Prevalence of metabolic syndrome among urban community residents in China.

BACKGROUND: Metabolic risk factors and abnormalities such as obesity and hypertension are rapidly rising among the Chinese population following China's tremendous economic growth and widespread westernization of lifestyle in recent decades. Limited information is available about the current burden of metabolic syndrome (MetS) in China. METHODS: We analyzed data on metabolic risk factors among 22,457 adults aged ≥ 32 years participating in the "Zhabei Health 2020" survey (2009-2010), a cross-sectional study of a representative sample of community residents in Zhabei District. We defined MetS using Chinese-specific cut-off points for central obesity according to consensus criteria recently endorsed by several international and national organizations in defining MetS in different populations worldwide. We used a multiple logistic regression model to assess the associations of potential risk factors with MetS. RESULTS: The unadjusted prevalence of the MetS was 35.1% for men and 32.5% for women according to the consensus criteria for Chinese. The prevalence increased progressively from 12.1% among participants aged 32-45 years to 45.4% among those aged ≥ 75 years. Age, smoking, family history of diabetes, and education are significantly associated with risk of MetS. CONCLUSIONS: The MetS is highly prevalent and has reached epidemic proportion in Chinese urban adult community residents.

How affordable are tuberculosis diagnosis and treatment in rural China? An analysis from community and tuberculosis patient perspectives.

OBJECTIVES: To assess equity in access to tuberculosis (TB) care by estimating and comparing the direct household costs perceived by community residents with actual costs experienced by TB patients and to identify the factors influencing the financial burden of TB patients. METHODS: Economic study in four provinces of China by means of a survey of 889 TB patients and 2560 community residents and in-depth interviews with key informants. RESULTS: The direct household costs for using TB health services perceived by the communities were two to five times higher than the actual costs incurred by the TB patients. Patients had to pay a substantial proportion of their annual income for TB services (12-40%), despite the fact that smear-positive and some severe smear-negative patients received free drugs. Repeated outpatient visits before diagnosis, over-prescription of drugs and prolonged treatments were common. CONCLUSIONS: The heavy financial burden (both perceived and real) on these patients is one of the main reasons that some TB patients fail to access and complete treatment. Pressure to generate revenue through current incentives in health-care financing and poor competence of health workers at the village and township levels cause delay and high expenses to TB patients and ultimately impede effective TB control in China.

Multiple perspectives on diagnosis delay for tuberculosis from key stakeholders in poor rural China: case study in four provinces.

This study aims to understand the contextual barriers to accessing timely TB diagnosis after first seeking care, especially among the poor and vulnerable in rural China. Both quantitative and qualitative methods were used to elicit the experiences and perspectives of TB patients and suspected TB patients, community residents, health providers and policy makers in poor, rural areas of four provinces. Between 30 and 60% of patients across the four provinces experienced a delay in receiving a diagnosis after first seeking care. Most patients had to visit health facilities more than once before diagnosis, with 17-30% patients making more than 6 visits. These delays and multiple visits mainly occurred because of the limited capacity of health providers to recognize TB, and financial disincentives to refer patients to TB dispensaries, due to the pressures of the cost recovery system. Poverty and socio-economic disadvantage amongst patients also influenced their capability to seek further care to obtain a reliable diagnosis. Qualitative data showed that women and the elderly patients were likely to experience more 'system' delay, and these findings were to some extent supported by the survey. The study concludes that 'system' delay is a serious problem, which is influenced by the financing mechanisms for both TB control and general health services as well as poverty and disadvantage amongst patients. This requires a comprehensive strategy to shorten 'system' delay in order to enable successful DOTS expansion, including developing appropriate financing mechanisms to improve general provider capacity and encourage referral, as well as measures to improve financial and social access to services for potential TB patients.

Differences in perception of dysentery and enteric fever and willingness to receive vaccines among rural residents in China.

BACKGROUND: Enteric diseases including dysentery and enteric fever remain significant public health problems in China. While vaccines offer great potential in controlling these diseases, greater understanding of factors influencing acceptance of vaccines is needed to create effective enteric disease control programs in rural China. DESIGN: Cross-sectional quantitative study with randomly sampled households from two sites in China, one experiencing high rates of shigellosis (Zengding) and the other of typhoid/paratyphoid (Lingchuan). METHODS: Sociobehavioral survey data were collected through face-to-face interviews from 501 respondents (56% female) in Zhengding regarding dysentery and 624 in Lingchuan (51% female) regarding enteric fever. Vaccine acceptability was measured by expressed need for vaccination and willingness to pay. Comparative and associative analyses were conducted to assess disease perception, vaccination service satisfaction, likelihood of improvements in water and sanitation, and vaccine acceptability. RESULTS: Nearly all respondents in Lingchuan considered enteric fever to be prevalent in the community, while only one half of the respondents in Zhengding considered dysentery to be problematic (p < 0.01). Nevertheless, more respondents in Zhengding were fearful that a household member would acquire dysentery than were Lingchuan respondents worried that a household member would acquire enteric fever (p < 0.01). Perceived vulnerability of specific subgroups (odds ratios ranging from 1.6 to 8.1), knowing someone who died of the disease (odds ratio reached infinity) and satisfaction with past vaccination services (odds ratios reached infinity) were consistently associated with perceived need for vaccines of target populations of all age groups while the association between perception of sanitary improvement and vaccine need was limited. Perceived need for a vaccine was associated with willingness to pay for the vaccine. CONCLUSIONS: Perceptions of enhanced vulnerability of specific subgroups to a disease and satisfactory experiences with vaccination services may increase the perceived need for a vaccine, leading to increased willingness to pay for vaccine. Vaccines are not perceived as important for the elderly.

