detailed viral detection, which confirmed that the avian HEV should be responsible for the aforementioned disease (6 of 20). Then, the capsid gene of the virus was sequenced to show the molecular characteristics of the strain circulating in the aforementioned flock. Sequence comparison showed that it shared 80.7 to 94.7% identities with 12 published strains, while phylogenetic analysis confirmed that it belongs to a new subtype of genotype 3. Moreover, basing on a 242 bp fragment, the novel also shared high similarities to reference strains identified as genotypes before, revealing the genotype 3 maybe very popular in China and even can be divided into several subgroups. In conclusion, a novel avian HEV strain was identified in this study, which belongs to a new subtype of genotype 3. The analysis makes up for the molecular epidemiologic data of avian HEV and provides a basis for further understanding the spread of avian HEV in China.

The Influencing Factors of Health-Seeking Preference and Community Health Service Utilization Among Patients in Primary Care Reform in Xiamen, China.

INTRODUCTION: Patients often seek healthcare at general hospitals rather than at community healthcare centres (CHCs) which leads to inefficiency of health services. The primary healthcare reform developed by Xiamen has proven to break through the barriers of hierarchical diagnosis and treatment. The influencing factors of health-seeking behaviours of patients in the Xiamen reform, however, are unclear. OBJECTIVE: This study aimed to assess patients' healthcare-seeking preferences and CHCs utilization, and identify influencing factors among patients affected by the Xiamen reform. METHODS: A cross-sectional study composed of 2200 individuals with hypertension or diabetes was conducted in association with Xiamen's reform. The choice of health institutions was used to measure health-seeking preference. The probability and frequency of outpatient service use were used to measure CHC utilization. The social ecological model and two-part model were employed to examine influencing factors. RESULTS: As high as 72.5% of the subjects, including those who were under 60 years old, had low education level, with long disease duration, good self-report health and low household income expressed a preference for CHC (P<0.05). Also, participants who had good-condition CHCs (χ2=6.736, P=0.010), joined in three-in-one chronic disease management (χ2=81.615, P<0.01) and were insured by medical insurance (χ2=21.142, P<0.01) significantly preferred to visit CHCs for treatment. In addition, patients who had a preference for CHC utilized many more CHCs (P<0.01). Analysis of influencing factors found that education, self-reported health, smoking, household income, condition of the CHC, whether the patient had joined the healthcare reform and whether the patient had medical insurance were important factors affecting health-seeking preference and CHC utilization (P<0.05). CONCLUSION: The Xiamen healthcare reform made some achievements in improving CHC utilization. However, certain challenges remain. The government should further strengthen CHCs, deepen and expand healthcare reform, and make efforts to guide reasonable healthcare-seeking behaviour and improve the efficiency of primary health systems.

Urban-Rural Differences in Long-Term Care Service Status and Needs Among Home-Based Elderly People in China.

BACKGROUND: Long-term care (LTC) needs for the elderly have become increasingly crucial policy concerns in rapidly aging Asia, especially in China, the most populous nation. However, very few studies have examined the cohort differences in terms of their existing and expected utilization of LTC services, above all urban-rural differences. This study aims to evaluate the differences of LTC current status and needs between urban-rural areas and age groups, and to identify influencing factors causing the different LTC needs. METHODS: The data come from the Chinese Longitudinal Health Longevity Survey in 2014. A total of 7192 home-based elderly aged ≥65 years by multistage sampling were enrolled. The Andersen Model was applied to categorize the influential factors into three components including predisposing, enabling and needs. Multivariate logistic regression analysis was used to analyze the influential factors of the three levels of LTC needs. RESULTS: A total of 6909 valid sample sizes were included in this study. The overall LTC needs of the elderly showed a rapidly increasing trend among which older people had the highest needs for bathing (27.29%) and toileting (15.8%). It was also demonstrated the aged cohort between urban and rural exerted an impact on all aspects of LTC status and needs to varying degrees (p < 0.05). Compared with urban areas, the LTC needs for the elderly in rural areas was more vigorous, but the supply was seriously inadequate. The elderly who were older, living in rural areas, unmarried, non-farming, with low income, in poor health and having less autonomy had higher anticipated needs for LTC services (OR > 1, p < 0.01). Compared with the young-old in rural areas, the young-old in urban areas were prone to live alone (OR = 1.61, p < 0.01). The elderly who were older, living in rural areas, farming, with low income, lonely and depressed had higher anticipated needs for community-based services (1 < OR < 1.69, p < 0.05). CONCLUSIONS: The aged cohort in urban-rural distinction were facing an increasing need for immediate care due to the inadequate support being provided, especially among rural elderly. The oldest elderly in rural areas had higher LTC needs, and different levels of needs were affected by age, economic level, family support, health status and other related effects. This study provides evidence-based recommendation for further improving the construction and development of the LTC system in China.