[Study of the disease burden of patients with drug-resistant and drug-sensitive tuberculosis in Guangdong and Zhejiang provinces].

OBJECTIVE: To investigate the disease burden of drug-resistant and drug-sensitive tuberculosis (TB) patients in Guangdong and Zhejiang provinces. METHODS: Three hundred and two patients with TB, who had been involved in the project for drug resistance surveillance and completed the full course of treatment, were enrolled for this study. The proportion method for drug susceptibility was used. The method of disability adjusted life year (DALY) was applied to assess the disease burden of TB patients. RESULTS: The average DALYs of initial cases with drug-sensitive and drug-resistant TB, and retreated cases with drug-sensitive and drug-resistant TB, were 0.26, 0.68, 0.49, and 1.04, respectively. The average DALY loss of drug-resistant TB patients was 0.86 and that of drug-sensitive TB patients was 0.44. CONCLUSIONS: The values of DALY for initial and retreated cases with drug-resistant TB were 2 times higher than those for patients with drug-sensitive TB, indicating the higher disease burden in drug-resistant TB patients. Therefore, to reduce the disease burden of patients with drug-resistant TB, standardized protocols must be applied in the treatment of TB.

Changing medical doctor productivity and its affecting factors in rural China.

Using the data collected from the health facility-based survey, part of the national health service survey conducted in 1993 and 1998, this paper tries to examine changes in labour productivity among the county-level hospitals and township health centres in rural China, and to analyse factors affecting the changes. The results presented in the paper show that the average number of outpatient visits per doctor per day and the average number of inpatient days per doctor per day declined significantly over the period from 1986 to 1997. The main factors resulting in the reduction of productivity are associated with the increase of inappropriate staff recruitment in these health facilities, the significant decline of rural population covered by health insurance, particularly rural cooperative medical schemes (CMS), and the rapid rise of health care costs. The latter two factors also have brought about a reduction in the use of these health facilities by the rural population. The paper suggests that the government should tighten up the entrance of health and non-health staff into the rural health sector and develop effective measures aimed to avoid providing pervasive financial incentives to the over-provision of services and over-use of drugs. In addition, other measures that help to increase the demand for health services, such as the establishment of rural health insurance, should be considered seriously.

[Study on the cost-effectiveness, benefit and utility analysis on the infant inoculation hepatitis B vaccine in Shanghai].

OBJECTIVE: To study the cost-effectiveness, benefit and utility of infant hepatitis B vaccination in Shanghai from 1992 to 2001. METHODS: To calculate the cost of hepatitis B vaccination by cost analysis method. Both the numbers of persons with HBsAg positive and patient with hepatitis B, cirrhosis and liver cancer decreased as the index of direct effect. To study the sick-time and the cost of treating hepatitis B, cirrhosis and liver cancer patients, a face to face questionnaire was used and quasi method was adopted to understand the effect of cure and the course of hepatitis B. The cost benefit analysis method was also used to calculate the cost benefit of HBV vaccine. The disability adjusted life years (DALY) was regarded as an index of utility to measure the disease burden. RESULTS: Input of 501,129.49 Yuan might have the result of reducing one liver cancer patient, ten cirrhosis patients, one hundred chronic hepatitis B patients and one thousand HBsAg positive people. The cost of hepatitis B vaccination was 0.24 hundred million Yuan during the past ten years in Shanghai, which had obtained the total benefit value of 41.22 hundred million Yuan, with a cost benefit ratio of 1:172 Yuan. It was estimated that the total disease burden of hepatitis B, cirrhosis and liver cancer patients was 59,762.55 DALY in order to reduce one DALY loss cost of 402.50 Yuan. CONCLUSION: HBV vaccine inoculation in infants seemed to be a low-cost input and high-effect output strategy.

[Forecast about number of patients with pulmonary tuberculosis 2001 - 2010].

OBJECTIVE: To forecast the number of patients with pulmonary tuberculosis in 2010. METHODS: A mathematical model was established based on the nationwide epidemiological survey on tuberculosis conducted in 2000 so as to forecast the numbers of patients with pulmonary tuberculosis in 2000s. RESULTS: (1) The number of patients with pulmonary tuberculosis would be a little more than that in 2000, with the pulmonary tuberculosis case detection rate rho of 0.26 being adopted. (2) The number of patients with pulmonary tuberculosis would be smaller than that in 2000, with the pulmonary tuberculosis case detection rate rho of 0.30 being adopted. (3) If the current intervention strategy manages to keep the pulmonary tuberculosis case detection rate at the level of 0.35, the decline in number of patients with pulmonary tuberculosis will approach the goal set by the national program that the number of patients with pulmonary tuberculosis be decreased by 50%. CONCLUSION: The goal set by the national program can be achieved only when the pulmonary tuberculosis case detection rate reaches 0.35.