Cost-effectiveness of augmenting universal hepatitis B vaccination with immunoglobulin treatment: a case study in Zhejiang Province, East China.

Objective: To evaluate the cost-effectiveness of the current strategy combining universal vaccination with hepatitis B immunoglobulin (HBIG) treatment for infants of hepatitis B surface antigen (HBsAg) positive mothers compared with universal vaccination with hepatitis B vaccine only.Methods: A decision tree model with a Markov process was constructed and used to simulate the lifetime of the birth cohort in Zhejiang Province during 2016. The current strategy was compared against universal vaccination with respect to costs and health effects. Costs were assessed from the health care system perspective. Health effects were measured by the number of hepatitis B virus (HBV) related diseases and deaths avoided and quality-adjusted life-years (QALYs) gained. The incremental cost­effectiveness ratio (ICER) is calculated and compared to standard willingness-to-pay thresholds. A one-way sensitivity analysis and a probabilistic sensitivity analysis (PSA) were performed to assess parameter uncertainties.Results: Over the cohort's lifetime, 182 acute symptomatic infections, 2215 chronic infections, 872 cases of cirrhosis, 595 cases of hepatocellular carcinoma (HCC) and 1,350 HBV-related deaths among the cohort of 624,000 infants would be further avoided by the current strategy compared to universal vaccination. Universal vaccination was dominated by the current strategy that produced not only higher total QALYs, but also had lower costs. The results remained robust over a wide range of assumptions.Conclusions: The current strategy was cost saving compared to universal vaccination, and continuing the current strategy is recommended to further decrease the burden of hepatitis B.

The impact of medical insurance on medical expenses for older Chinese: Evidence from the national baseline survey of CLHLS.

With the deepening population aging process in China, the medical expenses of older adults has become a widespread concerned. Medical insurance is a major source of Chinese medical financing and payment. The study aims to understand the current status of medical expenses for older adults and explore the effect of different types of health insurance on medical expenses in China.The data came from the Chinese Longitudinal Health Longevity Survey (CLHLS) in 2014. The Kruskal-Wallis test and general multivariate linear regression model were applied to analyze the current situation and to explore how medical insurance as the main payment impacts medical expenses.A total of 4376 older participants were included in this study. The median of medical expenses of a total was 1500 Yuan per year. The proportions of participants who had the urban employee-based basic medical insurance (UE-BMI), the urban residents basic medical insurance (UR-BMI), the new rural cooperative medical insurance scheme (NCMS), and the commercial medical insurance were 10.8%, 8.4%, 72.7%, and 0.9%, respectively. 34.8% of older adults paid the health care service via the NCMS and 11.9% paid via the UE-BMI. Participating in the NCMS and UR-BMI are significantly related to the level of the medical fees of older adults. UE-BMI, UR-BMI, and NCMS as main payment eased the pressure of medical expenses.The influence of different types of medical insurances as main payments on the medical expenses of older adults is varied. Implementation of medical insurance should be taken to further relieve the medical expenses of older adults.